‘No touch’ technologies for environmental decontamination: focus on ultraviolet devices and hydrogen peroxide systems

Current Opinion in Infectious Diseases - Tập 29 Số 4 - Trang 424-431 - 2016
David J. Weber1,2, Hajime Kanamori1, William A. Rutala1,2
1Department of Hospital Epidemiology, University of North Carolina Health Care
2Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, North Carolina, USA

Tóm tắt

Purpose of review This article reviews ‘no touch’ methods for disinfection of the contaminated surface environment of hospitalized patients’ rooms. The focus is on studies that assessed the effectiveness of ultraviolet (UV) light devices, hydrogen peroxide systems, and self-disinfecting surfaces to reduce healthcare-associated infections (HAIs). Recent findings The contaminated surface environment in hospitals plays an important role in the transmission of several key nosocomial pathogens including methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus spp., Clostridium difficile, Acinetobacter spp., and norovirus. Multiple clinical trials have now demonstrated the effectiveness of UV light devices and hydrogen peroxide systems to reduce HAIs. A limited number of studies have suggested that ‘self-disinfecting’ surfaces may also decrease HAIs. Summary Many studies have demonstrated that terminal cleaning and disinfection with germicides is often inadequate and leaves environmental surfaces contaminated with important nosocomial pathogens. ‘No touch’ methods of room decontamination (i.e., UV devices and hydrogen peroxide systems) have been demonstrated to reduce key nosocomial pathogens on inoculated test surfaces and on environmental surfaces in actual patient rooms. Further UV devices and hydrogen peroxide systems have been demonstrated to reduce HAI. A validated ‘no touch’ device or system should be used for terminal room disinfection following discharge of patients on contact precautions. The use of a ‘self-disinfecting’ surface to reduce HAI has not been convincingly demonstrated.

Từ khóa


Tài liệu tham khảo

Magill, 2014, Multistate point-prevalence survey of healthcare-associated infections, N Engl J Med, 370, 1198, 10.1056/NEJMoa1306801

Zimlichman, 2013, Healthcare-associated infections: a meta-analysis of costs and financial impact on the US healthcare system, AMA Intern Med, 173, 2039

Weinstein, 1991, Epidemiology and control of nosocomial infections in adult intensive care units, Am J Med, 91, 179S, 10.1016/0002-9343(91)90366-6

Otter, 2011, The role played by contaminated surfaces in the transmission of nosocomial pathogens, Infect Control Hosp Epidemiol, 32, 687, 10.1086/660363

Steifel, 2011, Contamination of hands with methicillin-resistant Staphylococcus aureus after contact with environmental surfaces and after contact with the skin of colonized patients, Infect Control Hosp Epidemiol, 32, 185, 10.1086/657944

Morgan, 2012, Transfer of multidrug-resistant bacteria to healthcare workers’ gloves and gowns after patient contact increases with environmental contamination, Crit Care Med, 40, 1045, 10.1097/CCM.0b013e31823bc7c8

Weber, 2016, Effectiveness of UV devices and hydrogen peroxide systems for terminal room decontamination: focus on clinical trials, Am J Infect Control, 44, e77, 10.1016/j.ajic.2015.11.015

Weber, 2010, Role of hospital surfaces in the transmission of emerging health care-associated pathogens: norovirus, Clostridium difficile, and Acinetobacter species, Am J Infect Control, 38, S25, 10.1016/j.ajic.2010.04.196

Otter, 2013, Evidence that contaminated surfaces contribute to the transmission of hospital pathogens and an overview of strategies to address contaminated surfaces in hospital settings, Am J Infect Control, 41, S6, 10.1016/j.ajic.2012.12.004

Weber, 2013, Role of the environment in the transmission of Clostridium difficile in healthcare facilities, Am J Infect Control, 41, S105, 10.1016/j.ajic.2012.12.009

Weber, 2013, The role of the surface environment in healthcare-associated infections, Curr Opin Infect Dis, 26, 338, 10.1097/QCO.0b013e3283630f04

Siani, 2015, Best practice in healthcare environmental decontamination, Eur J Clin Microbiol Infect Dis, 34, 1, 10.1007/s10096-014-2205-9

Mitchell, 2015, Risk of organism acquisition from prior room occupants: a systematic review and meta-analysis, J Hosp Infect, 91, 211, 10.1016/j.jhin.2015.08.005

Otter, 2016, Transmission of SARS and MERS coronaviruses and influenza virus in healthcare settings: the possible role of dry surface contamination, J Hosp Infect, 92, 235, 10.1016/j.jhin.2015.08.027

