1
|
Kunishima H, Ichiki K, Ohge H, Sakamoto F, Sato Y, Suzuki H, Nakamura A, Fujimura S, Matsumoto K, Mikamo H, Mizutani T, Morinaga Y, Mori M, Yamagishi Y, Yoshizawa S. Japanese Society for infection prevention and control guide to Clostridioides difficile infection prevention and control. J Infect Chemother 2024; 30:673-715. [PMID: 38714273 DOI: 10.1016/j.jiac.2024.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 05/09/2024]
Affiliation(s)
- Hiroyuki Kunishima
- Department of Infectious Diseases. St. Marianna University School of Medicine, Japan.
| | - Kaoru Ichiki
- Department of Infection Control and Prevention, Hyogo Medical University Hospital, Japan
| | - Hiroki Ohge
- Department of Infectious Diseases, Hiroshima University Hospital, Japan
| | - Fumie Sakamoto
- Quality Improvement and Safety Center, Itabashi Chuo Medical Center, Japan
| | - Yuka Sato
- Department of Infection Control and Nursing, Graduate School of Nursing, Aichi Medical University, Japan
| | - Hiromichi Suzuki
- Department of Infectious Diseases, University of Tsukuba School of Medicine and Health Sciences, Japan
| | - Atsushi Nakamura
- Department of Infection Prevention and Control, Graduate School of Medical Sciences, Nagoya City University, Japan
| | - Shigeru Fujimura
- Division of Clinical Infectious Diseases and Chemotherapy, Faculty of Pharmaceutical Sciences, Tohoku Medical and Pharmaceutical University, Japan
| | - Kazuaki Matsumoto
- Division of Pharmacodynamics, Faculty of Pharmacy, Keio University, Japan
| | - Hiroshige Mikamo
- Department of Clinical Infectious Diseases, Aichi Medical University, Japan
| | | | - Yoshitomo Morinaga
- Department of Microbiology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Japan
| | - Minako Mori
- Department of Infection Control, Hiroshima University Hospital, Japan
| | - Yuka Yamagishi
- Department of Clinical Infectious Diseases, Kochi Medical School, Kochi University, Japan
| | - Sadako Yoshizawa
- Department of Laboratory Medicine/Department of Microbiology and Infectious Diseases, Faculty of Medicine, Toho University, Japan
| |
Collapse
|
2
|
Cocker D, Birgand G, Zhu N, Rodriguez-Manzano J, Ahmad R, Jambo K, Levin AS, Holmes A. Healthcare as a driver, reservoir and amplifier of antimicrobial resistance: opportunities for interventions. Nat Rev Microbiol 2024:10.1038/s41579-024-01076-4. [PMID: 39048837 DOI: 10.1038/s41579-024-01076-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2024] [Indexed: 07/27/2024]
Abstract
Antimicrobial resistance (AMR) is a global health challenge that threatens humans, animals and the environment. Evidence is emerging for a role of healthcare infrastructure, environments and patient pathways in promoting and maintaining AMR via direct and indirect mechanisms. Advances in vaccination and monoclonal antibody therapies together with integrated surveillance, rapid diagnostics, targeted antimicrobial therapy and infection control measures offer opportunities to address healthcare-associated AMR risks more effectively. Additionally, innovations in artificial intelligence, data linkage and intelligent systems can be used to better predict and reduce AMR and improve healthcare resilience. In this Review, we examine the mechanisms by which healthcare functions as a driver, reservoir and amplifier of AMR, contextualized within a One Health framework. We also explore the opportunities and innovative solutions that can be used to combat AMR throughout the patient journey. We provide a perspective on the current evidence for the effectiveness of interventions designed to mitigate healthcare-associated AMR and promote healthcare resilience within high-income and resource-limited settings, as well as the challenges associated with their implementation.
Collapse
Affiliation(s)
- Derek Cocker
- David Price Evans Infectious Diseases & Global Health Group, University of Liverpool, Liverpool, UK
- Malawi-Liverpool-Wellcome Research Programme, Blantyre, Malawi
| | - Gabriel Birgand
- Centre d'appui pour la Prévention des Infections Associées aux Soins, Nantes, France
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London, London, UK
- Cibles et medicaments des infections et de l'immunitée, IICiMed, Nantes Universite, Nantes, France
| | - Nina Zhu
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London, London, UK
- Department of Infectious Disease, Imperial College London, London, UK
| | - Jesus Rodriguez-Manzano
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London, London, UK
- Department of Infectious Disease, Imperial College London, London, UK
| | - Raheelah Ahmad
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London, London, UK
- Department of Health Services Research & Management, City University of London, London, UK
- Dow University of Health Sciences, Karachi, Pakistan
| | - Kondwani Jambo
- Malawi-Liverpool-Wellcome Research Programme, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Anna S Levin
- Department of Infectious Disease, School of Medicine & Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil
| | - Alison Holmes
- David Price Evans Infectious Diseases & Global Health Group, University of Liverpool, Liverpool, UK.
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London, London, UK.
- Department of Infectious Disease, Imperial College London, London, UK.
| |
Collapse
|
3
|
Lee J, Kim EJ, Lim YJ, Kim EO, Bae S, Jung J, Kim SH. Effectiveness of ceiling-mounted ultraviolet-C lamps: An experimental study in a biocontainment unit of a tertiary care hospital. Am J Infect Control 2024:S0196-6553(24)00581-9. [PMID: 38945300 DOI: 10.1016/j.ajic.2024.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 06/23/2024] [Accepted: 06/24/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND We aimed to evaluate the performance of ceiling-mounted UV-C lamps. METHODS This study was conducted in an empty room with UV-C lamps in the biocontainment unit of a tertiary care hospital in South Korea. Each pathogen (Staphylococcus aureus, Escherichia coli, Candida krusei, Bacillus cereus, and Mycobacterium peregrinum) was inoculated on blood agar plates and placed in 20 selected places from the UV-C lamp, and irradiation was applied for 15 min. As a control group, the bacterial solution was diluted 10,000 times and UV was not applied. RESULTS A mean ± SD of 5.95 ± 0.91 log reduction was observed with UV irradiation compared with the control. The log reduction was greatest for S. aureus [median, 7.05 (IQR, 6.49-7.26)] and least for M. peregrinum [median, 4.88 (IQR, 4.58-5.24)]. The degree of log reduction was inversely proportional to the square of the distance from the UV-C lamp (R2 = -0.12, P < .001). CONCLUSIONS In this study, ceiling-mounted UV-C demonstrated effective disinfection of at least 4-log reduction of the test organisms within a 4-m distance. Mounted UV-C lighting is a considerable option for improving surface disinfection.
Collapse
Affiliation(s)
- Jeongyoung Lee
- Office for Infection Control, Asan Medical Center, Seoul, Republic of Korea
| | - Eun Ju Kim
- Office for Infection Control, Asan Medical Center, Seoul, Republic of Korea
| | - Young-Ju Lim
- Office for Infection Control, Asan Medical Center, Seoul, Republic of Korea
| | - Eun Ok Kim
- Office for Infection Control, Asan Medical Center, Seoul, Republic of Korea
| | - Seongman Bae
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jiwon Jung
- Office for Infection Control, Asan Medical Center, Seoul, Republic of Korea; Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Sung-Han Kim
- Office for Infection Control, Asan Medical Center, Seoul, Republic of Korea; Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
4
|
Di Bella S, Sanson G, Monticelli J, Zerbato V, Principe L, Giuffrè M, Pipitone G, Luzzati R. Clostridioides difficile infection: history, epidemiology, risk factors, prevention, clinical manifestations, treatment, and future options. Clin Microbiol Rev 2024; 37:e0013523. [PMID: 38421181 DOI: 10.1128/cmr.00135-23] [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] [Indexed: 03/02/2024] Open
Abstract
SUMMARYClostridioides difficile infection (CDI) is one of the major issues in nosocomial infections. This bacterium is constantly evolving and poses complex challenges for clinicians, often encountered in real-life scenarios. In the face of CDI, we are increasingly equipped with new therapeutic strategies, such as monoclonal antibodies and live biotherapeutic products, which need to be thoroughly understood to fully harness their benefits. Moreover, interesting options are currently under study for the future, including bacteriophages, vaccines, and antibiotic inhibitors. Surveillance and prevention strategies continue to play a pivotal role in limiting the spread of the infection. In this review, we aim to provide the reader with a comprehensive overview of epidemiological aspects, predisposing factors, clinical manifestations, diagnostic tools, and current and future prophylactic and therapeutic options for C. difficile infection.
Collapse
Affiliation(s)
- Stefano Di Bella
- Clinical Department of Medical, Surgical and Health Sciences, Trieste University, Trieste, Italy
| | - Gianfranco Sanson
- Clinical Department of Medical, Surgical and Health Sciences, Trieste University, Trieste, Italy
| | - Jacopo Monticelli
- Infectious Diseases Unit, Trieste University Hospital (ASUGI), Trieste, Italy
| | - Verena Zerbato
- Infectious Diseases Unit, Trieste University Hospital (ASUGI), Trieste, Italy
| | - Luigi Principe
- Microbiology and Virology Unit, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Mauro Giuffrè
- Clinical Department of Medical, Surgical and Health Sciences, Trieste University, Trieste, Italy
- Department of Internal Medicine (Digestive Diseases), Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Giuseppe Pipitone
- Infectious Diseases Unit, ARNAS Civico-Di Cristina Hospital, Palermo, Italy
| | - Roberto Luzzati
- Clinical Department of Medical, Surgical and Health Sciences, Trieste University, Trieste, Italy
| |
Collapse
|
5
|
Gagnon H, Pokhrel A, Bush K, Cordoviz M, Ewashko T, Galetta F, Leal J. Limited reduction in Clostridioides difficile and Methicillin-Resistant Staphylococcus aureus with the use of an aerosolized hydrogen peroxide disinfection system in tertiary health care facilities in Alberta, Canada. Am J Infect Control 2024; 52:410-418. [PMID: 37806387 DOI: 10.1016/j.ajic.2023.09.019] [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: 06/05/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Nonmanual room disinfection systems may reduce the transmission of infections. A variety of systems have emerged; however, a paucity of evidence exists to make an evidence-informed decision for the implementation of a specific system. Alberta Health Services assessed one of these systems. METHODS A quasi-experimental prepost design assessed an aerosolized hydrogen peroxide disinfection system on 6 units at 3 acute care facilities in Alberta. To assess clinical effectiveness an interrupted time-series analysis with Poisson distribution compared changes in hospital-acquired Clostridioides difficile infection (HA-CDI) and hospital-acquired Methicillin-resistant Staphylococcus aureus (HA-MRSA) between preintervention, intervention, and postintervention periods. To assess operational feasibility cleaning turnaround time, time to operate, and utilization were considered. A participatory research framework was used to understand the benefits and challenges of operationalization. RESULTS Incidence rate ratio (IRR) of HA-CDI decreased by 25.7% on FMC-A and 6.9% on RAH-B. Following withdrawal, the IRR of HA-CDI continued to decrease. IRR of HA-MRSA decreased by 25.0% on RAH-B. Following withdrawal, the IRR of HA-MRSA continued to decrease. None of the results were statistically significant. The average time to operate was 3.2 hours. Utilization was between 1.7% and 25.6%. Most staff reported benefits and challenges. DISCUSSION None of the changes observed in HA-CDI and HA-MRSA after the introduction of the aerosolized hydrogen peroxide system were statistically significant. While most respondents reported multiple benefits and challenges in using the system, the core challenge was delays in inpatient admissions due to the time operate the system. CONCLUSION Successful implementation of a nonmanual room disinfection system as an addition to standard cleaning and disinfection requires significant investment and must consider a variety of factors.
