Becker's Clinical Quality & Infection Control

34 Executive Briefing Sponsored by: H ealthcare-associated infections are a primary source of illness and death among hospitalized patients, and the fifth leading cause of death in U.S. acute care hospitals. Each year, approximately 687,000 HAIs occur in U.S. hospitals, resulting in 72,000 deaths and an estimated $20 billion in healthcare costs (Source: CDC). As hospitals and health systems work to reduce healthcare- associated infections, a number of harmful pathogens, such as Clostridioides difficile, may evade traditional disinfectants and manual cleaning processes. To help eliminate these pathogens from high-touch surfaces, many healthcare facilities have chosen to incorporate adjunct technologies, like UV-C disinfection, into cleaning routines to help reduce pathogens and lower HAI rates. Environmental hygiene contributes to HAI Contaminated surfaces play a significant role in the transmission of HAIs. To reduce risk, cleaning and disinfection of hands, surfaces and equipment is critical. Although there has been much focus on improving hand hygiene for decades, it is still estimated that only 50 percent of healthcare workers follow basic hand hygiene measures. Even if the hand hygiene compliance rate were higher, there is still the risk that hands can become re-contaminated by touching contaminated surfaces, which is why hand hygiene and surface cleaning and disinfection are both important factors to reduce infection. Frequently touched surfaces and those near patients are more frequently and heavily contaminated and represent a greater risk. Manual cleaning and disinfection is often inadequate, creating increased risk for transmission of pathogens. Studies have shown that the environment can act as a reservoir in healthcare settings. Pathogens can live on surfaces for days, weeks and even months. Unfortunately, data has also shown that cleaning and disinfection of patient rooms, operating rooms and shared patient equipment is suboptimal. Previous studies have demonstrated that less than 50 percent of patient room surfaces (Carling, 2008), and less than 25 percent of operating room surfaces are properly cleaned and disinfected during terminal cleaning (Jefferson, 2011). It has been demonstrated that a patient entering a room that was previously occupied by a colonized or infected patient has significantly higher odds of contracting that illness (Otter, 2013). Residual pathogens left on surfaces may be a cause for concern. UV-C reduces contamination and variability in process beyond standard cleaning and disinfection practices Key characteristics of UV-C Energy: Adjunct technologies, such as UV-C disinfection devices, have become an integral part of how healthcare settings control HAIs. Augmenting terminal cleans in patient rooms and operating rooms has proven effective in reducing the risk for HAIs (Anderson, 2017). The use of UV-C light is a recognized and reliable method of microorganism inactivation that involves exposing air, water or contaminated surfaces to UV-C light. UV light penetrates the deoxyribonucleic acid (DNA) or ribonucleic acid (RNA) of microorganisms, disrupts the cell's genetic material and impedes reproduction (Kaufmann, 2010). Diversey offers a comprehensive framework of cleaning and disinfecting solutions for healthcare facilities to help reduce HAIs, including a unique UV-C disinfection device. This portable UV-C device can be used to disinfect patient rooms, operating rooms, exam rooms, as well as other hard surfaces and noncritical shared patient equipment and devices. When deciding if it makes sense to incorporate UV-C disinfection technology into cleaning routines, hospital executives will want to understand how to optimize the technology to ensure the best return on invested capital. Below are some areas to consider when selecting UV-C disinfection devices. Things to Know about UV Disinfection: Not all Ultraviolet (UV) Light is UV-C – There are multiple forms of UV light which are differentiated by wavelength. UV-A and UV-B provide minimal biocidal efficacy. Devices designed to provide primarily UV-C energy will deliver higher efficacy. UV-C Kills Pathogens – UV-C light is the most powerful biocide in the UV spectrum. It is highly effective at killing pathogens on hard surfaces. Optimizing Energy – Energy absorbed determines efficacy. Distance and angle can be adjusted to reduce cycle time and improve efficacy. Line of Sight – Surfaces in the line of sight receive higher applications of energy. Operating devices in two positions can shorten overall cycle times and increase efficacy by reducing shadowing and distance. Using a UV-C device where the energy is delivered on multiple planes, such as independent arms, can help reduce shadowing. Distance Matters – The closer the light source is to surfaces, the more energy applied. UV-C energy declines quickly with distance, dropping by the square of the distance. It is more efficient to reposition the device and run two shorter cycles than to run a device from a single fixed location for a longer cycle time hoping that the light will bounce from surfaces and deliver UV-C light to shadowed and distant surfaces. Optimize the Angle – The angle of application impacts the energy absorbed – surfaces perpendicular to bulbs absorb the greatest dose. Adjusting the angle can deliver greater energy in less time. Time is Money – By increasing the UV-C energy delivered to surfaces, cycle times can be reduced without sacrificing efficacy. After about five minutes, the biocidal impact of UV-C is largely diminished. Soil can Spoil – UV-C light cannot penetrate heavy soil. Manual cleaning and disinfecting should be performed prior to the application of UV-C light. Optimizing performance of portable UV-C devices — What to know about UV-C energy and how to select UV-C devices

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