Evidence Based Practices for Ultraviolet Disinfection in the Clinical Environment
Name: Gordon West
Organization: The Geneva Foundation
Performance Site: Tripler Army Medical Center
Overview: This evidence based practice project aims to implement ultraviolet technology that can rapidly and simultaneously disinfect multiple high touch surfaces that pose a contamination/transmission risk to our patients and staff, some of which may be linked to the onset of HAIs. Implementation will include the placement of three UV devices for the smaller hand held items and one larger UV device for wheelchairs and bedside commodes. In addition to implementation, we aim to investigate whether improved and sustained awareness of and compliance with standard infection control practices will enhance the effectiveness of the technology. These competencies include an understanding of the specific items not covered by the environmental service contract (and therefore under the responsibility of nursing staff), basic hand hygiene mandates, and infection prevention best practices. Ultimately, we hope to demonstrate that the implementation of this project can contribute to a reduction in the bacterial burden of these prevalent, high touch surfaces as well as a reduction in HAIs as reported to the National Healthcare Safety Network (NHSN), especially categories marked for improvement in the preceding year. These HAIs are monitored and tracked by infection control staff who are serving as consultants on this project. Secondary outcomes will include improvements in hand hygiene compliance and environmental cleaning as these factors are commonly identified in clustered HAIs cases at thisfacility and are commonly utilized outcomes in the majority of environmental infection prevention literature.
Background: Evidence suggests that harmful bacteria populate nearly every environmental surface; additionally it is clear that high touch surfaces pose a greater risk due to their elevated frequency of hand to surface contact. Literature supports that decontamination procedures of many of these high-contact points are unclear, ineffective, or in some cases non-existent. Ultraviolet technology has consistently been shown to improve outcomes when used as an adjunct to traditional terminal room cleaning and the science of UV technology as a bactericide is well established. Though effective, these larger UV devices typically require ~30 minute disinfection cycles and are impractical to utilize for the high touch surfaces outlined in this project. Thisproject aims to implement smaller, intuitive UV devices that can deliver a bactericidal dose of UV faster than traditional room disinfection UV machines. These machines require minimal training and are effective against common hospital pathogens in as little as 30 seconds. The larger UV device for wheelchairs and bedside commodes is similarly easy to operate as staff place the items into the device, close the door, and hit the start button. To ensure an effective dose of UV against C. difficile spores, the larger device requires a two minute cycle. Equipping staff with accessible, rapid, and effective disinfection technology may improve adherence to environmental cleanliness standards and drive down HAIs. Measures to minimize the accumulation of potential nosocomial pathogens on these items are especially needed to prevent transmission to vulnerable patients. This project will use the Iowa model (revised) as the framework for implementation addressing the PICOT question guiding this 2-year EBP project.
PICOT: In both patients and nursing staff in a hospital setting (P) does ultraviolet disinfection of prevalent high touch items (I) compared to current cleaning practices (C) achieve a significant reduction in hospital acquired infection rates (O) over a two year period (T)?
Relevance: This project supports the TSNRP research priority of nursing competencies and practice and, secondarily, with force health protection. Beyond the military treatment facility, UV technology could benefit forward deployed units that often struggle to maintain cleaning practices in a field environment. The contract nature of housekeeping services, paired with high turnover of nursing staff, highlights the potential for the proposed items in this project to be inadequately cleaned and to harbor and transmit dangerous bacteria within the hospital. Asthe military health system strives to be a high-reliability organization, this work can assist in the development of protocols and safeguards to reduce HAIs and improve the quality and safety of the care we provide.