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Pulsed UV light disinfection system shows promise for OR decontamination
Pulsed UV light disinfection system shows promise for OR decontamination Leslie Knudson Managing Editor he emergence and prevalence of dangerous “superbugs,” such as Clostridium difficile (C. diff), methicillin-resistant Staphylococcus aureus (MRSA), and other multidrug-resistant organisms (MDROs), in health care settings has called for heightened infection prevention and control efforts in all aspects of patient care. In particular, greater attention has been given to the role of the environment in the transmission of deadly pathogens and the incidence of health care-acquired infections (HAIs). Evidence shows that contaminated hospital surfaces play a key role in the transmission of C. diff and that enhanced environmental cleaning is needed for rooms that house C. diff patients.1 As health care facilities look to improve their environmental cleaning, “no-touch” methods for room disinfection are emerging as viable options that can augment traditional room cleaning processes.
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Pulsed UV technology The pulsed xenon ultraviolet (UV) light disinfection system from Xenex Disinfection Services uses high intensity pulses to emit UV light at frequencies that cross the germicidal UV range, the range at which microorganisms are susceptible to UV damage. The high UV frequencies offer different pathways of damage to microorganisms by damaging cell walls and cellular structures and impeding the ability for microorganisms to replicate. “The intensity of the pulse gives it a couple other properties, so it reflects very differently around the room than conventional mercury UV and does different types of damage to organisms, but it’s also easier
THE PULSED XENON ULTRAVIOLET (UV) disinfection system uses high-energy UV light to damage the cell walls of bacteria, viruses, and bacterial spores. Photo courtesy of Xenex Disinfection Services.
on the equipment in the room as well,” said Mark Stibich, PhD, MHS, BA, chief scientific officer for Xenex. “It penetrates the cell wall of spores, viruses, and bacteria, so anything with DNA or RNA is susceptible.” Considered a green technology, the pulsed UV system uses xenon, a naturally occurring noble gas that is viewed as environmentally friendly. The device can be used across multiple areas in a health care facility, including patient rooms, ORs, equipment rooms, emergency rooms (ERs), intensive care units, shared staff member areas, and public areas. The most common usage is for ORs, either for in between cases or augmenting the end of the day cleaning. One device can serve multiple ORs and be on call for use between cases, and is especially beneficial for cleaning an UV LIGHT Continued on C9
http://dx.doi.org/10.1016/S0001-2092(13)01039-9
© AORN, Inc, 2013
November 2013 Vol 98 No 5 • AORN Connections | C1
UV LIGHT Continued from C1
OR after a “dirty” case (e.g., a patient with an MDRO). Health care facilities can get 24-hour use of the device, which can disinfect more than 30 rooms per day. Comparable in size and mobility to a wheelchair, the disinfection robot is wheeled into a room and the user unlocks the device with an ID and password on a keypad. Once the button is pushed to activate the device, the device waits 15 seconds for the user to exit the room, then motion sensors scan the room for 15 seconds before beginning to pulse the UV light. On average, each OR requires the device to be used in two positions for 5-10 minutes in each position. During this time, the device logs data of the room in use, when the device is used, and the dosage. Adoption of the pulsed UV system Individuals from Rose Medical Center, a private hospital in Denver, Colo. wanted to eliminate C. diff and all hospital-acquired MDROs from their facility, so they looked to technology to assist with providing the safest patient environment possible. “We are an organization where zero hospitalacquired infections is the only acceptable outcome for our patients,” said Michelle Bauer, director of environmental services at Rose Medical Center. “We looked at best practices across the country and this looked like one of the best opportunities for us to address any potential residual C. diff in any patient room or type of isolation room.” After looking at many technologies, including a disinfection system that used mercury to generate UV light and a hydrogen peroxide misting tool, Rose representatives chose the pulsed UV system primarily for its speed and ease of use. “It really answered all our questions as far as ‘Is it easy to use? Is it safe for the environment? Is it going in the direction of the environmental concerns for our world at this point?’ and ‘Is it going to help us achieve our zero infection rate goals?’” said Bauer. During a six-week trial period with the robot in January 2012, Rose experienced zero reports of C. diff or HAIs in the facility. The robot also helped Rose deal with a recent outbreak of norovirus in Colorado that had affected many staff members and was occurring at the same time as the trial. After using the robot to disinfect the shared staff member areas (e.g., nurses’ station), Rose staff members stopped calling in sick from the norovirus, which they attributed to the UV disinfection device.
