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IIR 12-347 – HSR&D Study

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IIR 12-347
Evaluation of a Pulsed-Xenon Ultraviolet Room Disinfection Device
John E Zeber PhD MHA BA
Central Texas Veterans Health Care System, Temple, TX
Temple, TX
Funding Period: May 2013 - April 2016

BACKGROUND/RATIONALE:
Hospital acquired infections (HAI), frequently transmitted via contaminated environmental surfaces, cause 1.7 million patient infections and 100,000 deaths annually, along with substantial treatment costs. Recognizing challenges of treating multiple drug resistant pathogens (e.g., MRSA, C.difficile), VA initiatives target HAI reductions, such as screenings, surveillance, and patient isolation. While transmission rates have declined, most preventive strategies are only partially effective, and proper disinfection rarely achieved.

OBJECTIVE(S):
Recognizing increasing challenges of treating multiple drug resistant pathogens (e.g., MRSA, C.difficile), VA initiatives have targeted HAI reductions, such as screenings, active surveillance, and patient isolation. While transmission rates have declined, most preventive strategies are only partially effective. Leveraging promising pilot data and close collaboration among VA facilities, this implementation study examined the benefits of a powerful new decontamination technology, since manual cleaning of discharged patient rooms requires substantial time, labor and supply costs. The anticipated reduction in infection rates and future ramifications such as unnecessary readmissions, plus efficient use of VA resources, offer numerous advantages over current cleaning procedures. Future applications include use in other VA settings where HAI presents a significant problem for aging veterans. The Central Texas Veterans Health Care System alone experiences 8000 annual admissions/transfers, each necessitating intensive cleaning. Unfortunately, manual efforts focusing on visibly soiled areas are insufficient and unreliable (70% of high-touch surfaces are missed). However, portable PX-UV machines represent an effective, convenient solution for providing safer patient environments without disrupting hospital operations. Our pilot study compared human-only efforts to PX-UV cleaning: MRSA and bacterial colony counts dropped precipitously and cost analyses suggested lower expenditures. Yet wider implementation was needed to validate this work, and demonstrate global implications for routine quality improvement efforts.

METHODS:
Our strong multidisciplinary team of clinical and health services researchers at four facilities conducted the evaluation of a broad technological implementation to reduce HAI; two intervention and two control sites followed for two years, linking monthly infection control reports, laboratory tests, administrative data and study observations of PX-UX disinfection versus human cleaning time. We evaluated the clinical impact and cost-effectiveness of implementing the novel disinfection system through both simple analysis of microbial lab data and more complex adjusted generalized longitudinal regression models controlling for baseline site differences (e.g., patient case-mix characteristics). At the intervention facilities, rooms and surgical suites were disinfected with PX-UV, while two control sites continued practicing standard manual cleaning. Infection control reports documented new HAI cases and microbial samples at selected high-touch room surfaces on multiple organisms were analyzed. This information can be linked to patient-level administrative data extracts for diagnostic information, treatment costs, and health utilization variables. Our primary objectives: 1) Negative binomial regression models, adjusting for baseline microbial counts, calculating the effect of PX-UV of laboratory disinfection compared with manual cleaning this new technology. 2) Both raw HAI count data and longitudinal models in progress are determining the clinical impact at reducing actual infections. 3) Finally, a rigorous cost-effectiveness analysis is targeting economic cost savings including labor time and fewer hospital days and use of antibiotics to treat HAI. Informally, this study also gathered observations of potential implementation challenges, staff and clinical impressions, and other factors associated with regular device usage.

FINDINGS/RESULTS:
Noted above, we demonstrated these devices greatly reduce microbial burden of several prevalent infections from laboratory analysis, with early results of nearly a 50% decrease in HAIs. Cost analysis and further work examining implementation barriers continues to better understand fluctuating device usage in clinical practice, along with leveraging these results for ongoing funding proposals.

IMPACT:
Senior VA infectious disease leadership, along with the National Infectious Disease Center, maintain communication with the study team to keep informed on progress, findings, and new research directions. We shared results and recommendations that these devices appear to be clinically superior to standard cleaning protocol while reducing adverse outcomes, and could potentially revolutionize disinfection procedures, substantially reducing HAIs, morbidity and mortality. This project set the foundation for numerous other studies, along with other VA infectious disease projects and studies with other colleagues. Drs. Zeber and Copeland, for example, are co-investigators on a recently funded HSRD pilot that will examine quality of life in patients diagnosed with Cdifficile.

PUBLICATIONS:

Journal Articles

  1. Jinadatha C, Villamaria FC, Restrepo MI, Ganachari-Mallappa N, Liao IC, Stock EM, Copeland LA, Zeber JE. Is the pulsed xenon ultraviolet light no-touch disinfection system effective on methicillin-resistant Staphylococcus aureus in the absence of manual cleaning? American journal of infection control. 2015 Aug 1; 43(8):878-81.
  2. Jinadatha C, Villamaria FC, Ganachari-Mallappa N, Brown DS, Liao IC, Stock EM, Copeland LA, Zeber JE. Can pulsed xenon ultraviolet light systems disinfect aerobic bacteria in the absence of manual disinfection? American journal of infection control. 2015 Apr 1; 43(4):415-7.
  3. Jinadatha C, Quezada R, Huber TW, Williams JB, Zeber JE, Copeland LA. Evaluation of a pulsed-xenon ultraviolet room disinfection device for impact on contamination levels of methicillin-resistant Staphylococcus aureus. BMC infectious diseases. 2014 Apr 7; 14:187.


DRA: Infectious Diseases
DRE: Prevention
Keywords: Cost-Effectiveness, Effectiveness, Guideline Development and Implementation, Implementation, Monitoring, Patient Safety, Quality Improvement
MeSH Terms: none