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Herrera S, Roca I, Del Río A, Fernández J, Pitart C, Fortes I, Torralbo B, Santana G, Parejo-González R, Veà-Baró A, Campistol JM, Aguilar M, Degea S, Casals-Pascual C, Soriano A, Martínez JA. Performance of an Autonomous Sanitary Sterilisation Ultraviolet Machine (ASSUM) on terminal disinfection of surgical theaters and rooms of an intensive-intermediate care unit. Infect Prev Pract 2024; 6:100396. [PMID: 39308772 PMCID: PMC11415570 DOI: 10.1016/j.infpip.2024.100396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 08/13/2024] [Indexed: 09/25/2024] Open
Abstract
Background Ultraviolet- C (UV-C) light is effective for reducing environmental bioburden in hospitals, and the use of robots to deliver it may be advantageous. Aim To evaluate the feasibility and clinical efficacy of an autonomous programmable UV-C robot in surgical and intensive care unit (ICU) rooms of a tertiary hospital. Method During ten consecutive months, the device was used in six theatres where cardiac, colorectal and orthopaedic surgeries were performed, and in the rooms previously occupied by patients subjected to contact precautions of a 14-bed ICU. Surgical site infection (SSI) rates of procedures performed in the UV-cleaned theatres were compared with those of the previous year. Incidence in clinical samples of ICU-acquired multiple-drug resistant (MDR) microorganisms was compared with that of the same period of the previous year. An UV-C exposure study done by semi-quantitative dosimeters and a survey of the bioburden on surfaces were carried out. Findings SSI rates in the pre- and post-intervention periods were 8.67% (80/922) and 7.5% (61/813), respectively (p=0.37). Incidence of target microorganisms in clinical samples remained unchanged (38.4 vs. 39.4 per 10,000 patient-days, p=0.94). All the dosimeters exposed to ≤1 meter received ≥500 mJ/cm2. The bacterial load on surfaces decreased after the intervention, particularly in ICU rooms (from 4.57±7.4 CFU to 0.27±0.8 CFU, p<0.0001). Conclusion Deployment of an UV-C robot in surgical and ICU rooms is feasible, ensures adequate delivery of germicidal UV-C light and reduces the environmental bacterial burden. Rates of surgical site infections or acquisition of MDR in clinical samples of critically-ill patients remained unchanged.
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Affiliation(s)
- Sabina Herrera
- Infectious Disease Service, Hospital Clínic, University of Barcelona, IDIBAPS, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Ignasi Roca
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Department of Microbiology, Biomedical Diagnostic Center (CDB) and ISGlobal, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Ana Del Río
- Infectious Disease Service, Hospital Clínic, University of Barcelona, IDIBAPS, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Javier Fernández
- Liver ICU, Liver Unit, Hospital Clinic, University of Barcelona, IDIBAPS and CIBERehd, Spain
- EF Clif, EASL-CLIF Consortium, Barcelona, Spain
- CovidWarriors, Barcelona, Spain
| | - Cristina Pitart
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Department of Microbiology, Biomedical Diagnostic Center (CDB) and ISGlobal, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Isabel Fortes
- Preventive Medicine Service, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Blanca Torralbo
- Preventive Medicine Service, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Gemina Santana
- Preventive Medicine Service, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Romina Parejo-González
- Preventive Medicine Service, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Andreu Veà-Baró
- Andreu Veà, Ph.D. advisor to the CEO (on Digital-Transformation & Optimization) Hospital Clinic Barcelona CovidWarrior, Barcelona, Spain
| | - Josep Maria Campistol
- Hospital Clínic, University of Barcelona, August Pi i Sunyer Biomedical Research Institute Barcelona, Spain
| | - Mireia Aguilar
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Department of Microbiology, Biomedical Diagnostic Center (CDB) and ISGlobal, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Sergi Degea
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Department of Microbiology, Biomedical Diagnostic Center (CDB) and ISGlobal, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Climent Casals-Pascual
