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healthcare-associated infections (HAI) program

Emerging Technologies


​What are the benefits of new whole-room disinfection technologies?

  • The adequacy of manual cleaning and disinfection is often suboptimal; e.g., wet contact time is not always achieved
  • "Touchless" or non-manual techniques can provide a higher level of disinfection
  • These technologies have been shown to be clinically effective in stopping outbreaks (read report via Canadian Agency for Drugs and Technologies in Health)

​What is environmental fogging?

Hydrogen peroxide in either a dry mist or vapor form.

  • Pros
    • Reliable microbiology activity against many pathogens
    • Mist or vapor is uniformly distributed; no furniture needs to be moved
    • No toxic residues
    • Evidence is still being gathered; CDC has no recommendations for use
  • Cons
    • Patients and staff must leave room because the vapor can cause airway or mucous membrane irritation
    • Room must be sealed and monitored for leaks
    • Rooms cannot be rapidly turned over
    • High-level training required
    • Cost is substantial

AHRQ Technical Brief #22, Environmental Cleaning for the Prevention of
HealthcareAssociated Infections, 2015 (read the Technical Brief via Agency for Healthcare Research and Quality)

​What is the efficacy of vapor or mist-based fogging technologies?

  • In direct comparison between hydrogen peroxide dry-mist versus bleach solution in rooms that had previously housed patients with CDI:
    • Manual cleaning with bleach reduced C. difficile spores 50%
    • The addition of hydrogen peroxide vapor after manual cleaning reduced spores  by91% (p<.005).

Barbut et al. ICHE. 2009 (read article via PubMed)

​What are some caveats to use of whole-room disinfection technologies?

  • Whole room disinfection cannot substitute for good physical cleaning practices, including compliance with hand hygiene and avoiding cross-contamination

  • Infection preventionists, industrial hygienists, and environmental services supervisors should assess the cleaning procedures, chemicals used, and the safety issues to determine if nearby patients need to be temporarily relocated when disinfecting a room

​What is ultraviolet (UV) disinfection?

  • UV light halts the growth and reproduction of microorganisms by denaturing essential proteins (i.e. DNA)

  • Efficacy may be enhanced by using special paint on the walls
  • Pros
    • Disinfection is not solely dependent upon individual practice
    • Kills organisms on frequently missed areas
    • Safe, rapid, automated, non-corrosive
    • Requires fewer staff resources
  • Cons
    • Influenced by organic matter, does not penetrate porous surfaces
    • Shadowed areas may still require chemical disinfection; may need to move UV light device several times during disinfection process
    • Not as consistently effective as peroxide vapor in reducing levels of contamination
    • Room turnover is slower
    • Cannot be used in occupied rooms
    • Potential exposure of staff to UV if door sensor malfunctions
    • The expense is significant
  • Two types:
    • Emitting devices provide a continuous light from a bulb in a portable machine or hand-held wand
    • Pulsed xenon-UV (UV-C) works using the entire disinfecting spectrum of UV light

Anderson et al. Infection Control. 2006 (read article via PubMed) (read about UV cleaning device at
Anderson et al. Infection Control. 2006 (read article via PubMed)
Miller et al. AJIC. 2015; Nagaraja et al. AJIC. 2015;
Nerandzic et al. BMC Infections Diseases. 2010 (read article via PubMed)
HICPAC 2008 (read Guideline for Disinfection and Sterilization via CDC) (read the Technical Brief via Agency for Healthcare Research and Quality)

​Summary of Key Points

  • A properly cleaned care environment is essential to prevent or contain HAIs

  • A surface must be physically cleaned before it can be disinfected

  • Consistent use of best practices and clarity of roles should be emphasized

  • Use of technologies such as microfiber, monitoring systems, and whole-room disinfection after cleaning are increasingly becoming the community standard of care

  • EVS staff should be valued and supported so they can maximize their unique contributions to preventing HAI

​Environmental Cleaning Resources

CDC/HICPAC Guidelines for Environmental Infection Control in Health-Care Facilities, 2003

CDC/HICPAC Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008

CDC Options for Evaluating Environmental Cleaning Toolkit

CDC Environmental Checklist for Monitoring Terminal Cleaning

CDC Environmental Checklist (scroll to bottom of page and download word doc)

CDC Environmental Cleaning Eval Worksheet (scroll to bottom of page and download excel doc)

CDC/HICPAC Guidelines for Hand Hygiene in Healthcare Settings Published 2002

WHO Guidelines on Hand Hygiene in Healthcare (2009)  

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