Effect of far ultraviolet light emitted from an optical diffuser on methicillin-resistant Staphylococcus aureus in vitro

Far-UV-C irradiation promotes synergistic bactericidal action against adhered cells of Escherichia coli and Staphylococcus epidermidis

The contamination of indoor areas is a global health problem that can cause the dispersion of infectious diseases. In that sense, it is urgent to find new strategies applying a lower concentration of the traditional chemicals used for cleaning and disinfection. Ultraviolet radiation (UV), in particular far-UV-C (200-225 nm), has emerged as a successful, powerful, easy-to-apply, and inexpensive approach for bacterial eradication that still requires scientific assessment. This study investigated new strategies for disinfection based on far-UV-C (222 nm) combined with chlorine and mechanical cleaning, providing an innovative solution using low doses. The bactericidal activity of far-UV-C (222 nm) was tested at an intensity of irradiation from 78.4 μW/cm2 to 597.7 μW/cm2 (for 1 min) against Escherichia coli and Staphylococcus epidermidis adhered on polystyrene microtiter plates. It was further tested in combination with mechanical cleaning (ultrasounds for 1 min) and free chlorine (0.1, 0.5, and 1 mg/L for 5 min). The triple combination consisting of mechanical cleaning + free chlorine (0.5 mg/L) + far-UV-C (54 mJ/cm2) was tested against cells adhered to materials found in hospital settings and other public spaces: polyvinyl chloride (PVC), stainless steel (SS), and polyetheretherketone (PEEK). Disinfection with far-UV-C (54 mJ/cm2) and free chlorine at 0.5 mg/L for 5 min allowed a total reduction of culturable E. coli cells and a logarithmic reduction of 2.98 ± 0.03 for S. epidermidis. The triple combination of far-UV-C, free chlorine, and mechanical cleaning resulted in a total reduction of culturable cells for both adhered bacteria. Bacterial adhesion to PVC, SS, and PEEK occurred at distinct extents and influenced the bactericidal activity of the triple combination, with logarithmic reductions of up to three. The overall results highlight that, based on culturability assessment, far-UV-C (54 mJ/cm2) with chlorine (0.5 mg/L; 5 min) and mechanical cleaning (1 min) as an efficient disinfection strategy using mild conditions. The combination of culturability and viability assessment of disinfection is recommended to detect regrowth events and increase the effectiveness in microbial growth control.

Fluence-dependent degradation of fibrillar type I collagen by 222 nm far-UVC radiation

For more than 100 years, germicidal lamps emitting 254 nm ultraviolet (UV) radiation have been used for drinking-water disinfection and surface sterilization. However, due to the carcinogenic nature of 254 nm UV, these lamps have been unable to be used for clinical procedures such as wound or surgical site sterilization. Recently, technical advances have facilitated a new generation of germicidal lamp whose emissions centre at 222 nm. These novel 222 nm lamps have commensurate antimicrobial properties to 254 nm lamps while producing few short- or long-term health effects in humans upon external skin exposure. However, to realize the full clinical potential of 222 nm UV, its safety upon internal tissue exposure must also be considered. Type I collagen is the most abundant structural protein in the body, where it self-assembles into fibrils which play a crucial role in connective tissue structure and function. In this work, we investigate the effect of 222 nm UV radiation on type I collagen fibrils in vitro. We show that collagen's response to irradiation with 222 nm UV is fluence-dependent, ranging from no detectable fibril damage at low fluences to complete fibril degradation and polypeptide chain scission at high fluences. However, we also show that fibril degradation is significantly attenuated by increasing collagen sample thickness. Given the low fluence threshold for bacterial inactivation and the macroscopic thickness of collagenous tissues in vivo, our results suggest a range of 222 nm UV fluences which may inactivate pathogenic bacteria without causing significant damage to fibrillar collagen. This presents an initial step toward the validation of 222 nm UV radiation for internal tissue disinfection.

222 nm Far-UVC from filtered Krypton-Chloride excimer lamps does not cause eye irritation when deployed in a simulated office environment

Far-UVC, from filtered Krypton-Chloride lamps, is promising for reducing airborne transmission of disease. While significant research has been undertaken to investigate skin safety of these lamps, less work has been undertaken on eye safety. There is limited data on human eye safety or discomfort from the deployment of this germicidal technology. In this pilot study, immediate and delayed eye discomfort were assessed in a simulated office environment with deployment of Krypton-Chloride lamps, located on the ceiling and directed downwards into the occupied room. Discomfort was assessed immediately postexposure and several days after exposure using validated, Standard Patient Evaluation Eye Dryness (SPEED) and Ocular Surface Disease Index (OSDI) questionnaires. Our results show no significant eye discomfort or adverse effects from the deployment of Far-UVC in this simulated office environment, even when lamps were operated continuously with participants receiving head exposures of up to 50 mJ cm-2 . In addition, a statistically significant reduction in bacteria and fungi of 52% was observed. Far-UVC in this simulated office environment did not cause any clinically significant eye discomfort and was effective at reducing pathogens in the room. These results contribute an important step to further investigation of the interaction of Far-UVC with the human eye.