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Department of Microbiology, Biomedical Diagnostic Center (CDB) and ISGlobal, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Alex Soriano
- Infectious Disease Service, Hospital Clínic, University of Barcelona, IDIBAPS, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - José A. Martínez
- Infectious Disease Service, Hospital Clínic, University of Barcelona, IDIBAPS, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
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Hygiene requirements for cleaning and disinfection of surfaces: recommendation of the Commission for Hospital Hygiene and Infection Prevention (KRINKO) at the Robert Koch Institute. GMS HYGIENE AND INFECTION CONTROL 2024; 19:Doc13. [PMID: 38655122 PMCID: PMC11035912 DOI: 10.3205/dgkh000468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
This recommendation of the Commission for Hospital Hygiene and Infection Prevention (KRINKO) addresses not only hospitals, but also outpatient health care facilities and compiles current evidence. The following criteria are the basis for the indications for cleaning and disinfection: Infectious bioburden and tenacity of potential pathogens on surfaces and their transmission routes, influence of disinfecting surface cleaning on the rate of nosocomial infections, interruption of cross infections due to multidrug-resistant organisms, and outbreak control by disinfecting cleaning within bundles. The criteria for the selection of disinfectants are determined by the requirements for effectiveness, the efficacy spectrum, the compatibility for humans and the environment, as well as the risk potential for the development of tolerance and resistance. Detailed instructions on the organization and implementation of cleaning and disinfection measures, including structural and equipment requirements, serve as the basis for their implementation. Since the agents for surface disinfection and disinfecting surface cleaning have been classified as biocides in Europe since 2013, the regulatory consequences are explained. As possible addition to surface disinfection, probiotic cleaning, is pointed out. In an informative appendix (only in German), the pathogen characteristics for their acquisition of surfaces, such as tenacity, infectious dose and biofilm formation, and the toxicological and ecotoxicological characteristics of microbicidal agents as the basis for their selection are explained, and methods for the evaluation of the resulting quality of cleaning or disinfecting surface cleaning are presented.
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Crall VD, Lewis CL, Dickman DJ, Grinage DW, George T, Ayres AM, Ciccone C, Snyder GM. Strategies for deployment of ultraviolet disinfection in an acute care facility: A quality improvement initiative. Am J Infect Control 2023; 51:1230-1236. [PMID: 37116712 DOI: 10.1016/j.ajic.2023.04.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/16/2023] [Accepted: 04/17/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND Mobile ultraviolet (UV) disinfection uses UV-C light to render microorganisms nonviable and reduce environmental transmission of pathogens in hospital settings. Optimal strategies for deployment must consider the cost, physical layout, and staffing resources. The aim of this quality improvement study was to increase UV disinfection utilization by developing novel deployment strategies without adding resources. METHODS A novel deployment strategy and tools were developed by a multidisciplinary group that included infection prevention, environmental services, and nursing unit staff. Utilization was tracked via a manufacturer-supported database. The infection prevention team analyzed the weekly UV disinfection minutes, cycles, and proportions of cycles completed in defined areas across 4 periods: baseline, pilot, baseline 2, and intervention. RESULTS The median (range) disinfection cycle times per week during a geographically confined pilot (4,985 minutes [3,476-6,551] minutes) and the intervention period (1,454 [512-3,085] minutes) were lower than either baseline period (5,394 [3,953-6,987] and 6,641 [2,830-7,276] minutes, respectively). Cycles per week were lower in the intervention period than in the preceding 3 periods. CONCLUSIONS Use of UV disinfection in acute care settings should be guided by multidisciplinary groups balancing resources against efficacy and using tailored tools to promote efficiency.
