Perspective

UV-C light technology reduces CDIs by 25%

A technique using ultraviolet C light to clean hospital rooms reduced the incidence of Clostridium difficile infections by 25% among hematology-oncology patients and saved up to $1.5 million in health care costs in a single year, according to University of Pennsylvania researchers. Moreover, adding UV-C disinfection to standard cleaning protocols did not significantly impact turnaround time.

“There can be additional benefit in terms of reducing the risk of a target infection like C. difficile from the use of a terminal, no-touch disinfection technology, and by ‘additional benefit’ I mean over thorough terminal room cleaning provided by environmental services,” David A. Pegues, MD, professor of medicine at the Hospital of the University of Pennsylvania, told Infectious Disease News.

David A. Pegues, MD
David A. Pegues

During a 1-year period, Pegues and colleagues studied the impact of UV-C germicidal irradiation on C. difficile infection (CDI) rates in three adult hematology-oncology units at the Hospital of the University of Pennsylvania. The 789-bed tertiary care hospital averages more than 3,000 inpatient admissions for hematology-oncology services each year, the researchers said, and CDI rates had been persistently higher in this patient population than in other units.

The hospital’s environmental services staff added UV-C disinfection (Optimum-UV, Clorox Healthcare) to the terminal cleaning of hospital rooms of former patients who were on contact precautions.

Results of the analysis, which were originally presented at IDWeek 2015 and most recently published in Infection Control and Hospital Epidemiology, indicated that UV-C disinfection significantly reduced CDI rates among new patients admitted to the three hematology-oncology units. The researchers observed a 25% reduction in incidence rates in these units. Meanwhile, rates dropped 16% in non-study units during the intervention period.

With 53 fewer cases of hospital-onset CDI compared with the previous year, the researchers estimated that the use of UV-C disinfection averted $348,528 to $1,537,000 in direct medical costs. Deploying UV-C disinfection added only about 5 minutes to the amount of time spent each week cleaning the rooms and about 7 minutes in turnaround time on average.

Source: Clorox Healthcare

Clorox Healthcare Optimum-UV System

Source: Clorox Healthcare

“A rapid technology like UV-C, when used in a targeted fashion, can be done in a cost-effective way with limited impact on patient throughput,” Pegues said. “We’re not using it in every room, and it is rapidly germicidal and sporicidal, so its overall impact on room turnover was relatively modest.”

Pegues said the highest priority during the 12-month study period was placed on the rooms of patients with CDIs, and if given the opportunity, UV-C was also used to clean the rooms of patients with multidrug-resistant organisms. The study was primarily a quality improvement evaluation of UV-C disinfection. Fully optimizing the technology, however, requires scaling up its use and increasing staff levels. In the first year following this evaluation (FY16), Penn purchased three devices and hired three additional personnel to deploy UV-C in high-risk rooms on all inpatient units. This fiscal year (FY17), three more devices and personnel are being deployed to further improve UV-C coverage.

C. difficile bacteria are the most common cause of hospital-acquired infections (HAIs) in the United States, according to researchers, with almost a half a million infections reported in 2011. Several studies have linked environmental contamination with an increased risk for HAIs. Antibiotic use has been singled out as a significant risk factor for CDI, and new research published in JAMA Internal Medicine suggests the risk for infection increases for newly admitted patients if the prior occupant of their hospital room was prescribed antibiotics (adjusted HR = 1.22; 95% CI, 1.02-1.45).

However, in a patient population like the one described in the study, particularly those with hematologic malignancies, there are “limited opportunities” to reduce antibiotic use through antimicrobial stewardship, Pegues said.

“This just isn’t a population where you are going to reduce the overall use of antibiotics very much,” he said. “As a result, in this population, we have to disproportionately rely upon infection control and environmental control.” – by John Schoen

References:

Chemaly RF, et al. Ther Adv Infect Dis. 2014;2:79-90.

Pegues DA, et al. Infect Control Hosp Epidemiol. 2016;doi:10.1017/ice.2016.222.

Pegues DA, et al. Abstract 1715. Presented at: IDWeek; Oct. 7-11, 2015; San Diego.

Lessa FC, et al. N Engl J Med. 2015;doi:10.1056/NEJMoa1408913.

Disclosure: The researchers report no relevant financial disclosures.

A technique using ultraviolet C light to clean hospital rooms reduced the incidence of Clostridium difficile infections by 25% among hematology-oncology patients and saved up to $1.5 million in health care costs in a single year, according to University of Pennsylvania researchers. Moreover, adding UV-C disinfection to standard cleaning protocols did not significantly impact turnaround time.

