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2019 HSR&D/QUERI National Conference Abstract

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1090 — Addition of UV-C to commonly used hospital disinfectants: is there a difference in residual bio-burden?

Lead/Presenter: John Zeber,  Central Texas Veterans Health Care System
All Authors: Zeber JE (Central Texas VA), Coppin JD (Central Texas VA), Villamaria FC (Central Texas VA) Williams MD (Central Texas VA) Copeland LA (Northampton Leeds VA) Chatterjee P (Central Texas VA) Choi H (Central Texas VA) Jinadatha C (Central Texas VA)

Objectives:
Hospital associated infections (HAI) affect nearly 2 million patients and cause over 100,000 deaths annually, yet preventive strategies remain only partially effective. Fortunately, novel disinfection tools have increasingly supplemented standard hospital cleaning protocols. One common "no-touch" intervention incorporates portable ultraviolet ray devices that quickly clean patent rooms more proficiently than traditional manual efforts alone. This study was conducted to determine if adding newer Pulsed Xenon Ultraviolet disinfection (PX-UV) increased the effectiveness of four different environmental cleaning and disinfecting agents, and how combination approaches compared in performance to the industry standard of sodium hypochlorite 10%.

Methods:
Research staff in one large VA hospital collected 600 pre-clean, post-manual clean, and post-manual + PX-UV environmental samples of aerobic bacterial colonies (ABC) and MRSA from five high touch surfaces (e.g., bedrail, toilet seat, tray table). The PX-UV device was used three times per standard device protocol - five minute cycles on each side of the patient bed and in the restroom.

Results:
Wilcoxon signed-rank tests showed post-manual ABC counts were significantly different from post-manual + PX-UV counts for soap and water, quaternary ammonium compound, and hydrogen peroxide (all p < 0.001), but not for sodium hypochlorite 10%. Negative binomial regression models revealed residual post-manual + PX-UV ABC counts were between 6 and 8.6 times higher than post-clean ABC counts for sodium hypochlorite 10% solution, holding other factors constant. We observed no statistically significant difference in MRSA counts between chemicals with or without PX-UV, indicating the cleaning solutions performed equally well at each stage.

Implications:
The addition of PX-UV significantly improves disinfection for soap and water, hydrogen peroxide, and quaternary ammonium compound, but perhaps not for sodium hypochlorite 10%, where microbial levels were not reduced to that observed with disinfection by this cleaner alone. However, prior research on these novel devices demonstrated far superior disinfection to typical manual cleaning.

Impacts:
Pragmatic environmental interventions can tackle crucial healthcare concerns including the reduction of pernicious hospital infections. Innovative technologies such as efficient no-touch solutions can enhance standard manual efforts while minimizing human variation, hence providing optimism for advances against HAI and serious health implications.