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Affiliation(s)
- Victoria D Crall
- Department of Infection Control and Hospital Epidemiology, UPMC Presbyterian-Shadyside, Pittsburgh, PA
| | - Casey L Lewis
- Department of Infection Control and Hospital Epidemiology, UPMC Presbyterian-Shadyside, Pittsburgh, PA
| | - Daniel J Dickman
- Department of Environmental Services, UPMC Presbyterian-Shadyside, Pittsburgh, PA
| | - Darnell W Grinage
- Department of Environmental Services, UPMC Presbyterian-Shadyside, Pittsburgh, PA
| | - Trish George
- Department of Patient Safety and Innovation, UPMC Presbyterian-Shadyside, Pittsburgh, PA
| | - Ashley M Ayres
- Department of Infection Control and Hospital Epidemiology, UPMC Presbyterian-Shadyside, Pittsburgh, PA
| | - Carl Ciccone
- Department of Infection Control and Hospital Epidemiology, UPMC Presbyterian-Shadyside, Pittsburgh, PA
| | - Graham M Snyder
- Department of Infection Control and Hospital Epidemiology, UPMC Presbyterian-Shadyside, Pittsburgh, PA; Division of Infectious Diseases, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
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4
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Resendiz M, Blanchard D, West GF. A systematic review of the germicidal effectiveness of ultraviolet disinfection across high-touch surfaces in the immediate patient environment. J Infect Prev 2023; 24:166-177. [PMID: 37333872 PMCID: PMC10273798 DOI: 10.1177/17571774231159388] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023] Open
Abstract
Background There is not yet a consensus regarding the in-use effectiveness of ultraviolet irradiation (UV-C) as a supplementary tool for terminal room disinfection. Aims and Objectives To summarize and evaluate literature detailing the germicidal effectiveness of UV-C disinfection on high-touch surfaces in the patient environment. Methods A literature search was carried out utilizing PRISMA guidelines. Studies were included if intervention included UV-C after standard room disinfection in hospital rooms evaluated microbiologically by surface type. Findings/Results Twelve records met our criteria for inclusion. Studies predominantly focused on terminal disinfection of patient rooms, including five reports carried out in isolation rooms and three studies including operating room (OR) surfaces. Bedrails, remote controls, phones, tray tables, assist rails, floors, and toilets were the most commonly reported surfaces. Across study designs, surfaces, and room types, flat surfaces tended to showcase UV-C effectiveness best, particularly isolation room floors. In contrast, handheld surfaces (i.e., bed controls and assist bars) tended to show reduced efficacies (81-93%). In the OR, complex surfaces similarly demonstrated reduced UV-C effectiveness. Bathroom surfaces demonstrated 83% UV-C effectiveness overall, with surface characteristics uniquely impacted depending on the room type. Isolation room studies tended to include effectiveness comparison with standard treatment, reporting UV-C superiority most of the time. Discussion This review highlights the enhanced effectiveness of UV-C surface disinfection over standard protocols across various study designs and surfaces. However, surface and room characteristics do appear to play a role in the level of bacterial reduction.
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Affiliation(s)
- Marisol Resendiz
- Center for Nursing Science & Clinical Inquiry, Tripler Army Medical Center, Honolulu, HI, USA
| | - Dawn Blanchard
- Center for Nursing Science & Clinical Inquiry, Tripler Army Medical Center, Honolulu, HI, USA
| | - Gordon F West
- Center for Nursing Science & Clinical Inquiry, Madigan Army Medical Center, Tacoma, WA, USA
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Tan C, Wang S, Yang H, Huang Q, Li S, Liu X, Ye H, Zhang G. Understanding the interaction of nucleotides with UVC light: an insight from quantum chemical calculation-based findings. Phys Chem Chem Phys 2023; 25:3270-3278. [PMID: 36625732 DOI: 10.1039/d2cp05054d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Short-wave ultraviolet (also called UVC) irradiation is a well-adopted method of viral inactivation due to its ability to damage genetic material. A fundamental problem with the UVC inactivation method is that its mechanism of action on viruses is still unknown at the molecular level. To address this problem, herein we investigate the response mechanism of genome materials to UVC light by means of quantum chemical calculations. The spectral properties of four nucleotides, namely, adenine, cytosine, guanine, and uracil, are mainly focused on. Meanwhile, the transition state and reaction rate constant of uracil molecules are also considered to demonstrate the difficulty level of adjacent nucleotide reaction without and with UVC irradiation. The results show that the peak wavelengths are 248.7 nm, 226.1 nm (252.7 nm), 248.3 nm, and 205.8 nm (249.2 nm) for adenine, cytosine, guanine, and uracil nucleotides, respectively. Besides, the reaction rate constants of uracil molecules are 6.419 × 10-49 s-1 M-1 and 5.436 × 1011 s-1 M-1 for the ground state and excited state, respectively. Their corresponding half-life values are 1.56 × 1048 s and 1.84 × 10-12 s. This directly suggests that the molecular reaction between nucleotides is a photochemical process and the reaction without UVC irradiation almost cannot occur.
