Ambulance disinfection using Ultraviolet Germicidal Irradiation (UVGI): Effects of fixture location and surface reflectivity

Evaluation of cleaning methods for change-over after the processing of cell products to avoid cross-contamination risk

Introduction

Cell-processing facilities face the risk of environmental bacteria contaminating biosafety cabinets during processing, and manual handling of autologous cell products can result in contamination. We propose a risk- and evidence-based cleaning method for cross-contamination, emphasizing proteins and DNA.

Methods

The transition and residual risks of the culture medium were assessed by measuring both wet and dried media using fluorescence intensity. Residual proteins and DNA in dried culture medium containing HT-1080 cells were analyzed following ultraviolet (UV) irradiation, wiping, and disinfectant treatment.

Results

Wet conditions showed a higher transition to distilled water (DW), whereas dry conditions led to higher residual amounts on SUS304 plates. Various cleaning methods for residual culture medium were examined, including benzalkonium chloride with a corrosion inhibitor (BKC + I) and DW wiping, which demonstrated significantly lower residual protein and DNA compared to other methods. Furthermore, these cleaning methods were tested for residual medium containing cells, with BKC + I and DW wiping resulting in an undetectable number of cells. However, in some instances, proteins and DNA remained.

Conclusions

The study compared cleaning methods for proteins and DNA in cell products, revealing their advantages and disadvantages. Peracetic acid (PAA) proved effective for nucleic acids but not proteins, while UV irradiation was ineffective against both proteins and DNA. Wiping emerged as the most effective method, even though traceability remained challenging. However, wiping with ETH was not effective as it caused protein immobilization. Understanding the characteristics of these cleaning methods is crucial for developing effective contamination control strategies.

Study on disinfection effect of a 222-nm UVC excimer lamp on object surface

Effective disinfection of contaminated surfaces is essential for preventing the transmission of pathogens. In this study, we investigated the UV irradiance and wavelength distribution of a 222-nm ultraviolet C (UVC) excimer lamp and its disinfection efficacy against microorganisms in laboratory conditions. By using a carrier quantitative germicidal test with stainless steel sheets as carriers, we examined the disinfection effect of the 222-nm UVC lamp on three standard strains-Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa. We tested the disinfection efficacy under different conditions by adjusting irradiation time, as well as the state and temperature of the stainless steel carriers. Our results indicated that a bacterial suspension in PBS and not-dried stainless steel carriers yielded better disinfection than in TSB and dried carriers. Additionally, carrier temperature had no significant impact on disinfection efficacy. When utilizing a bacterial suspension in PBS and non-dried carriers at a temperature of 20 °C, the three bacteria were eliminated by 222-nm UVC excimer lamp irradiation in just 15 s. In contrast, when using a bacterial suspension in TSB and dried carriers at temperatures of 20 °C, 4 °C, or - 20 °C, the three bacteria were eradicated by 222-nm UVC excimer lamp irradiation in 60 s. Comparatively, the LPM lamp required more than 10 min to achieve the same disinfection effect. Our data demonstrate that the 222-nm UVC excimer lamp has higher irradiance and a more potent microbial disinfection effect than the LPM lamp, requiring significantly less irradiation time to achieve the same disinfection effect under identical conditions. Furthermore, the 222-nm UVC excimer lamp exhibited a substantial disinfection effect on bacterial propagules at low temperatures. Our findings support the optimization of "tunnel-type" cold-chain goods disinfection devices, providing an alternative, highly efficient, and practical tool to combat the spread of SARS-CoV-2 through cold-chain systems.

Blue 405 nm LED light effectively inactivates bacterial pathogens on substrates and packaging materials used in food processing

This study investigates the antimicrobial effectiveness of 405 nm light emitting diodes (LEDs) against pathogenic Escherichia coli O157:H7, Listeria monocytogenes, Pseudomonas aeruginosa, Salmonella Typhimurium, and Staphylococcus aureus, in thin liquid films (TLF) and on solid surfaces. Stainless steel (SS), high density polyethylene (HDPE), low density polyethylene (LDPE), and borosilicate glass were used as materials typically encountered in food processing, food service, and clinical environments. Anodic aluminum oxide (AAO) coupons with nanoscale topography were used, to evaluate the effect of topography on inactivation. The impact of surface roughness, hydrophobicity, and reflectivity on inactivation was assessed. A 48 h exposure to 405 nm led to reductions ranging from 1.3 (E. coli) to 5.7 (S. aureus) log CFU in TLF and 3.1 to 6.3 log CFU on different solid contact surfaces and packaging materials. All inactivation curves were nonlinear and followed Weibull kinetics, with better inactivation predictions on surfaces (0.89 ≤ R2 ≤ 1.0) compared to TLF (0.76 ≤ R2 ≤ 0.99). The fastest inactivation rate was observed on small nanopore AAO coupons inoculated with L. monocytogenes and S. aureus, indicating inactivation enhancing potential of these surfaces. These results demonstrate significant promise of 405 nm LEDs for antimicrobial applications in food processing and handling and the healthcare industry.

