Issue link: https://beckershealthcare.uberflip.com/i/447830
10 Executive Briefing: UV Light Disinfection Sponsored by: 10.875" R ecently, there has been an in- creased focus in many healthcare facilities on preventing the spread of emerging pathogens, especially those that are resistant to antimicrobial drugs. These emerging infection risks have also made it more and more important for fa- cilities to develop and implement emer- gency preparedness plans to both iso- late and treat symptomatic patients while safeguarding the hospital staff and larger community. However, for those health- care facilities that wish to adopt a more comprehensive approach to environmen- tal infection control, there is little guid- ance on how to incorporate a bundled approach of manual disinfectants and ultraviolet treatment. The Centers for Disease Control and Pre- vention and U.S. Environmental Protec- tion Agency developed a recommended approach to help bridge the gap between disinfectant efficacy claims for common healthcare-associated pathogens and emerging pathogens. 1,2,3 The aim of this approach is to help healthcare profession- als choose appropriate manual disinfec- tants for use against emerging pathogens when no disinfectants with EPA-registered claims are available. This article will out- line the CDC and EPA approach and how it can be extended to provide guidance for the use of supplemental UV devices in an environmental protection strategy against emerging pathogens. Manual environmental cleaning & disinfection approach for emerging pathogens For emerging pathogens or pathogens that are hard to isolate or handle safely in the laboratory, such as the Ebola virus, there often is no regulatory pathway to obtain an EPA-registered sanitization or disinfection claim. In this case, a new microbiological analysis protocol must be developed fol- lowing EPA guidelines. 4 However this is a time-consuming process that sometimes involves using a surrogate organism to represent the target pathogen to reduce safety risks and deliver an organism for test purposes. 5 This waiting period can leave hospital infection control teams at a loss when trying to determine appropriate disinfectants for use in the interim. When an emerging pathogen poses a sig- nificant public health risk, the CDC and EPA guidance is intended to bridge the gap by identifying disinfectant products that may be used while effective test pro- tocols are being developed. The approach draws on well-established pathogen hi- erarchy and efficacy data, in addition to peer-reviewed studies. Table I shows the EPA-recognized pathogen hierarchy for the selection of disinfectants to be used against emerging pathogens. This hierar- chy ranks classes of microorganisms by order of their relative susceptibility to hard surface disinfectants, 6 with the hardest pathogens to kill (bacterial endospores) at the top of the list and the organisms most susceptible to disinfectants at the bottom. Using this pathogen hierarchy and the wealth of micro-efficacy testing data for EPA-registered disinfectants, the CDC de- veloped recommendations specifically for the Ebola virus. 8 Though the Ebola virus is an enveloped virus, the CDC recommends the use of EPA-registered hospital disin- fectants with kill claims against harder-to- kill non-enveloped viruses in order to dis- infect rooms of patients with suspected or confirmed Ebola virus disease. The same approach can be applied to develop rec- ommendations for other emerging patho- gens as well. Applying the "bridge the gap" approach to UV devices It is well documented that UV-C light, a high energy form of ultraviolet light, is a highly effective germicide 9,10 – so well, in fact, that Kowalski's UV handbook states that "given sufficient exposure time, any exposed pathogen can be inactivated." 11 Bridging the Gap: Establishing UV Claims for Emerging Pathogens By Sarah S. Snow, PhD, Senior Scientist, Clorox Professional Products Company Table I Pathogen Hierarchy 7 Descending order of resistance to germicidal chemicals Bacterial Spores (Bacillus subtilis, Clostridium sporogenes) Mycobacteria (Mycobacterium tuberculosis var. bovis, Nontuberculous mycobacteria) Nonlipid, Non-enveloped, or Small Viruses (Poliovirus, Coxsackievirus, Rhinovirus) Fungi (Trichophyton, Cryptococcus, Candida spp.) Vegetative Bacteria (P. aeruginosa, S. aureus, S. choleraesuis, Enterococci) Lipid, Enveloped, or Medium-sized Viruses (Herpes simplex, Cytomegalovirus, RSV, Hepatitis B, Hepatitis C, HIV, Hantavirus, Ebola virus)