Clinical, operational, and financial impact of an ultraviolet-C terminal disinfection intervention at a community hospital

Raggi, R; Archulet, Kenneth; Haag, Cody; Tang, Weiming

doi:10.1016/j.ajic.2018.05.012

Cited by 26 publications

(39 citation statements)

References 22 publications

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“…Thus, any addition to the standard of care required to enhance infection control requires a consideration of the cost of the intervention with respect to its impact on the HAI rate. 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.…”

Section: Discussionmentioning

confidence: 99%

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

Schmidt

Attaway

Fairey

et al. 2019

Appl Environ Microbiol

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Microbial burden associated with near-patient touch surfaces results in a greater risk of health care-associated infections (HAIs). Acute care beds may be a critical fomite, as traditional plastic surfaces harbor the highest concentrations of bacteria associated with high-touch surfaces in a hospital room’s patient zone. Five high-touch intensive care unit (ICU) bed surfaces encountered by patients, health care workers, and visitors were monitored by routine culture to assess the effect U.S. Environmental Protection Agency (U.S. EPA)-registered antimicrobial copper materials have on the microbial burden. Despite both daily and discharge cleaning and disinfection, each control bed’s plastic surfaces exceeded bacterial concentrations recommended subsequent to terminal cleaning and disinfection (TC&D) of 2.5 aerobic CFU/cm2. Beds with self-disinfecting (copper) surfaces harbored significantly fewer bacteria throughout the patient stay than control beds, at levels below those considered to increase the likelihood of HAIs. With adherence to routine daily and terminal cleaning regimes throughout the study, the copper alloy surfaces neither tarnished nor required additional cleaning or special maintenance. Beds encapsulated with U.S. EPA-registered antimicrobial copper materials were found to sustain the microbial burden below the TC&D risk threshold levels throughout the patient stay, suggesting that outfitting acute care beds with such materials may be an important supplement to controlling the concentration of infectious agents and thereby potentially reducing the overall HAI risk. IMPORTANCE Despite cleaning efforts of environmental service teams and substantial compliance with hand hygiene best practices, the microbial burden in patient care settings often exceeds concentrations at which transfer to patients represents a substantial acquisition risk for health care-associated infections (HAIs). Approaches to limit HAI risk have relied on designing health care equipment and furnishings that are easier to clean and/or the use of no-touch disinfection interventions such as germicidal UV irradiation or vapor deposition of hydrogen peroxide. In a clinical trial evaluating the largest fomite in the patient care setting, the bed, a bed was encapsulated with continuously disinfecting antimicrobial copper surfaces, which reduced the bacteria on surfaces by 94% and sustained the microbial burden below the terminal cleaning and disinfection risk threshold throughout the patient’s stay. Such an intervention, which continuously limits microbes on high-touch surfaces, should be studied in a broader range of health care settings to determine its potential long-range efficacy for reducing HAI.

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Section: Discussionmentioning

confidence: 99%

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

Schmidt

Attaway

Fairey

et al. 2019

Appl Environ Microbiol

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“…These studies would have been seriously compromised by such initiatives, when such activities are already known to have a major impact of HAI rates. The studies by Raggi et al [22] and Haas et al [43], Ethington et al [26], Kane et al [27], McCord et al [37] and Horn and Otter [38] illustrate a range of pitfalls in a decontamination assessment [59]. Conversely, the articles by Pegues et al [31] and Brite et al [23] are good examples of studies that attempted to control confounders.…”

Section: Common Confounders Infection Prevention and Controlmentioning

confidence: 99%

“…These authors are not necessarily employees of the company but may be contracted or asked to provide support such as statistical analysis, writing or laboratory testing. This was evident in studies using UV devices, in particular [22,26,27,35,36,39,41]. Another strategy is socalled 'salami slicing' , whereby multiple publications are linked with one original study; this is seen with the BETR study, which generated several papers examining whole or partial datasets using different objectives and/or perspectives for analyses [21,24,30,[63][64][65].…”

Section: Business and Industry Involvementmentioning

confidence: 99%

“…This is called Simpson's paradox, where a trend appears to be positive when the data is aggregated but negative when it is disaggregated (when examining individual groups or data collections). Several studies amalgamated selected outcomes together in order to achieve statistical significance [21,22,26,29,30,34,35,39,43,47]. This clearly skews reporting and future conclusions from metanalyses.…”

Section: Statistical Aberrationsmentioning

confidence: 99%

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Systematic review on use, cost and clinical efficacy of automated decontamination devices