Real-Life Assessment of the Ability of an Ultraviolet C Lamp (SanificaAria 200, Beghelli) to Inactivate Airborne Microorganisms in a Healthcare Environment

Airborne-mediated microbial diseases represent one of the major challenges to public health. Ultraviolet C radiation (UVC) is among the different sanitation techniques useful to reduce the risk of infection in healthcare facilities. Previous studies about the germicidal activity of UVC were mainly performed in artificial settings or in vitro models. This study aimed to assess the sanitizing effectiveness of a UVC device (SanificaAria 200, Beghelli, Valsamoggia, Bologna, Italy) in 'real-life' conditions by evaluating its ability to reduce microbial loads in several hospital settings during routine daily activities. The efficacy of the UVC lamp in reducing the bacterial component was evaluated by microbial culture through the collection of air samples in different healthcare settings at different times (30 min-24 h) after turning on the device. To assess the anti-viral activity, air samplings were carried out in a room where a SARS-CoV-2-positive subject was present. The UVC device showed good antibacterial properties against a wide range of microbial species after 6 h of activity. It was effective against possible multi-drug resistant microorganisms (e.g., Pseudomonas spp., Acinetobacter spp.) and spore-forming bacteria (e.g., Bacillus spp.). In addition, the UVC lamp was able to inactivate SARS-CoV-2 in just one hour. Thanks to its effectiveness and safety, SanificaAria 200 could be useful to inactivate airborne pathogens and reduce health risks.

Disinfection of an ambulance using a compact atmospheric plasma device

AIMS

The worldwide spread of the coronavirus SARS-CoV-2 has highlighted the need for fast and simple disinfection processes, amongst others for ambulance cars on site. To overcome current drawbacks regarding room disinfection, the use of cold atmospheric plasma in remote operation represents a promising alternative for the disinfection of larger volumes. In this study, a compact plasma system was evaluated regarding its disinfection efficiency inside an ambulance car.

METHODS AND RESULTS

The developed plasma device is based on a dielectric barrier discharge (DBD) and operates with ambient air as process gas. The humidified afterglow from the plasma nozzle was introduced into an ambulance car with a volume of approximately 10 m³ while B. atrophaeus endospores, S. aureus or Phi 6 bacteriophages dried on different surfaces (PET-films, glass slides or aluminum foil) were exposed to the reactive gas inside the ambulance vehicle at eight different positions. Reductions of spores by more than 4 orders of magnitude were found on all surfaces and positions within 2 hours. Due to their higher susceptibility, Phi 6 bacteriophages and S. aureus counts were reduced by at least 4 orders of magnitude within 30 min on all surfaces.

CONCLUSION

The results show that different microorganisms dried on variable surfaces can be inactivated by several orders of magnitude inside an ambulance by plasma gas from of a compact DBD plasma nozzle.

SIGNIFICANCE AND IMPACT OF STUDY

Plasma gas generated on site by a DBD plasma nozzle proved to be highly efficient for the disinfection of the interior of an ambulance car. Compact plasma systems could be a viable alternative for the disinfection of vehicles or rooms.

Rapid disinfection of radiology treatment rooms using an autonomous ultraviolet germicidal irradiation robot

BACKGROUND

Ultraviolet germicidal irradiation (UVGI) technologies have emerged as a promising adjunct to manual cleaning, however, their potential to shorten cleaning times remains unexplored.

METHODS

A <10-minute disinfection procedure was developed using a robotic UVGI platform. The efficacy and time to perform the UVGI procedure in a CT scan treatment room was compared with current protocols involving manual disinfection using biocides. For each intervention, environmental samples were taken at 12 locations in the room before and after disinfection on seven distinct occasions.