“There can be additional benefit in terms of reducing the risk of a target infection like C. difficile from the use of a terminal, no-touch disinfection technology, and by ‘additional benefit’ I mean over thorough terminal room cleaning provided by environmental services,” David A. Pegues, MD, professor of medicine at the Hospital of the University of Pennsylvania, told Infectious Disease News.

David A. Pegues, MD
David A. Pegues

During a 1-year period, Pegues and colleagues studied the impact of UV-C germicidal irradiation on C. difficile infection (CDI) rates in three adult hematology-oncology units at the Hospital of the University of Pennsylvania. The 789-bed tertiary care hospital averages more than 3,000 inpatient admissions for hematology-oncology services each year, the researchers said, and CDI rates had been persistently higher in this patient population than in other units.

The hospital’s environmental services staff added UV-C disinfection (Optimum-UV, Clorox Healthcare) to the terminal cleaning of hospital rooms of former patients who were on contact precautions.

Results of the analysis, which were originally presented at IDWeek 2015 and most recently published in Infection Control and Hospital Epidemiology, indicated that UV-C disinfection significantly reduced CDI rates among new patients admitted to the three hematology-oncology units. The researchers observed a 25% reduction in incidence rates in these units. Meanwhile, rates dropped 16% in non-study units during the intervention period.

With 53 fewer cases of hospital-onset CDI compared with the previous year, the researchers estimated that the use of UV-C disinfection averted $348,528 to $1,537,000 in direct medical costs. Deploying UV-C disinfection added only about 5 minutes to the amount of time spent each week cleaning the rooms and about 7 minutes in turnaround time on average.

Source: Clorox Healthcare

Clorox Healthcare Optimum-UV System

Source: Clorox Healthcare

“A rapid technology like UV-C, when used in a targeted fashion, can be done in a cost-effective way with limited impact on patient throughput,” Pegues said. “We’re not using it in every room, and it is rapidly germicidal and sporicidal, so its overall impact on room turnover was relatively modest.”

Pegues said the highest priority during the 12-month study period was placed on the rooms of patients with CDIs, and if given the opportunity, UV-C was also used to clean the rooms of patients with multidrug-resistant organisms. The study was primarily a quality improvement evaluation of UV-C disinfection. Fully optimizing the technology, however, requires scaling up its use and increasing staff levels. In the first year following this evaluation (FY16), Penn purchased three devices and hired three additional personnel to deploy UV-C in high-risk rooms on all inpatient units. This fiscal year (FY17), three more devices and personnel are being deployed to further improve UV-C coverage.

C. difficile bacteria are the most common cause of hospital-acquired infections (HAIs) in the United States, according to researchers, with almost a half a million infections reported in 2011. Several studies have linked environmental contamination with an increased risk for HAIs. Antibiotic use has been singled out as a significant risk factor for CDI, and new research published in JAMA Internal Medicine suggests the risk for infection increases for newly admitted patients if the prior occupant of their hospital room was prescribed antibiotics (adjusted HR = 1.22; 95% CI, 1.02-1.45).

However, in a patient population like the one described in the study, particularly those with hematologic malignancies, there are “limited opportunities” to reduce antibiotic use through antimicrobial stewardship, Pegues said.

“This just isn’t a population where you are going to reduce the overall use of antibiotics very much,” he said. “As a result, in this population, we have to disproportionately rely upon infection control and environmental control.” – by John Schoen

References:

Chemaly RF, et al. Ther Adv Infect Dis. 2014;2:79-90.

Pegues DA, et al. Infect Control Hosp Epidemiol. 2016;doi:10.1017/ice.2016.222.

Pegues DA, et al. Abstract 1715. Presented at: IDWeek; Oct. 7-11, 2015; San Diego.

Lessa FC, et al. N Engl J Med. 2015;doi:10.1056/NEJMoa1408913.

Disclosure: The researchers report no relevant financial disclosures.

    Perspective
    Deverick J. Anderson

    Deverick J. Anderson

    The article by Pegues and colleagues adds to the growing data that UV disinfection is an important part of terminal room disinfection, particularly in high-risk rooms and high-risk units.  The UV devices were employed in wards with high baseline rates of CDI. Notably, the disinfection intervention was added to other ongoing efforts to prevent C. difficile. The data presented, including data regarding how the devices were deployed and utilized, will be helpful for hospitals trying to adopt this technology.

    • Deverick J. Anderson, MD, MPH
    • Associate professor of medicine Duke Infection Control Outreach Network Duke University Medical Center

    Disclosures: Anderson reports no relevant financial disclosures.