SEE THE LIGHT Mobile disinfection systems target infection-causing bacteria hiding throughout the room.

As thorough as your manual room cleaning processes may be, there's always going to be nooks and crannies in your OR equipment, counters and surfaces that your staff just can't get to. Today's ultraviolet disinfection systems are designed to disperse ultraviolet light throughout your ORs and patient rooms, attacking those tough-to-reach spots where infection-causing bacteria like to hide. These systems can't replace your manual room cleaning procedures, but they provide an additional weapon in the fight against healthcare-associated infections. Here's what you need to know about these powerful new machines.

Targeting bacteria
Hospitals have actually employed ultraviolet-C (UVC), or short-wave ultraviolet radiation, to kill microorganisms for decades. Today's UV disinfection systems, however, are mobile, which lets you efficiently clean multiple rooms throughout your facility without disrupting everyday operations.

During the manual cleaning process, the room is set up to expose the surfaces to be disinfected, and the UVC light is placed in the center of the room. Doors are closed, with vertical and horizontal openings evaluated for gaps. Apply the motion sensor to the doors, and place signage on the doors alerting staff that the system is in use. Our UV disinfection system consists of 3 components: the UVC light, a motion sensor and a handheld device that scans the room. On the handheld device, you check items from a start-up checklist — the system is in the center of the room, "Do Not Enter" sign is posted, doors are closed and sensors armed — to confirm that a safe and consistent process is initiated. The user inputs her security code and the UVC light activates.

Once the system is activated, sensors on the outside of the machine take a 360-degree measurement of the room, including equipment inside the room, and measure in real time the ideal UVC dose for the specific room characteristics, to determine how long the cycle will take to complete. Systems may also have multiple settings to choose from. For example, our system has a bactericidal and a sporicidal setting. The sporicidal setting penetrates hard surfaces and kills spore-forming organisms like C. difficile, while the bactericidal setting kills such non-spore forming organisms as MRSA.

Depending on the size of the room, the system can effectively do its job in as little as 10 minutes to 15 minutes. When activated, the system's UV light rays provide rapid inactivation of microorganisms. When bacteria and viruses are exposed to the germicidal wavelengths of UV light, they're rendered incapable of reproducing and infecting.

MAKING A LIST A handheld device provides a checklist to ensure consistent and thorough disinfection.

PROOF THAT IT WORKS

Is UV Disinfection Doing Its Job?

For your room disinfection practices to be effective, you must be able to measure them. Many UV whole-room disinfection systems make tracking the process simple. For example, our system includes service documentation software that communicates with a web-based server to capture room-cleaning information in real time, and lets you record with a handheld remote device which rooms have been treated, when and by whom. Data is uploaded to the server to document the treatment of each room. Administrators or infection preventionists can download new reports each day, and use this data to better manage disinfection programs.

We sometimes use the system to clean as many as 15 rooms in a day. Each day, our infection preventionist reviews which rooms were cleaned the previous day, and compares that list with contact precaution discharges. In the event that a contact room was not disinfected, that room is placed on a priority list for the next time the room is available. This lets us track disinfection for individual rooms, as well as who's running the system in each room. In addition, the software lets you collect session, location and treatment logging data, which can be used to modify work routines in order to eliminate bottlenecks in workflow, which helps identify areas for improvement in your disinfection processes.

— Kathy Puthoff, RN, CIC

Proper precautions
Today's mobile systems are large, but are simple to move from room to room. UV systems may be up to 5 feet high, 2 feet in diameter and weigh as much as 300 lbs., but the average staff member should be able to roll the system safely throughout your facility.

They're also easy to operate, and most staff members can be trained to use them. At our facility, infection control specialists, environmental service staff, ICU nurses, patient care assistants, unit secretaries, patient companions and volunteers are trained to activate and operate the systems. We provide vendor-issued handouts and perform demonstrations of the systems in action to train users, which typically takes between 2 hours and 3 hours per person.

Still, there are important safety precautions to take before activating the system.

• First, clear the room of items with clear, thin-walled containers such as IV fluid containers, water bottles and saline bullets that the UVC light could penetrate.
• If you're running the UVC light in a room, you'll need to look for the aforementioned openings that would let light pass through, and apply tape to gaps greater than one-quarter inch in size.
• You must also shield any nearby areas where medications are stored. Automated medication dispensing systems are typically made of glass or Plexiglas, but still have small openings that light can sneak through. Luckily, filling these gaps is quick and easy. Simply use tape or paper to block any openings where UV rays could enter.
• Make sure the room itself is enclosed before beginning the disinfection process, and clear staff members from the room as well.

From a staff and patient safety standpoint, UV systems should include redundant safety features that prevent inadvertent exposure to UVC. Our system employs multiple motion detection systems to detect staff members in the area, including a door sensor for hanging on room-access door handles and remote activation once door sensors are properly placed.

In addition to offering quicker and more thorough disinfection, UV systems don't contain the toxic or significant non-toxic by-products found in some cleaning products. These are significant benefits, but the ultimate goal is seeing significant reductions in your healthcare-associated infection numbers.

We've employed our system — known affectionately among our staff as "The Germinator" — for nearly 1 year in contact precaution inpatient rooms. In this time, we've seen our facility's C. diff rate drop more than 32%. The incidence of vancomycin-resistant enterococci (VRE) has dropped by 83% over that time. In addition, our surgery unit has been using the system to disinfect rooms at least once a week, usually toward the end of the week when caseloads are lighter. Take note that ORs are usually much larger than patient rooms, and will take longer to disinfect using a UV system. At our facility, the average cycle time for an OR is between 25 and 30 minutes.