RESULTS

The mean UVC dose at each sample location was found to be 13.01 ± 4.36 mJ/cm², which exceeded published UVC thresholds for achieving log reductions of many common pathogens. Significant reductions in microbial burden were measured after both UVGI (P≤.001) and manual cleaning (P≤.05) conditions, with the UVGI procedure revealing the largest effect size (r = 0.603).

DISCUSSION

These results support the hypothesis that automated deployments of UVGI technology can lead to germicidal performance that is comparable with, and potentially better than, current manual cleaning practices.

CONCLUSIONS

Our findings provide early evidence that the incorporation of automated UVGI procedures into cleaning workflow could reduce turnaround times in radiology, and potentially other hospital settings.

Public Buses Decontamination by Automated Hydrogen Peroxide Aerosolization System

BACKGROUND: Public transportation has been linked to an increase in the risk of coronavirus disease 2019 transmission. The effective decontamination system using aerosolized hydrogen peroxide can mitigate the transmission risk from using public transportation. AIM: The aim of this study was to develop and validate an effective decontamination system for public transport. METHODS: The experimental research was performed in 13 inter-city public buses. The aerosol generator with ultrasonic atomizer was used in the experiment. The validation process for disinfection was conducted using both a chemical indicator (CI) and spore discs biological indicator (inoculated with 106 Geobacillus stearothermophilus enclosed in glassine envelopes). The CIs and biological indicators were marked by number and placed in nine locations on each bus. The decontamination cycle was developed by analyzed of various aerosolized and decomposition period. Both concentrations of hydrogen peroxide, 5% and 7%, were used for comparison. RESULTS: In an aerosolized period, both concentrations of hydrogen peroxide at 30 min were effective for sporicidal 6-log reductions. The decontamination cycle totaled 100 min, based on a 70 min average decomposition time. CONCLUSIONS: The automated hydrogen peroxide aerosolized system is a highly effective and safe method of decontaminating public buses.

Spatial analysis of the impact of UVGI technology in occupied rooms using ray-tracing simulation

The use of Ultraviolet Germicidal Irradiation (UVGI) devices in the upper zones of occupied buildings has gained increased attention as one of the most effective mitigation technologies for the transmission of COVID-19. To ensure safe and effective use of upper-room UVGI, it is necessary to devise a simulation technique that enables engineers, designers, and users to explore the impact of different design and operational parameters. We have developed a simulation technique for calculating UV-C fluence rate within the volume of the upper zone and planar irradiance in the lower occupied zone. Our method is based on established ray-tracing light simulation methods adapted to the UV-C wavelength range. We have included a case study of a typical hospital patient room. In it, we explored the impact of several design parameters: ceiling height, device location, room configuration, proportions, and surface materials. We present a spatially mapped parametric study of the UV-C irradiance distribution in three dimensions. We found that the ceiling height and mounting height of the UVGI fixtures combined can cause the largest variation (up to 22%) in upper zone fluence rate. One of the most important findings of this study is that it is crucial to consider interreflections in the room. This is because surface reflectance is the design parameter with the largest impact on the occupant exposure in the lower zone: Applying materials with high reflectance ratio in the upper portion of the room has the highest negative impact (over 700% variation) on increasing hot spots that may receive over 6 mJ/cm² UV dose in the lower occupied zone.

Shielding of viruses such as SARS-Cov-2 from ultraviolet radiation in particles generated by sneezing or coughing: Numerical simulations of survival fractions

SARS-CoV-2 and other microbes within aerosol particles can be partially shielded from UV radiation. The particles refract and absorb light, and thereby reduce the UV intensity at various locations within the particle. Previously, we demonstrated shielding in calculations of UV intensities within spherical approximations of SARS-CoV-2 virions within spherical particles approximating dried-to-equilibrium respiratory fluids. The purpose of this paper is to extend that work to survival fractions of virions (i.e., fractions of virions that can infect cells) within spherical particles approximating dried respiratory fluids, and to investigate the implications of these calculations for using UV light for disinfection. The particles may be on a surface or in air. Here, the survival fraction (S) of a set of individual virions illuminated with a UV fluence (F, in J/m²) is assumed described by S(kF) = exp(-kF), where k is the UV inactivation rate constant (m²/J). The average survival fraction (S_p) of the simulated virions in a group of particles is calculated using the energy absorbed by each virion in the particles. The results show that virions within particles of dried respiratory fluids can have larger S_p than do individual virions. For individual virions, and virions within 1-, 5-, and 9-µm particles illuminated (normal incidence) on a surface with 260-nm UV light, the S_p = 0.00005, 0.0155, 0.22, and 0.28, respectively, when kF = 10. The S_p decrease to <10^-7, <10^-7, 0.077, and 0.15, respectively, for kF = 100. Results also show that illuminating particles with UV beams from widely separated directions can strongly reduce the S_p. These results suggest that the size distributions and optical properties of the dried particles of virion-containing respiratory fluids are likely important to effectively designing and using UV germicidal irradiation systems for microbes in particles. The results suggest the use of reflective surfaces to increase the angles of illumination and decrease the S_p. The results suggest the need for measurements of the S_p of SARS-CoV-2 in particles having compositions and sizes relevant to the modes of disease transmission.

