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14 Executive Briefing: Eradicating HAIs Sponsored by R oughly a quarter of hospitalized patients in the United States experience a healthcare-associated infection, and many of them don't survive: An estimated 75,000 hospital patients with HAIs died during their hospitalization in 2011, ac- cording to the Centers for Disease Control and Prevention. In addition to HAIs being costly to patient safety, they are also expensive for hospitals and health systems. A 2009 report from the CDC estimated that the overall annual direct medical costs of HAIs to U.S. hospitals fall somewhere between $28.4 billion and $45 billion. Armed with those statistics — as well as the treat of losing Medi- care reimbursement due to high hospital-acquired condition rates — many hospitals and health systems are doubling down on their infection prevention strategies to limit the number of HAIs in their facilities. For instance, many are revisiting hand hygiene compli- ance programs, while still others turned to making uniforms out of antimicrobial fabrics to help stem the spread of infection. Other hospitals have gone high-tech and turned to robots to help prevent HAIs — ultraviolet light-emitting robots. UV-C light, a part of the UV spectrum, can kill pathogens like C. diff and methicil- lin-resistant Staphylococcus aureus that cause HAIs. The light passes through the cell walls of bacteria, viruses and other mi- croorganisms, which then absorb the energy into their DNA, RNA and proteins. This fuses the DNA and deactivates it, meaning the germ is no longer infectious. Germ-zapping robots that emit this lethal light are still fairly new in the hospital environmental cleaning setting. "I think it's still up and coming," says Mark Stibich, PhD, chief scientific officer and founder of Xenex, which offers a pulsed xenon UV room disin- fection system. "It's in the early stage in the market. There's still confusion on how it's deployed and how to use it." How it works In the case of Xenex's UV robot, cleaning a normal patient room will take roughly 15 minutes after the room is "visibly clean," ac- cording to Dr. Stibich. Generally, the process starts with the robot cleaning the patient's bathroom for about five minutes while the housekeepers clean the rest of the room. Then, after raising the bed rails and opening cabinets to expose the surfaces to the light, the housekeeper would move the robot to one side of the bed and run it for five minutes. The process is then repeated with the robot on the other side of the bed. The process only takes 15 minutes because of the patented tech- nology Xenex uses in its UV light robots: pulsed xenon UV. The most familiar form of UV is produced by mercury vapor lamps, but a lamp using this technology would take an hour or more to clean a normal patient room. Additionally, mercury UV only causes one type of damage to the DNA of germs, while pulsed xenon UV causes four types of cellular damage. Combined, this makes pulsed xenon UV more effective and efficient than mercury UV light for hospital disinfection. Advantages of UV disinfection Adding UV disinfection to the usual terminal cleaning protocol has several advantages to the standard manual cleaning procedures alone. Some benefits include: Lower infection rates. Westchester Medical Center in Valhalla, N.Y., saw the rate of HAIs caused by multidrug-resistant organ- isms and C. diff drop 20 percent after implementing pulsed xenon UV disinfection (despite only treating 22 percent of their overall discharges) according to a study in the American Journal of Infec- tion Control. More effective than manual cleaning. Even when pulsed xenon UV light is used alone, it is more effective in killing MRSA than manual cleaning. One study in BMC Infectious Diseases showed pulsed xenon UV light was more effective than manual cleaning for MRSA, as colony counts were lower after a room was exposed to pulsed xenon than when it was cleaned manually. Cleaner air. When Cambridge (Mass.) Health Alliance, a three- hospital system, implemented pulsed xenon UV light to disinfect A New Soldier in the War Against HAIs: UV Robots By Heather Punke Mercury UV only causes one type of damage to the DNA of germs, while pulsed xenon UV causes four types of cellular damage. Combined, this makes pulsed xenon UV more effective and efficient than mercury UV light for hospital disinfection.