With more than 2 million cases each year and an estimated cost to hospitals of more than $30 billion, healthcare-associated infections (HAIs) pose important challenges to the entire healthcare industry. However, given young patients' higher risk of infection, among other factors, children's hospitals in particular need higher levels of protection and cleaning. One promising approach is the use of UVC disinfection—exposing patient rooms or other spaces to ultraviolet-C light that kills or inactivates multidrug-resistant organisms.
Children tend to be at greater than average risk for HAIs for multiple reasons. Very young patients, such as those in neonatal intensive care units, have yet to develop immunity. Others are in a hospital setting for treatment of a disease or condition placing them in immunocompromised states.
Alice Brewer, Director of Clinical Affairs for Tru-D SmartUVC, a UVC device manufacturer, says children's hospitals "end up with a densely populated area of individuals who have little defense against infections and are being subjected to procedures, tests and medications that can further reduce their immunity. So it's almost a domino effect."
Brewer says an infection prevention program in a children's hospital should place additional emphasis on several factors speciﬁc to the setting. "Hand hygiene tends not to be great among kids," she says, so children's hospitals may need to increase focus on surface cleaning.
Additional resources may be directed toward education—teaching young patients and their parents about the roles they can play in preventing infections. And children's hospitals without private rooms may cohort the sickest patients in order to minimize cross-contamination. In addition to these best practices, UVC disinfection provides hospitals with another tool in their infection prevention efforts.
Meeting the Challenge with UVC Disinfection
According to the results of a randomized clinical trial published last year in The Lancet, the addition of UVC to existing chemical disinfection plans within the Duke Infection Control Outreach Network in North Carolina signiﬁcantly lowered the incidence of infections acquired in patient rooms by a cumulative 30 percent.
An additional study published this summer in The Lancet Infectious Diseases pointed to hospital-wide reductions in Clostridium difficile and vancomycin-resistant enterococci infections following the addition of UVC to patient room disinfection procedures. Both studies used Tru-D SmartUVC devices but were funded and designed with no input from the company.
Children's hospitals around the United States have experienced similar outcomes. At Children's Hospital & Medical Center in Omaha, Nebraska, the overall incidence of HAIs decreased by just more than 50 percent following the 2015 implementation of UVC disinfection with Tru-D devices. In particular, the hospital's incidence of C. difficile infections has been reduced to zero in 2018.
With similar results, Children's of Alabama has added Tru-D UVC disinfection to its overall efforts to prevent surgical site infection rates, and St. Jude Children's Research Hospital in Memphis has made it a part of the disinfection protocol in areas with patients highly susceptible to infection, including those undergoing organ transplants or intensive cancer treatments.
Brewer points to ease of use as one of the reasons hospitals have successfully added Tru-D devices to their infection prevention plans. Since Tru-D is a single placement device and tracks the amount of UVC light emitted into a room, shutting off when it has delivered the appropriate amount, a staff member can start the procedure and move on to other tasks without needing to reposition the equipment or make other adjustments.
"Unless you measure how much UVC you're putting into a room, you're just guessing," says Brewer. "Just like we don't want to guess the dosage of a medication, we don't want to guess at the amount of UVC we're putting into a room. We want to ensure the dosage is enough to kill whatever germs may be lingering behind in the room."
Part of a Bigger Picture
UVC disinfection is "absolutely an adjunct to manual cleaning processes," says Brewer. "UVC is not a silver bullet." Existing cleaning procedures, using the appropriate chemicals, remain just as critical to the overall process. Brewer says UVC works best in conjunction with a comprehensive infection prevention program including hand hygiene, antimicrobial stewardship, diagnostic stewardship and other environmental disinfection procedures.
"The environment contributes somewhere between 10 to 25 percent of the burden of HAIs, with the rest of that burden coming from things that might happen during the care of the patient," she says. "UVC disinfection is taking the environment out of that equation."
Implementing a Better Solution
According to Brewer, the weight of research based and real-world evidence has overcome questions about the efficacy of UVC disinfection systems. The primary barrier to adoption, she says, is resource allocation. Device cost is an important consideration for budget-conscious hospitals, as is additional training and workload for environmental services (ES) personnel.
Purchasing managers face an array of choices and limited information on which to base their decision. Brewer encourages as much research as possible. "If you're making a purchase of this size, look at everything. Look at the evidence in the clinical space, look at the published research, look at who funded the studies."
Tru-D also encourages hospitals to conduct trial runs. "That's what I did when I was an infection prevention director," says Brewer. "Let's bring a few in. Let's see which one our ES team prefers. Let's see what the nurses are going to like. If staff members aren't on board with a device, it won't be used, and you've wasted the money."
Beyond the decision-making process, Brewer says the buy-in and involvement of staff members is important for successful implementation of UVC technology. ES, infection prevention and nursing staff members should be just as invested as hospital leadership. With enthusiasm and commitment from all levels, Brewer says hospitals can create—and adhere to—procedures that will be followed. "Everybody can be a cheerleader for their own part of the work that needs to be done for these patients."