Bin, 2016, Environmental contamination and viral shedding in MERS patients during MERS-CoV outbreak in South Korea, Clin Infect Dis, 62, 755, 10.1093/cid/civ1020

Lerner, 2013, Environmental contamination by carbapenem-resistant Enterobacteriaceae, J Clin Microbiol, 51, 177, 10.1128/JCM.01992-12

Weber, 2015, Carbapenem-resistant Enterobacteriaceae: frequency of hospital room contamination and survival on various inoculated surfaces, Infect Control Hosp Epidemiol, 36, 590, 10.1017/ice.2015.17

Biswas, 2015, Contamination of the hospital environment from potential Clostridium difficile excretors without active infection, Infect Control Hosp Epidemiol, 36, 975, 10.1017/ice.2015.79

Kundrapu, 2015, Skin and environmental contamination in patients diagnosed with Clostridium difficile infection but not meeting clinical criteria for testing, Infect Control Hosp Epidemiol, 36, 1348, 10.1017/ice.2015.191

Faden, 2015, Importance of asymptomatic shedding of Clostridium difficile in environmental contamination of a neonatal intensive care unit, Am J Infect Control, 43, 887, 10.1016/j.ajic.2015.04.187

Villamaria, 2015, Comparison of environmental MRSA levels on high-touch surfaces in contact isolation and noncontact isolation patient rooms, Infect Control Hosp Epidemiol, 36, 1472, 10.1017/ice.2015.207

Rutala, 2014, Effectiveness of improved hydrogen peroxide in decontaminating privacy curtains contaminated with multidrug-resistant pathogens, Am J Infect Control, 42, 426, 10.1016/j.ajic.2013.11.022

Carling, 2008, Improving cleaning of the environment surrounding patients in 36 acute care hospitals, Infect Control Hosp Epidemiol, 29, 1035, 10.1086/591940

Carling, 2010, Improving environmental hygiene in 27 intensive care units to decrease multidrug-resistant bacterial transmission, Crit Care Med, 38, 1054, 10.1097/CCM.0b013e3181cdf705

Donskey, 2013, Does improving surface cleaning and disinfection reduce healthcare-associated infections?, Am J Infect Control, 41, S12, 10.1016/j.ajic.2012.12.010

Han, 2015, Cleaning hospital rooms to prevent health care-associated infections: a technical brief, Ann Intern Med, 163, 598, 10.7326/M15-1192

Otter, 2013, The role of ‘no-touch’ automated room disinfection systems in infection prevention and control, J Hosp Infect, 83, 1, 10.1016/j.jhin.2012.10.002

Barbut, 2015, How to eradicate Clostridium difficile from the environment, J Hosp Infect, 89, 287, 10.1016/j.jhin.2014.12.007

Doll, 2015, Touchless technologies for decontamination in the hospital: a review of hydrogen peroxide and UV devices, Curr Infect Dis Rep, 17, 498, 10.1007/s11908-015-0498-1

Rutala, 2016, Disinfection and sterilization in health-care facilities: an overview and current issues, Infect Dis Clinic N Am, 10.1016/j.idc.2016.04.002

Weber, 2013, Self-disinfecting surfaces: review of current methodologies and future prospects, Am J Infect Control, 41, S31, 10.1016/j.ajic.2012.12.005

Humphreys, 2014, Self-disinfecting and microbiocide-impregnated surfaces and fabrics: what potential in interrupting the spread of healthcare-associated infection?, Clin Infect Dis, 58, 848, 10.1093/cid/cit765

Muller, 2016, Antimicrobial surfaces to prevent healthcare-associated infections: a systematic review, J Hosp Infect, 92, 7, 10.1016/j.jhin.2015.09.008

Rutala, 2013, Rapid hospital room decontamination using ultraviolet (UV) light with a nanostructured UV-reflective wall coating, Infect Control Hosp Epidemiol, 34, 527, 10.1086/670211

Rutala, 2014, Room decontamination using an ultraviolet-C device with short ultraviolet exposure time, Infect Control Hosp Epidemiol, 35, 1070, 10.1086/677149

Fu, 2012, Efficacy, efficiency and safety aspects of hydrogen peroxide vapour and aerosolized hydrogen peroxide room disinfection systems, J Hosp Infect, 80, 199, 10.1016/j.jhin.2011.11.019

Barbut, 2013, Hydrogen peroxide room disinfection: there is no elephant in the room but there's plenty of evidence in the trunk, J Hosp Infect, 83, 353, 10.1016/j.jhin.2012.12.007

