High-tech Cleaning Help

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Disinfecting light is turning up in all types of effective forms and applications.


An increasing number of disinfecting robots have been rolling through the hallways at Texas Health Harris Methodist Hospital Fort Worth. They’re being used in various areas of the facility, including the ORs. Not surprisingly, after a year of the pandemic, they’re in high demand.

Prinu Gabriel, MS, SM(ASCP)CM, CIC, the facility’s manager of infection prevention, says two of the machines first arrived around six years ago, and their number has grown since that time. Most employ UVC technology that operates at the favorably germicidal wavelength of between 240 and 280 nanometers.

The robots are used as regularly as possible in the hospital’s 30-plus OR suites. “It’s highly impossible to target all of the rooms in one day, so we do them in a cycle,” says Ms. Gabriel. “At the end of the day, the expectation is we at least utilize them in four ORs. Then the next day we use them in the next four, and so on.”

As at many facilities, the UVC robots are an adjunct to manual cleaning, providing peace-of-mind and reassurance that pathogens that vigorously wiping staffers miss will be eliminated. “UVC reaches surfaces that the manual clean may not reach,” says Ms. Gabriel. It takes the UVC robots about 30 minutes to disinfect the hospital’s larger OR suites, but Ms. Gabriel says they don’t need to be repositioned once they’re in the room. “You bring the robot to the room, set it in one spot and it measures the room,” she says. “The timing for each OR is different based upon the size of the room.”

However, just because the robots are in demand doesn’t mean a staffer can grab one whenever they’d like. For one, even though they’re on wheels, they’re not easy to move. In addition, they’re costly and must be handled with care. “Because of the expense of the machines, our environmental services department has dedicated supervisors and technicians who are trained to use them,” says Ms. Gabriel.

Environmental services (EVS) staff leverage electronic communications to ensure the machines are used efficiently. “Once the terminal cleaning is done on a room, an EVS employee will tag in their system that the room is ready to go, and somebody else brings in the robot,” says Ms. Gabriel.

Once the machine is turned on, humans can’t enter the room because they can be harmed by UVC light. As the machine performs its cycle, EVS staff time when the cycle will be complete so they can retrieve the machine when it’s done.

The electronic documentation EVS staff use is useful for monitoring compliance and, perhaps more importantly, for retrospective analysis. “If we get a serious infection, we can go back and see which room it was in, and whether the room was treated with UVC disinfection.” says Ms. Gabriel.

Overall, the hospital is pleased with the performance of the robots, and even partnered with the health department on a study about their effectiveness. “We swabbed rooms after they had been manually cleaned, and also swabbed rooms after a manual clean followed by UV disinfection,” says Ms. Gabriel. “We were able to isolate C. diff spores after the manual clean, but could not find it anywhere in the rooms where we used UV disinfection.”

Ms. Gabriel’s hospital hasn’t employed UVC beyond its fleet of robots, and views it primarily as an adjunct to surface disinfection technology. She is confident that frequent air exchanges in the ORs handle airborne pathogens effectively — and as a bonus, aerosolized particles that may still remain in a room will be eradicated by the robots as its rays bounce from one surface to another.

Beyond the robots

HELPFUL RAYS UVC robots are widely used to reinforce vigorous manual cleaning in ORs and other public areas in surgical facilities. Matthew Patterson

Larry Perez, CHTM, of Rockford, Mich.-based UVC Experts, which provides consulting and education surrounding the technology, agrees that UVC is primarily seen as a surface disinfection technology. But that’s changing.

“I think the biggest evolution we’ve seen most recently is air disinfection products,” he says. “Before, UV was heavily concentrated on surface disinfection, but with the COVID-19 virus and other aerosolized pathogens out there, we now know they can be just as harmful.”

Mr. Perez believes robust air exchanges in today’s ORs do a good job of neutralizing airborne pathogens. “If you’re in the OR, the number of air exchanges are exceptional,” he says. Mr. Perez sees UVC-based air disinfection effectiveness in other places in a surgical facility, such as waiting rooms and other public, non-sterile environments. He notes, however, that not all UV light is the same, and not all UV light requires the room to be cleared for use.

Take Far-UVC, for example, which operates at a frequency of 222 nanometers. “The claim to fame on Far-UVC is that it can be on while you’re in the room,” says Mr. Perez, noting that there are limits on how long a person can safely coexist with Far-UVC in a closed space — usually several hours at a time. He also points to a hybrid technology employed by several manufacturers that blends different ultraviolet bands. “This is meant to allow you to be in the room while it’s being treated and disinfected through the air,” he says.

A growing number of ORs use this hybrid UV continuously during procedures. It appears to surgeons, staffers and patients as normal white light, but it’s disinfecting the air the whole time. Even though he thinks air exchanges do a good job of keeping OR air safe, Mr. Perez doesn’t feel the use of these hybrid UV lights is overkill.

“In an OR, you’re trying to mitigate surgical site infections,” he says. “One of the biggest risks you have is the team that’s around the patient and the surgical site. Their skin, hair and other particles on their persons can become airborne. If those aren’t immediately treated, they can linger through air currents and end up in the surgical site.”

Another application of UV light is its conjunctive usage with HEPA filtration within HVAC systems. Mr. Perez believes this can be effective, but it depends heavily on where the UV light actually resides in the system. “In a typical HVAC system in a surgical environment, the air treated by UV is located far downstream from the actual point of use,” he says.

In between that location and the OR, the air passes through air-handling units and other processing equipment, encountering different levels of humidity and cleanliness. Citing the stances of the CDC and American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE) on this topic, Mr. Perez says surgical facilities looking to benefit from HVAC-based UV disinfection need an effectively designed system that treats the air along the entire path of its movement, instead of just at a central location. Mr. Perez has seen another UV application that could interest surgical facilities. “The most intriguing one I’ve run into recently was a product that’s like a UVC flashlight,” says Mr. Perez. “It’s a very concentrated beam of light that, at a very close proximity, can destroy pathogens at a 4-log reduction level, which is pretty impressive.” He says the focused light could be great for disinfecting high-contact areas on the fly.

Mr. Perez says UV light is also being employed in storage cabinets and chambers that can disinfect laptops, radios, smartphones and other handheld devices in a matter of 15 to 30 seconds. This could help facilities where phone use in the OR is a recurring issue. One local hospital, he says, is using UV chambers for all of its high-touch keyboards and computer mouse devices. Mr. Perez says these chambers can run from one thousand to several thousand dollars, with more expensive models providing more rapid cycles and things like RFID traceability and item recognition, even sending data to the cloud about what was sterilized so you can track compliance.

As the potential uses for UV light continue to expand, the majority of facilities that currently utilize the technology feel very strongly about its benefits. Just ask Ms. Gabriel, who believes adding UVC disinfection to complement manual cleaning is money well spent. “The technology provides an additional layer of protection,” she says. “It’s really a worthwhile investment.” OSM

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