healthcare-associated infections (HAI) program

Emerging 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

http://www.cadth.ca/sites/default/files/pdf/htis/nov-2014/RC0545%20Room%20Disinfection%20Final.pdf (read report via Canadian Agency for Drugs and Technologies in Health)

Hydrogen peroxide in either a dry mist or vapor form.

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)

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)

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

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

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

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)
http://www.xenex.com/how-uv-disinfection-works (read about UV cleaning device at Xenex.com)
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)
http://effectivehealthcare.ahrq.gov/ehc/products/592/2103/healthcare-infections-report-150810.pdf (read the Technical Brief via Agency for Healthcare Research and Quality)

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