Collapse
Affiliation(s)
- Heather Gagnon
- Infection Prevention and Control, Alberta Health Services, Alberta, Canada
| | - Arun Pokhrel
- Infection Prevention and Control, Alberta Health Services, Alberta, Canada; Emergency Medical Services, Alberta Health Services, Alberta, Canada
| | - Kathryn Bush
- Infection Prevention and Control, Alberta Health Services, Alberta, Canada
| | - Melody Cordoviz
- Infection Prevention and Control, Alberta Health Services, Alberta, Canada
| | - Tanya Ewashko
- Health Evidence and Innovation, Alberta Health Services, Alberta, Canada
| | - Frank Galetta
- Linen and Environmental Services, Alberta Health Services, Alberta, Canada
| | - Jenine Leal
- Infection Prevention and Control, Alberta Health Services, Alberta, Canada; Department of Community Health Services, Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Microbiology, Immunology and Infectious Diseases, Cumming School of Medicine, University of Calgary, Alberta, Canada; O'Brien Institute for Public Health, University of Calgary, Alberta, Canada.
| |
Collapse
|
6
|
Ayub A, Cheong YK, Castro JC, Cumberlege O, Chrysanthou A. Use of Hydrogen Peroxide Vapour for Microbiological Disinfection in Hospital Environments: A Review. Bioengineering (Basel) 2024; 11:205. [PMID: 38534479 DOI: 10.3390/bioengineering11030205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/14/2024] [Accepted: 02/19/2024] [Indexed: 03/28/2024] Open
Abstract
Disinfection of nosocomial pathogens in hospitals is crucial to combat healthcare-acquired infections, which can be acquired by patients, visitors and healthcare workers. However, the presence of a wide range of pathogens and biofilms, combined with the indiscriminate use of antibiotics, presents infection control teams in healthcare facilities with ongoing challenges in the selection of biocides and application methods. This necessitates the development of biocides and innovative disinfection methods that overcome the shortcomings of conventional methods. This comprehensive review finds the use of hydrogen peroxide vapour to be a superior alternative to conventional methods. Motivated by observations in previous studies, herein, we provide a comprehensive overview on the utilisation of hydrogen peroxide vapour as a superior high-level disinfection alternative in hospital settings. This review finds hydrogen peroxide vapour to be very close to an ideal disinfectant due to its proven efficacy against a wide range of microorganisms, safety to use, lack of toxicity concerns and good material compatibility. The superiority of hydrogen peroxide vapour was recently demonstrated in the case of decontamination of N95/FFP2 masks for reuse to address the critical shortage caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the COVID-19 pandemic. Despite the significant number of studies demonstrating antimicrobial activity, there remains a need to critically understand the mechanism of action by performing studies that simultaneously measure damage to all bacterial cell components and assess the correlation of this damage with a reduction in viable cell count. This can lead to improvement in antimicrobial efficacy and foster the development of superior approaches.
Collapse
Affiliation(s)
- Aaqib Ayub
- School of Physics, Engineering and Computer Science, University of Hertfordshire, Hatfield AL10 9AB, UK
| | - Yuen Ki Cheong
- School of Physics, Engineering and Computer Science, University of Hertfordshire, Hatfield AL10 9AB, UK
| | - Jesus Calvo Castro
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK
| | | | - Andreas Chrysanthou
- School of Physics, Engineering and Computer Science, University of Hertfordshire, Hatfield AL10 9AB, UK
| |
Collapse
|
7
|
Zhou R, Wu R, Wang L, Yang H. Increasing ratio of opportunistic infections associated with sunshine exposure and economic level burdening Chinese inflammatory bowel disease hospitalized patients: the first nationwide survey from 2014 to 2019. BMC Public Health 2024; 24:133. [PMID: 38195452 PMCID: PMC10777555 DOI: 10.1186/s12889-024-17635-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 01/01/2024] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND The rising prevalence of opportunistic infections (OIs) in inflammatory bowel disease (IBD) in conjunction with the use of biologics/immunosuppressive agents has garnered attention. However, there is a dearth of research on OIs in Mainland China. This study seeks to evaluate the national ratio trend of OIs in IBD and elucidate the influence of economic and climate factors on IBD patients with OIs and their outcomes. METHODS The nationwide data was obtained from the Inpatient medical record home page via the Health Statistics and Information Reporting System (HSRS). Patients diagnosed with IBD were enlisted for participation, and their demographic and clinical information, encompassing infection type, surgical procedures, and expenses, were gathered. The National Bureau of Statistics provided data on monthly sunshine exposure hours and yearly Gross Domestic Product (GDP). RESULTS Findings indicate that between 2014 and 2019, a total of 381,752 patients with IBD were admitted to hospitals, with 364,249 patients lacking OIs and 17,503 patients presenting with OIs. The annual proportion of OIs exhibited an upward trend, rising from 3.54% in 2014 to 4.81% in 2019. There was a significant correlation observed between individuals who identified as male, those who visited hospitals in southern regions, or those originating from areas with lower GDP or shorter sunshine exposure hours, and a higher incidence of OIs. Among patients diagnosed with either Crohn's disease (CD) or ulcerative colitis (UC), Clostridium difficile was found to be the most prevalent infection, followed by Epstein-Barr virus and cytomegalovirus. Furthermore, the occurrence of OIs was found to be associated with an increased rate of surgical interventions in UC patients. CONCLUSIONS The rising prevalence of OIs among hospitalized patients with IBD necessitates heightened attention towards mitigating associated risk factors, particularly among IBD patients residing in less developed regions or experiencing limited exposure to sunlight. This approach aims to minimize hospital stays and associated costs.
Collapse
Affiliation(s)
- Runing Zhou
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Ruixian Wu
- Center for Health Statistics and Information, National Health Commission, Beijing, 100044, China
| | - Li Wang
- Department of Epidemiology and Biostatistics, School of Basic Medicine Peking Union Medical College, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, Beijing, 100005, China
| | - Hong Yang
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
| |
Collapse
|
8
|
Halmans Y, Wellenstein DJ, Romijn M, Cremers S, Smit JJ, Hopman J, Takes RP, van den Broek GB. Is ultraviolet light disinfection fit to be the future standard for the disinfection of flexible endoscopes without a working channel? Clin Otolaryngol 2024; 49:130-135. [PMID: 37882501 DOI: 10.1111/coa.14119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/10/2023] [Accepted: 09/21/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE To investigate colony-forming unit (CFU) reduction on contaminated flexible endoscopes (FEs) without a working channel after UV-C light disinfection, compared to the current disinfection method with the endoscope washer disinfector (EWD). DESIGN, SETTING AND PARTICIPANTS After pharyngolaryngoscopy, a manual pre-cleaning with tap water was performed. A culture was then collected by rolling the distal 8-10 cm of the FE over an Agar plate. The FE was disinfected using the D60 (60-s disinfection process with UV-C light) or the EWD (gold standard reprocessing process with water and chemicals). Another culture was then taken. After incubation, a CFU count was performed. RESULTS A total of 200 FEs without a working channel were divided equally between the two disinfection groups. After clinical use and manual pre-cleaning, 84 of the 100 (84.0%) (UV-C light group) and 79 of the 100 (79.0%) (EWD) FEs were contaminated with at least 1 CFU. FEs that showed no contamination after use were excluded from further analysis. After disinfection with UV-C light, 72 (85.7%) FEs showed no contamination (i.e., 0 CFUs) versus 66 (83.5%) FEs after reprocessing with the EWD. CONCLUSION There is no difference in CFUs reduction on contaminated FEs without a working channel between UV-C light disinfection and the current gold standard, the EWD.
Collapse
Affiliation(s)
- Yana Halmans
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University, Medical Center Nijmegen, Nijmegen, The Netherlands
| | - David J Wellenstein
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University, Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Michael Romijn
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University, Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Suzan Cremers
- Department of Hygiene and Infection Prevention, Radboud University, Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Jannie J Smit
- Department of Pharmacy, Radboud University, Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Joost Hopman
- Department of Medical Microbiology, Radboud University, Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Robert P Takes
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University, Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Guido B van den Broek
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University, Medical Center Nijmegen, Nijmegen, The Netherlands
| |
Collapse
|
9
|
Weber DJ, Rutala WA, Anderson DJ, Sickbert-Bennett EE. ..úNo touch..Ñ methods for health care room disinfection: Focus on clinical trials. Am J Infect Control 2023; 51:A134-A143. [PMID: 37890944 DOI: 10.1016/j.ajic.2023.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 04/03/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Hospital patient room surfaces are frequently contaminated with multidrug-resistant organisms. Since studies have demonstrated that inadequate terminal room disinfection commonly occurs, ..úno touch..Ñ methods of terminal room disinfection have been developed such as ultraviolet light (UV) devices and hydrogen peroxide (HP) systems. METHODS This paper reviews published clinical trials of ..úno touch..Ñ methods and ..úself-disinfecting..Ñ surfaces. RESULTS Multiple papers were identified including clinical trials of UV room disinfection devices (N.ß=.ß20), HP room disinfection systems (N.ß=.ß8), handheld UV devices (N.ß=.ß1), and copper-impregnated or coated surfaces (N.ß=.ß5). Most but not all clinical trials of UV devices and HP systems for terminal disinfection demonstrated a reduction of colonization/infection in patients subsequently housed in the room. Copper-coated surfaces were the only ..úself-disinfecting..Ñ technology evaluated by clinical trials. Results of these clinical trials were mixed. DISCUSSION Almost all clinical trials reviewed used a ..úweak..Ñ design (eg, before-after) and failed to assess potential confounders (eg, compliance with hand hygiene and environmental cleaning). CONCLUSIONS The evidence is strong enough to recommend the use of a ..úno-touch..Ñ method as an adjunct for outbreak control, mitigation strategy for high-consequence pathogens (eg, Candida auris or Ebola), or when there are an excessive endemic rates of multidrug-resistant organisms.
Collapse
Affiliation(s)
- David J Weber
- Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC; Department of Infection Prevention, UNC Medical Center, Chapel Hill, NC.
| | - William A Rutala
- Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC
| | - Deverick J Anderson
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, NC
| | - Emily E Sickbert-Bennett
- Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC; Department of Infection Prevention, UNC Medical Center, Chapel Hill, NC
| |
Collapse
|
10
|
Sun Y, Wu Q, Liu J, Wang Q. Effectiveness of ultraviolet-C disinfection systems for reduction of multi-drug resistant organism infections in healthcare settings: A systematic review and meta-analysis. Epidemiol Infect 2023; 151:e149. [PMID: 37644902 PMCID: PMC10540170 DOI: 10.1017/s0950268823001371] [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: 04/25/2023] [Revised: 08/17/2023] [Accepted: 08/17/2023] [Indexed: 08/31/2023] Open
Abstract
This study aimed to summarise the findings of the studies assessing the effectiveness of ultraviolet C (UV-C) room disinfection in reducing the incidence rate of healthcare-associated multi-drug-resistant organism (MDRO) infections. A systematic screening was conducted using PubMed, EMBASE, and Scopus for randomised controlled trials (RCTs), quasi-experimental studies, and before-after studies, which assessed the efficacy of the UV-C disinfectant system in reducing the incidence of MDRO infections. A random-effects model was used for the analysis. Effect sizes were described as incidence rate ratio (IRR) with 95% confidence intervals (CI). Nine studies were included, all of which were conducted in the USA. No statistically significant reduction in Clostridioides difficile (CD) (IRR: 0.90, 95% CI; 0.62-1.32) and vancomycin-resistant enterococcal (VRE) infection rates (IRR 0.72, 95% CI; 0.38-1.37) was observed with the use of UV-C, but the risk of Gram-negative rod infection was reduced (IRR 0.82, 95% CI; 0.68-0.99).
Collapse
Affiliation(s)
- YanLin Sun
- Day Surgery Center, The Affiliated Qingdao Central Hospital of Qingdao University, Qingdao, China
| | - Qi Wu
- Department of Infection Management, The Affiliated Qingdao Central Hospital of Qingdao University, Qingdao, China
| | - Jinzhi Liu
- Department of Gastroenterology, The Affiliated Qingdao Central Hospital of Qingdao University, Qingdao, China
| | - Qian Wang
- Department of Infection Management, The Affiliated Qingdao Central Hospital of Qingdao University, Qingdao, China
| |
Collapse
|
11
|
Biadsee A, Crosby L, Chow W, Sowerby LJ. Cost minimization analysis of nasopharyngoscope reprocessing in community practice. J Otolaryngol Head Neck Surg 2023; 52:8. [PMID: 36750881 PMCID: PMC9906939 DOI: 10.1186/s40463-022-00610-9] [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: 06/15/2022] [Accepted: 11/16/2022] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Reprocessing of nasopharyngoscopes represents a large financial burden to community physicians. The aim of this study was to perform a cost analysis of nasopharyngoscope reprocessing methods at the community level. METHODS Electronic surveys were distributed by email to community otolaryngologists. Surveys were comprised of 14 questions assessing clinic size, nasopharyngoscope volume, scope reprocessing method and maintenance. Four manual techniques were evaluated: (1) soak with ortho-phthalaldehyde solution (Cidex-OPA; Advanced Sterilization Products, Johnson and Johnson Inc., Markham, Canada), (2) soak with accelerated hydrogen peroxide solution (Revital-Ox; Steris Canada Inc., Mississauga, Canada), (3) disinfection with chlorine dioxide wipe (Tristel Trio Wipes System; Tristel plc., Cambridgeshire, UK), (4) UV-C light system (UV Smart, Delft, The Netherlands). All costs are reported in CAD, and consumable and capital costs for reprocessing methods were obtained from reported vendor prices. Time costs were derived from manufacturer recommendations, the Ontario Medical Association Physician's Guide to Uninsured Services, and the Ontario Nurses Association Collective Agreement. Cost analyses determined the most cost-effective reprocessing method in the community setting. Sensitivity analyses assessed the impact of reprocessing volume and labour costs. RESULTS Thirty-six (86%) otolaryngologists responded and answered the survey. The cost per reprocessing event for Cidex-OPA, Revital-Ox, Tristel and UV system were $38.59, $26.47, $30.53, and $22.74 respectively when physicians reprocessed their endoscopes themselves. Sensitivity analyses demonstrated that Revital-Ox was the least costly option in a low volume, however, the UV system remained the most cost effective in higher volumes. The cost per reprocessing event when done by clinic staff was $5.51, $4.42, $11.23 and $6.21 for Cidex-OPA, Revital-Ox, Tristel and the UV system. CONCLUSIONS The UV light system appears to be the most cost-effective method in high volumes of reprocessing, and Revital-Ox is cheaper in lower volumes and when performed by clinic staff rather than physicians. It is important to consider the anticipated work volume, shared clinic space and number of co-workers prior to choosing a reprocessing method.
