Implementation of an Environmental Cleaning Protocol in Hospital Critical Areas Using a UV-C Disinfection Robot

Kinetics of inactivation of bacteria responsible for infections in hospitals using UV-LED

Controlling the microbial load in the environment is crucial to prevent the spread of organisms. The continuous spread of nosocomial infections in hospital facilities and the emergence of the coronavirus (COVID-19) highlighted the importance of disinfection processes in health safety. This work aimed to evaluate the effectiveness of LED-based disinfection lamps on bacteria from the ESKAPEE group and virus phage in vitro inactivation to be applied in hospital environments and health facilities disinfection. This study evaluated the effect of different UV wavelengths (275 nm, 280 nm (UVC), 310 nm (UVB) and 340 nm (UVA)) on the disinfection process of various microbial indicators including E. coli, S. aureus, P. aeruginosa, B. subtilis and Bacteriophage lambda DSM 4499. Exposure time (5 min-30 min), exposure distance (0.25 m and 0.5 m) and surface materials (glass, steel, and polished wood) were evaluated on the disinfection efficiency. Furthermore, the study determined the recovery capacity of each species after UV damage. UVC-LED lamps could inactivate 99.99 % of microbial indicators after 20 min exposures at a 0.5 m distance. The exposure time needed to completely inactivate E. coli, S. aureus, P. aeruginosa, B. subtilis and Bacteriophage lambda DSM 4499 can be decreased by reducing the exposure distance. UVB-LED and UVA-LED lamps were not able to promote a log reduction of 4 and were not effective on B. subtilis or bacteriophage lambda DSM 4499 inactivation. Thus, only UVC-LED lamps were tested on the decontamination of different surface materials, which was successful. P. aeruginosa showed the ability to recover from UV damage, but its inactivation rate remains 99.99 %, and spores from B. subtilis were not completely inactivated. Nevertheless, the inactivation rate of these indicators remained at 99.99 % with 24 h incubation after UVC irradiation. UVC-LED lamps emitting 280 nm were the most indicated to disinfect surfaces from microorganisms usually found in hospital environments.

Characterization and Photocatalytic and Antibacterial Properties of Ag- and TiOx-Based (x = 2, 3) Composite Nanomaterials under UV Irradiation

Metal and metal oxide nanostructured materials have been chemically and physically characterized and tested concerning methylene blue (MB) photoremoval and UV antibacterial activity against Escherichia coli and Staphylococcus aureus. In detail, silver nanoparticles and commercial BaTiO3 nanoparticles were modified to obtain nanocomposites through sonicated sol-gel TiO2 synthesis and the photodeposition of Ag nanoparticles, respectively. The characterization results of pristine nanomaterials and synthetized photocatalysts revealed significant differences in specific surface area (SSA), the presence of impurities in commercial Ag nanoparticles, an anatase phase with brookite traces for TiO2-based nanomaterials, and a mixed cubic-tetragonal phase for BaTiO3. Silver nanoparticles exhibited superior antibacterial activity at different dosages; however, they were inactive in the photoremoval of the dye. The silver-TiOx nanocomposite demonstrated an activity in the UV photodegradation of MB and UV inhibition of bacterial growth. Specifically, TiO2/AgNP (30-50 nm) reduced growth by 487.5 and 1.1 × 103 times for Escherichia coli and Staphylococcus aureus, respectively, at a dose of 500 μg/mL under UV irradiation.

Shedding light on the problem: Influence of the radiator power, source-sample distance, and exposure time on the performance of UV-C lamps in laboratory and real-world conditions

Effective surface disinfection is crucial for preventing the spread of pathogens in hospitals. Standard UltraViolet-C (UV-C) lamps have been widely used for this purpose, but their disinfection efficiency under real-world conditions is not well understood. To fill this gap, the influence of the power of the ultraviolet radiator, source-sample distance, and exposure time on the performance of UV-C lamps against Escherichia coli and Staphylococcus epidermidis were experimentally determined in the laboratory and hospital. The obtained results showed that the UV irradiance and, thus, the UV-C disinfection efficiency decreased significantly at distances greater than 100 cm from the UV-C lamp. Moreover, increasing the total power of the radiators does not improve the performance of UV-C lamps under real conditions. The UV-C disinfection efficiency greater than 90% was achieved only under laboratory conditions at a close distance from the UV-C lamp, i.e., 10 cm. These findings provide novel insights into the limitations of UV-C lamps in real-world conditions and highlight the need for more effective disinfection strategies in hospitals.

Characterization of class 1 integrons in metallo-β-lactamase-producing Acinetobacter baumannii isolates from hospital environment

BACKGROUND AND OBJECTIVE

The emergence and widespread dissemination of antibiotic resistance in A. baumannii, has become a globally challenge. The increasing hospital outbreaks by multi-drug resistant (MDR) A. baumannii strains, shows the necessity of continuous monitoring to find sources of resistant strains in hospitals. This study aimed to identify the presence of class 1 integrons and metallo-β-lactamase (MBL) related genes in A. baumannii isolates from hospital environment.