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Affiliation(s)
- Chunjian Tan
- Electronic Components, Technology and Materials, Delft University of Technology, 2628 CD Delft, The Netherlands. .,Engineering Research Center of Integrated Circuits for Next-Generation Communications, Ministry of Education, School of Microelectronics, Southern University of Science and Technology, Shenzhen 518055, P. R. China.
| | - Shaogang Wang
- Electronic Components, Technology and Materials, Delft University of Technology, 2628 CD Delft, The Netherlands. .,Engineering Research Center of Integrated Circuits for Next-Generation Communications, Ministry of Education, School of Microelectronics, Southern University of Science and Technology, Shenzhen 518055, P. R. China.
| | - Huiru Yang
- Engineering Research Center of Integrated Circuits for Next-Generation Communications, Ministry of Education, School of Microelectronics, Southern University of Science and Technology, Shenzhen 518055, P. R. China.
| | - Qianming Huang
- Engineering Research Center of Integrated Circuits for Next-Generation Communications, Ministry of Education, School of Microelectronics, Southern University of Science and Technology, Shenzhen 518055, P. R. China.
| | - Shizhen Li
- Engineering Research Center of Integrated Circuits for Next-Generation Communications, Ministry of Education, School of Microelectronics, Southern University of Science and Technology, Shenzhen 518055, P. R. China.
| | - Xu Liu
- Electronic Components, Technology and Materials, Delft University of Technology, 2628 CD Delft, The Netherlands. .,Engineering Research Center of Integrated Circuits for Next-Generation Communications, Ministry of Education, School of Microelectronics, Southern University of Science and Technology, Shenzhen 518055, P. R. China.
| | - Huaiyu Ye
- Engineering Research Center of Integrated Circuits for Next-Generation Communications, Ministry of Education, School of Microelectronics, Southern University of Science and Technology, Shenzhen 518055, P. R. China.
| | - Guoqi Zhang
- Electronic Components, Technology and Materials, Delft University of Technology, 2628 CD Delft, The Netherlands.
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van der Starre CM, Cremers-Pijpers SAJ, van Rossum C, Bowles EC, Tostmann A. The in situ efficacy of whole room disinfection devices: a literature review with practical recommendations for implementation. Antimicrob Resist Infect Control 2022; 11:149. [PMID: 36471395 PMCID: PMC9724435 DOI: 10.1186/s13756-022-01183-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/10/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Terminal cleaning and disinfection of hospital patient rooms must be performed after discharge of a patient with a multidrug resistant micro-organism to eliminate pathogens from the environment. Terminal disinfection is often performed manually, which is prone to human errors and therefore poses an increased infection risk for the next patients. Automated whole room disinfection (WRD) replaces or adds on to the manual process of disinfection and can contribute to the quality of terminal disinfection. While the in vitro efficacy of WRD devices has been extensively investigated and reviewed, little is known about the in situ efficacy in a real-life hospital setting. In this review, we summarize available literature on the in situ efficacy of WRD devices in a hospital setting and compare findings to the in vitro efficacy of WRD devices. Moreover, we offer practical recommendations for the implementation of WRD devices. METHODS The in situ efficacy was summarized for four commonly used types of WRD devices: aerosolized hydrogen peroxide, H2O2 vapour, ultraviolet C and pulsed xenon ultraviolet. The in situ efficacy was based on environmental and clinical outcome measures. A systematic literature search was performed in PubMed in September 2021 to identify available literature. For each disinfection system, we summarized the available devices, practical information, in vitro efficacy and in situ efficacy. RESULTS In total, 54 articles were included. Articles reporting environmental outcomes of WRD devices had large variation in methodology, reported outcome measures, preparation of the patient room prior to environmental sampling, the location of sampling within the room and the moment of sampling. For the clinical outcome measures, all included articles reported the infection rate. Overall, these studies consistently showed that automated disinfection using any of the four types of WRD is effective in reducing environmental and clinical outcomes. CONCLUSION Despite the large variation in the included studies, the four automated WRD systems are effective in reducing the amount of pathogens present in a hospital environment, which was also in line with conclusions from in vitro studies. Therefore, the assessment of what WRD device would be most suitable in a specific healthcare setting mostly depends on practical considerations.