Ocular and Facial Far-UVC Doses from Ceiling-Mounted 222 nm Far-UVC Fixtures

Far-UVC radiation, defined in this paper as ultraviolet (UV) radiation with wavelengths from 200 to 235 nm, is a promising tool to help prevent the spread of disease. The unique advantage of far-UVC technology over traditional UV germicidal irradiation lies in the potential for direct application of far-UVC into occupied spaces since antimicrobial doses of far-UVC are significantly below the recommended daily safe exposure limits. This study used a ceiling-mounted far-UVC fixture emitting at 222 nm to directly irradiate an indoor space and then evaluated the doses received upon a manikin. Radiation-sensitive film was affixed to the head, nose, lip and eyes of the manikin, and the 8-h equivalent exposure dose was determined. Variables examined included manikin height (sitting or standing position), manikin offset from directly below the fixture, tilt of the manikin, the addition of glasses, the addition of hair and different anatomical feature sizes. Importantly, at the manikin position with the highest dose to eyes, the average eye dose was only 5.8% of the maximum directly measured dose. These results provide the first experimental analysis of possible exposure doses a human would experience from an indoor far-UVC installation.

UV C Light from a Light-Emitting Diode at 275 Nanometers Shortens Wound Healing Time in Bacterium- and Fungus-Infected Skin in Mice

Due to the changes in pathogenic species and the absence of research on topical skin antibiotics, the therapy of skin and soft tissue infections (SSTIs) is facing more and more severe challenges. It is particularly urgent to look for alternative therapies without induction of drug resistance. UV C (UVC) light within the range of 200 to 280 nm is one of the most common techniques used to kill and/or inactivate pathogenic microorganisms. However, the traditional most commonly used wavelength of 254 nm irradiated from a low-pressure mercury lamp is hazardous to human health, being both carcinogenic and damaging to eye tissues, which limits its applications in vivo. This research aimed to investigate the antimicrobial properties and influence of 275-nm UVC light from a light-emitting diode (UVC-LED light) on wound healing time. Five bacteria, three fungi, and scalded-mouse models combined with SSTIs were used to evaluate the antimicrobial effect in vitro and in vivo. 275-nm UVC-LED light inactivated both bacteria and fungi with a very short irradiation time in vitro and induced neither DNA damage nor epidermal lesions in the mice's skin. Furthermore, in mouse models of SSTIs induced by either methicillin-resistant Staphylococcus aureus (MRSA) or Candida albicans, the 275-nm UVC-LED light showed significant antimicrobial effects and shortened the wound healing time compared with that in the no-irradiation group. UVC-LED light at 275 nm has the potential to be a new form of physical therapy for SSTIs. IMPORTANCE As a common clinical problem, the therapy of SSTIs is facing growing challenges due to an increase in the number of drug-resistant bacteria and fungi. UV C (UVC) light sterilization has been widely used in all aspects of daily life, but there are very few reports about in vivo therapy using UVC light. It is well known that prolonged exposure to UVC light increases the possibility of skin cancer. In addition, it is also very harmful for eyes. UV irradiation with 254-nm UVC light can cause corneal damage, like thinning of the corneal epithelial layer, superficial punctate keratitis, corneal erosion, etc. In this study, we focused on looking for a more accessible light source and safer UVC wavelength, and 275-nm UVC LED light was chosen. We investigated its applicability for SSTIs therapy with relative skin safety and expected that it could be used as a new physical therapy method for SSTIs.

Efficacy of immunotherapy in obese patients with cancer

Obesity is a condition of excessive fat tissue and high body mass index (BMI ≥30), which is increasing worldwide. Excess body weight is associated with poorer results in cancer treatments; however, recent studies emphasized that elevated BMI was associated with improved outcomes in cases treated by immune checkpoint inhibitor (ICI) therapies, which is called the obesity paradox. In this review, we discuss the correlation between obesity and cancer immunotherapy, especially ICIs, the underlying mechanisms, and the outcomes in different types of cancers. In addition, we describe the occurrence of immune-related adverse events (irAE) and the effect of gender in obese patients during immunotherapy using all relevant studies with available full texts.