Collapse
Affiliation(s)
- Ameen Biadsee
- grid.39381.300000 0004 1936 8884Department of Otolaryngology- Head and Neck Surgery, Western University, 268 Grosvenor Street, London, ON N6A 4V2 Canada ,grid.415250.70000 0001 0325 0791Department of Otolaryngology- Head and Neck Surgery, Meir Medical Center, Kfar Saba, Israel ,grid.12136.370000 0004 1937 0546Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Lauren Crosby
- grid.22072.350000 0004 1936 7697Department of Anesthesiology, Perioperative and Pain Medicine, Foothills Medical Centre, University of Calgary, Calgary, Canada
| | - Winsion Chow
- grid.28046.380000 0001 2182 2255Deptartment of Otolaryngology- Head and Neck Surgery, University of Ottawa, Ottawa, ON Canada
| | - Leigh J Sowerby
- Department of Otolaryngology- Head and Neck Surgery, Western University, 268 Grosvenor Street, London, ON, N6A 4V2, Canada.
| |
Collapse
|
12
|
Goto M, Hasegawa S, Balkenende EC, Clore GS, Safdar N, Perencevich EN. Effectiveness of Ultraviolet-C Disinfection on Hospital-Onset Gram-Negative Rod Bloodstream Infection: A Nationwide Stepped-Wedge Time-Series Analysis. Clin Infect Dis 2023; 76:291-298. [PMID: 36124706 DOI: 10.1093/cid/ciac776] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/09/2022] [Accepted: 09/14/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The effectiveness of enhanced terminal room cleaning with ultraviolet C (UV-C) disinfection in reducing gram-negative rod (GNR) infections has not been well evaluated. We assessed the association of implementation of UV-C disinfection systems with incidence rates of hospital-onset (HO) GNR bloodstream infection (BSI). METHODS We obtained information regarding UV-C use and the timing of implementation through a survey of all Veterans Health Administration (VHA) hospitals providing inpatient acute care. Episodes of HO-GNR BSI were identified between January 2010 and December 2018. Bed days of care (BDOC) was used as the denominator. Over-dispersed Poisson regression models were fitted with hospital-specific random intercept, UV-C disinfection use for each month, baseline trend, and seasonality as explanatory variables. Hospitals without UV-C use were also included to the analysis as a nonequivalent concurrent control group. RESULTS Among 128 VHA hospitals, 120 provided complete survey responses with 40 reporting implementations of UV-C systems. We identified 13 383 episodes of HO-GNR BSI and 24 141 378 BDOC. UV-C use was associated with a lower incidence rate of HO-GNR BSI (incidence rate ratio: 0.813; 95% confidence interval: .656-.969; P = .009). There was wide variability in the effect size of UV-C disinfection use among hospitals. CONCLUSIONS In this large quasi-experimental analysis within the VHA System, enhanced terminal room cleaning with UV-C disinfection was associated with an approximately 19% lower incidence of HO-GNR BSI, with wide variability in effectiveness among hospitals. Further studies are needed to identify the optimal implementation strategy to maximize the effectiveness of UV-C disinfection technology.
Collapse
Affiliation(s)
- Michihiko Goto
- Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA.,Division of Infectious Diseases, Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Shinya Hasegawa
- Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA.,Division of Infectious Diseases, Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Erin C Balkenende
- Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA.,Division of General Internal Medicine, Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Gosia S Clore
- Division of General Internal Medicine, Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Nasia Safdar
- Primary and Specialty Medicine Service Line, WIlliam S. Middleton Memorial VA Medical Center, Madison, Wisconsin, USA.,Department of Medicine, Division of Infectious Diseases, University of Wisconsin School of Public Health and Medicine, Madison, Wisconsin, USA
| | - Eli N Perencevich
- Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA.,Division of General Internal Medicine, Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | | |
Collapse
|
13
|
Garcia R, Barnes S, Boukidjian R, Goss LK, Spencer M, Septimus EJ, Wright MO, Munro S, Reese SM, Fakih MG, Edmiston CE, Levesque M. Recommendations for change in infection prevention programs and practice. Am J Infect Control 2022; 50:1281-1295. [PMID: 35525498 PMCID: PMC9065600 DOI: 10.1016/j.ajic.2022.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 01/25/2023]
Abstract
Fifty years of evolution in infection prevention and control programs have involved significant accomplishments related to clinical practices, methodologies, and technology. However, regulatory mandates, and resource and research limitations, coupled with emerging infection threats such as the COVID-19 pandemic, present considerable challenges for infection preventionists. This article provides guidance and recommendations in 14 key areas. These interventions should be considered for implementation by United States health care facilities in the near future.
Collapse
Affiliation(s)
- Robert Garcia
- Department of Healthcare Epidemiology, State University of New York at Stony Brook, Stony Brook, NY.
| | - Sue Barnes
- Infection Preventionist (Retired), San Mateo, CA
| | | | - Linda Kaye Goss
- Department of Infection Prevention, The Queen's Health System, Honolulu, HI
| | | | - Edward J Septimus
- Department of Population Medicine, Harvard Medical School, Boston, MA
| | | | - Shannon Munro
- Department of Veterans Affairs Medical Center, Research and Development, Salem, VA
| | - Sara M Reese
- Quality and Patient Safety Department, SCL Health System Broomfield, CO
| | - Mohamad G Fakih
- Clinical & Network Services, Ascension Healthcare and Wayne State University School of Medicine, Grosse Pointe Woods, MI
| | | | - Martin Levesque
- System Infection Prevention and Control, Henry Ford Health, Detroit, MI
| |
Collapse
|
14
|
Piletić K, Linšak DT, Kovač B, Mežnarić S, Repustić M, Radmanović-Skrbić M, Gobin I. Ozone disinfection efficiency against airborne microorganisms in hospital environment: a case study. Arh Hig Rada Toksikol 2022; 73:270-276. [PMID: 36607720 PMCID: PMC9985346 DOI: 10.2478/aiht-2022-73-3651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/01/2022] [Accepted: 12/01/2022] [Indexed: 01/07/2023] Open
Abstract
Even though ozone has shown its potential for air disinfection in hospital environment, its more frequent use has earned attention only with the COVID-19 pandemic due to its proven antimicrobial effect and low cost of production. The aim of this study was to determine its antimicrobial efficiency against the most common bacterial species in a real-life setting, that is, in the air of one postoperative room of the General Hospital Dr Ivo Pedišić (Sisak, Croatia). Air was sampled for aiborne bacteria before and after treatment with the ozone concentration of 15.71 mg/m3 for one hour. The most dominant Gram-positive bacteria of the genera Micrococcus, Staphylococcus, and Bacillus were reduced by 33 %, 58 %, and 61 %, respectively. The genus Micrococcus proved to be the most resistant. Considering our findings, we recommend longer air treatment with higher ozone concentrations in combination with mechanical cleaning and frequent ventilation.
Collapse
Affiliation(s)
- Kaća Piletić
- University of Rijeka Faculty of Medicine, Department of Microbiology and Parasitology, Rijeka, Croatia
| | - Dijana Tomić Linšak
- University of Rijeka Faculty of Medicine, Department of Health Ecology, Rijeka, Croatia
| | - Bruno Kovač
- University of Rijeka Faculty of Medicine, Department of Microbiology and Parasitology, Rijeka, Croatia
| | - Silvestar Mežnarić
- University of Rijeka Faculty of Medicine, Department of Microbiology and Parasitology, Rijeka, Croatia
| | | | | | - Ivana Gobin
- University of Rijeka Faculty of Medicine, Department of Microbiology and Parasitology, Rijeka, Croatia
| |
Collapse
|
15
|
Rudhart SA, Günther F, Dapper LI, Gehrt F, Stuck BA, Hoch S. Analysis of bacterial contamination and the effectiveness of UV light-based reprocessing of everyday medical devices. PLoS One 2022; 17:e0268863. [PMID: 36350807 PMCID: PMC9645592 DOI: 10.1371/journal.pone.0268863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/10/2022] [Indexed: 11/11/2022] Open
Abstract
Background The reprocessing of daily used medical devices is often inadequate, making them a potential source of infection. In addition, there are usually no consistent and technically standardized procedures available for this purpose. Hence, the aim of this study is to analyze the bacterial contamination and the effectiveness of Ultraviolet light-based (UV light-based) reprocessing of daily used medical devices. Material and methods Six different everyday medical devices (20 each; stethoscopes, tourniquets, bandage scissors, reflex hammers, tuning forks, and nystagmus glasses) were tested for bacterial contamination. All medical devices were then exposed to UV-C light for 25 seconds. Medical devices with a smooth surface were pre-cleaned with a water-based wipe. Contact samples were taken before and after reprocessing. Results Immediately after clinical use, 104 of 120 contact samples showed an average bacterial contamination of 44.8±64.3 colony forming units (CFU) (0–300 CFU), also including potentially pathogenic bacteria. Two further culture media were completely overgrown with potentially pathogenic bacteria. The stethoscopes were found to have the highest average contamination of 90±91.6 CFU. After reprocessing, 118 of 120 samples were sterile, resulting in an average residual contamination of 0.02±0.1 CFU in two samples, whereby only bacteria of the ordinary skin flora were found. Conclusion The present study shows the potentially clinically relevant bacterial contamination of everyday used medical devices. The reprocessing method tested here using UV light appears to be a suitable method for disinfection, especially for objects that up to now have been difficult to disinfect or cannot be disinfected in a standardized manner.
Collapse
Affiliation(s)
- Stefan Alexander Rudhart
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-University, Marburg, Hessen, Germany
| | - Frank Günther
- Department of Medical Microbiology and Hygiene, University Hospital Marburg, Philipps-University, Marburg, Hessen, Germany
| | - Laura Isabel Dapper
- Department of Medical Microbiology and Hygiene, University Hospital Marburg, Philipps-University, Marburg, Hessen, Germany
| | - Francesca Gehrt
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-University, Marburg, Hessen, Germany
| | - Boris Alexander Stuck
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-University, Marburg, Hessen, Germany
| | - Stephan Hoch
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-University, Marburg, Hessen, Germany
- * E-mail:
| |
Collapse
|
16
|
Piletić K, Kovač B, Perčić M, Žigon J, Broznić D, Karleuša L, Lučić Blagojević S, Oder M, Gobin I. Disinfecting Action of Gaseous Ozone on OXA-48-Producing Klebsiella pneumoniae Biofilm In Vitro. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106177. [PMID: 35627712 PMCID: PMC9140702 DOI: 10.3390/ijerph19106177] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/11/2022] [Accepted: 05/17/2022] [Indexed: 02/04/2023]
Abstract
Klebsiella pneumoniae is an emerging multidrug-resistant pathogen that can contaminate hospital surfaces in the form of a biofilm which is hard to remove with standard disinfectants. Because of biofilm resistance to conservative disinfectants, the application of new disinfection technologies is becoming more frequent. Ozone gas has antimicrobial activity but there is lack of data on its action against K. pneumoniae biofilm. The aim of this study was to investigate the effects and mechanisms of action of gaseous ozone on the OXA-48-procuding K. pneumoniae biofilm. A 24 h biofilm of K. pneumoniae formed on ceramic tiles was subsequently exposed to different concentrations of ozone during one and two hours to determine the optimal ozone concentration. Afterwards, the total bacteria count, total biomass and oxidative stress levels were monitored. A total of 25 ppm of gaseous ozone was determined to be optimal ozone concentration and caused reduction in total bacteria number in all strains of K. pneumoniae for 2.0 log10 CFU/cm2, followed by reduction in total biomass up to 88.15%. Reactive oxygen species levels significantly increased after the ozone treatment at 182% for the representative K. pneumoniae NCTC 13442 strain. Ozone gas in the concentration of 25 ppm caused significant biofilm reduction but did not completely eradicate the K. pneumoniae biofilm formed on ceramics. In conclusion, ozone gas has great potential to be used as an additional hygiene measure in joint combat against biofilm in hospital environments.