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Affiliation(s)
- Caroline M. van der Starre
- grid.10417.330000 0004 0444 9382Unit of Hygiene and Infection Prevention, Department of Medical Microbiology, Radboud Center for Infectious Diseases (RCI), Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Suzan A. J. Cremers-Pijpers
- grid.10417.330000 0004 0444 9382Unit of Hygiene and Infection Prevention, Department of Medical Microbiology, Radboud Center for Infectious Diseases (RCI), Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Carsten van Rossum
- grid.10417.330000 0004 0444 9382Unit of Hygiene and Infection Prevention, Department of Medical Microbiology, Radboud Center for Infectious Diseases (RCI), Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Edmée C. Bowles
- grid.10417.330000 0004 0444 9382Unit of Hygiene and Infection Prevention, Department of Medical Microbiology, Radboud Center for Infectious Diseases (RCI), Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Alma Tostmann
- grid.10417.330000 0004 0444 9382Unit of Hygiene and Infection Prevention, Department of Medical Microbiology, Radboud Center for Infectious Diseases (RCI), Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
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Anforderungen an die Hygiene bei der Reinigung und Desinfektion von Flächen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2022; 65:1074-1115. [PMID: 36173419 PMCID: PMC9521013 DOI: 10.1007/s00103-022-03576-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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8
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Schnizlein MK, Young VB. Capturing the environment of the Clostridioides difficile infection cycle. Nat Rev Gastroenterol Hepatol 2022; 19:508-520. [PMID: 35468953 DOI: 10.1038/s41575-022-00610-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 12/11/2022]
Abstract
Clostridioides difficile (formerly Clostridium difficile) infection is a substantial health and economic burden worldwide. Great strides have been made over the past several years in characterizing the physiology of C. difficile infection, particularly regarding how gut microorganisms and their host work together to provide colonization resistance. As mammalian hosts and their indigenous gut microbiota have co-evolved, they have formed a complex yet stable relationship that prevents invading microorganisms from establishing themselves. In this Review, we discuss the latest advances in our understanding of C. difficile physiology that have contributed to its success as a pathogen, including its versatile survival factors and ability to adapt to unique niches. Using discoveries regarding microorganism-host and microorganism-microorganism interactions that constitute colonization resistance, we place C. difficile within the fiercely competitive gut environment. A comprehensive understanding of these relationships is required to continue the development of precision medicine-based treatments for C. difficile infection.
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Affiliation(s)
- Matthew K Schnizlein
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, MI, USA
| | - Vincent B Young
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, MI, USA.
- Department of Internal Medicine/Division of Infectious Diseases, University of Michigan Medical School, Ann Arbor, MI, USA.
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9
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Freeman S, Kibler K, Lipsky Z, Jin S, German GK, Ye K. Systematic evaluating and modeling of SARS-CoV-2 UVC disinfection. Sci Rep 2022; 12:5869. [PMID: 35393480 PMCID: PMC8988105 DOI: 10.1038/s41598-022-09930-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 03/29/2022] [Indexed: 11/09/2022] Open
Abstract
The ongoing COVID-19 global pandemic has necessitated evaluating various disinfection technologies for reducing viral transmission in public settings. Ultraviolet (UV) radiation can inactivate pathogens and viruses but more insight is needed into the performance of different UV wavelengths and their applications. We observed greater than a 3-log reduction of SARS-CoV-2 infectivity with a dose of 12.5 mJ/cm2 of 254 nm UV light when the viruses were suspended in PBS, while a dose of 25 mJ/cm2 was necessary to achieve a similar reduction when they were in an EMEM culture medium containing 2%(v/v) FBS, highlighting the critical effect of media in which the virus is suspended, given that SARS-CoV-2 is always aerosolized when airborne or deposited on a surface. It was found that SARS-CoV-2 susceptibility (a measure of the effectiveness of the UV light) in a buffer such as PBS was 4.4-fold greater than that in a cell culture medium. Furthermore, we discovered the attenuation of UVC disinfection by amino acids, vitamins, and niacinamide, highlighting the importance of determining UVC dosages under a condition close to aerosols that wrap the viruses. We developed a disinfection model to determine the effect of the environment on UVC effectiveness with three different wavelengths, 222 nm, 254 nm, and 265 nm. An inverse correlation between the liquid absorbance and the viral susceptibility was observed. We found that 222 nm light was most effective at reducing viral infectivity in low absorbing liquids such as PBS, whereas 265 nm light was most effective in high absorbing liquids such as cell culture medium. Viral susceptibility was further decreased in N95 masks with 222 nm light being the most effective. The safety of 222 nm was also studied. We detected changes to the mechanical properties of the stratum corneum of human skins when the 222 nm accumulative exposure exceeded 50 J/cm2.The findings highlight the need to evaluate each UV for a given application, as well as limiting the dose to the lowest dose necessary to avoid unnecessary exposure to the public.