Influence and analysis of ambulance on the containment of COVID-19 in China

New coronavirus (COVID-19) is a newly emerging and highly infectious form of typical pneumonia with a high rate of transmission. The COVID-19 pneumonia has spread to 147 countries and areas as of Mar.16th 2020, which has tremendous impact on the global public health. It is well known that, in China, the pandemic has been contained effectively with a series of emergency measures. It is necessary to share the existing experience of China in the fight against the pandemic to the world. Especially, during the process of prevention and containment of the pandemic, ambulances play an important role in transporting infectious patients. In this paper, focusing on the safety and quantity of negative pressure ambulances, the influence of ambulance on newly confirmed cases is given. Analysis of negative pressure ambulance on the containment of COVID-19 is shown. The potential development of ambulance is discussed. While the pandemic still continues spreading across the world, we hope to share our experience in the implementation of these strategies by China to save more life.

Surface Dosimetry of Ultraviolet Germicidal Irradiation Using a Colorimetric Technique

Ultraviolet germicidal irradiation uses ultraviolet C (UV-C) energy to disinfect surfaces in clinical settings. Verifying that the doses of UV-C energy received by surfaces are adequate for proper disinfection levels can be difficult and expensive. Our study aimed to test commercially available colorimetric labels, sensitive to UV-C energy, and compare their precision with an accepted radiometric technique. The color-changing labels were found to predictably change color in a dose-dependent manner that would allow them to act as a qualitative alternative to radiometry when determining the minimum UV-C energy dosage received at surfaces. If deployed using careful protective techniques to avoid unintentional exposure to sunlight or other light sources, the use of colorimetric labels could provide inexpensive, easy, and accurate verification of effective UV-C dosing in clinical spaces.

The use of a UV-C disinfection robot in the routine cleaning process: a field study in an Academic hospital

Background

Environmental surface decontamination is a crucial tool to prevent the spread of infections in hospitals. However, manual cleaning and disinfection may be insufficient to eliminate pathogens from contaminated surfaces. Ultraviolet-C (UV-C) irradiation deploying autonomous disinfection devices, i.e. robots, are increasingly advertised to complement standard decontamination procedures with concurrent reduction of time and workload. Although the principle of UV-C based disinfection is proven, little is known about the operational details of UV-C disinfection delivered by robots. To explore the impact of a UV-C disinfection robot in the clinical setting, we investigated its usability and the effectiveness as an add-on to standard environmental cleaning and disinfection. Additionally, its effect on Candida auris, a yeast pathogen resistant to antifungals and disinfectants, was studied.

Methods

After setting the parameters “surface distance” and “exposure time” for each area as given by the manufacturer, the robot moved autonomously and emitted UV-C irradiation in the waiting areas of two hospital outpatient clinics after routine cleaning and/or disinfection. To quantify the efficacy of the robotic UV-C disinfection, we obtained cultures from defined sampling sites in these areas at baseline, after manual cleaning/disinfection and after the use of the robot. Four different C. auris strains at two concentrations and either in a lag or in a stationary growth phase were placed in these areas and exposed to UV-C disinfection as well.

Results

The UV-C irradiation significantly reduced the microbial growth on the surfaces after manual cleaning and disinfection. C. auris growth in the lag phase was inhibited by the UV-C irradiation but not in the presence of the rim shadows. The effects on C. auris in the stationary phase were differential, but overall C. auris strains were not effectively killed by the standard UV-C disinfection cycle. Regarding usability, the robot’s interface was not intuitive, requiring advanced technical knowledge or intensive training prior to its use. Additionally, the robot required interventions by the technical operator during the disinfection process, e.g. stopping due to unforeseen minor dislocation of items during the clinical service or due to moving individuals, making it a delicate high-tech device but not yet ready for the autonomous use in the clinical routine.