After purchasing the device, Rose staff members spent a week in training with vendors. End users were trained on how to use the device, and nurses, physicians, and managers attended meetings to learn how to maximize its use across the facility. The training involved as many clinical staff members as possible to get buy-in to the process and make staff members feel comfortable using the robot. Stibich said that robots are often named during the orientation process, and some even receive their own employee ID badges. “Facilities kind of adopt the robot as part of the team and it’s a neat phenomenon,” said Stibich. “Environmental services staff members especially take a lot of pride in the robot and it helps with being acknowledged that they’re part of the continuum of care for patients.” Usage and results On average, the robot is used to disinfect 15 rooms a day at Rose. Facility members strategize use of the device based on their top priority rooms, which are the isolation rooms, critical care rooms, ORs, and procedural rooms, and then dispatch the device to other discharge rooms as needed. Users also run the device daily in the ER and clean all of their surgical suites on a weekly basis. “Most of our rooms take about 15 minutes to run the unit properly through the room, and for a terminal clean of a C. diff room, it saves us about 45 minutes time,” said Katie Sawicki, infection control specialist at Rose Medical Center. Infection prevention team members also provide unit-by-unit infection rates, and when rates decline or reach zero, they will send notes to
ROSE MEDICAL CENTER, Denver, Colo., uses the pulsed UV disinfection device in 15 rooms a day on average. UV LIGHT Continued on C10 November 2013 Vol 98 No 5 • AORN Connections | C9
UV LIGHT Continued from C9
environmental services staff members to let them know they’re saving lives. Staff members also leave table tents in every patient room cleaned with the device to notify patients that their room has been disinfected using UV light to make the environment safer for them. Since Rose implemented the technology, staff members have been able to reduce the use of bleach in their facility’s cleaning processes and have kept their C. diff rates at zero. The only challenge they reported is competition for time with the device. Their goal is to be able to clean 28 rooms a day with the robot. “We feel like the benefit of it [the system] is that if we can be at zero C. diff and HAIs, we will have saved tons of money and impacted personal lives,” said Sawicki. “If anyone is questioning whether or not to do something like this with this technology, it’s more about the value of your patient’s experience as far as C. diff or MRSA and where are you at with managing that.” Conclusion As more attention is given to the role of the environment in HAI risk, the use of “no-touch” technologies, like the pulsed xenon UV system, may become part of standard room disinfection
C10 | AORN Connections
practices as more research studies validate the benefits of such technologies. “The innovative hospitals that are really interested in making a change and working closely with all their teams, such as the infection control team and the environmental team, they’re the ones asking the question ‘What more can we do?’” said Stibich. Rose Medical Center’s experience demonstrated that a health care facility does not need high infection rates to get a measurable return on investment from using pulsed UV disinfection technology. The disinfection method has helped the facility become more environmentally friendly through the reduced use of bleach, garnered positive staff member and patient feedback, and contributed to a safe environment for patients and staff members and significant cost savings by keeping C. diff and MDROs at bay. “Here at Rose, we really do feel that the Xenex technology is a commitment to our patient safety,” said Sawicki. References 1. Weber DJ, Anderson DJ, Sexton DJ, Rutala WA. Role of the environment in the transmission of Clostridium difficile in health care facilities. Am J Inf Cont. 2013;41(5):S105-S110.
T
Pulsed UV technology The pulsed xenon ultraviolet (UV) light disinfection system from Xenex Disinfection Services uses high intensity pulses to emit UV light at frequencies that cross the germicidal UV range, the range at which microorganisms are susceptible to UV damage. The high UV frequencies offer different pathways of damage to microorganisms by damaging cell walls and cellular structures and impeding the ability for microorganisms to replicate. “The intensity of the pulse gives it a couple other properties, so it reflects very differently around the room than conventional mercury UV and does different types of damage to organisms, but it’s also easier
THE PULSED XENON ULTRAVIOLET (UV) disinfection system uses high-energy UV light to damage the cell walls of bacteria, viruses, and bacterial spores. Photo courtesy of Xenex Disinfection Services.