METHODS

In order to identify A. baumannii isolates, a total of 297 environmental samples were collected from burn wards and intensive care units (ICUs) of two university hospitals. Resistance to common antibiotics was studied by disk diffusion method and microbroth dilution assay was used to determine the minimum inhibitory concentrations (MICs) of imipenem, colistin and tigecycline. The A. baumannii isolates were studied by polymerase chain reaction (PCR) for the presence of class 1 integrons (intI1, intl CS) and metallo-β-lactamases (MBLs) (blaIMP, blaVIM, blaNDM) genes.

RESULTS

A. baumannii was identified in 68/297 (22.9%) of hospital environment. All A. baumannii strains were multidrug-resistant (MDR), but none of them were resistant to colistin, tigecycline and ampicillin-sulbactam. All (100%) and 38 (95.0%) of A. baumannii isolates from ICUs and burn wards were imipenem resistant respectively. Class 1 integrons was identified in 30/40 (75.0%) and 23/28 (82.1%) isolates from burn wards and ICUs respectively. Two different types of gene cassettes were identified, which included: arr-2, ereC, aadA1, cmlA5 and arr2, cmlA5. MBL genes including blaVIM and blaIMP were detected in 26/28 (92.8%), 27/28(96.4%) and 39/40 (97.5%) and 31/40 (77.5%) of the isolates from the ICUs and the burn wards respectively. None of the isolates contained the blaNDM-1 gene.

CONCLUSION

The findings of the present study showed that the isolation rate of MBL producing carbapenem-resistant A. baumannii (CRAB) was relatively high in the environmental surface of burn wards and ICUs, which can be considered as a potential source of outbreaks in hospitalized patients.

úNo touch..Ñ methods for health care room disinfection: Focus on clinical trials

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.

Using photon disinfection technologies for reducing bioburden in hospitals

BACKGROUND

Environmental cleaning and disinfection is the basis of the prevention of healthcare-acquired infections (HAIs).

AIM

This study aimed to describe photon disinfection technologies (PDTs), report their impact on inactivating micro-organisms and preventing HAIs and to create recommendations for their implementation in hospital settings.

METHODS

An integrated literature review was completed to evaluate and report the impact of PDTs in hospital settings. The quality of 23 articles were assessed, their contents analysed and results reported according to the PICOT model.

FINDINGS

The microbiological impact of the PDT varied by micro-organism, settings and according to the used devices. It was crucial that environmental cleaning was completed before the disinfection.

CONCLUSION

The implementation of PDT in the hospital setting requires inquiry from the viewpoints of microbiological, environmental, occupational, technical and human safety. To enhance the safe implementation of PDTs, the construction and use of evidence-based global standards for PDT are crucial.

Hospital cleaning: past, present, and future

INTRODUCTION

The importance of hospital cleaning for controlling healthcare-associated infection (HAI) has taken years to acknowledge. This is mainly because the removal of dirt is inextricably entwined with gender and social status, along with lack of evidence and confusion over HAI definitions. Reducing so-called endogenous infection due to human carriage entails patient screening, decolonisation and/or prophylaxis, whereas adequate ventilation, plumbing and cleaning are needed to reduce exogenous infection. These infection types remain difficult to separate and quantitate. Patients themselves demonstrate wide-ranging vulnerability to infection, which further complicates attempted ranking of control interventions, including cleaning. There has been disproportionate attention towards endogenous infection with less interest in managing environmental reservoirs.

QUANTIFYING CLEANING AND CLEANLINESS

Finding evidence for cleaning is compromised by the fact that modelling HAI rates against arbitrary measurements of cleaning/cleanliness requires universal standards and these are not yet established. Furthermore, the distinction between cleaning (soil removal) and cleanliness (soil remaining) is usually overlooked. Tangible bench marking for both cleaning methods and all surface types within different units, with modification according to patient status, would be invaluable for domestic planning, monitoring and specification.

AIMS AND OBJECTIVES

This narrative review will focus on recent history and current status of cleaning in hospitals. While its importance is now generally accepted, cleaning practices still need attention in order to determine how, when and where to clean. Renewed interest in removal and monitoring of surface bioburden would help to embed risk-based practice in hospitals across the world.

Preventing Multidrug-Resistant Bacterial Transmission in the Intensive Care Unit with a Comprehensive Approach: A Policymaking Manual

Patients referred to intensive care units (ICU) commonly contract infections caused by multidrug-resistant (MDR) bacteria, which are typically linked to complications and high mortality. There are numerous independent factors that are associated with the transmission of these pathogens in the ICU. Preventive multilevel measures that target these factors are of great importance in order to break the chain of transmission. In this review, we aim to provide essential guidance for the development of robust prevention strategies, ultimately ensuring the safety and well-being of patients and healthcare workers in the ICU. We discuss the role of ICU personnel in cross-contamination, existing preventative measures, novel technologies, and strategies employed, along with antimicrobial surveillance and stewardship (AMSS) programs, to construct effective and thoroughly described policy recommendations. By adopting a multifaceted approach that combines targeted interventions with broader preventive strategies, healthcare facilities can create a more coherent line of defense against the spread of MDR pathogens. These recommendations are evidence-based, practical, and aligned with the needs and realities of the ICU setting. In conclusion, this comprehensive review offers a blueprint for mitigating the risk of MDR bacterial transmission in the ICU, advocating for an evidence-based, multifaceted approach.