Dancer

King

2021

Antimicrob Resist Infect Control

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Background More evidence is emerging on the role of surface decontamination for reducing hospital-acquired infection (HAI). Timely and adequate removal of environmental pathogens leads to measurable clinical benefit in both routine and outbreak situations. Objectives This systematic review aimed to evaluate published studies describing the effect of automated technologies delivering hydrogen peroxide (H202) or ultra-violet (UV) light on HAI rates. Methods A systematic review was performed using relevant search terms. Databases were scanned from January 2005 to March 2020 for studies reporting clinical outcome after use of automated devices on healthcare surfaces. Information collected included device type, overall findings; hospital and ward data; study location, length and size; antimicrobial consumption; domestic monitoring; and infection control interventions. Study sponsorship and duplicate publications were also noted. Results While there are clear benefits from non-touch devices in vitro, we found insufficient objective assessment of patient outcome due to the before-and-after nature of 36 of 43 (84%) studies. Of 43 studies, 20 (47%) used hydrogen peroxide (14 for outbreaks) and 23 (53%) used UV technology (none for outbreaks). The most popular pathogen targeted, either alone or in combination with others, was Clostridium difficile (27 of 43 studies: 63%), followed by methicillin-resistant Staphylococcus aureus (MRSA) (16 of 43: 37%). Many owed funding and/or personnel to industry sponsorship (28 of 43: 65%) and most were confounded by concurrent infection control, antimicrobial stewardship and/or cleaning audit initiatives. Few contained data on device costs and rarely on comparable costs (1 of 43: 2%). There were expected relationships between the country hosting the study and location of device companies. None mentioned the potential for environmental damage, including effects on microbial survivors. Conclusion There were mixed results for patient benefit from this review of automated devices using H202 or UV for surface decontamination. Most non-outbreak studies lacked an appropriate control group and were potentially compromised by industry sponsorship. Concern over HAI encourages delivery of powerful disinfectants for eliminating pathogens without appreciating toxicity or cost benefit. Routine use of these devices requires justification from standardized and controlled studies to understand how best to manage contaminated healthcare environments.

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“…Multidrug-resistant organisms (MDROs) are hyperendemic in health care settings of developing countries, including Brazil. 1,2 Given their epidemiologic pressure, it is possible that MDROs migrate from hospitals to the community. 3 Recent studies have reported increasing identification of MDROs in cultures from nonhospitalized persons.…”

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confidence: 99%

Shining a light on ultraviolet-C disinfection: No golden promises for infection prevention

Kraker

Harbarth

Dancer

2018

American Journal of Infection Control

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We read with interest the article by Raggi et al, "Clinical, Operational, and Financial Impact of an Ultraviolet-C Terminal Disinfection Intervention at a Community Hospital." 1 Unfortunately, we believe that this article has methodological flaws, along with unreported data, which undermine the stated conclusions. It is a single-center, before-after study, in a 377-bed community hospital, with an illdefined primary outcome: incidence of multidrug-resistant (MDR) hospital-acquired infections (HAIs). The authors concluded that ultraviolet-C (UVC) terminal disinfection resulted in a statistically significantly reduced incidence of MDR HAIs, saving the hospital $1.2 million. 1 However, the cost of the UVC systems and their implementation was not provided, nor was it subtracted from the overall cost savings provided.The applied definition of HAIs was as follows: "(1) cultures collected after 48 hours of admission, (2) diagnosis at admission different from HAI diagnosis, and (3) colonization or infection contributing to increased length of hospital stay." 1 The culture sites included blood, body fluid, nares, sputum, urine, and wounds. It is unclear how it was determined whether HAI increased the length of stay. Single patients could have had multiple HAIs if multiple body sites were positive. How did the authors know which positive sample was responsible for an increased length of stay? Moreover, how did colonized nares increase the length of stay? Although positive blood cultures are most likely to indicate infection, culture-positive body fluids, sputum, or urine are less so, and positive nares almost never represent an infection. How can simple carriage events contribute to the incidence of HAI? This study did not evaluate HAI but rather colonization, which is an important difference and does not have the same implications.Furthermore, no information was provided on the MDR screening 0196-6553/Crown

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Clinical, operational, and financial impact of an ultraviolet-C terminal disinfection intervention at a community hospital

Cited by 26 publications

References 22 publications

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

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

Systematic review on use, cost and clinical efficacy of automated decontamination devices

Shining a light on ultraviolet-C disinfection: No golden promises for infection prevention

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