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Affiliation(s)
- Sebastian Freeman
- Department of Biomedical Engineering, Binghamton University, State University of New York (SUNY), PO Box 6000, Binghamton, NY, 13902, USA.,Center of Biomanufacturing for Regenerative Medicine, Binghamton University, State University of New York (SUNY), Binghamton, NY, 13902, USA
| | - Karen Kibler
- Biodesign Institute, Arizona State University, McAllister Ave, Tempe, AZ, 85281, USA
| | - Zachary Lipsky
- Department of Biomedical Engineering, Binghamton University, State University of New York (SUNY), PO Box 6000, Binghamton, NY, 13902, USA
| | - Sha Jin
- Department of Biomedical Engineering, Binghamton University, State University of New York (SUNY), PO Box 6000, Binghamton, NY, 13902, USA.,Center of Biomanufacturing for Regenerative Medicine, Binghamton University, State University of New York (SUNY), Binghamton, NY, 13902, USA
| | - Guy K German
- Department of Biomedical Engineering, Binghamton University, State University of New York (SUNY), PO Box 6000, Binghamton, NY, 13902, USA.,Center of Biomanufacturing for Regenerative Medicine, Binghamton University, State University of New York (SUNY), Binghamton, NY, 13902, USA
| | - Kaiming Ye
- Department of Biomedical Engineering, Binghamton University, State University of New York (SUNY), PO Box 6000, Binghamton, NY, 13902, USA. .,Center of Biomanufacturing for Regenerative Medicine, Binghamton University, State University of New York (SUNY), Binghamton, NY, 13902, USA.
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10
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Automated room decontamination: report of a Healthcare Infection Society Working Party. J Hosp Infect 2022; 124:97-120. [DOI: 10.1016/j.jhin.2022.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/07/2022] [Indexed: 01/24/2023]
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11
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Birchansky B, Dexter F, Epstein RH, Loftus RW. Statistical Design of Overnight Trials for the Evaluation of the Number of Operating Rooms That Can Be Disinfected by an Ultraviolet Light Disinfection Robotic System. Cureus 2021; 13:e18861. [PMID: 34804714 PMCID: PMC8597859 DOI: 10.7759/cureus.18861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2021] [Indexed: 11/25/2022] Open
Abstract
Background and objective The number of ultraviolet light disinfection robot systems that are needed for a facility’s surgical suite(s) and/or procedure suite(s) depends in part on how many rooms need to be disinfected overnight by each robot and how long this will take. The answer needs to be determined separately for each surgical and procedure suite because those variables vary both among facilities and among operating rooms or procedure rooms within facilities. In this study, we consider statistical designs to assess how many rooms a facility can reliably (≥90% chance) disinfect overnight using an ultraviolet light disinfection robot system. Methods We used 133,927 observed disinfection times from 700 rooms as a population from which repeated samples were drawn with replacement in Monte-Carlo simulations. We used eight-hour and 10-hour shift lengths being multiples of 40 hours for full-time hourly employees. Results One possible strategy that we examined was to estimate total disinfection times by estimating the mean for each room and then summing up the means. However, that did not correctly answer the question of how many rooms can reliably be available for the next day’s first case. Summing up a percentile (e.g., 90%) instead also was inaccurate, because the proper percentile depended on the number of rooms. A suitable strategy is a brief trial (e.g., nine nights or 19 nights) with the endpoint being the daily number of rooms disinfected. Empirically, the smallest count of rooms disinfected among nine nights or the second smallest count among 19 nights are 10th percentiles (i.e., ≈90% probability that at least that number of rooms can be disinfected in the future). The drawback is that while this approach gives the probability of a night with fewer rooms disinfected, it does not give information as to how many fewer rooms may either skip ultraviolet decontamination or start late the next workday because disinfection was not completed. Our simulations showed that there is a substantial probability (≥95%) of at most two rooms fewer or one room greater than the 10th percentile with a nine-night trial and one room fewer or greater with a 19-night trial. Conclusions Because probability distributions of disinfection times are heterogeneous both among rooms and among treatments for the same room, each facility should plan to perform its own trial of nine nights or 19 nights. This will provide results that are within two rooms or one room of the correct answer in the long term. This information can be used when planning purchasing decisions, leasing, and technician staffing decisions.
