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Souped-up Surface Cleaning
Whole-room disinfection solutions and fine-tuned manual scrubbing will eradicate infection-causing microorganisms.
Bill Donahue
Publish Date: April 25, 2017   |  Tags:   Infection Prevention
whole-room disinfection robot LIGHT WORK Whole-room disinfection robots cover surface areas that sprays and wipes might have missed during manual cleaning.

After they've hit the OR surfaces with liquid disinfectants and elbow grease, they wheel in the heavy-duty artillery to put the finishing touches on the terminal clean at St. Charles Bend (Ore.) Medical Center: a disinfection robot that bathes the ORs in UV light. The ultraviolet light kills the microbes hardy enough to survive manual terminal cleaning — and hits the hard-to-reach nooks and crannies that the cleaning crew might have missed with their spray bottles and wipes containers.

Randy Barnes, CHESP, director of hospitality services at St. Charles Bend, has grown fond of the reassurance the robot provides. "When you bathe the room in ultraviolet light, you're scrubbing the atmosphere, so it kills everything in the surrounding environment," says Mr. Barnes.

Should you join St. Charles Bend in enlisting innovative new weapons to seek and destroy surface bacteria? Or is good old-fashioned elbow grease enough to wipe away infection-causing microorganisms? The choice comes down to convenience, caseload and cost.

Relying on robots
In January, St. Charles Bend brought in a robot for a 45-day trial. Satisfied with the results in reducing hospital-acquired infections (HAIs) without impeding room turnovers, the hospital now intends to invest in 3 more units: one for the ORs; one for patient rooms on the medical floor; and one to be used as a floater where it's needed most.

Mr. Barnes expects the robots to reduce HAIs, including cases involving spores of tough-to-kill Clostridium difficile, by 30%. Such gains won't come free — each robot has a price tag of $114,000 — but he says the reduction in HAIs and the associated cost-of-care savings should help the hospital achieve a return on its investment in less than 4 months.

"A lot of hospitals will shy away from buying high-ticket technology unless it brings in revenue, but this is an exception," he adds. "It has a patient safety benefit and essentially pays for itself."

whole-room disinfection RUNNING TIME For surgical facilities mulling the addition of a whole-room disinfection system, the duration of each cycle is a key factor to consider.

For anyone mulling whole-room disinfection technology, the time required for each disinfecting cycle is a key consideration. Cycles range from as little as 2 minutes to as long as an hour, but that depends on the make, model and delivery mechanism — namely, short-wavelength ultraviolet (UV-C) light, vaporized hydrogen peroxide and ozone gas.

Elmhurst (Ill.) Hospital is a year into its new-and-improved surface cleaning protocol, which includes the use of a whole-room disinfection device that treats surfaces using an aerosolized agent. The only drawback, according to Annemarie Schmocker, BSN, RN, CIC, Elmhurst's infection control manager: It takes 90 minutes to treat each room, and each has to be sealed off for the duration of the cycle. The hospital's decision-makers considered other options, including UVC-based systems, but Ms. Schmocker believes the one they chose is the best solution for reducing infection risk.

"If you're dealing with shadowing or anything in the way of a surface, the UV light will not penetrate the barrier and can't kill what it's supposed to, meaning you have to stage the robot several times," she says. "Our unit covers every surface in a single shot."

Ms. Schmocker puts the cost of each aerosol delivery device at about $80,000 with a 12-month warranty, though, she says, the hospital was able to negotiate a slightly lower cost and an extended warranty by purchasing 2 units at once. Based on the promising initial results of the technology, she's mulling the addition of a third unit.

A good cleaning protocol must not only rid surfaces of harmful bioburden, but also work within your facility's workflow. Wendy Ferro-Grant, MSN, MBA, CNOR, executive director of perioperative services and endoscopy at Mission Hospital in Mission Viejo, Calif., believes that adding 2 UV-C disinfection robots as an adjunct to her hospital's high-touch cleaning processes has given her the best of both worlds.

Ms. Ferro-Grant says her hospital's disinfection robot delivers metered doses of UV-C light to higher-risk rooms — namely, those known or suspected to be infected C. diff and MRSA. And she likes receiving daily reports, accessed through an online portal, that let her know exactly which rooms got treated and when.