Collapse
Affiliation(s)
- Kaća Piletić
- Department of Microbiology and Parasitology, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia; (K.P.); (B.K.)
| | - Bruno Kovač
- Department of Microbiology and Parasitology, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia; (K.P.); (B.K.)
| | - Marko Perčić
- Faculty of Engineering & Centre for Micro- and Nanosciences and Technologies, University of Rijeka, 51000 Rijeka, Croatia;
| | - Jure Žigon
- Department of Wood Science and Technology, Biotechnical Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia;
| | - Dalibor Broznić
- Department of Medical Chemistry, Biochemistry and Clinical Chemistry, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia;
| | - Ljerka Karleuša
- Department of Physiology and Immunology, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia;
| | - Sanja Lučić Blagojević
- Faculty of Chemical Engineering and Technology, University of Zagreb, 10000 Zagreb, Croatia;
| | - Martina Oder
- Department of Sanitary Engineering, Faculty of Health Sciences, University of Ljubljana, 1000 Ljubljana, Slovenia;
| | - Ivana Gobin
- Department of Microbiology and Parasitology, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia; (K.P.); (B.K.)
- Correspondence:
| |
Collapse
|
17
|
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.
Collapse
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.
| |
Collapse
|
18
|
Mantelli M, Dos Santos L, de Fraga L, Miotto G, Bergamin A, Cardoso E, Serrano M, Maffei R, Prestes E, Netto J, Kolberg M. Autonomous Environment Disinfection Based on Dynamic UV-C Irradiation Map. IEEE Robot Autom Lett 2022; 7:4789-4796. [PMID: 35582267 PMCID: PMC9014471 DOI: 10.1109/lra.2022.3152719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 02/13/2022] [Indexed: 11/24/2022]
Abstract
The COVID-19 pandemic has become a worldwide concern and has motivated the entire scientific community to join efforts to fight it. Studies have shown that SARS-CoV-2 remains viable onsurfaces for days, increasing the chances of human infection. Environmental disinfection is thus an important action to prevent the transmission of the virus. Despite the valuable contribution of the research community to the field of UV-C disinfection by robots, there still lacks a disinfection system that is fully autonomous and computes its trajectory in real-time and in unknown environments. To meet this need, we propose an autonomous UV-C disinfection strategy for indoor environments based on a dynamic Irradiation Map that indicates the amount of energy applied in each region. Our method was tested in different scenarios and compared with other disinfection strategies. Experiments show that our approach delivers better results, especially when targeting high ideal UV-C doses.
Collapse
Affiliation(s)
- Mathias Mantelli
- Institute of InformaticsUniversidade Federal do Rio Grande do Sul Porto Alegre 90650-001 Brazil
| | - Leticia Dos Santos
- Institute of InformaticsUniversidade Federal do Rio Grande do Sul Porto Alegre 90650-001 Brazil
| | - Lucas de Fraga
- Institute of InformaticsUniversidade Federal do Rio Grande do Sul Porto Alegre 90650-001 Brazil
| | - Giovanna Miotto
- Institute of InformaticsUniversidade Federal do Rio Grande do Sul Porto Alegre 90650-001 Brazil
| | | | | | - Miguel Serrano
- Instor Robotics and Projects 94410-970 Porto Alegre Brazil
| | - Renan Maffei
- Institute of InformaticsUniversidade Federal do Rio Grande do Sul Porto Alegre 90650-001 Brazil
| | - Edson Prestes
- Institute of InformaticsUniversidade Federal do Rio Grande do Sul Porto Alegre 90650-001 Brazil
| | - Joao Netto
- Institute of InformaticsUniversidade Federal do Rio Grande do Sul Porto Alegre 90650-001 Brazil
| | - Mariana Kolberg
- Institute of InformaticsUniversidade Federal do Rio Grande do Sul Porto Alegre 90650-001 Brazil
| |
Collapse
|
19
|
Rudhart SA, Günther F, Dapper L, Stuck BA, Hoch S. UV-C Light-Based Surface Disinfection: Analysis of Its Virucidal Efficacy Using a Bacteriophage Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063246. [PMID: 35328933 PMCID: PMC8950158 DOI: 10.3390/ijerph19063246] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 01/17/2023]
Abstract
Background: The reprocessing of medical devices has become more complex due to increasing hygiene requirements. Previous studies showed satisfactory bactericidal disinfection effects of UV-C light in rigid and flexible endoscopes. Especially in the context of the current COVID-19 pandemic, virucidal properties are of high importance. In the present study, the virucidal efficacy of UV-C light surface disinfection was analyzed. Methods: MS-2 bacteriophages were applied to the test samples and irradiated by UV-C light using the UV Smart D25 device; unirradiated test samples were used as controls. A dilution series of the samples was mixed with 1 × 108 Escherichia coli and assayed. Results: 8.6 × 1012 pfu could be harvested from the unprocessed test samples. In the control group without UV-C exposure, a remaining contamination of 1.2 × 1012 pfu was detected, resulting in a procedural baseline reduction rate with a LOG10 reduction factor of 0.72. The LOG10 reduction factor was found to be 3.0 after 25 s of UV-C light exposure. After 50 and 75 s of UV-C radiation LOG10 reduction factors 4.2 and 5.9, respectively, were found, with all reductions being statistically significantly different to baseline. Conclusions: The tested UV system seems to provide a significant virucidal effect after a relatively short irradiation time.
Collapse
Affiliation(s)
- Stefan A. Rudhart
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-University Marburg, 35043 Marburg, Germany; (S.A.R.); (B.A.S.)
| | - Frank Günther
- Department of Medical Microbiology and Hygiene, University Hospital Marburg, Philipps-University Marburg, 35043 Marburg, Germany; (F.G.); (L.D.)
| | - Laura Dapper
- Department of Medical Microbiology and Hygiene, University Hospital Marburg, Philipps-University Marburg, 35043 Marburg, Germany; (F.G.); (L.D.)
| | - Boris A. Stuck
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-University Marburg, 35043 Marburg, Germany; (S.A.R.); (B.A.S.)
| | - Stephan Hoch
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-University Marburg, 35043 Marburg, Germany; (S.A.R.); (B.A.S.)
- Correspondence:
| |
Collapse
|
20
|
Taryudi T, Lindayani L, Purnama H, Mutiar A. Nurses’ View towards the Use of Robotic during Pandemic COVID-19 in Indonesia: A Qualitative Study. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.7645] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Rapid advances in artificial intelligence and robotics have alleviated difficulties for patients, hospitals, and the industry as a whole. However, the health care system is identically human-centered at its core, and many healthcare professions may not be ready to work with robots. Understanding nurses' views toward robotics can help integrate robotic technologies into future patient care.
Objectives: This study aimed to explore how nurses view using robotics during the COVID-19 pandemic.
Methods: This study used a qualitative descriptive technique to registered nurses who provide direct care to the patients with COVID-19 recruited from two hospitals in Indonesia. Purposive sampling was used to select respondents with criteria of those who had worked for at least one year and were willing to participate—the analysis used qualitative content analysis.
Results: A total of 20 female nurses with an average age of 32.8 ± 4.0 years participated in this study. The qualitative findings revealed three themes with nine sub-themes, namely the use of robotic in nursing care (sub-theme: reducing the risk of COVID-19 transmission, monitoring patients remotely, and helping in providing care), the burden of using robotic in nursing care (sub-theme: digital literacy in nursing care, culture difference in providing care, changing care practice habits, and safety concern, and attitude toward robotic in nursing care (sub-theme: negative response).
Conclusions: This study explored nurses' views on the usage of robotics during the pandemic COVID-10. It implies that a strategic plan would have many benefits and limitations, such as nursing care burden, negative attitude, and cultural awareness.
Collapse
|
21
|
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]
|
22
|
Lee LD, Delclos G, Berkheiser ML, Barakat MT, Jensen PA. Evaluation of multiple fixed in-room air cleaners with ultraviolet germicidal irradiation, in high-occupancy areas of selected commercial indoor environments. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2022; 19:67-77. [PMID: 34647857 DOI: 10.1080/15459624.2021.1991581] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The use of ultraviolet germicidal irradiation (UVGI) to combat disease transmission has come into the international spotlight again because of the recent SARS-CoV-2 pandemic and ongoing outbreaks of multidrug resistant organisms in hospitals. Although the implementation of ultraviolet disinfection technology is widely employed in healthcare facilities and its effectiveness has been repeatedly demonstrated, the use of such technology in the commercial sector has been limited. Considering that most disease transmission occurs in commercial, public, and residential indoor environments as opposed to healthcare facilities, there is a need to understand whether ultraviolet (UV) disinfection technology can be effective for mitigating disease transmission in these environments. The results presented here demonstrate that the installation of fixed in-room UVGI air cleaners in commercial buildings, including restaurants and offices, can produce significant reductions in both airborne and surface-borne bacterial contamination. Total airborne reductions after UV implementation at six separate commercial sites averaged 73% (p < 0.0001) with a range of 71-88%. Total non-high touch surface reductions after implementation averaged 55% (p < 0.0001) with a range of 28-88%. All reductions at the mitigated sites were statistically significant. The mean value of indoor airborne bacteria was 320 CFU/m3 before intervention and 76 CFU/m3 after. The mean value of indoor non-high touch surface borne bacteria was 131 CFU/plate before intervention and 47 CFU/plate after. All test locations and controls had their required pandemic cleaning procedures in place for pre- and post-sampling events. Outdoor levels of airborne bacteria were monitored and there was no significant correlation between the levels of airborne bacteria in the outside air as opposed to the indoor air. Rooms with fixed in-room UVGI air cleaners installed had significant CFU reductions on local surface contamination, which is a novel and important finding. Installation of fixed in-room UVGI air cleaners in commercial buildings will decontaminate the indoor environment and reduce hazardous exposure to human pathogens.
Collapse
Affiliation(s)
- Linda D Lee
- University of Texas School of Public Health, Houston, Texas
| | - George Delclos
- University of Texas, Health Science Center at Houston, Houston, Texas
| | - Matthew Lee Berkheiser
- Environmental Health & Safety, University of Texas, Anderson Cancer Center, Houston, Texas
| | | | | |
Collapse
|
23
|
Joshi S, Shallal A, Zervos M. Vancomycin-Resistant Enterococci: Epidemiology, Infection Prevention, and Control. Infect Dis Clin North Am 2021; 35:953-968. [PMID: 34752227 DOI: 10.1016/j.idc.2021.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Vancomycin-resistant enterococcus (VRE) is a pathogen of growing concern due to increasing development of antibiotic resistance, increasing length of hospitalizations and excess mortality. The utility of some infection control practices are debatable, as newer developments in infection prevention strategies continued to be discovered. This article summarizes the significance of VRE and VRE transmission, along with highlighting key changes in infection control practices within the past 5 years.
Collapse
Affiliation(s)
- Seema Joshi
- Division of Infectious Diseases, Henry Ford Hospital, CFP-3, 2799 W Grand Boulevard, Detroit, MI, USA.
| | - Anita Shallal
- Division of Infectious Diseases, Henry Ford Hospital, CFP-3, 2799 W Grand Boulevard, Detroit, MI, USA
| | - Marcus Zervos
- Wayne State University, CFP-3, 2799 W Grand Boulevard, Detroit, MI, USA
| |
Collapse
|
24
|
Krishna A, Chopra T. Prevention of Infection due to Clostridium (Clostridioides) difficile. Infect Dis Clin North Am 2021; 35:995-1011. [PMID: 34752229 DOI: 10.1016/j.idc.2021.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Clostridium (Clostridioides) difficile infection (CDI) causes significant morbidity and mortality in the United States every year. Prevention of CDI is difficult because of spore durability and requires implementation of multipronged strategies. Two categories of prevention strategies are infection control and prevention and risk factor reduction. Hand hygiene, contact precautions, patient isolation, and environmental decontamination are cornerstones of infection control and prevention. Risk factor reduction should focus on antibiotic stewardship to reduce unnecessary antibiotic use. If CDI incidence remains higher than the institution's goal despite these measures, then special measures should be considered.