on the equipment in the room as well,” said Mark Stibich, PhD, MHS, BA, chief scientific officer for Xenex. “It penetrates the cell wall of spores, viruses, and bacteria, so anything with DNA or RNA is susceptible.” Considered a green technology, the pulsed UV system uses xenon, a naturally occurring noble gas that is viewed as environmentally friendly. The device can be used across multiple areas in a health care facility, including patient rooms, ORs, equipment rooms, emergency rooms (ERs), intensive care units, shared staff member areas, and public areas. The most common usage is for ORs, either for in between cases or augmenting the end of the day cleaning. One device can serve multiple ORs and be on call for use between cases, and is especially beneficial for cleaning an UV LIGHT Continued on C9
http://dx.doi.org/10.1016/S0001-2092(13)01039-9
© AORN, Inc, 2013
November 2013 Vol 98 No 5 • AORN Connections | C1
UV LIGHT Continued from C1
OR after a “dirty” case (e.g., a patient with an MDRO). Health care facilities can get 24-hour use of the device, which can disinfect more than 30 rooms per day. Comparable in size and mobility to a wheelchair, the disinfection robot is wheeled into a room and the user unlocks the device with an ID and password on a keypad. Once the button is pushed to activate the device, the device waits 15 seconds for the user to exit the room, then motion sensors scan the room for 15 seconds before beginning to pulse the UV light. On average, each OR requires the device to be used in two positions for 5-10 minutes in each position. During this time, the device logs data of the room in use, when the device is used, and the dosage. Adoption of the pulsed UV system Individuals from Rose Medical Center, a private hospital in Denver, Colo. wanted to eliminate C. diff and all hospital-acquired MDROs from their facility, so they looked to technology to assist with providing the safest patient environment possible. “We are an organization where zero hospitalacquired infections is the only acceptable outcome for our patients,” said Michelle Bauer, director of environmental services at Rose Medical Center. “We looked at best practices across the country and this looked like one of the best opportunities for us to address any potential residual C. diff in any patient room or type of isolation room.” After looking at many technologies, including a disinfection system that used mercury to generate UV light and a hydrogen peroxide misting tool, Rose representatives chose the pulsed UV system primarily for its speed and ease of use. “It really answered all our questions as far as ‘Is it easy to use? Is it safe for the environment? Is it going in the direction of the environmental concerns for our world at this point?’ and ‘Is it going to help us achieve our zero infection rate goals?’” said Bauer. During a six-week trial period with the robot in January 2012, Rose experienced zero reports of C. diff or HAIs in the facility. The robot also helped Rose deal with a recent outbreak of norovirus in Colorado that had affected many staff members and was occurring at the same time as the trial. After using the robot to disinfect the shared staff member areas (e.g., nurses’ station), Rose staff members stopped calling in sick from the norovirus, which they attributed to the UV disinfection device.
After purchasing the device, Rose staff members spent a week in training with vendors. End users were trained on how to use the device, and nurses, physicians, and managers attended meetings to learn how to maximize its use across the facility. The training involved as many clinical staff members as possible to get buy-in to the process and make staff members feel comfortable using the robot. Stibich said that robots are often named during the orientation process, and some even receive their own employee ID badges. “Facilities kind of adopt the robot as part of the team and it’s a neat phenomenon,” said Stibich. “Environmental services staff members especially take a lot of pride in the robot and it helps with being acknowledged that they’re part of the continuum of care for patients.” Usage and results On average, the robot is used to disinfect 15 rooms a day at Rose. Facility members strategize use of the device based on their top priority rooms, which are the isolation rooms, critical care rooms, ORs, and procedural rooms, and then dispatch the device to other discharge rooms as needed. Users also run the device daily in the ER and clean all of their surgical suites on a weekly basis. “Most of our rooms take about 15 minutes to run the unit properly through the room, and for a terminal clean of a C. diff room, it saves us about 45 minutes time,” said Katie Sawicki, infection control specialist at Rose Medical Center. Infection prevention team members also provide unit-by-unit infection rates, and when rates decline or reach zero, they will send notes to
ROSE MEDICAL CENTER, Denver, Colo., uses the pulsed UV disinfection device in 15 rooms a day on average. UV LIGHT Continued on C10 November 2013 Vol 98 No 5 • AORN Connections | C9
UV LIGHT Continued from C9
environmental services staff members to let them know they’re saving lives. Staff members also leave table tents in every patient room cleaned with the device to notify patients that their room has been disinfected using UV light to make the environment safer for them. Since Rose implemented the technology, staff members have been able to reduce the use of bleach in their facility’s cleaning processes and have kept their C. diff rates at zero. The only challenge they reported is competition for time with the device. Their goal is to be able to clean 28 rooms a day with the robot. “We feel like the benefit of it [the system] is that if we can be at zero C. diff and HAIs, we will have saved tons of money and impacted personal lives,” said Sawicki. “If anyone is questioning whether or not to do something like this with this technology, it’s more about the value of your patient’s experience as far as C. diff or MRSA and where are you at with managing that.” Conclusion As more attention is given to the role of the environment in HAI risk, the use of “no-touch” technologies, like the pulsed xenon UV system, may become part of standard room disinfection
C10 | AORN Connections
practices as more research studies validate the benefits of such technologies. “The innovative hospitals that are really interested in making a change and working closely with all their teams, such as the infection control team and the environmental team, they’re the ones asking the question ‘What more can we do?’” said Stibich. Rose Medical Center’s experience demonstrated that a health care facility does not need high infection rates to get a measurable return on investment from using pulsed UV disinfection technology. The disinfection method has helped the facility become more environmentally friendly through the reduced use of bleach, garnered positive staff member and patient feedback, and contributed to a safe environment for patients and staff members and significant cost savings by keeping C. diff and MDROs at bay. “Here at Rose, we really do feel that the Xenex technology is a commitment to our patient safety,” said Sawicki. References 1. Weber DJ, Anderson DJ, Sexton DJ, Rutala WA. Role of the environment in the transmission of Clostridium difficile in health care facilities. Am J Inf Cont. 2013;41(5):S105-S110.