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Affiliation(s)
| | | | - Richard H Epstein
- Anesthesiology, University of Miami Miller School of Medicine, Miami, USA
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Weppner J, Gabet J, Linsenmeyer M, Yassin M, Galang G. Clostridium difficile Infection Reservoirs Within an Acute Rehabilitation Environment. Am J Phys Med Rehabil 2021; 100:44-47. [PMID: 32889863 DOI: 10.1097/phm.0000000000001579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Clostridium difficile infection is a common hospital-associated infection spread via patient contact or contaminated environments. The risk for spread of C difficile may be greater in inpatient rehabilitation units than in some hospital units as patients are not confined to their rooms and often share equipment. Environmental disinfection is challenging in shared medical equipment, especially in equipment with complex designs. The study aimed to examine the presence of C difficile spores within an acute rehabilitation environment and to evaluate disinfection effectiveness. DESIGN Cultures were performed on 28 rehabilitation rooms, 28 rehabilitation floor surfaces, and 80 shared devices and equipment. Two disinfection interventions were implemented, and environmental cultures then were repeated postintervention. RESULTS Environmental cultures positive for CD spores were rehabilitation rooms (1/28), rehabilitation floors (13/28), and wheelchairs (3/20). After the implementation of new disinfection methods, repeat cultures were obtained and produced negative results. CONCLUSIONS Nonsporicidal disinfectant was not effective on hospital floors. Sporicidal disinfection of the floor is important when rates of C difficile infection are increased. Wheelchairs are complex devices and difficult to properly clean. The hospital purchased an ultraviolent device for wheelchair cleaning with a subsequent reduction in spores on repeat cultures. TO CLAIM CME CREDITS Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. CME OBJECTIVES Upon completion of this article, the reader should be able to: (1) Recognize the impact of Clostridium difficile infections on the healthcare system; (2) Describe potential reservoirs of Clostridium difficile in the inpatient rehabilitation environment; and (3) Discuss interventions that may be implemented to reduce the reservoirs of Clostridium difficile on the rehabilitation unit. LEVEL Advanced. ACCREDITATION The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
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Affiliation(s)
- Justin Weppner
- From the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (JW, JG, ML, MY, GG); and Virginia Tech Carilion School of Medicine, Roanoke, Virginia (JW)
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Abstract
Clostridioides difficile remains a leading cause of healthcare-associated infection. Efforts at C. difficile prevention have been hampered by an increasingly complex understanding of transmission patterns and a high degree of heterogeneity among existing studies. Effective prevention of C. difficile infection requires multimodal interventions, including contact precautions, hand hygiene with soap and water, effective environmental cleaning, use of sporicidal cleaning agents, and antimicrobial stewardship. Roles for probiotics, avoidance of proton pump inhibitors, and isolation of asymptomatic carriers remain poorly defined.
