UV light disinfection heats up at APIC

The ever-widening influence of ultraviolet (UV) light as a tool to combat bacteria in patient care areas was on display at the just-concluded Association for Professionals in Infection Control and Epidemiology (APIC) Conference.

From the release of recent studies on the impact of UV disinfection to the unveiling of a new overhead light fixture designed to continuously kill bacteria linked to health care-associated infections (HAIs), news came fast and furious.

Light fixture delivers continuous cleaning

Just prior to the APIC meeting, Kenosha, Wis.-based Kenall Manufacturing gave Health Facilities Management a sneak peek at its Indigo-Clean™ light fixture. The light, which operates continuously and requires no operator, is designed to inactivate a wide range of microorganisms such as methicillin-resistant Staphylococcus aureus (MRSA), Clostridium difficile, and vancomycin-resistant enterococci (VRE).

Indigo-Clean uses a narrow stream of indigo-colored light at an output of 405 nanometers on the light spectrum. This high-intensity, narrow spectrum light is absorbed by molecules within the bacteria, producing a chemical reaction that kills the bacteria from inside as if bleach had been released within the bacterial cells.

The light fixture is manufactured through an exclusive agreement with the University of Strathclyde in Glasgow, Scotland, which developed, verified through research and patented the technology. Strathclyde’s technology has been in use since 2008 at Glasgow Royal Infirmary, a large teaching hospital operated by National Health Service Greater Glasgow and Strathclyde. More than 20 peer-reviewed academic studies have been published since 2008 on the indigo light technology, Kenall notes.

“As part of Strathclyde’s clinical engagement in the U.K. over the last seven years, this technology has proven effective in killing bacteria in hospital settings,” said Cliff Yahnke, Kenall’s director of clinical affairs. He stressed that the Indigo-Clean light fixture is a complementary technology to established cleaning and disinfection protocols.

Froedtert Hospital, a 655-bed teaching hospital in Milwaukee, earlier this year began evaluating the Indigo-Clean fixture in its gastroenterology endoscope clinic’s waiting room. Results from more than 1,000 samples collected during a month-long period showed a 40 percent continuous bacterial reduction while the fixture was configured in a blended solution combining 405nm light and standard LEDs to create the look of white overhead lighting while providing a continuous bacteria-killing benefit.

“The initial results suggest even higher levels of bacteria reduction could be obtained with a configuration optimized for the area, taking into account its size and patient traffic,” said Nathan Ledeboer, associate professor of pathology at the Medical College of Wisconsin, in a news release from Kenall. “We are beginning a second evaluation to understand the potential impact of an optimized configuration upon the bacteria levels in medically relevant spaces within our institution.”

Meanwhile, evaluations of the light fixture in two identical patient rooms are getting underway at Kenosha Medical Center, part of the United Hospital System. One room will be equipped with an indigo-only 405nm fixture in the center of the room and the other room will be equipped with two blended light fixtures across the room. “We are very interested in documenting how Indigo-Clean can improve the hospital environment and benefit patient health outcomes,” said Tom Duncan, vice president and COO of United Hospital System.

Studies evaluate UV light effectiveness

Elsewhere on the UV light disinfection front, results from two Clorox Healthcare-sponsored studies were presented during the APIC conference. In a poster presentation, Sonya Mauzey, R.N., CIC, infection preventionist at the Women’s Hospital in Newburgh, Ind., shared results from a study that found a dramatic decrease at her institution in Pseudomonas cultures after UV light disinfection was implemented. From January 2012 through June 2013 (before UV disinfection was implemented), there were 32 total positive Pseudomonas cultures (3.17 per 1,000 patient days) that involved 13 infants (2.34 percent of total admissions). From July 2013, when Clorox Healthcare’s Optimum-UV light disinfection system was implemented, through September 2014, there was only one positive Pseudomonas culture (0.10 per 1,000 patient days) involving one infant (0.17 percent of total admissions). Further review also revealed UV disinfection was not used during the third quarter 2014, due to a high patient census.

In the second study, authors Maurice E. Croteau and Tawnya M. Grover, R.N., discussed findings from their study at IASIS Healthcare in Franklin, Tenn.

In that report, the Optimum-UV light was evaluated in two hospitals in tandem with manual surface disinfection methods. A variety of surface types were sampled following manual surface disinfection with EPA-registered bleach or quaternary ammonium products, and again following treatment with a UV-C device. Surfaces tested included vertical and horizontal surfaces, as well as surfaces that are sensitive to manual cleaning methods. UV-C treatment resulted in a statistically significant reduction in mean plate counts for all sites tested, the authors noted. The report concluded that UV light disinfection was effective on both vertical and horizontal surfaces and that the results reinforced the need for a comprehensive cleaning solution (i.e., EPA-registered surface disinfectants along UV light disinfection).

Taking a bold step in infection prevention

Another major player in the UV light disinfection field, Xenex announced the day before APIC’s conference that it would begin offering what it called the “industry’s first HAI-reduction guarantee.” Under the program, Xenex will provide up to a full refund if in the first 12 months of use customers do not achieve an infection rate reduction sufficient to produce savings to cover the annualized cost of acquiring and operating the company’s robots. The guarantee applies to HAIs including those that hospitals are required to report to the Centers for Medicare & Medicaid Services as key performance standards in value-based purchasing and hospital-acquired condition reduction programs, such as C. difficile, MRSA and surgical-site infections. Xenex notes that customers of its room disinfection robots have reported and published greater than 50 percent reductions in MRSA and C. difficile in peer-reviewed literature.

During the APIC conference, two poster presentations were made by health care facilities that use the Xenex Pulsed Xenon Full Spectrum UV disinfection system. Orlando Health System South Seminole Hospital presented findings from its use of the Xenex system as an adjunct to traditional cleaning practices on multidrug-resistant organism infection rates in the intensive care unit (ICU) and non-ICU areas at the facility. The hospital disinfected all isolation discharges within its ICU and experienced a 61 percent decrease in MRSA, VRE and C. difficile infection rates in the ICU. The hospital disinfected only C. difficile discharges throughout the rest of the facility, which resulted in a 41 percent decrease in C. difficile infections facilitywide. According to the poster’s authors, the reduction in infections saved the hospital $730,000 over a 22-month period.

In the second poster, Morningside Ministries at The Manor, a Texas skilled nursing facility (SNF), reported a nearly 80 percent decrease in health care-associated C. difficile rates after using Xenex robots for room disinfection. In an effort to decrease C. difficile occurrences, the facility retrained staff on hand-hygiene practices and implemented the use of sodium hypochlorite cleaning. No immediate change in infection rates was seen, so the facility began using a Xenex robot to disinfect all C. difficle isolation rooms and all common areas (dining room and community living areas). Following implementation of the Xenex robot, the SNF’s C. difficle infection rate dropped 76.8 percent.

“This validation from Morningside Ministries and South Seminole Hospital is similar to the data we are seeing from many of our customers after they began using Xenex robots for disinfection. Three hospitals have published their HAI reductions in peer-reviewed journals and several more are in press or in review,” said Mark Stibich, co founder and chief scientific officer at Xenex in a press release about the findings from the posters.

Tru-D SmartUVC LLC also had a presence at the conference, demonstrating its UV disinfection robots and sponsoring a preconference workshop titled “Disinfection, Sterilization and Antisepsis: Principles, Practices, Current Issue, New Research and New Technologies.” The company also noted that the highly anticipated results of its UV disinfection study at Duke University’s Prevention Epicenter Program would be released later this year. The study was funded by the Centers for Disease Control and Prevention.