Conclusions

Presently, the UV-C robot tested in this study is not ready to be integrated in the environmental cleaning and disinfection procedures in our hospital. The single standard disinfection UV-C irradiation cycle is not sufficient to inactivate pathogens with augmented environmental resilience, e.g. C. auris, particularly when microbial loads are high.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13756-021-00945-4.

The Impact of a Novel Operational Readiness Response Model on the Environmental Cleanliness of Emergency Ambulances

Objectives: Environmental cleanliness of emergency ambulances may be associated with increased risk of healthcare acquired infection (HAI). Surface cleanliness, measured using adenosine triphosphate (ATP) testing, has been demonstrated to correlate with potentially harmful levels of microbial pathogens. In most ambulance services, environmental cleanliness of ambulances and the equipment within them is the responsibility of paramedics. In 2016 NSW Ambulance introduced the Make Ready Model (MRM), in which ambulances are systematically cleaned by non-clinical support staff at the end of each shift. This prospective study aimed to 1) provide a baseline level of ambulance cleanliness; and 2) compare the MRM to a standard cleaning model (SCM). Methods: A prospective comparative study was conducted comparing cleanliness of ambulances in the SCM to those in the MRM. Adenosine-triphosphate (ATP) bioluminescence testing was performed in a pseudo-randomised sample of ambulances. Six 'high touch' areas within each ambulance were systematically sampled. Testing occurred without warning to operational staff. The primary outcome was 'overall bioburden' (OB)' measured in radiant light units ('RLU'). Non-parametric tests were used to assess differences in RLU values between each of the test points, while Poisson multivariate regression was used to compare median overall bioburden between the two groups, adjusting for the confounder variable of 14-day ambulance workload. Results: Sixty-eight ambulances were sampled, 32 from the SCM and 36 from the MRM. Median surface bioburden was significantly lower in the MRM for four of the six test points (preparation table, mobile data terminal, stretcher handles and steering wheel). For the primary outcome of overall bioburden, the unadjusted MRM OB was 35% lower than for the SCM group (RR 0.65 (0.64-0.66; p < 0.01)). After adjusting for the significant confounding variable of 14-day workload, the OB was 38% lower for the MRM group (ARR 0.68 (0.61-0.63; p < 0.001)). Conclusion: The innovative MRM cleaning system was associated with significantly improved cleanliness in frontline emergency ambulances. The magnitude of improvement in cleanliness suggests this cleaning model has the potential to make a major contribution to infection control strategies in paramedicine. Future research should focus on cost effectiveness of the MRM and its applicability to regional and remote ambulance service operations.

Ultraviolet disinfection robots to improve hospital cleaning: Real promise or just a gimmick?

The global COVID-19 pandemic due to the novel coronavirus SARS-CoV-2 has challenged the availability of traditional surface disinfectants. It has also stimulated the production of ultraviolet-disinfection robots by companies and institutions. These robots are increasingly advocated as a simple solution for the immediate disinfection of rooms and spaces of all surfaces in one process and as such they seem attractive to hospital management, also because of automation and apparent cost savings by reducing cleaning staff. Yet, there true potential in the hospital setting needs to be carefully evaluated. Presently, disinfection robots do not replace routine (manual) cleaning but may complement it. Further design adjustments of hospitals and devices are needed to overcome the issue of shadowing and free the movement of robots in the hospital environment. They might in the future provide validated, reproducible and documented disinfection processes. Further technical developments and clinical trials in a variety of hospitals are warranted to overcome the current limitations and to find ways to integrate this novel technology in to the hospitals of to-day and the future.

