The Pros and Cons of Whole-Room Disinfection Approaches

Hydrogen peroxide vapor, UV robots and integrated lighting systems can augment your already robust manual cleaning practices.

Manual cleaning done properly is effective for eradicating microorganisms. Performing the task correctly, however, requires busy surgical and environmental services personnel to not take shortcuts when it comes to giving surface disinfectants the proper amount of exposure time before applying significant elbow grease.

Extra help

Fortunately, there are multiple high-tech, no-touch adjuncts to manual cleaning that kill harmful pathogens that can put patients at risk.

Vaporized and aerosol hydrogen peroxide, continuous ultraviolet light from mobile units, pulsed xenon UV light and even high-intensity narrow-spectrum 405nm light are all options to add to end-of-day terminal cleaning.

The technologies take time to use, but have been shown to reduce bacterial contamination of surfaces in support of your staff’s fight against infections.

“Whole-room disinfection systems can be a valuable adjunct to routine disinfection and room turnover procedures. It does require leadership support for the staff training and utilization of those systems,” says Marie H. Wilson, MSN, RN, CIC, FAPIC, chair of the Association for Professionals in Infection Control and Epidemiology’s Communications Committee and an infection preventionist at Fred Hutchinson Cancer Center in Seattle. “It also requires auditing, just like any other cleaning verification that we do for performance, to ensure they’re being used properly, consistently and only as an adjunct that’s not taking place of the routine.”

Hydrogen peroxide systems

These fogging and misting systems are 100% effective in disinfecting ORs of viruses, bacteria and other microorganisms that can be in any nook and cranny that manual cleaners might miss.

“This technology does completely sterilize the environment, so it would be a fabulous terminal cleaning system in surgery centers,” says Nancy Havill, MT(ASCP), MHA, CIC, an infection prevention manager at Yale New Haven Health System in Connecticut. “ORs have anesthesia machines, med carts, tubes and things hanging everywhere. Manual cleaning can’t cover every inch, so this is a good way to make sure everything is reached.”

The hydrogen peroxide systems are small, portable and relatively easy to operate, so they require minimal training. They also cost significantly less than UV robot technology, and the airborne mist and vapors don’t damage equipment in the rooms.

Ms. Havill notes doors must be completely sealed and no one can be in the room when the systems are in use. HVAC vents must be sealed as well for the extended time the machines take to do their work, which can be tricky as many ORs employ positive air pressure.

“OR air is generally blown through the vents into and then out of the room to keep pathogens out and these systems are much harder to seal off,” she says. “Some facilities will need to have someone go into the system and close a damper to prevent any leakage into other areas of the building.”

Someone should monitor the machines while in use to ensure the chemical doesn’t escape during treatment. The length of the process depends on the size of the room. Yale New Haven Health used these systems to disinfect one of its ASCs that was employed as an ICU at the height of the COVID.

Ultraviolet options

FROM THE TOP Ultraviolet germicidal radiation is emitted from ceiling systems tucked behind light fixtures that protect patients and staff from airborne microbial threats.

With so many UV options on the market that do a good job, Ms. Havill says purchasers should educate themselves about all of them, including the different designs, intensity of the bulbs, the distance from which they are effective and where they should be placed in the room. “All of this can affect the efficacy,” she says.

UV systems are effective in reducing environmental contamination on high-touch areas and can reduce the levels of vegetative bacteria and C. difficile spores. The robots work well, and the UV systems behind ceiling light fixture also keep the air clean above the sterile field and are extremely effective. “That’s a significant capital expense, but they’ve been shown to decrease the rates of surgical site infections,” says Ms. Havill.

UV robots are used more than hydrogen peroxide systems. Their portability allows them to be easily rolled from OR to OR and kill most of the germs in the device’s direct line of sight as it automatically moves around the room overnight. Doors and vents don’t need to be sealed while they are in use.

J. Darell Hicks, BA, CHESP, CMIP, owner of Safe, Clean and Disinfected, an infection control company, agrees that automated disinfecting systems are appropriate for same-day surgical settings but says facilities could be challenged to get returns on their investments because of the price points of the products. “I think the jury remains out on how effective these devices are for reducing HAIs,” says Mr. Hicks. “However, you certainly achieve a cost avoidance if you do prevent infections from happening, and there’s evidence to show that less than 50% of terminally cleaned rooms actually get disinfected. That fact alone, to me, shows me there is a place for these systems in OR environments.”

Additional approaches

SEAL THE DEAL Hydrogen peroxide vapor effectively sterilizes operating rooms, but the doors and air vents must be closed first.

Ultraviolet germicidal irradiation (UVGI) technology is another product placed behind ceiling lights and, unlike other UV systems, patients and staff can be in the room while it’s running, so this option can be used to reduce the number of pathogens that settle on surfaces around the clock. Products that use 405nm lights are also used 24/7 with bulbs that illuminate and disinfect rooms simultaneously. Models with occupancy sensors turn off when people leave the room.

Mr. Hicks says there are products that use chlorine dioxide tablets placed in water that create a gas to disinfect rooms that must be vacant for four hours. “Like the hydrogen peroxide products, a once-a-week total disinfection over the weekend when an ASC is closed would be a valid use for this,” he says.

Another promising technology that Mr. Hicks says we’ll see in the future is continuous action disinfection (CAD) products. Essentially, the chemicals in the product are intermediate-level disinfectants that kill germs on contact, but remain on surfaces for an extended period of time and kill what lands there weeks and months later. “It’s not a silver bullet, but I think CAD applications will provide a bit more security for facilities because it acts like a shield that will provide active, ongoing disinfection on surfaces for three or four months,” says Mr. Hicks.

He also sees a bright future for applying disinfectants in ORs with electrostatic sprayers. In theory, this method could require less pre-cleaning by traditional methods. “Any EPA-registered disinfectant that has an electrostatic application on their labels can be used,” says Mr. Hicks. “Most surfaces have a negative charge, and the electrical positive charge from the mobile sprayer units looks for areas of the surfaces that don’t already have a disinfectant on it. It gets into nooks and crannies than manual cleaning doesn’t — and you can apply it quickly and safely.”

Mr. Hicks says these additional efforts to back up manual cleaning practices are more important than ever. “With healthcare’s staffing shortages and other challenges, the human element of our efforts isn’t getting any better,” he says. “We need to do something that is more of a belt-and-suspenders approach.” OSM