Hospital-acquired infections (HAIs) may be acquired through surgery, the use of medical devices, the hospital environment, the patient’s own flora, and from contact with health care workers (HCWs) and visitors. With an estimated one in 25 hospitalized patients having at least one hospital-associated infection on any given day, this serious issue continues to cause morbidity and deaths while adding billions to health care costs.
The thoroughness of terminal cleaning of patient rooms is one area of focus to reduce HAIs, and some hospitals have adopted environmental disinfection systems that use ultraviolet-C (UV-C) light or hydrogen peroxide vapor (HPV) to complement existing infection control protocols. Two of ECRI Institute’s previous Top 10 Hospital C-suite Watch Lists featured devices using ultraviolet (UV) light (disinfection robots) and visible LED ceiling fixtures (Indigo-Clean™ lights). These devices can also help to battle hard-to-eradicate pathogens like Clostridium difficile (C. diff), methicillin-resistant Staphylococcus aureus (MRSA), and other multidrug-resistant organisms. Challenges of using UV robots include their bulk, significant time required to disinfect a room, and lack of continuous disinfection protection. LED fixtures installed in the ceiling can provide continuous disinfection over areas they cover, but may provide undesirable lighting effects that patients don’t like for long periods in their rooms. And neither of these technologies are used to disinfect mobile technologies, such as phones and stethoscopes, which clinicians carry from patient to patient.
The Tru-D Ultraviolet (UV-C) Disinfection System is a portable, remote-controlled device intended for environmental disinfection to prevent spread of hospital-associated infections by emitting UV-C irradiation. Tru-D uses an intuitive technology to calculate the dose of UV light required to kill harmful pathogens. The system uses low-pressure mercury vapor lamps to deliver UV-C light at a UV wavelength of 254 nanometers (nm).
A new LED disinfection option, which comes in strips, has recently been introduced by the LED industry. There have been advances in LEDs that emit light in the “deep UV” range, also called UV-C, which is a range below 290 nm (wavelengths between 250 and 280 nm are known to have the greatest germicidal effect). These advances include innovation in LED materials to emit light in the germicidal range, reduced power consumption, stabilized and increased output power, and the longer life of the lights. These new LED lights are flexible enough that they can be arranged to disinfect out-of-the-way surfaces (e.g., under beds, under countertops). Manufacturers are developing LED lights for health care applications; devices like sanitizing wands and UV disinfecting cabinets for smartphones and tablets are under way.
In several studies using these UV-C LEDs, colony forming units for common pathogenic microbes were significantly reduced when treated with UV-C LEDs using at least 30 seconds of exposure time and placed 2 inches or closer to the light source. Other distinct advantages include availability in very compact sizes that offer enormous flexibility to create point-of-use disinfection devices with a smaller footprint. In addition, arrays of LEDs can be mounted in any geometry to eliminate disinfection “cold spots” found in patient rooms. One of the biggest advantages is that LEDs have no warm-up time and can cycle on and off instantaneously, which provides faster disinfection. With a lower initial purchase cost and reduced maintenance compared to UV robots and UV lamps, LED disinfection systems may be more financially viable. Important to note is that none of these options replaces terminal cleaning of patient rooms – these are intended for use in conjunction with terminal cleaning protocols.
Contaminated surfaces in hospitals, including in patient rooms and nursing stations, can be reservoirs for pathogenic microorganisms such as bacteria and viruses. Organisms such as MRSA, vancomycin-resistant enterococci (VRE), C. diff spores, and norovirus can inhabit various surfaces of hospital rooms, causing infection risks to patients. Healthcare workers can contaminate their hands on these surfaces, further spreading these pathogens after an infected patient has left the room. Given these hazards, efforts are ongoing to improve and refine environmental disinfection techniques, particularly in hospitals, medical clinics, and laboratories.
Environmental disinfection procedures include the use of hydrogen peroxide vapor, gaseous systems using formaldehyde or chlorine dioxide, and sodium hypochlorite (bleach) solutions to wipe down surfaces. More recently, UV light has been increasingly used as an effective method to kill microorganisms. UV light has been used routinely to disinfect air and drinking water for many years. UV light wavelengths fall within the 10 to 400 nm range, but studies have shown the most effective wavelengths for killing bacteria are in the 200 to 320 nm range: the UV-B and UV-C ranges of the UV spectrum. Other UV room disinfection systems include the Xenex Germ-Zapping Robot, Clorox Optimum-UV, and Steris Pathogon.
What You Can Do
Have your infection prevention and value analysis teams work together to trial some of these new offerings in small areas (e.g., under countertops) and for point-of-use disinfection of devices like cellphones and stethoscopes in disinfection boxes and workstation disinfection wands to combat pathogenic microbes with these well-known carrier locations.
Consider using overhead arrays of UV-C LEDs instead of mercury vapor lamps in room-air-disinfection systems for an environmentally safer solution.
Look for public and other areas in your facilities where low-cost UV-C LED disinfection devices could be used, such as overhead ambient air disinfection in waiting rooms or in laboratory workstations where point-of-use devices could be used.
Stay tuned! In the next issue of TechNation, we’ll take a deeper dive into another topic featured on ECRI Institute’s 2017 Top 10 Hospital C-Suite Watch List.
This article is excerpted from ECRI Institute’s 2017 Top 10 Hospital C-Suite Watch List. To download the full report, visit www.ecri.org/2017watchlist. For more information on ECRI Institute’s evidence-based health technology assessment or consulting services, contact firstname.lastname@example.org, or call (610) 825-6000, ext. 5889.
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