Symmetrization and Amplification of Germicidal Radiation Flux Produced by a Mercury Amalgam UV Lamp in Cylindrical Cavity with Diffusely Reflective Walls

The study focused on increasing the efficiency of germicidal UV radiation by using highly diffuse reflective materials such as PTFE in irradiated cavities of UV air purifiers. In a conventional cylindrically symmetric cavity with a linear amalgam mercury lamp as UV-radiation source on the axis UV-radiation, flux directed from the lamp to the walls dropped from the axis to the periphery. To increase the UV irradiation, the walls are often made mirror-reflective, but the radiation flux distribution remained radially symmetric with a maximum on the source emitting surface in this case as well. When most of the emitted light is returned to the source after one reflection, the conditions of its operation are disturbed. If the walls are made of highly diffuse reflective materials, the radiation flux density inside the cavity increases on average, and its distribution becomes uniform and highly symmetric. Thus, the effect of amplification of the radiation flux due to the highly diffuse reflectivity of the walls increases with radius and reaches a maximum at the wall. Experiments were performed to demonstrate increasing amplification of germicidal UV radiation flux with a diffuse reflection coefficient in cylindrical cavities with walls of PTFE and ePTFE. The irradiation of the cavity wall was observed to increase up to 20 times at the resonant mercury line of 253.7 nm and up to 40 times at some non-resonant lines of the visible range due to highly diffuse reflectivity of the cavity walls. The flux amplification effect was limited by the diffuse reflectivity value of the walls and absorption coefficient of the radiation emitting surface. A formula for calculating the radiation flux amplification factor in a diffusely reflecting cylindrically symmetric cavity was derived for the case of Lambertian source and reflector, including wall reflectivity and source surface absorption coefficients. The effects of heating and cooling of the mercury lamp amalgam directly affected the amplification, and symmetrization of germicidal irradiation was observed and is discussed in the paper. Numerical calculations were performed by the ray tracing method. The calculated model was verified by comparing the numerical results with those of both the approximate theoretical consideration and experiments. The promising use of diffusely reflecting cylindrical cavities for UV air purifiers is discussed. Designs of air inlet and outlet ports that allow effective locking of germicidal radiation inside the UV air purifiers were considered. The results of this work may be of interest for further developments in the UV disinfection technique.

Skin tolerant inactivation of multiresistant pathogens using far-UVC LEDs

Multiresistant pathogens such as methicillin-resistant Staphylococcus aureus (MRSA) cause serious postoperative infections. A skin tolerant far-UVC (< 240 nm) irradiation system for their inactivation is presented here. It uses UVC LEDs in combination with a spectral filter and provides a peak wavelength of 233 nm, with a full width at half maximum of 12 nm, and an irradiance of 44 µW/cm2. MRSA bacteria in different concentrations on blood agar plates were inactivated with irradiation doses in the range of 15-40 mJ/cm2. Porcine skin irradiated with a dose of 40 mJ/cm2 at 233 nm showed only 3.7% CPD and 2.3% 6-4PP DNA damage. Corresponding irradiation at 254 nm caused 15-30 times higher damage. Thus, the skin damage caused by the disinfectant doses is so small that it can be expected to be compensated by the skin's natural repair mechanisms. LED-based far-UVC lamps could therefore soon be used in everyday clinical practice to eradicate multiresistant pathogens directly on humans.

The impact of far-UVC radiation (200-230 nm) on pathogens, cells, skin, and eyes - a collection and analysis of a hundred years of data

Background: The ongoing coronavirus pandemic requires new disinfection approaches, especially for airborne viruses. The 254 nm emission of low-pressure vacuum lamps is known for its antimicrobial effect, but unfortunately, this radiation is also harmful to human cells. Some researchers published reports that short-wavelength ultraviolet light in the spectral region of 200-230 nm (far-UVC) should inactivate pathogens without harming human cells, which might be very helpful in many applications. Methods: A literature search on the impact of far-UVC radiation on pathogens, cells, skin and eyes was performed and median log-reduction doses for different pathogens and wavelengths were calculated. Observed damage to cells, skin and eyes was collected and presented in standardized form. Results: More than 100 papers on far-UVC disinfection, published within the last 100 years, were found. Far-UVC radiation, especially the 222 nm emission of KrCl excimer lamps, exhibits strong antimicrobial properties. The average necessary log-reduction doses are 1.3 times higher than with 254 nm irradiation. A dose of 100 mJ/cm2 reduces all pathogens by several orders of magnitude without harming human cells, if optical filters block emissions above 230 nm. Conclusion: The approach is very promising, especially for temporary applications, but the data is still sparse. Investigations with high far-UVC doses over a longer period of time have not yet been carried out, and there is no positive study on the impact of this radiation on human eyes. Additionally, far-UVC sources are unavailable in larger quantities. Therefore, this is not a short-term solution for the current pandemic, but may be suitable for future technological approaches for decontamination in rooms in the presence of people or for antisepsis.