Lemmen, 2015, Evaluation of hydrogen peroxide vapor for the inactivation of nosocomial pathogens on porous and nonporous surfaces, Am J Infect Control, 43, 82, 10.1016/j.ajic.2014.10.007

Boyce, 2016, Impact of room location on UV-C irradiance and UV-C dosage and antimicrobial effect delivered by a mobile UV-C light device, Infect Control Hosp Epidemiol, 10.1017/ice.2016.35

Cadnum, 2016, Effect of variation in test methods on performance of ultraviolet-C radiation room decontamination, Infect Control Hosp Epidemiol, 37, 555, 10.1017/ice.2015.349

Nerandzic, 2015, Evaluation of a pulsed xenon ultraviolet disinfection system for reduction of healthcare-associated pathogens in hospital rooms, Infect Control Hosp Epidemiol, 36, 192, 10.1017/ice.2014.36

Wong, 2016, Postdischarge decontamination of MRSA, VRE, and Clostridium difficile isolation rooms using 2 commercially available automated ultraviolet-C-emitting devices, Am J Infect Control, 44, 416, 10.1016/j.ajic.2015.10.016

Vianna, 2016, Impact of pulsed xenon ultraviolet light on hospital-acquired infection rates in a community hospital, Am J Infect Control, 44, 299, 10.1016/j.ajic.2015.10.009

Horn, 2015, Hydrogen peroxide vapor room disinfection and hand hygiene improvements reduce Clostridium difficile infection, methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and extended-spectrum β-lactamase, Am J Infect Control, 43, 1354, 10.1016/j.ajic.2015.06.029

Pegues, 2015, Reducing Clostridium difficile infection among hematology-oncology patients using ultraviolet irradiation for terminal disinfection, IDweek

Nagaraja, 2015, Clostridium difficile infections before and during use of ultraviolet disinfection, Am J Infect Control, 43, 940, 10.1016/j.ajic.2015.05.003

Miller, 2015, Utilization and impact of a pulsed-xenon ultraviolet room disinfection system and multidisciplinary care team on Clostridium difficile in a long-term acute care facility, Am J Infect Control, 43, 1350, 10.1016/j.ajic.2015.07.029

Mitchell, 2014, Controlling methicillin-resistant Staphylococcus aureus (MRSA) in a hospital and the role of hydrogen peroxide decontamination: an interrupted time series analysis, BMJ Open, 4, e004522, 10.1136/bmjopen-2013-004522

Haas, 2014, Implementation and impact of ultraviolet environment disinfection in an acute care setting, Am J Infect Control, 42, 586, 10.1016/j.ajic.2013.12.013

Manian, 2013, Implementation of hospital-wide enhanced terminal cleaning of targeted patient rooms and its impact on endemic Clostridium difficile infection rates, Am J Infect Control, 41, 537, 10.1016/j.ajic.2012.06.014

Passaretti, 2013, An evaluation of environmental decontamination with hydrogen peroxide vapor for reducing the risk of patient acquisition of multidrug-resistant organisms, Clin Infect Dis, 56, 27, 10.1093/cid/cis839

Levin, 2013, The effect of portable pulsed xenon ultraviolet light after terminal cleaning on hospital-associated Clostridium difficile infection in a community hospital, Am J Infect Control, 41, 746, 10.1016/j.ajic.2013.02.010

Cooper, 2011, Impact of environmental decontamination using hydrogen peroxide vapour on the incidence of Clostridium difficile infection in one hospital trust, J Hosp Infect, 78, 238, 10.1016/j.jhin.2010.12.013

Boyce, 2008, Impact of hydrogen peroxide vapor room decontamination on Clostridium difficile environmental contamination and transmission in a healthcare setting, Infect Control Hosp Epidemiol, 29, 723, 10.1086/589906

Catalanotti, 2016, Influence of pulsed-xenon ultraviolet light-based environmental disinfection on surgical site infections, Am J Infect Control, 10.1016/j.ajic.2015.12.018

Barnes, 2014, Preventing the transmission of multidrug-resistant organisms: modeling the relative importance of hand hygiene and environmental cleaning interventions, Infect Control Hosp Epidemiol, 35, 1156, 10.1086/677632

Sitzlar, 2013, An environmental disinfection odyssey: evaluation of sequential interventions to improve disinfection of Clostridium difficile isolation rooms, Infect Control Hosp Epidemiol, 34, 459, 10.1086/670217

Thông tin
Thông tin xuất bản

Current Opinion in Infectious Diseases

Tập 29 Số 4

424-431

Thông tin tác giả