Mission Hospital's disinfection robots are currently being used to treat 16 ORs, including 3 labor and delivery units, as well as cath labs and other areas with a high infection risk. Last year, Mission Hospital had only 1 deep organ-space SSI among all total hip cases — "an extremely significant drop," says Ms. Ferro-Grant — and zero surgical site infections out of 330 total knee replacements. She doesn't attribute the improved outcomes solely to the disinfection robots, but she's confident they played a significant role.

Disinfect Your ORs 24/7

disinfecting lights ALWAYS ON In "white" mode, the disinfecting lights offer ambient lighting and continuous disinfection during surgery. An "indigo" mode provides a deeper clean for when the OR is not in use.

Is it possible to conduct around-the-clock disinfection in your ORs? One surgical facility leader says, yes, it can be done.

The Ambulatory Surgery Center of Spartanburg (S.C.) recently swapped out the overhead lights in one of its ORs with light-emitting diode (LED) fixtures that bathe surfaces in germ-killing 405 nm visible light. Although harmless to humans, the ambient light from these fixtures eradicates Staphylococcus aureus, Enterococcus faecalis and other resilient bugs that might make it past your terminal clean, according to Administrator Mike Pankey, RN, MBA.

"We wanted to start a total joint program, and as part of that effort we wanted to do everything we could to drive down our infection risk," says Mr. Pankey.

The LEDs run continuously, and room sensors switch automatically between 2 modes. A "white" disinfection mode, which bathes the room in disinfecting ambient light, runs when the room is occupied. A deeper-cleaning "indigo" mode amps up the killing power when the room's not in use.

Although it's too soon to put a number to the the LEDs' impact, Mr. Pankey cites studies showing that the high-intensity narrow-spectrum light kills at least 70% more bacteria in the air and on surfaces than routine cleaning (osmag.net/hm5peq); the LEDs cost a fraction of whole-room disinfection robots; and, once they're installed, they require no additional maintenance.

— Bill Donahue

All hands on deck
Even so, the high cost of entry might be deterring broader adoption of whole-room disinfection solutions. Some surgical facility leaders are dubious about the cost-to-benefit ratio.

LoAnn Vande Leest, RN, MBA-H, CNOR, CASC, CHSP, the CEO of Northwest Michigan Surgery Center in Traverse City, says a team approach to between-case cleanings has helped the center maintain a low infection rate. It also holds an outsourced cleaning crew for terminal cleanings to a high standard. This two-pronged approach appears to be paying off: The center hosts more than 21,000 annual cases and had just 10 SSIs last year, says Ms. Vande Leest.

"We do 85 to 100 cases a day, and we use disinfecting wipes between cases that have a 2-minute dwell time," adds Christy Bingham, RN, the center's clinical director and infection control practitioner. "With all of us pitching in, turning over a room could take 2 to 3 minutes."

The center is now looking to increase its volume of total joints cases, which are known for their infection risk. Although they're confident in their current protocol, Ms. Bingham and Ms. Vande Leest will keep their eyes open for ways to mitigate risk. Will whole-room disinfection play a role going forward?

"Maybe if the technology gets to the point where it's more affordable, we'll take a closer look," says Ms. Vande Leest. "If we could find a product that would show a decent return on investment and efficacy, [we'd be interested in adding it]. For now, our manual cleaning process has worked very well for us."

manual surface cleaning\ ALL FOR ONE High standards and a team approach to manual surface cleaning can help maintain a low infection rate.

Teresa Aikens, RN, MSN, CIC, nurse manager for infection prevention and control at the University of Southern Alabama Medical Center in Mobile, says surface disinfection comes down to mastering "the basics" — meticulous between-cases wipe downs and floor-to-ceiling, wall-to-wall terminal cleanings.

"In OR suites, which are big and have lots of equipment, we're diligent about wiping down every surface," says Ms. Aikens. "Many organisms can survive on surfaces in the environment for up to 3 months, and staff can sometimes miss areas during manual cleaning. That's where whole-room disinfection comes in."

USAMC recently purchased a UV-C light disinfection robot. Ms. Aikens says it's been a good addition, but she believes some people have a misunderstanding about how the technology works. It's a supplement to — certainly not a replacement of — a thorough swabbing of surfaces with a spray or wipe that has a rapid kill time, which can range from 30 seconds to 10 minutes, depending on the targeted bacteria and the cleaning product. "Whole-room disinfection technology and manual cleaning work together," she says. "First you have to remove all the visible soil with people power." OSM