Collapse
Affiliation(s)
- Amar Krishna
- Internal Medicine, Norther Light AR Gould Hospital, 140 Academy Street, Presque Isle, ME 04769, USA.
| | - Teena Chopra
- Infectious Diseases, Wayne State University/Detroit Medical Center, UHC-2B, 4201 St Antoine, Detroit, MI 48201, USA
| |
Collapse
|
25
|
Sood G, Perl TM. Outbreaks in Health Care Settings. Infect Dis Clin North Am 2021; 35:631-666. [PMID: 34362537 DOI: 10.1016/j.idc.2021.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Outbreaks and pseudo-outbreaks in health care settings are complex and should be evaluated systematically using epidemiologic and molecular tools. Outbreaks result from failures of infection prevention practices, inadequate staffing, and undertrained or overcommitted health care personnel. Contaminated hands, equipment, supplies, water, ventilation systems, and environment may also contribute. Neonatal intensive care, endoscopy, oncology, and transplant units are areas at particular risk. Procedures, such as bronchoscopy and endoscopy, are sources of infection when cleaning and disinfection processes are inadequate. New types of equipment can be introduced and lead to contamination or equipment and medications can be contaminated at the manufacturing source.
Collapse
Affiliation(s)
- Geeta Sood
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, Mason F. Lord Building, Center Tower, 3rd Floor, 5200 Eastern Avenue, Baltimore, MD 21224, USA.
| | - Trish M Perl
- Division of Infectious Diseases and Geographic Medicine, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Y7;302, Dallas, TX 75390, USA
| |
Collapse
|
26
|
Kitagawa H, Tadera K, Mori M, Kashiyama S, Nomura T, Omori K, Shigemoto N, Ohge H. The effect of pulsed-xenon ultraviolet disinfection on surfaces contaminated with vancomycin-resistant Enterococci in a Japanese hospital. J Infect Chemother 2021; 27:1665-1668. [PMID: 34419352 DOI: 10.1016/j.jiac.2021.08.011] [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: 06/01/2021] [Revised: 08/04/2021] [Accepted: 08/10/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Recently, a worldwide outbreak of vancomycin-resistant Enterococci (VRE) was reported. However, due to the low incidence of VRE infection and colonization, VRE contamination of hospital environments has not been fully investigated in Japan. METHODS Surfaces were swabbed, before and after manual cleaning and after pulsed xenon ultraviolet (PX-UV) disinfection, in five patient rooms that had been occupied by patients colonized with VRE. Difference in the number of VRE-positive samples and VRE colony forming units (CFUs), before and after disinfection, for each cleaning method was estimated. RESULTS We detected VRE contamination in 22/60 (37%) and 14/60 (23%) samples collected before and after manual cleaning, respectively. In contrast, VRE contamination was not detected in the samples collected after PX-UV disinfection. In addition, 3/5 (60%) spray nozzles of electric warm-water bidet toilet seats were found to be contaminated with VRE before terminal cleaning. Manual cleaning caused a significant decrease in the number of VRE CFUs compared with that before cleaning (P = 0.031). PX-UV disinfection also caused a significant decrease in the number of VRE CFUs compared to that of manual cleaning (P < 0.001). CONCLUSION We identified hot spots of severe contamination, such as private bathrooms in patient rooms and areas around the bed of patients using diapers and required assistance. VRE contamination persisted even after terminal disinfection; PX-UV disinfection in addition to terminal disinfection was effective at eliminating VRE contamination. These results can be useful in controlling the spread of VRE infections in Japanese hospitals.
Collapse
Affiliation(s)
- Hiroki Kitagawa
- Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan; Project Research Center for Nosocomial Infectious Diseases, Hiroshima University, Hiroshima, Japan; Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Kayoko Tadera
- Project Research Center for Nosocomial Infectious Diseases, Hiroshima University, Hiroshima, Japan; Section of Clinical Laboratory, Division of Clinical Support, Hiroshima University Hospital, Hiroshima, Japan; Division of Laboratory Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Minako Mori
- Division of Infection Control, Hiroshima University Hospital, Hiroshima, Japan; Division of Nursing, Hiroshima University Hospital, Hiroshima, Japan
| | - Seiya Kashiyama
- Project Research Center for Nosocomial Infectious Diseases, Hiroshima University, Hiroshima, Japan; Section of Clinical Laboratory, Division of Clinical Support, Hiroshima University Hospital, Hiroshima, Japan; Division of Laboratory Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Toshihito Nomura
- Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan
| | - Keitaro Omori
- Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan
| | - Norifumi Shigemoto
- Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan; Project Research Center for Nosocomial Infectious Diseases, Hiroshima University, Hiroshima, Japan; Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan; Translational Research Center, Hiroshima University, Hiroshima, Japan
| | - Hiroki Ohge
- Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan; Project Research Center for Nosocomial Infectious Diseases, Hiroshima University, Hiroshima, Japan
| |
Collapse
|
27
|
Kitagawa H, Mori M, Kawano R, Hara T, Kashiyama S, Hayashi Y, Sasabe Y, Ukon K, Shimokawa N, Nomura T, Omori K, Shigemoto N, Shime N, Ohge H. Combining pulsed xenon ultraviolet disinfection with terminal manual cleaning helps reduce the acquisition rate of methicillin-resistant Staphylococcus aureus. Am J Infect Control 2021; 49:1048-1051. [PMID: 33516751 DOI: 10.1016/j.ajic.2021.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND The clinical effectiveness of ultraviolet light (UV) disinfection remains unclear. This study aimed to investigate the effect of adding pulsed xenon UV (PX-UV) disinfection to the terminal cleaning protocol on the rate of methicillin-resistant Staphylococcus aureus (MRSA) acquisition at a Japanese hospital. METHODS The use of a PX-UV disinfection device was added to the manual terminal cleaning protocol applied after the discharge or transfer of patients treated in the intensive and high care units. We used a Poisson regression model to examine the incidence of MRSA acquisition, based on the study period, PX-UV intervention status, unit type, and the rate of consumption of alcohol-based hand rub (ABHR). RESULTS Approximately 86% of the rooms in the intervention units were terminally disinfected with the PX-UV device. In the intervention units, the incidence of MRSA acquisition decreased from 3.56 per 1,000 patient-days in the nonintervention period to 2.21 per 1,000 patient-days in the intervention period. Moreover, the use of PX-UV disinfection decreased the risk of MRSA acquisition (incident rate ratio: 0.556; 95% confidence interval, 0.309-0.999; P = .0497). ABHR consumption did not affect the risk of MRSA acquisition. CONCLUSIONS Adding PX-UV disinfection to terminal manual cleaning reduced the rate of MRSA acquisition.
Collapse
Affiliation(s)
- Hiroki Kitagawa
- Project Research Center for Nosocomial Infectious Diseases, Hiroshima University, Hiroshima, Japan; Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan; Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Minako Mori
- Department of Infection Control, Hiroshima University Hospital, Hiroshima, Japan; Department of Nursing, Hiroshima University Hospital, Hiroshima, Japan
| | - Reo Kawano
- Clinical Research Center in Hiroshima, Hiroshima University Hospital, Hiroshima, Japan
| | - Toshinori Hara
- Project Research Center for Nosocomial Infectious Diseases, Hiroshima University, Hiroshima, Japan; Section of Infection Diseases Laboratory, Department of Clinical Support, Hiroshima University Hospital, Hiroshima, Japan
| | - Seiya Kashiyama
- Project Research Center for Nosocomial Infectious Diseases, Hiroshima University, Hiroshima, Japan; Section of Infection Diseases Laboratory, Department of Clinical Support, Hiroshima University Hospital, Hiroshima, Japan
| | - Yoko Hayashi
- Department of Nursing, Hiroshima University Hospital, Hiroshima, Japan
| | - Yayoi Sasabe
- Department of Nursing, Hiroshima University Hospital, Hiroshima, Japan
| | - Kiyoko Ukon
- Department of Nursing, Hiroshima University Hospital, Hiroshima, Japan
| | - Naomi Shimokawa
- Department of Nursing, Hiroshima University Hospital, Hiroshima, Japan
| | - Toshihito Nomura
- Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan
| | - Keitaro Omori
- Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan
| | - Norifumi Shigemoto
- Project Research Center for Nosocomial Infectious Diseases, Hiroshima University, Hiroshima, Japan; Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan; Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan; Translational Research Center, Hiroshima University, Hiroshima, Japan
| | - Nobuaki Shime
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hiroki Ohge
- Project Research Center for Nosocomial Infectious Diseases, Hiroshima University, Hiroshima, Japan; Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan
| |
Collapse
|
28
|
Zohdi TI. A Digital-Twin and Machine-Learning Framework for Ventilation System Optimization for Capturing Infectious Disease Respiratory Emissions. ARCHIVES OF COMPUTATIONAL METHODS IN ENGINEERING : STATE OF THE ART REVIEWS 2021; 28:4317-4329. [PMID: 34108839 PMCID: PMC8179093 DOI: 10.1007/s11831-021-09609-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/22/2021] [Indexed: 06/12/2023]
Abstract
The pandemic of 2019 has led to an enormous interest in all aspects of modeling and simulation of infectious diseases. One central issue is the redesign and deployment of ventilation systems to mitigate the transmission of infectious diseases, produced by respiratory emissions such as coughs. This work seeks to develop a combined Digital-Twin and Machine-Learning framework to optimize ventilation systems by building on rapidly computable respiratory emission models developed in Zohdi (Comput Mech 64:1025-1034, 2020). This framework ascertains the placement and flow rates of multiple ventilation units, in order to optimally sequester particles released from respiratory emissions such as coughs, sneezes, etc. Numerical examples are provided to illustrate the framework.
Collapse
Affiliation(s)
- T. I. Zohdi
- Department of Mechanical Engineering 6195 Etcheverry Hall, University of California, Berkeley, CA 94720-1740 USA
| |
Collapse
|
29
|
Sierra Marín SD, Gomez-Vargas D, Céspedes N, Múnera M, Roberti F, Barria P, Ramamoorthy S, Becker M, Carelli R, Cifuentes CA. Expectations and Perceptions of Healthcare Professionals for Robot Deployment in Hospital Environments During the COVID-19 Pandemic. Front Robot AI 2021; 8:612746. [PMID: 34150856 PMCID: PMC8208489 DOI: 10.3389/frobt.2021.612746] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 03/31/2021] [Indexed: 12/18/2022] Open
Abstract
Several challenges to guarantee medical care have been exposed during the current COVID-19 pandemic. Although the literature has shown some robotics applications to overcome the potential hazards and risks in hospital environments, the implementation of those developments is limited, and few studies measure the perception and the acceptance of clinicians. This work presents the design and implementation of several perception questionnaires to assess healthcare provider's level of acceptance and education toward robotics for COVID-19 control in clinic scenarios. Specifically, 41 healthcare professionals satisfactorily accomplished the surveys, exhibiting a low level of knowledge about robotics applications in this scenario. Likewise, the surveys revealed that the fear of being replaced by robots remains in the medical community. In the Colombian context, 82.9% of participants indicated a positive perception concerning the development and implementation of robotics in clinic environments. Finally, in general terms, the participants exhibited a positive attitude toward using robots and recommended them to be used in the current panorama.
Collapse
Affiliation(s)
- Sergio D. Sierra Marín
- Department of Biomedical Engineering, Colombian School of Engineering Julio Garavito, Bogota, Colombia
| | - Daniel Gomez-Vargas
- Department of Biomedical Engineering, Colombian School of Engineering Julio Garavito, Bogota, Colombia
| | - Nathalia Céspedes
- Department of Biomedical Engineering, Colombian School of Engineering Julio Garavito, Bogota, Colombia
| | - Marcela Múnera
- Department of Biomedical Engineering, Colombian School of Engineering Julio Garavito, Bogota, Colombia
| | - Flavio Roberti
- Institute of Automatics, National University of San Juan, San Juan, Argentina
| | - Patricio Barria
- Club de Leones Cruz del Sur Rehabilitation Center, Punta Arenas, Chile
| | | | - Marcelo Becker
- Department of Mechanical Engineering, São Carlos School of Engineering, University of São Paulo, São Carlos, Brazil
| | - Ricardo Carelli
- Institute of Automatics, National University of San Juan, San Juan, Argentina
| | - Carlos A. Cifuentes
- Department of Biomedical Engineering, Colombian School of Engineering Julio Garavito, Bogota, Colombia
| |
Collapse
|
30
|
Kaiki Y, Kitagawa H, Hara T, Nomura T, Omori K, Shigemoto N, Takahashi S, Ohge H. Methicillin-resistant Staphylococcus aureus contamination of hospital-use-only mobile phones and efficacy of 222-nm ultraviolet disinfection. Am J Infect Control 2021; 49:800-803. [PMID: 33186680 DOI: 10.1016/j.ajic.2020.11.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/06/2020] [Accepted: 11/06/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Mobile phones may be contaminated with nosocomial pathogens such as methicillin-resistant Staphylococcus aureus (MRSA). The aim of this study was to investigate the MRSA contamination rate on doctors' hospital-use-only mobile phones and the efficacy of 222-nm ultraviolet light (UV) disinfection. METHODS We investigated the MRSA contamination rate of doctors' hospital-use-only mobile phones, as well as the reduction in MRSA counts on plastic plates and aerobic bacteria (AB) on mobile phones before and after exposure to 222-nm UV irradiation. RESULTS Five (10%) of the 50 mobile phones investigated were contaminated with MRSA. Exposure to 0.1 mJ/cm2 222-nm UVC irradiation for 1.5 and 2.5 min (9 and 15 mJ/cm2) achieved mean log10 MRSA colony-forming units reductions of 2.91 and 3.95, respectively. Exposure to 9 mJ/cm2 222-nm UVC irradiation (0.1 mW/cm2 for 1.5 minutes) significantly reduced AB contamination on mobile phones (P < .001). CONCLUSIONS The use of 222-nm UV disinfection resulted in effective in vitro reduction of MRSA and significantly reduced AB contamination of mobile phone surfaces.