Improved Ultraviolet Radiation Film Dosimetry Using OrthoChromic OC-1 Film†

There is growing interest in far-UVC lighting, defined as wavelengths from 200 to 230 nm, because research has demonstrated these wavelengths to be an effective antimicrobial technology while posing a minimal hazard to human health. Far-UVC lighting is now being installed to directly irradiate spaces where humans are present, and it will be important to perform measurements to verify far-UVC lighting installations are operating within widely accepted exposure guidelines. In this work, we explore the use of a commercially available film, known as OrthoChromic OC-1, to measure ultraviolet radiation exposure. The film was tested with a variety of ultraviolet wavelengths and irradiance conditions, and the color change of the film was analyzed for increasing levels of radiant exposure. The film response extended over a dynamic range that was greater than the recommended exposure limits for far-UVC radiation so it can potentially be useful for health hazard monitoring. The spectrum of the incident ultraviolet radiation strongly affected the response of the film; therefore, for accurate measurements we recommend the measured spectrum match the spectrum used for calibration. Overall, dosimetry with this film provides a simple, accurate, and inexpensive method of quantifying ultraviolet radiation exposure that is suitable for far-UVC measurements.

Harmless Effects of Sterilizing 222-nm far-UV Radiation on Mouse Skin and Eye Tissues

In this issue, Yamano et al. provide further evidence that germicidal 222-nm far UV light has no immediate and delayed harmful effects on the skin and ocular tissue of rats. The safety of 222-nm krypton-chlorine excimer lamps, highlighted in the commentary article, has already received relevant applications in the treatment of surgical site infections and in the control of airborne and foodborne pathogens.

DNA Damage Kills Bacterial Spores and Cells Exposed to 222-Nanometer UV Radiation

This study examined the microbicidal activity of 222-nm UV radiation (UV₂₂₂), which is potentially a safer alternative to the 254-nm UV radiation (UV₂₅₄) that is often used for surface decontamination. Spores and/or growing and stationary-phase cells of Bacillus cereus, Bacillus subtilis, Bacillus thuringiensis, Staphylococcus aureus, and Clostridioides difficile and a herpesvirus were all killed or inactivated by UV₂₂₂ and at lower fluences than with UV₂₅₄B. subtilis spores and cells lacking the major DNA repair protein RecA were more sensitive to UV₂₂₂, as were spores lacking their DNA-protective proteins, the α/β-type small, acid-soluble spore proteins. The spore cores' large amount of Ca²⁺-dipicolinic acid (∼25% of the core dry weight) also protected B. subtilis and C. difficile spores against UV₂₂₂, while spores' proteinaceous coat may have given some slight protection against UV₂₂₂ Survivors among B. subtilis spores treated with UV₂₂₂ acquired a large number of mutations, and this radiation generated known mutagenic photoproducts in spore and cell DNA, primarily cyclobutane-type pyrimidine dimers in growing cells and an α-thyminyl-thymine adduct termed the spore photoproduct (SP) in spores. Notably, the loss of a key SP repair protein markedly decreased spore UV₂₂₂ resistance. UV₂₂₂-treated B. subtilis spores germinated relatively normally, and the generation of colonies from these germinated spores was not salt sensitive. The latter two findings suggest that UV₂₂₂ does not kill spores by general protein damage, and thus, the new results are consistent with the notion that DNA damage is responsible for the killing of spores and cells by UV₂₂₂IMPORTANCE Spores of a variety of bacteria are resistant to common decontamination agents, and many of them are major causes of food spoilage and some serious human diseases, including anthrax caused by spores of Bacillus anthracis Consequently, there is an ongoing need for efficient methods for spore eradication, in particular methods that have minimal deleterious effects on people or the environment. UV radiation at 254 nm (UV₂₅₄) is sporicidal and commonly used for surface decontamination but can cause deleterious effects in humans. Recent work, however, suggests that 222-nm UV (UV₂₂₂) may be less harmful to people than UV₂₅₄ yet may still kill bacteria and at lower fluences than UV₂₅₄ The present work has identified the damage by UV₂₂₂ that leads to the killing of growing cells and spores of some bacteria, many of which are human pathogens, and UV₂₂₂ also inactivates a herpesvirus.