Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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1062 — A Multisite Implementation Trial of Portable Pulsed Xenon Ultraviolet Ray Technology to Reduce Hospital Associated Infections

Lead/Presenter: John Zeber
All Authors: Zeber JE (Central Texas VA) Jinadatha C (Central Texas VA) Copeland LA (VA Central Western Massachusetts) Pfeiffer C (Portland VA Medical Center) Baddley JW (Birmingham VA Medical Center) Restrepo MI (San Antonio VA) Cadena-Zuluaga J (San Antonio VA) Hendricks J (San Antonio)

Objectives:
Hospital associated infections (HAI) affect 1.7 million patients and cause 100,000 deaths annually, yet preventive strategies remain only partially effective. HAI are transmitted via healthcare worker contact or contaminated room surfaces; increased antibiotic-resistant organisms compound the problem. We examine implementation and outcomes of novel pulsed-xenon ultraviolet ray (PX-UV) devices for disinfecting patient rooms.

Methods:
Aims targeted effectiveness on laboratory samples, actual infection rates, and cost-effectiveness of the portable machines. This real-world trail documented implementation challenges in context of numerous other infection control efforts, gauging barriers to widespread adoption. Two VA facilities used PX-UX while two control sites employed standard manual cleaning efforts; we examined 36 month pre-post rates on microbial surface counts, incidence for methicillin-resistant Staphylococcus aureus (MRSA), aerobic bacteria colonies (ABC), and Clostridium difficile (C.diff), plus associated treatment costs. Poisson regression compared colony count reductions on PX-UV versus manual cleaning then actual HAI rates, controlling for patient severity characteristics.

Results:
Samples (77 rooms) were collected before and immediately following terminal cleaning from five high-touch room surfaces (e.g., bedside rail, toilet seat) and sent to an independent laboratory for analyses. PX-UV was superior to human cleaning for MRSA and ABC in reducing overall colony counts 75.3% and 84.1%, respectively, versus 25-30% at the control sites. Adjusting for baseline differences, manually cleaned rooms had significantly higher residual microbes with an incident rate ratio of 2.51 (p < .0001). HAI rates were also reduced nearly in half, especially where devices used most frequently (ICU). Cost models in progress, with pilot study evidence suggesting a return on investment after 18-21 months.

Implications:
We found dramatic improvements in laboratory benefits of PX-UV technology and indications of strong clinical effectiveness against real HAI, at least where implementation was greatest. Optimistic results highlight both tremendous promise and potential barriers of introducing innovative advances to protect veterans from HAI that perniciously evolve with containment strategies.

Impacts:
Pragmatic clinical interventions supported by insightful research can tackle crucial healthcare concerns, but understanding how to maintain effective strategies requires involving multiple stakeholders to ensure translational promise. Our work on such innovative technologies, especially if cost-effectiveness, provides optimism for advances against HAI and its serious health implications.