Collapse
|
31
|
Grist SM, Geldert A, Gopal A, Su A, Balch HB, Herr AE. Current Understanding of Ultraviolet-C Decontamination of N95 Filtering Facepiece Respirators. APPLIED BIOSAFETY 2021; 26:90-102. [DOI: 10.1089/apb.20.0051] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Samantha M. Grist
- Department of Bioengineering and University of California Berkeley, Berkeley, California, USA
| | - Alisha Geldert
- Department of Bioengineering and University of California Berkeley, Berkeley, California, USA
- The UC Berkeley—UCSF Graduate Program in Bioengineering, Berkeley, California, USA
| | - Anjali Gopal
- Department of Bioengineering and University of California Berkeley, Berkeley, California, USA
- The UC Berkeley—UCSF Graduate Program in Bioengineering, Berkeley, California, USA
| | - Alison Su
- Department of Bioengineering and University of California Berkeley, Berkeley, California, USA
- The UC Berkeley—UCSF Graduate Program in Bioengineering, Berkeley, California, USA
| | - Halleh B. Balch
- Department of Physics, University of California Berkeley, Berkeley, California, USA
| | - Amy E. Herr
- Department of Bioengineering and University of California Berkeley, Berkeley, California, USA
- The UC Berkeley—UCSF Graduate Program in Bioengineering, Berkeley, California, USA
| | | |
Collapse
|
32
|
McMullen K, Guth RM, Wood H, Mueller C, Dunn G, Wade R, Siddiqui A, Dubberke ER, Woeltje KF, Warren DK. Impact of no-touch ultraviolet light room disinfection systems on Clostridioides difficile infections. Am J Infect Control 2021; 49:646-648. [PMID: 32860846 DOI: 10.1016/j.ajic.2020.08.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/21/2020] [Accepted: 08/21/2020] [Indexed: 11/25/2022]
Abstract
Ultraviolet light (UVL) room disinfection has emerged as an adjunct to manual cleaning of patient rooms. Two different no-touch UVL devices were implemented in 3 health system hospitals to reduce Clostridioides difficile infections (CDI). CDI rates at all 3 facilities remained unchanged following implementation of UVL disinfection. Preintervention CDI rates were generally low, and data from one hospital showed high compliance with manual cleaning, which may have limited the impact of UVL disinfection.
Collapse
|
33
|
Rudhart SA, Günther F, Dapper L, Thangavelu K, Geisthoff UW, Stankovic P, Wilhelm T, Stuck BA, Hoch S. UV light-based reprocessing of flexible endoscopes without working channel in Oto-Rhino-Laryngology: an effective method? Eur Arch Otorhinolaryngol 2021; 278:4075-4080. [PMID: 33713189 PMCID: PMC8382609 DOI: 10.1007/s00405-021-06737-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/04/2021] [Indexed: 11/30/2022]
Abstract
Background Reprocessing of flexible endoscopes (FEs) is often expensive, time consuming, and becomes increasingly complex, due to rising demands of hygiene. After beneficial results in reprocessing of rigid endoscopes using Impelux™ UV-C light technology, we tested the same method for reprocessing of FEs without working channel. Materials and methods Testing was performed on FEs without working channel after routine clinical use (transnasal flexible endoscopy). Disinfection consisted of mechanical precleaning and 60 s exposure to Impelux™ UV-C light technology. Bacterial contamination was tested on 50 FEs before and after disinfection. Further 50 FEs regarding protein residuals. The absolute effectiveness of the D60 was tested on 50 test bodies (RAMS) with a standardized contamination of 107 colony-forming units (CFU) of Enterococcus faecium. Results The FEs were contaminated with a high average value of 916.7 CFU (± 1057 CFU) after clinical usage. After reprocessing, an average contamination of 2.8 CFU (± 1.6) on 14% (n = 7) of the FEs was detected consisting of non-pathogenic species, the remaining FE were sterile. After reprocessing, all FEs were protein-free (< 1 μg). The artificially contaminated test bodies showed no remaining bacterial contamination after disinfection, resulting in an average absolute germ reduction of about 107 CFU. Conclusion Impelux™ UV-C light technology efficiently reduces bacterial contamination of FEs and might be useful in daily practice.
Collapse
Affiliation(s)
- Stefan A Rudhart
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Frank Günther
- Department of Medical Microbiology and Hygiene, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - Laura Dapper
- Department of Medical Microbiology and Hygiene, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - Kruthika Thangavelu
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Urban W Geisthoff
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Petar Stankovic
- Department of Otolaryngology, Head/Neck and Facial Plastic Surgery, Sana Kliniken Leipziger Land, Borna, Germany
| | - Thomas Wilhelm
- Department of Otolaryngology, Head/Neck and Facial Plastic Surgery, Sana Kliniken Leipziger Land, Borna, Germany.,Medical Faculty, Philipps-Universität Marburg, Marburg, Germany
| | - Boris A Stuck
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Stephan Hoch
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Baldingerstrasse, 35043, Marburg, Germany.
| |
Collapse
|
34
|
Feasibility of ultraviolet light-emitting diode irradiation robot for terminal decontamination of coronavirus disease 2019 (COVID-19) patient rooms. Infect Control Hosp Epidemiol 2021; 43:232-237. [PMID: 33685546 PMCID: PMC8160490 DOI: 10.1017/ice.2021.95] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To investigate the feasibility of using an ultraviolet light-emitting diode (UV LED) robot for the terminal decontamination of coronavirus disease 2019 (COVID-19) patient rooms. METHODS We assessed the presence of viral RNA in samples from environmental surfaces before and after UV LED irradiation in COVID-19 patient rooms after patient discharge. RESULTS We analyzed 216 environmental samples from 17 rooms: 2 from airborne infection isolation rooms (AIIRs) in the intensive care unit (ICU) and 15 from isolation rooms in the community treatment center (CTC). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA was detected in 40 (18.5%) of 216 samples after patient discharge: 12 (33.3%) of 36 samples from AIIRs in the ICU, and 28 (15.6%) of 180 samples from isolation rooms in the CTC. In 1 AIIR, all samples were PCR negative after UV LED irradiation. In the CTC rooms, 14 (8.6%) of the 163 samples were PCR positive after UV LED irradiation. However, viable virus was not recovered from the culture of any of the PCR-positive samples. CONCLUSIONS Although no viable virus was recovered, SARS-CoV-2 RNA was detected on various environmental surfaces. The use of a UV LED disinfection robot was effective in spacious areas such as an ICU, but its effects varied in small spaces like CTC rooms. These findings suggest that the UV LED robot may need enough space to disinfect rooms without recontamination by machine wheels or insufficient disinfection by shadowing.
Collapse
|
35
|
Kitagawa H, Nomura T, Nazmul T, Omori K, Shigemoto N, Sakaguchi T, Ohge H. Effectiveness of 222-nm ultraviolet light on disinfecting SARS-CoV-2 surface contamination. Am J Infect Control 2021; 49:299-301. [PMID: 32896604 PMCID: PMC7473342 DOI: 10.1016/j.ajic.2020.08.022] [Citation(s) in RCA: 120] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 08/13/2020] [Accepted: 08/14/2020] [Indexed: 12/16/2022]
Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), has emerged as a serious threat to human health worldwide. Efficient disinfection of surfaces contaminated with SARS-CoV-2 may help prevent its spread. This study aimed to investigate the in vitro efficacy of 222-nm far-ultraviolet light (UVC) on the disinfection of SARS-CoV-2 surface contamination. Methods We investigated the titer of SARS-CoV-2 after UV irradiation (0.1 mW/cm2) at 222 nm for 10-300 seconds using the 50% tissue culture infectious dose (TCID50). In addition, we used quantitative reverse transcription polymerase chain reaction to quantify SARS-CoV-2 RNA under the same conditions. Results One and 3 mJ/cm2 of 222-nm UVC irradiation (0.1 mW/cm2 for 10 and 30 seconds) resulted in 88.5 and 99.7% reduction of viable SARS-CoV-2 based on the TCID50 assay, respectively. In contrast, the copy number of SARS-CoV-2 RNA did not change after UVC irradiation even after a 5-minute irradiation. Conclusions This study shows the efficacy of 222-nm UVC irradiation against SARS-CoV-2 contamination in an in vitro experiment. Further evaluation of the safety and efficacy of 222-nm UVC irradiation in reducing the contamination of real-world surfaces and the potential transmission of SARS-CoV-2 is needed.
Collapse
Affiliation(s)
- Hiroki Kitagawa
- Project Research Center for Nosocomial Infectious Diseases, Hiroshima University, Hiroshima, Japan; Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan; Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Toshihito Nomura
- Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan; Department of Virology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tanuza Nazmul
- Department of Virology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Keitaro Omori
- Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan
| | - Norifumi Shigemoto
- Project Research Center for Nosocomial Infectious Diseases, Hiroshima University, Hiroshima, Japan; Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan; Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan; Translational Research Center, Hiroshima University, Hiroshima, Japan
| | - Takemasa Sakaguchi
- Department of Virology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hiroki Ohge
- Project Research Center for Nosocomial Infectious Diseases, Hiroshima University, Hiroshima, Japan; Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan
| |
Collapse
|
36
|
Dancer SJ, King MF. Systematic review on use, cost and clinical efficacy of automated decontamination devices. Antimicrob Resist Infect Control 2021; 10:34. [PMID: 33579386 PMCID: PMC7881692 DOI: 10.1186/s13756-021-00894-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 01/21/2021] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND More evidence is emerging on the role of surface decontamination for reducing hospital-acquired infection (HAI). Timely and adequate removal of environmental pathogens leads to measurable clinical benefit in both routine and outbreak situations. OBJECTIVES This systematic review aimed to evaluate published studies describing the effect of automated technologies delivering hydrogen peroxide (H202) or ultra-violet (UV) light on HAI rates. METHODS A systematic review was performed using relevant search terms. Databases were scanned from January 2005 to March 2020 for studies reporting clinical outcome after use of automated devices on healthcare surfaces. Information collected included device type, overall findings; hospital and ward data; study location, length and size; antimicrobial consumption; domestic monitoring; and infection control interventions. Study sponsorship and duplicate publications were also noted. RESULTS While there are clear benefits from non-touch devices in vitro, we found insufficient objective assessment of patient outcome due to the before-and-after nature of 36 of 43 (84%) studies. Of 43 studies, 20 (47%) used hydrogen peroxide (14 for outbreaks) and 23 (53%) used UV technology (none for outbreaks). The most popular pathogen targeted, either alone or in combination with others, was Clostridium difficile (27 of 43 studies: 63%), followed by methicillin-resistant Staphylococcus aureus (MRSA) (16 of 43: 37%). Many owed funding and/or personnel to industry sponsorship (28 of 43: 65%) and most were confounded by concurrent infection control, antimicrobial stewardship and/or cleaning audit initiatives. Few contained data on device costs and rarely on comparable costs (1 of 43: 2%). There were expected relationships between the country hosting the study and location of device companies. None mentioned the potential for environmental damage, including effects on microbial survivors. CONCLUSION There were mixed results for patient benefit from this review of automated devices using H202 or UV for surface decontamination. Most non-outbreak studies lacked an appropriate control group and were potentially compromised by industry sponsorship. Concern over HAI encourages delivery of powerful disinfectants for eliminating pathogens without appreciating toxicity or cost benefit. Routine use of these devices requires justification from standardized and controlled studies to understand how best to manage contaminated healthcare environments.
Collapse
Affiliation(s)
- Stephanie J Dancer
- Department of Microbiology, Hairmyres Hospital, NHS, Lanarkshire, G75 8RG, Scotland, UK.