Evaluation of UV-C Decontamination of Clinical Tissue Sections for Spatially Resolved Analysis by Mass Spectrometry Imaging (MSI)

Clinical tissue specimens are often unscreened, and preparation of tissue sections for analysis by mass spectrometry imaging (MSI) can cause aerosolization of particles potentially carrying an infectious load. We here present a decontamination approach based on ultraviolet-C (UV-C) light to inactivate clinically relevant pathogens such as herpesviridae, papovaviridae human immunodeficiency virus, or SARS-CoV-2, which may be present in human tissue samples while preserving the biodistributions of analytes within the tissue. High doses of UV-C required for high-level disinfection were found to cause oxidation and photodegradation of endogenous species. Lower UV-C doses maintaining inactivation of clinically relevant pathogens to a level of increased operator safety were found to be less destructive to the tissue metabolome and xenobiotics. These doses caused less alterations of the tissue metabolome and allowed elucidation of the biodistribution of the endogenous metabolites. Additionally, we were able to determine the spatially integrated abundances of the ATR inhibitor ceralasertib from decontaminated human biopsies using desorption electrospray ionization-MSI (DESI-MSI).

Exploring the Applicability of Robot-Assisted UV Disinfection in Radiology

The importance of infection control procedures in hospital radiology departments has become increasingly apparent in recent months as the impact of COVID-19 has spread across the world. Existing disinfectant procedures that rely on the manual application of chemical-based disinfectants are time consuming, resource intensive and prone to high degrees of human error. Alternative non-touch disinfection methods, such as Ultraviolet Germicidal Irradiation (UVGI), have the potential to overcome many of the limitations of existing approaches while significantly improving workflow and equipment utilization. The aim of this research was to investigate the germicidal effectiveness and the practical feasibility of using a robotic UVGI device for disinfecting surfaces in a radiology setting. We present the design of a robotic UVGI platform that can be deployed alongside human workers and can operate autonomously within cramped rooms, thereby addressing two important requirements necessary for integrating the technology within radiology settings. In one hospital, we conducted experiments in a CT and X-ray room. In a second hospital, we investigated the germicidal performance of the robot when deployed to disinfect a CT room in <15 minutes, a period which is estimated to be 2-4 times faster than current practice for disinfecting rooms after infectious (or potentially infectious) patients. Findings from both test sites show that UVGI successfully inactivated all of measurable microbial load on 22 out of 24 surfaces. On the remaining two surfaces, UVGI reduced the microbial load by 84 and 95%, respectively. The study also exposes some of the challenges of manually disinfecting radiology suites, revealing high concentrations of microbial load in hard-to-reach places. Our findings provide compelling evidence that UVGI can effectively inactivate microbes on commonly touched surfaces in radiology suites, even if they were only exposed to relatively short bursts of irradiation. Despite the short irradiation period, we demonstrated the ability to inactivate microbes with more complex cell structures and requiring higher UV inactivation energies than SARS-CoV-2, thus indicating high likelihood of effectiveness against coronavirus.

Transmittance and Survival of SARS-CoV-2 in Global Trade: The Role of Supply Chain and Packaging

We are living in uncertain times and facing a paradigm shift in human health and sustainability. The number of SARS-CoV-2 victims is rising daily and all nations are going through dramatic effects and exploring various solutions to this imminent calamity facing the humanity. The world is confronting a public health issue that has forced it to come to a halt and evaluate the future of our modern society and our way of living. It can be stated that the sustainability of our societies inextricably depends on the performance of our global trade and supply chains. This review article is the first published assessment on the global trade and especially packaging’s role in the transmittance of SARS-CoV-2 virus. Surprisingly, based on our findings, the lack of knowledge on transmittance and survival of SARS-CoV-2 in supply chain and packaging is substantial. Although there are several existing and available technologies that can be used for the risk mitigation, our assessment shows a major and timely need for broad conceptual advancements and necessary understanding of the supply chain risks associated with the viral surface transmittances. The specificity to the current and possibly future pandemics demands an increasing amount of multidisciplinary research and involvement of public and private sectors. This proposed erudition is imminent and may be highly critical in safeguarding and the sustainability of the critical supply chains in our society now and in the future.

UV-C light: A powerful technique for inactivating microorganisms and the related side effects to the skin

Hospital-associated infections have led to a significant increment of morbidity and mortality among patients. As a result, the public health had concentrated on preventing the transmission of infection using environmental controls. UV-C radiation or ultraviolet germicidal irradiation (UVGI) had caught interest for decades as it can potentially degrade many kinds of microorganisms. This review aims to highlight the current information regarding the ability of UV-C radiation in terms of disinfection and focuses on its application and safety in the medical field.

