orm_may-2024 - 6

Surface disinfection: How to play your cards right with UVC light
STERILIZATION & INFECTION PREVENTION
pproximately one in 31 hospital
patients has at least one infection
on any given day, according
to the Centers for Disease Control and
Prevention (CDC). In surgical settings,
the risk is even higher, with up to 7% of
patients developing an infection during
surgery. These infections can lead to
a range of complications, including increased
readmission risk and prolonged
hospital stays. Additionally, the average
cost of treating an infection can be upwards
of $48,000 per patient.
Wiping down workstations, bed
rails, and other surfaces with even the
most powerful chemicals might not be
enough. According to research recently
published in the American Journal of Infection
Control, lesser-known pathogens
in skin flora or environmental bacteria
often survive routine hospital disinfection
procedures.
A
However, research also shows that
shining a little light-specifically, highly
germicidal ultraviolet-C (UVC) light-can
help fully mitigate the risk of endocarditis,
meningitis, and other hospitalacquired
infections. Used alongside
existing cleaning and sanitization protocols,
UVC is potent against microorganisms,
including viruses, methicillinresistant
Staphylococcus aureus, and
vancomycin-resistant enterococci. The
practice has been shown to be more
than 97% effective in reducing colony
forming units (CFUs, a minimum number
of cells to form a viable colony) in
some hospital settings.
Integrating UVC light into a hospital's
workflow need not be burdensome.
Used in the past to control conditions
ranging from influenza to severe acute
respiratory syndrome (SARS), UVC disinfection
systems saw a spike in sales
amid the recent COVID-19 pandemic.
Whether a hospital has a system in
place already or is thinking of adding
one, regularly assessing the efficacy of
UVC disinfection in achieving comprehensive
microbial reduction is essential.
This article provides the requisite UVC
6
OR Manager | May 2024
dosages and procedural steps essential
for conducting a successful audit.
The science of UVC disinfection
UVC is distinguished from other forms
of ultraviolet light (UVA, UVB) by its high
energy and shorter wavelength: 250-
280 nm, the most effective range of
the electromagnetic spectrum for inactivating
microorganisms. With the right
range applied at the right time to the
right bug, UVC emissions can prevent
viruses and bacteria from replicating by
destroying their genetic material.
Autonomous UVC disinfection systems
can navigate through a room on
their own accord, eliminating the need
for manual repositioning. On average,
the time between cases ranges from
30 minutes to one hour, during which
the surgical suite must be thoroughly
cleaned and disinfected to reduce the
risk of infections. Using an autonomous
system, disinfection can be completed
in as little as 10 minutes.
At such speeds, autonomous UVC
could be employed between surgical
cases rather than waiting until the end
of the day to disinfect. More efficient
turnovers could enable performing more
procedures on a given day while also
keeping patients safer through each
stage of the perioperative process.
Setup and operation
First, identify the high-touch surfaces
in the area to be disinfected. While an
autonomous disinfection solution will
disinfect everything in its light range,
the testing procedure should focus on
specific, controlled surfaces to best
observe results. In the OR, high-touch
surfaces typically include bed rails, remotes,
touch screens, phones, monitoring
equipment, faucets, drawers, and
closet handles.
Next is the set up. For an autonomous
system, map the room according
to the instructions provided by the
manufacturer, being sure to navigate as
closely as possible to target surfaces.
BY TRA VU
Locating devices close to target surfaces
is important due to the Inverse
Square Law, since the UV dose required
for inactivation is the product of UV intensity
[I] (expressed as energy per unit
surface area) and exposure time [T].
Therefore: DOSE = I x T. This dose is
commonly expressed as millijoule per
square centimeter (mJ/cm2).
The reduction of microorganisms is
classified using a logarithmic scale. A
single log reduction is a 90% reduction
of organisms. A Log2 reduction is a
99% reduction of organisms, followed
by a Log3 reduction (99.9%), and so
forth. Independent testing of one autonomous
system shows that 254-nm UVC
eliminates pathogens like MRSA, VRE,
P. aeruginosa, E. coli, and SARS-COV-2
with an efficacy of 99.999%.
If the device allows customizing the
disinfection intensity, adjust it based
on the pathogens that need eliminating.
Next, disinfect the area using the
appropriate disinfection intensity on the
UVC device. Some devices offer " auto
sense, " " low power, " and " high power. "
The intensity guide on the next page
is an example of what one manufacturer
provides to guide its customers.
As indicated, bacteria are generally easier
to inactivate than viruses, with fungi
and spores being even harder to inactivate
with UV.
UVC dosage, denoted in mJ/cm2,
signifies the quantity of UVC light administered
to a specific area over a designated
duration. Industry-recognized
standards outline the requisite mJ/
cm2 thresholds for deactivating various
pathogens.
Auditing UVC disinfection
Featuring treated surfaces that change
color when exposed to UV light, dosimeter
cards provide a means of validating
dosage and determining the efficacy of
disinfection. When used weekly, dosimeter
cards can help to audit OR disinfection
with high throughput.
An alternative audit method that
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