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, Scotland, UK.
| | | |
Collapse
|
37
|
Kanamori H, Rutala WA, Gergen MF, Sickbert-Bennett EE, Knelson LP, Anderson DJ, Sexton DJ, Weber DJ. Microbial Assessment of Health Care-Associated Pathogens on Various Environmental Sites in Patient Rooms After Terminal Room Disinfection. Open Forum Infect Dis 2021; 8:ofab008. [PMID: 33575427 PMCID: PMC7863860 DOI: 10.1093/ofid/ofab008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 01/01/2021] [Indexed: 11/14/2022] Open
Abstract
We examined the microbial burden on hospital room environmental sites after standard (quaternary ammonium [Quat]) or enhanced disinfection (quat/ultraviolet light [UV-C], bleach, or bleach/UV-C). An enhanced terminal room disinfection reduced the microbial burden of epidemiologically important pathogens on high-touch surfaces in patient rooms, especially sites around the bed, better than standard room disinfection.
Collapse
Affiliation(s)
- Hajime Kanamori
- Department of Infectious Diseases, Internal Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.,Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA
| | - William A Rutala
- Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Maria F Gergen
- Hospital Epidemiology, University of North Carolina Health, Chapel Hill, North Carolina, USA
| | - Emily E Sickbert-Bennett
- Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA.,Hospital Epidemiology, University of North Carolina Health, Chapel Hill, North Carolina, USA
| | - Lauren P Knelson
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | - Deverick J Anderson
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | - Daniel J Sexton
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | - David J Weber
- Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA.,Hospital Epidemiology, University of North Carolina Health, Chapel Hill, North Carolina, USA
| |
Collapse
|
38
|
Kitagawa H, Mori M, Hara T, Kashiyama S, Shigemoto N, Ohge H. Effectiveness of pulsed xenon ultraviolet disinfection for Clostridioides (Clostridium) difficile surface contamination in a Japanese hospital. Am J Infect Control 2021; 49:55-58. [PMID: 32485271 DOI: 10.1016/j.ajic.2020.05.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/20/2020] [Accepted: 05/21/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Contaminated environmental surfaces are important sources of transmission for healthcare-associated pathogens, including Clostridioides (Clostridium) difficile. The effectiveness of manual bleach cleaning and pulsed xenon ultraviolet (PX-UV) disinfection on C. difficile contamination of hospital room high-touch surfaces in Japan was evaluated. METHODS The environmental surfaces of 20 C. difficile infection (CDI) isolation rooms were sampled immediately after CDI patients were discharged or transferred. High-touch surfaces were sampled before and after either bleach cleaning or PX-UV disinfection in addition to nonbleach cleaning. Changes in the number of C. difficile-positive samples and bacterial counts for each cleaning method were assessed. RESULTS Overall, 286 samples were collected (bleach cleaning, 144 samples; PX-UV disinfection, 142 samples). Before cleaning, the positive rates of C. difficile were 27.8% and 31.0% in bleach cleaning and PX-UV disinfection, respectively. Both bleach cleaning and PX-UV disinfection significantly reduced overall C. difficile-positive samples (P = .018 and P = .002, respectively) and C. difficile colony-forming unit counts (P = .002 and P = .001, respectively). CONCLUSIONS PX-UV disinfection in addition to manual nonbleach cleaning effectively reduces C. difficile contamination from high-touch surfaces. Further studies are warranted to evaluate the effect of PX-UV disinfection on CDI rates in Japanese hospitals.
Collapse
Affiliation(s)
- Hiroki Kitagawa
- Project Research Center for Nosocomial Infectious Diseases, Hiroshima University, Hiroshima, Japan; Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan; Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Minako Mori
- Department of Infection Control, Hiroshima University Hospital, Hiroshima, Japan; Department of Nursing, Hiroshima University Hospital, Hiroshima, Japan
| | - Toshinori Hara
- Project Research Center for Nosocomial Infectious Diseases, Hiroshima University, Hiroshima, Japan; Section of Clinical Laboratory, Department of Clinical Practice and Support, Hiroshima University Hospital, Hiroshima, Japan
| | - Seiya Kashiyama
- Project Research Center for Nosocomial Infectious Diseases, Hiroshima University, Hiroshima, Japan; Section of Clinical Laboratory, Department of Clinical Practice and Support, Hiroshima University Hospital, Hiroshima, Japan
| | - Norifumi Shigemoto
- Project Research Center for Nosocomial Infectious Diseases, Hiroshima University, Hiroshima, Japan; Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan; Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan; Translational Research Center, Hiroshima University, Hiroshima, Japan
| | - Hiroki Ohge
- Project Research Center for Nosocomial Infectious Diseases, Hiroshima University, Hiroshima, Japan; Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan
| |
Collapse
|
39
|
Malhotra S, Wlodarczyk J, Kuo C, Ngo C, Glucoft M, Sumulong I, Smit MA, Bender JM. Shining a light on the pathogenicity of health care providers' mobile phones: Use of a novel ultraviolet-C wave disinfection device. Am J Infect Control 2020; 48:1370-1374. [PMID: 32512083 PMCID: PMC7274098 DOI: 10.1016/j.ajic.2020.05.040] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/29/2020] [Accepted: 05/30/2020] [Indexed: 12/19/2022]
Abstract
Novel UV-C device found to significantly decrease total and pathogenic bacteria on mobile phones. UV-C phone disinfecting device is renewable, efficient and effective.. UV-C device implementation in a hospital system would be desired by healthcare providers. Healthcare providers felt their mobile phones were an important risk factor in infection transmission and that they would use this device daily to weekly. UV-C technology is shown to kill coronaviruses and implementation of this device could be impactful during pandemic.
Background Mobile phones are known to carry pathogenic bacteria and viruses on their surfaces, posing a risk to healthcare providers (HCPs) and hospital infection prevention efforts. We utilize an Ultraviolet-C (UV-C) device to provide an effective method for mobile phone disinfection and survey HCPs about infection risk. Methods Environmental swabs were used to culture HCPs’ personal mobile phone surfaces. Four cultures were obtained per phone: before and after the UV-C device's 30-second disinfecting cycle, at the beginning and end of a 12-hour shift. Surveys were administered to participants pre- and poststudy. Results Total bacterial colony forming units were reduced by 90.5% (P = .006) after one UV-C disinfection cycle, and by 99.9% (P = .004) after 2 cycles. Total pathogenic bacterial colony forming units were decreased by 98.2% (P = .038) after one and >99.99% (P = .037) after 2 disinfection cycles. All survey respondents were willing to use the UV-C device daily to weekly, finding it convenient and beneficial. Discussion This novel UV-C disinfecting device is effective in reducing pathogenic bacteria on mobile phones. HCPs would frequently use a phone disinfecting device to reduce infection risk. Conclusions In light of the ongoing coronavirus (COVID-19) pandemic, a standardized approach to phone disinfection may be valuable in preventing healthcare-associated infections.
Collapse
Affiliation(s)
- Sanchi Malhotra
- Children's Hospital Los Angeles Pediatric Residency Program, Los Angeles, CA.
| | - Jordan Wlodarczyk
- University of Southern California, General Surgery Residency Program, Los Angeles, CA
| | - Christopher Kuo
- Children's Hospital Los Angeles Pediatric Residency Program, Los Angeles, CA
| | - Catherine Ngo
- Children's Hospital Los Angeles, Department of Infection Prevention & Control, Los Angeles, CA
| | - Marisa Glucoft
- Children's Hospital Los Angeles, Department of Infection Prevention & Control, Los Angeles, CA
| | - Ivan Sumulong
- Children's Hospital Los Angeles, Department of Infection Prevention & Control, Los Angeles, CA
| | - Michael A Smit
- Children's Hospital Los Angeles, Division of Infectious Diseases, Los Angeles, CA
| | - Jeffrey M Bender
- Children's Hospital Los Angeles, Division of Infectious Diseases, Los Angeles, CA
| |
Collapse
|
40
|
Doll M, Marra AR, Apisarnthanarak A, Al-Maani AS, Abbas S, Rosenthal VD. Prevention of Clostridioides difficile in hospitals: A position paper of the International Society for Infectious Diseases. Int J Infect Dis 2020; 102:188-195. [PMID: 33122100 DOI: 10.1016/j.ijid.2020.10.039] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 02/07/2023] Open
Abstract
Clostridioides difficile infection is an increasing presence worldwide. Prevention is multipronged, reflecting a complex and evolving epidemiology. Multiple guidelines exist regarding the prevention of C. difficile infection in healthcare settings; however, existing guidelines do not address C. difficile in low- and middle-income countries (LMIC). Nevertheless, the prevalence of C. difficile in LMIC likely parallels, if not exceeds, that of high-income countries, and LMIC may experience additional challenges in C. difficile diagnosis and control. A panel of experts was convened by the International Society for Infectious Diseases (ISID) to review the current state of C. difficile infections globally and make evidence-based recommendations for infection prevention that are broadly applicable.
Collapse
Affiliation(s)
- Michelle Doll
- Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Alexandre R Marra
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA; Division of Medical Practice, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Anucha Apisarnthanarak
- Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Amal Saif Al-Maani
- Department of Infection Control and Prevention, Ministry of Health, Muscat, Oman
| | - Salma Abbas
- Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | - Victor D Rosenthal
- International Nosocomial Infection Control Consortium (INICC), Buenos Aires, Argentina
| |
Collapse
|
41
|
Soler M, Scholtz A, Zeto R, Armani AM. Engineering photonics solutions for COVID-19. APL PHOTONICS 2020; 5:090901. [PMID: 33015361 PMCID: PMC7523711 DOI: 10.1063/5.0021270] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 08/17/2020] [Indexed: 05/04/2023]
Abstract
As the impact of COVID-19 on society became apparent, the engineering and scientific community recognized the need for innovative solutions. Two potential roadmaps emerged: developing short-term solutions to address the immediate needs of the healthcare communities and developing mid/long-term solutions to eliminate the over-arching threat. However, in a truly global effort, researchers from all backgrounds came together in tackling this challenge. Short-term efforts have focused on re-purposing existing technologies and leveraging additive manufacturing techniques to address shortages in personal protective equipment and disinfection. More basic research efforts with mid-term and long-term impact have emphasized developing novel diagnostics and accelerating vaccines. As a foundational technology, photonics has contributed directly and indirectly to all efforts. This perspective will provide an overview of the critical role that the photonics field has played in efforts to combat the immediate COVID-19 pandemic as well as how the photonics community could anticipate contributing to future pandemics of this nature.
Collapse
Affiliation(s)
- Maria Soler
- Nanobiosensors and Bioanalytical Applications
Group (NanoB2A), Catalan Institute of Nanoscience and Nanotechnology (ICN2), CSIC, BIST
and CIBER-BBN, Barcelona, Spain
| | - Alexis Scholtz
- Department of Biomedical Engineering, University
of Southern California, Los Angeles, California 90089,
USA
| | - Rene Zeto
- Mork Family Department of Chemical Engineering and
Materials Science, University of Southern California, Los Angeles,
California 90089, USA
| | | |
Collapse
|
42
|
Zohdi T. Rapid simulation of viral decontamination efficacy with UV irradiation. COMPUTER METHODS IN APPLIED MECHANICS AND ENGINEERING 2020; 369:113216. [PMID: 32834173 PMCID: PMC7320717 DOI: 10.1016/j.cma.2020.113216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 05/27/2020] [Indexed: 05/21/2023]
Abstract
This paper focuses on viral decontamination by ultraviolet (UV) irradiation technologies. This work develops an efficient and rapid computational method to simulate a UV pulse in order to ascertain the decontamination efficacy of UV irradiation for a surface. It is based on decomposition of a pulse into a group of rays, which are then tracked as they progress towards the target contact surface. The algorithm computes the absorption at the point of contact and color codes it relative to the incoming irradiation. This allows one to quickly quantify the decontamination efficacy across the topology of a structure.
