Implementation Lessons Learned From the Benefits of Enhanced Terminal Room (BETR) Disinfection Study: Process and Perceptions of Enhanced Disinfection with Ultraviolet Disinfection Devices

Abstract

OBJECTIVE To summarize and discuss logistic and administrative challenges we encountered during the Benefits of Enhanced Terminal Room (BETR) Disinfection Study and lessons learned that are pertinent to future utilization of ultraviolet (UV) disinfection devices in other hospitals DESIGN Multicenter cluster randomized trial SETTING AND PARTICIPANTS Nine hospitals in the southeastern United States METHODS All participating hospitals developed systems to implement 4 different strategies for terminal room disinfection. We measured compliance with disinfection strategy, barriers to implementation, and perceptions from nurse managers and environmental services (EVS) supervisors throughout the 28-month trial. RESULTS Implementation of enhanced terminal disinfection with UV disinfection devices provides unique challenges, including time pressures from bed control personnel, efficient room identification, negative perceptions from nurse managers, and discharge volume. In the course of the BETR Disinfection Study, we utilized several strategies to overcome these barriers: (1) establishing safety as the priority; (2) improving communication between EVS, bed control, and hospital administration; (3) ensuring availability of necessary resources; and (4) tracking and providing feedback on compliance. Using these strategies, we deployed ultraviolet (UV) disinfection devices in 16,220 (88%) of 18,411 eligible rooms during our trial (median per hospital, 89%; IQR, 86%-92%). CONCLUSIONS Implementation of enhanced terminal room disinfection strategies using UV devices requires recognition and mitigation of 2 key barriers: (1) timely and accurate identification of rooms that would benefit from enhanced terminal disinfection and (2) overcoming time constraints to allow EVS cleaning staff sufficient time to properly employ enhanced terminal disinfection methods. TRIAL REGISTRATION Clinical trials identifier: NCT01579370 Infect Control Hosp Epidemiol 2018;39:157-163.

Effectiveness of targeted enhanced terminal room disinfection on hospital-wide acquisition and infection with multidrug-resistant organisms and Clostridium difficile: a secondary analysis of a multicentre cluster randomised controlled trial with crossover design (BETR Disinfection)

“…13 This finding further suggests that patients with asymptomatic colonisation with multidrug-resistant organisms might serve as a source of environmental contamination that increases risk for subsequent patients admitted to hospital. Coupled with implementation data from our trial, 23 this finding also underscores the challenge of providing enhanced terminal disinfection with UV to high-risk rooms. Despite casting a wide net to capture eligible rooms, we only used the UV machine in 60% of seed rooms (see categories 2 and 4 in figure 2) because of delays in assessment of microbiological results or missed opportunities.…”

Self-Disinfecting Copper Beds Sustain Terminal Cleaning and Disinfection Effects throughout Patient Care

“…Consequently, as the significance of the findings is considered here, the observation that the antimicrobial action of copper on near-patient surfaces kept these areas at microbial burden levels below the TC&D risk threshold may suggest infection control dividends of fewer infections and better outcomes. Furthermore, it is anticipated that encapsulated copper surfaces will have a higher likelihood of reducing the inherent risk associated with near-patient surfaces than will adjunct, intermittent, and discontinuous disinfection technologies entering the marketplace, such as UV irradiation and vapor phase hydrogen peroxide, or indicator glow markers, covertly placed on near-patient contact locations (35)(36)(37)(38)(39)(40), which are intended to identify surfaces that environmental services (EVS) workers endeavored to clean, rather than whether the surfaces are, in fact, microbiologically clean.…”

“…Additional methods evaluated extensively by the infection control community, like the process of daily cleaning, are two "no-touch" technologies: hydrogen peroxide vapor deposition (HPV) within patient care settings (42) and UV C (100 nm to 280 nm spectrum energy)-based systems (43,44). Both methods have been shown to be effective in reducing burden within the built environment (35,36,42,(45)(46)(47), but each is limited as an intervention by being a discontinuous antimicrobial technology, with each adding significantly to the cost of terminal cleaning and disinfection of patient rooms.…”

Reduced isolation room turnover time using Lean methodology

“…Step 4 UV tech disinfects room 13 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23) 11 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) .1940…”

“…Reports from a recent large trial indicate that hospital staff perception is important, one barrier to program success was a perceived delay in patient flow caused by UV disinfection. 7 The goal of this study was to maximize program efficiency and enhance UV disinfection coverage of isolation rooms without postponing subsequent admissions or requiring additional capital investment. Because we elected to not hold rooms for disinfection, technicians needed to complete UV treatment in the time between completion of room cleaning and room occupancy by the next patient.…”