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Affiliation(s)
- Nicholas A Turner
- Duke University Medical Center, Department of Medicine, Division of Infectious Diseases, Durham, North Carolina.,Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina
| | - Deverick J Anderson
- Duke University Medical Center, Department of Medicine, Division of Infectious Diseases, Durham, North Carolina.,Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina
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Otter J, Yezli S, Barbut F, Perl T. An overview of automated room disinfection systems: When to use them and how to choose them. DECONTAMINATION IN HOSPITALS AND HEALTHCARE 2020. [PMCID: PMC7153347 DOI: 10.1016/b978-0-08-102565-9.00015-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Conventional disinfection methods are limited by reliance on the operator to ensure appropriate selection, formulation, distribution, and contact time of the agent. Automated room disinfection (ARD) systems remove or reduce reliance on operators and so they have the potential to improve the efficacy of terminal disinfection. The most commonly used systems are hydrogen peroxide vapor (H2O2 vapor), aerosolized hydrogen peroxide (aHP), and ultraviolet (UV) light. These systems have important differences in their active agent, delivery mechanism, efficacy, process time, and ease of use. The choice of ARD system should be influenced by the intended application, the evidence base for effectiveness, practicalities of implementation, and cost considerations.
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Affiliation(s)
- J.A. Otter
- NIHR Health Protection Research Unit (HPRU) in HCAIs and AMR at Imperial College London, and Imperial College Healthcare NHS Trust, Infection Prevention and Control, London, United Kingdom
| | - S. Yezli
- Global Centre for Mass Gatherings Medicine, WHO Collaborating Centre for Mass Gatherings Medicine, Ministry of Health-Public Health Directorate, Riyadh, Kingdom of Saudi Arabia
| | - F. Barbut
- National Reference Laboratory for C. difficile, Infection Control Unit, Hôpital Saint Antoine, Paris, France,INSERM S-1139, Faculté de Pharmacie de Paris, Université de Paris, Paris, France
| | - T.M. Perl
- Infectious Diseases and Geographic Medicine, UT Southwestern Medical Center, Dallas, TX, United States
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A tryptophan synchronous and normal fluorescence study on bacteria inactivation mechanism. Proc Natl Acad Sci U S A 2019; 116:18822-18826. [PMID: 31481620 DOI: 10.1073/pnas.1909722116] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The UV photodissociation kinetics of tryptophan amino acid, Trp, attached to the membrane of bacteria, Escherichia coli and Bacillus subtilis, have been studied by means of normal and synchronous fluorescence. Our experimental data suggest that the fluorescence intensity of Trp increases during the first minute of irradiation with 250 nm to ∼ 280 nm, 7 mW/cm2 UV light, and subsequently decreases with continuous irradiation. During this short, less than a minute, period of time, 70% of the 107 cell per milliliter bacteria are inactivated. This increase in fluorescence intensity is not observed when tryptophan is in the free state, namely, not attached to a protein, but dissolved in water or saline solution. This increase in fluorescence is attributed to the additional fluorescence of tryptophan molecules formed by protein unfolding, the breakage of the bond that attaches Trp to the bacterial protein membrane, or possibly caused by the irradiation of 2 types of tryptophan residues that photolyze with different quantum yields.
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Sampathkumar P, Folkert C, Barth JE, Nation L, Benz M, Hesse A, Mielke MS, CL, Zaveleta KW. A trial of pulsed xenon ultraviolet disinfection to reduce Clostridioides difficile infection. Am J Infect Control 2019; 47:406-408. [PMID: 30502111 DOI: 10.1016/j.ajic.2018.09.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 09/15/2018] [Accepted: 09/17/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND An intervention was designed to test whether the addition of an ultraviolet (UV) disinfection step after terminal cleaning would be helpful in reducing Clostridium difficile infection (CDI) rates in a real-world situation. METHODS This study was a quasi-experimental design using 3 units as intervention units for the intervention and 3 similar units as control units. Intervention units 2 hematology and bone marrow transplant units and one medical-surgical unit at a large teaching hospital in the Midwest. UV disinfection was added after patient discharge and terminal cleaning in the intervention units. RESULTS At baseline, CDI rates in the intervention and control arms were similar. During the 6 months of UV disinfection, the CDI rate in the intervention units decreased to 11.2 per 10,000 patient days, compared with 28.7 per 10,000 patient days in the control units (P = .03). In addition, the intervention units also saw a reduction in vancomycin-resistant enterococci acquisition. CONCLUSIONS The addition of UV disinfection to the terminal cleaning resulted in a reduction in CDI that has been sustained over several months 2 years.
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