Collapse
Affiliation(s)
- T.I. Zohdi
- Department of Mechanical Engineering 6117 Etcheverry Hall, University of California, Berkeley, CA, 94720-1740, USA
| |
Collapse
|
43
|
Chau JPC, Liu X, Lo SHS, Chien WT, Wan X. Effects of environmental cleaning bundles on reducing healthcare-associated Clostridioides difficile infection: a systematic review and meta-analysis. J Hosp Infect 2020; 106:734-744. [PMID: 32861741 DOI: 10.1016/j.jhin.2020.08.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 08/24/2020] [Indexed: 02/04/2023]
Abstract
Environmental contamination with Clostridioides difficile plays an important role in the transmission of C. difficile infection (CDI) in healthcare and long-term care facilities, which results in prolonged length of stay, higher risk of mortality and increased healthcare costs. Environmental cleaning bundles are introduced to improve environmental cleanliness. This study aimed to evaluate whether environmental cleaning bundles applied in hospital, community and long-term care settings reduce the incidence of healthcare-associated CDI compared with conventional cleaning practices. Relevant databases, websites and trial registration platforms were searched. Two reviewers conducted study screening and selection, data collection, risk of bias assessment and evidence quality assessment independently. Meta-analyses were conducted using Review Manager 5.3. Ten eligible studies [one randomized controlled trial (RCT) and nine non-RCTs] were included. No significant effect of environmental cleaning bundles on the CDI incidence rate was found [risk ratio (RR)=0.96, 95% confidence interval (CI) 0.71-1.29; studies=2; I2=49%; very low quality]. However, the removal of surface markers was improved significantly (RR=1.55, 95% CI 1.30-1.84; studies=3; I2=98%; very low quality), and the percentage of CDI rooms with positive cultures of C. difficile (RR=0.16, 95% CI 0.08-0.31; studies=4; I2=7%; moderate quality) was reduced significantly after the implementation of environmental cleaning bundles. Environmental cleaning bundles may consequently be helpful in improving the thoroughness of cleaning of environmental surfaces in hospital and long-term care settings. More well-conducted RCTs are expected to provide stronger evidence.
Collapse
Affiliation(s)
- J P C Chau
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - X Liu
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
| | - S H S Lo
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - W T Chien
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - X Wan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| |
Collapse
|
44
|
Role of pulsed-xenon ultraviolet light in reducing healthcare-associated infections: a systematic review and meta-analysis. Epidemiol Infect 2020; 148:e165. [PMID: 32624072 PMCID: PMC7424602 DOI: 10.1017/s095026882000148x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Pulsed-xenon-ultraviolet light (PX-UVL) is increasingly used as a supplemental disinfection method in healthcare settings. We undertook a systematic search of the literature through several databases and conducted a meta-analysis to evaluate the efficacy of PX-UVL in reducing healthcare-associated infections. Eleven studies were included in the systematic review and nine in the meta-analysis. Pooled analysis of seven studies with before-after data indicated a statistically significant reduction of Clostridium difficile infection (CDI) rates with the use of the PX-UVL (incidence rate ratio (IRR): 0.73, 95% CI 0.57–0.94, I2 = 72%, P = 0.01), and four studies reported a reduction of risk of methicillin-resistant Staphylococcus aureus (MRSA) infections (IRR: 0.79, 95% CI 0.64–0.98, I2 = 35%, P = 0.03). However, a further four trials found no significant reduction in vancomycin-resistant enterococci (VRE) infection rates (IRR: 0.80, 95% CI 0.63–1.01, I2 = 60%, P = 0.06). The results for CDI and MRSA proved unstable on sensitivity analysis. Meta-regression analysis did not demonstrate any influence of study duration or intervention duration on CDI rates. We conclude that the use of PX-UVL, in addition to standard disinfection protocols, may help to reduce the incidence of CDI and MRSA but not VRE infection rates. However, the quality of evidence is not high, with unstable results and wide confidence intervals, and further high-quality studies are required to supplement the current evidence.
Collapse
|
45
|
Häring A, Heudorf U, Exner M, Pitten FA, Waidmann O, Hack D, Kempf VAJ, Reinheimer C. Impact of surface disinfection with hydrogen peroxide on the prevalence of vancomycin-resistant enterococci (VRE) in hospital wards. GMS HYGIENE AND INFECTION CONTROL 2020; 15:Doc13. [PMID: 32685357 PMCID: PMC7336168 DOI: 10.3205/dgkh000348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objective: Vancomycin-resistant enterococci (VRE) are of major concern in infection control. Although broad infection control actions to check VRE have been implemented, VRE remain part of daily infection prevention in clinical settings. Cleaning procedures in the inanimate ward environment might play a key role in controlling VRE. In order to optimize infection control management at University Hospital Frankfurt, Germany (UHF), this study evaluates the impact of H2O2-containing cleaning wipes compared to Glucoprotamin containing wipes on VRE prevalence in intensive care wards. Methods: Retrospective analyses were conducted of the VRE prevalence on environmental materials obtained from three intensive care units (ICU) at UHF for 17 months prior to (T1) and during the 25 months after (T2) the implementation of H2O2-containing cleaning wipes from January 2016 to June 2019. The bactericidal power of the two disinfectants against VRE was compared using the 4-field test according to EN 16615 (2015). Results: At T1 and T2, n=666 and n=710 environmental samples, respectively, were obtained. At T1, 24.2% (n=161/666; 95% confidence interval: 21.0–27.6) and at T2, 6.9% (n=49/710; 5.1–9.0) samples were positive for VRE. In vitro disinfectant testing did not reveal any superiority of H2O2 over glucoprotamin. No effect on the VRE prevalence in patients’ rectal screening materials was observed. Conclusion: Though Glucoprotamin and H2O2 were in vitro equally effective against VRE, the prevalence of VRE in ICU environment at UHF decreased after implementation of H2O2-containig wipes. This might be due to multiple factors, of which we consider the impact of the Hawthorne effect to be the strongest. Success of infection control strategies might depend on the compliance of the persons critically involved. Transparent information on infection control strategies is suggested to increase compliance and should therefore be considered both in daily infection control and outbreak management.
Collapse
Affiliation(s)
- Anna Häring
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Ursel Heudorf
- Public Health Department of the City of Frankfurt am Main, Germany
| | - Martin Exner
- Institute for Hygiene and Public Health, University Hospital Bonn, Germany
| | | | - Oliver Waidmann
- Department of Internal Medicine I, University Hospital Frankfurt, Frankfurt am Main, Germany.,University Center of Infectious Diseases, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Daniel Hack
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Frankfurt am Main, Germany.,University Center of Infectious Diseases, University Hospital Frankfurt, Frankfurt am Main, Germany.,University Center of Competence for Infection Control Frankfurt - Giessen - Marburg, Frankfurt am Main, Germany
| | - Volkhard A J Kempf
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Frankfurt am Main, Germany.,University Center of Infectious Diseases, University Hospital Frankfurt, Frankfurt am Main, Germany.,University Center of Competence for Infection Control Frankfurt - Giessen - Marburg, Frankfurt am Main, Germany
| | - Claudia Reinheimer
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Frankfurt am Main, Germany.,University Center of Infectious Diseases, University Hospital Frankfurt, Frankfurt am Main, Germany.,University Center of Competence for Infection Control Frankfurt - Giessen - Marburg, Frankfurt am Main, Germany
| |
Collapse
|
46
|
UV light-based decontamination: an effective and fast way for disinfection of endoscopes in otorhinolaryngology? Eur Arch Otorhinolaryngol 2020; 277:2363-2369. [PMID: 32358650 PMCID: PMC7335372 DOI: 10.1007/s00405-020-05978-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 04/10/2020] [Indexed: 12/28/2022]
Abstract
Background Reprocessing of endoscopes becomes increasingly complex, due to rising demands of hygiene. Established methods are often expensive/time-consuming. Recent studies suggest beneficial aspects of disinfection by UV light. In this study we analyzed the efficiency of UV light disinfection of rigid otorhinolaryngological endoscopes. Materials and methods After mechanical pre-cleaning, the endoscopes were decontaminated for 25 s in the D25 using Impelux™ UV C light technology (UV Smart B.V., Delft, The Netherlands). First, the surface contact samples were taken from 50 used endoscopes to evaluate the bacterial load. Additionally, surface contact samples were taken from further 50 used endoscopes after reprocessing with the D25. Another 50 endoscopes were tested on protein residuals. Furthermore, the absolute effectiveness of the D25 was tested on 50 test bodies (RAMS) with a standardized contamination of 107 colony-forming units (CFU) of Enterococcus faecium. Results The used endoscopes showed a high bacterial contamination with an average value of 66.908 (± 239.215) CFU. After reprocessing, only a minimal contamination on 10% (n = 5) of the endoscopes with a mean value of 0.12 CFU (± 0.39) was found, resulting in a log-5 reduction in a clinical environment. The documented bacteria were components of the normal skin flora. All tested endoscopes were practically protein-free (< 1 μg). Furthermore, the average absolute germ reduction of the D25 was about 106 CFU on the tested RAMS. Conclusion The D25 UV light system seems to be an effective device for the reprocessing of rigid ORL endoscopes, and therefore, might be suitable for the usage in clinical practice on site.
Collapse
|
47
|
Sunshine WL. Using Ultraviolet Light Technology to Enhance Cleaning in Health Care Settings. AORN J 2020; 111:486-489. [PMID: 32343390 DOI: 10.1002/aorn.13017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
48
|
Efficacy of pulsed xenon ultraviolet disinfection of multidrug-resistant bacteria and Clostridioides difficile spores. Infect Dis Health 2020; 25:181-185. [PMID: 32284309 DOI: 10.1016/j.idh.2020.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/04/2020] [Accepted: 03/08/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Contamination of healthcare environments by multidrug-resistant organisms (MDRO) and Clostridioides difficile is a risk for healthcare-associated infections. The efficacy of pulsed xenon ultraviolet (PX-UV) disinfection in healthcare environments has been described previously. However, there are few reports about PX-UV disinfection in Japan. The aim of this study was to investigate in vitro the efficacy of PX-UV disinfection of MDRO and C. difficile spores commonly isolated in Japanese hospitals. METHODS We investigated reductions in microbial counts after exposure to PX-UV of the following clinically-isolated organisms on seeding agar plates: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus faecium, carbapenemase-producing Klebsiella pneumoniae, extended spectrum β-lactamase-producing Escherichia coli, multidrug resistant Acinetobacter baumannii, and C. difficile spores. We also visually assessed the attenuation of disinfection by shielding of MRSA and carbapenemase-producing K. pneumoniae from PX-UV exposure. RESULTS PX-UV disinfection for 5 min induced >5-log colony-forming units (CFU)/cm2 growth inhibition of all the MDRO. PX-UV disinfection for 15 min induced >3-log CFU/cm2 growth inhibition of C. difficile spores. Where a plate was shielded from PX-UV exposure the bacteria showed confluent growth, but no colonies were observed on unshielded (exposed) parts of the plates. CONCLUSION This study shows the efficacy of PX-UV disinfection against clinical MDROs. C. difficile spores were more resistant to PX-UV disinfection than vegetative bacteria. Further evaluation of the efficacy of PX-UV disinfection in reducing the contamination of real-world surfaces and the incidence of healthcare-associated infections is needed.
Collapse
|
49
|
Challenges in assessing contamination levels and novel decontamination technologies in the critical care setting. Infect Control Hosp Epidemiol 2020; 41:622-623. [PMID: 32131907 DOI: 10.1017/ice.2020.38] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
50
|
Kitagawa H, Mori M, Kashiyama S, Sasabe Y, Ukon K, Shimokawa N, Shime N, Ohge H. Effect of pulsed xenon ultraviolet disinfection on methicillin-resistant Staphylococcus aureus contamination of high-touch surfaces in a Japanese hospital. Am J Infect Control 2020; 48:139-142. [PMID: 31627987 DOI: 10.1016/j.ajic.2019.08.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 08/30/2019] [Accepted: 08/30/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND The hospital environment is an important source of multidrug-resistant organisms such as methicillin-resistant Staphylococcus aureus (MRSA). Here, we evaluated the efficacy of pulsed xenon ultraviolet (PX-UV) disinfection in addition to manual cleaning in a Japanese hospital. METHODS Environmental samples were collected from inpatient rooms that had been occupied for at least 48 hours by patients infected or colonized with MRSA. High-touch surfaces from 11 rooms were sampled before and after manual cleaning and then after PX-UV disinfection. Changes in bacterial counts and in the number of aerobic bacteria (AB)- and MRSA-positive samples between sampling points were assessed. The time taken to complete PX-UV treatment of patient rooms was also recorded. RESULTS A total of 306 samples were collected. PX-UV disinfection resulted in a significant decrease in abundance of AB and MRSA (mean colony-forming units 14.4 ± 38.7 to 1.7 ± 6.1, P < .001 and 1.1 ± 3.9 to 0.3 ± 2.0, P < .001, respectively) and in the number of AB- and MRSA-positive samples (58.8%-28.4%, P = .001 and 19.6%-3.9%, P < .001, respectively) compared with manual cleaning. The median time of in-room use of the PX-UV device was 20 minutes. CONCLUSIONS The addition of PX-UV disinfection to the manual cleaning process significantly reduced AB and MRSA contamination of high-touch surfaces in hospital inpatient rooms.
Collapse
|