By William A. Rutala and Alice Brewer / Special to Healthcare Facilities Today

As we enter a new decade, we applaud the progress that has been made in improving hospital technology and modernizing healthcare environments.  However, in infection control, while there have been significant developments, key challenges persist, including how to effectively and efficiently prevent healthcare-associated infections (HAIs) to protect the health of patients in our care. According to the CDC, HAIs remain a serious health issue. It is estimated that 687,000 patients developed a HAI in United States acute-care facilities in 2015, causing or contributing to 72,000 deaths. 

Advances in infection control

What’s promising, however, is that the decade has produced significant advancements in infection control that are transforming the industry. Innovations include new “no-touch” or total room decontamination technologies such as ultraviolet (UVC) light and vaporized hydrogen peroxide as well as continuous room decontamination technologies such as self-disinfecting surfaces and continuously active disinfectants.^1-6 A growing number of clinical studies have demonstrated that “no-touch” technologies are effective in reducing bacterial contamination of surfaces and can reduce colonization/infection in patients admitted to these hospital rooms.^1-3 

UVC technology

One leading technology being used today is UVC light systems, which emit UV light from portable automated units at a wavelength that kills bacteria, viruses and other pathogens. In recent years, multiple trials have demonstrated a reduction of HAIs with the use of UVC.²  In addition, numerous studies have assessed the effectiveness of UVC devices to inactivate microbes on test surfaces, which were placed in typical hospital rooms. Overall, there is substantial consistency across many of these studies showing reliable, safe and rapid decontamination against a wide range of infectious agents.^1-3 

Integrated approach is essential

New advances in decontamination have moved the healthcare industry toward a more effective, layered or “bundled” approach to infection prevention,⁴ which combines traditional hard surface cleaning and disinfection with terminal room “no touch” decontamination after discharge of patients on contact precautions. An integrated approach addresses all common sources of infection and transmission, including caregivers’ hands, patients’ skin, surfaces and the overall environment.  The key is the combination of standard “touch” methods, such as wipes and hard surface disinfection, with “no-touch,” automated room decontamination technologies such as UVC.   

'No-touch' plus 'touch' is key

HAIs can be transmitted by multiple sources, including the environment.  Multiple studies have demonstrated that surfaces in hospital rooms are often insufficiently cleaned during standard terminal cleaning and disinfection. In fact, studies showed that less than 50% of room surfaces were properly cleaned.⁴ Adding an automated technology as part of a comprehensive, layered process is essential for combating all types of pathogens on all surfaces.

Manual cleaning/disinfection still needed

Still, it is important to note that automated room decontamination technologies should not replace traditional “touch” cleaning/disinfection methods. Rather, UVC should be used in conjunction with standard “touch” cleaning/disinfection protocols to effectively remove organic dust, debris and pathogens. The surface environment in patients’ rooms may be persistently re-contaminated by healthcare personnel and patients, despite daily room cleaning and disinfection. Hands of healthcare providers can become colonized by touching contaminated surfaces and equipment and then transfer the pathogens to patients.⁴ 

Recent research supports integrated approach

In a study led by Duke Health and sponsored by the CDC, UVC technology in combination with manual disinfection that included the use of surface disinfectants, reduced the relative risk of colonization and infection caused by epidemiologically-important pathogens among patients admitted to the same room by as much as 30% in hospital settings with 93% compliance of standard disinfection protocols. Individual hospital results may vary.³

Cost savings

Despite the sizeable initial costs, the savings associated with preventing infections and saving lives, year after year, are clearly more significant. If the UVC device reduced HAIs for approximately 20% of patients (patients of Contact Precautions) by 10-30% as demonstrated in a randomized trial,^3,7 a 900-bed hospital with an infection rate of approximately 4 per 1,000 patient days would see approximately 18-55 fewer infections per year. If the hospital prevented 10% of infections per year (18 per year) for two years, the cost savings would be $309,000.  If 30% of infections were prevented per year (55 per year) for two years, the cost savings would be $2,085,000.⁸ An independent analysis found the cost savings of no-touch terminal room disinfection on Clostridioides difficile infection incidence to be $348,528 to $1,537,000 per fiscal year.⁹

Best practices

To combat the ongoing battle against infection and patient harm, healthcare facilities need to establish a comprehensive, layered set of procedures combining appropriate cleaning and disinfecting products and “no-touch” technology.  Staff at all levels need to be educated on proper protocols, and compliance must be monitored.⁴ As the scientific community continues to test and research new technologies, we will be better prepared to protect patients and save lives based on evidence-based policies.

William A. Rutala, Ph.D., M.P.H., CIC, is the Director of the North Carolina Statewide Program for Infection Control and Epidemiology (SPICE) , Professor, UNC., and a consultant for PDI and Alice Brewer, MPH, CIC, is the Director of Clinical Affairs for Tru-D® SmartUVC.

References:

1. Weber DJ, Kanamori H, Rutala WA. “No touch” technologies for environmental decontamination: Focus on UV devices and hydrogen peroxide systems.  Current Opinions Infect Dis.  2016;29:424-431.

2. Weber DJ, Rutala WA, Anderson DJ, Chen LF, Sickbert-Bennett EE, Boyce JM. Effectiveness of UV devices and hydrogen peroxide systems for terminal room decontamination: Focus on clinical trials. Am J Infect Control 2016;44:e77-e84.

3. Anderson D, Chen LF, Weber DJ, Moehring RW, Lewis SS, Triplett P, Blocker M, Becherer P, Schwab JC, Knelson LP,  Lokhnygina Y, Rutala WA, Sexton DJ, and CDC Prevention Epicenter Program. The benefits of enhanced terminal room (BETR) disinfection study: A cluster randomized, multicenter crossover study with 2x2 factorial design to evaluate the impact of enhanced terminal room disinfection on acquisition and infection caused by multidrug-resistant organisms (MDROs). The Lancet. 2017;389:805-814.

4. Rutala WA, Weber DJ.  Best practices for disinfection of noncritical environmental surfaces and equipment in health care facilities: A bundle approach.  Am J Infect Control. 2019;47:A96-A105

5. Rutala WA, Gergen MF, Weber DJ. Room decontamination with UV radiation. Infect Control Hosp Epidemiol 2010;31:1025-9.

6. Rutala WA, Sickbert-Bennett EE, Anderson DJ, Weber DJ, CDC Prevention Epicenters Program. Antimicrobial activity of a continuously active disinfectant against healthcare pathogens. Infect Control Hosp Epidemiol. 2019:doi:10.1017/ice.2019.260.

7. Rutala WA, Kanamori H, Gergen MF, Knelson LP, Sickbert-Bennett EE, Chen LF, Anderson DJ, Sexton DJ, Weber DJ, CDC Prevention Epicenters Program. Enhanced disinfection leads to a reduction in microbial contamination and a reduction in patient infection and colonization. Infect Control Hosp Epidemiol. 2018;39:1118-1121.

8. Rutala WA. Healthcare Hygiene Magazine. January 2020. https://www.healthcarehygienemagazine.com/monthly-issues/

9. Pegues DA, Han J, Gilmar C, McDonnell B, Gaynes S. Impact of ultraviolet germicidal irradiation for no-touch terminal room disinfection on Clostridium difficile infection incidence among heamatology-oncology patients. Infect Control Hosp Epidemiol 2017;38:39-44