Integration of aeromedicine in the response to the COVID-19 pandemic

There is limited guidance on the use of helicopter medical personnel to facilitate care of critically ill COVID-19 patients. This manuscript describes the emergence of this novel virus, its mode of transmission, and the potential impacts on patient care in the unique environment of rotor wing aircraft. It details the development of clinical and operational guidelines for flight crew members. This allows other out-of-hospital clinicians to utilize our framework to augment or supplement their own for the current response effort to COVID-19. It further serves as a road map for future response to the care of high consequence infectious disease patients.

Understanding ultraviolet light surface decontamination in hospital rooms: A primer

Ongoing challenges in maintaining optimum manual cleaning and disinfection of hospital rooms have created increased interest in "no-touch" decontamination technologies including the use of ultraviolet light (UV). Trials have shown that some UV devices can decrease surface contamination and reduce healthcare-associated infections. Despite substantial marketing of these devices for use in healthcare settings, few data are available regarding the doses of UV-C necessary to yield desired reductions in healthcare pathogens and the ability of mobile devices to deliver adequate doses to various surfaces in patient rooms. This review summarizes the physical aspects of UV that affect the doses delivered to surfaces, the UV-C doses needed to yield 3 log10 reductions of several important healthcare-associated pathogens, the doses of UV-C that can be achieved in various locations in patient rooms using mobile UV-C devices, and methods for measuring UV doses delivered to surfaces.

Prehospital infection control and prevention in Denmark: a cross-sectional study on guideline adherence and microbial contamination of surfaces

Background

Prehospital acute care and treatment have become more complex, and while invasive procedures are standard procedures, focus on infection control and prevention is scarce. We aimed to evaluate guideline adherence, microbial contamination, and associated risk factors.

Methods

In a nationwide cross-sectional study, we evaluated guideline adherence to thorough cleaning (TC) once a day, and moderate cleaning (MC) in-between patient courses. Microbial contamination on hand-touch sites (HTS) and provider-related sites (PRS) was assessed by total aerobic colony forming units (CFU) and presence of selected pathogens, using swab and agar imprints. Also, microbial contamination was assessed in relation to potential risk factors.

Results

80 ambulances and emergency medical service (EMS) providers were enrolled. Adherence to guidelines regarding TC was 35%, but regarding MC it was 100%. In total, 129 (27%) of 480 HTS presented a total CFU > 2.5/cm² and/or pathogenic growth, indicating hygiene failures. The prevalence of selected pathogens on HTS was: S. aureus 7%; Enterococcus 3% and Enterobacteriaceae 1%. Total CFU on the PRS ranged from 0 to 250/cm², and the prevalence of pathogens was 18% (S. aureus 15%, Enterococcus 3% and Enterobacteriaceae 0.3%). Methicillin-resistant S. aureus was found in one sample, and Vancomycin-resistant Enterococcus in two. No Enterobacteriaceae with extended-spectrum beta-lactamases were recorded.

Conclusion

Guideline adherence was suboptimal, and many HTS did not comply fully with proposed standards for cleanliness. Pathogens were demonstrated on both HTS and PRS, indicating that the EMS may be a source of infection in hospitalized patients. Moreover, cleaning effort and time appears associated with microbial contamination, but a comprehensive investigation of risk factors is needed.

Comparing and optimizing ultraviolet germicidal irradiation systems use for patient room terminal disinfection: an exploratory study using radiometry and commercial test cards

Background

Ultraviolet germicidal irradiation (UVGI) systems are gaining popularity, however objective comparisons of their characteristics are lacking. While environmental cultures and reduction of hospital-associated infections rates are excellent study endpoints, they are impractical for centers with limited resources who want to compare or optimize UVGI systems use.

Methods

We evaluated radiometry and commercial test cards, two simple and low cost tools, to compare 2 full size UVGI systems (Tru-D and Optimum-UV Enlight) and 2 small units (Lumalier EDU 435 and MRSA-UV Turbo-UV).

Results

Radiometry-derived output curves show that if both large devices emit enough energy to reach C. difficile lethal doses at 10 ft, the reduction in output in distance is almost perfectly logarithmic. In a patient room environment, Enlight and Tru-D performed similarly when compared using radiometry and commercial test cards. The two small devices reached C. difficile range around the bathroom with the device raised above the floor, but longer times are needed.

Conclusions

Despite different workflows and price points, no clear superiority emerges between Tru-D and Enlight. Bathroom disinfection should be dealt with separately from the main room and small, cheaper units can be used. Radiometry and commercial test cards are promising ways to compare UVGI systems, but further validation is needed using correlation with environmental cultures.

Trial registration

Not applicable.