An introduction to Automated Room Disinfection

Nov. 02, 2021

Infection prevention and control continues to be a challenge for healthcare facilities. Healthcare-associated infections (HCAIs) affect approximately 1 in 31 hospital patients globally at any one time* and in the Middle East the prevalence rate can be as high as 16%* . The cost to manage a patient who acquires an HCAI is 3x higher than that of managing a patient without one.

A variety of factors that are specific to the Middle East including a wide income disparity, travel trends and overuse and subsequent build-up of resistance to antibiotics has led to the GCC countries experiencing a higher level of HCAIs than other regions. One particular superbug, (carbapenem-resistant bacteria) has seen a rise in prevalence of up to 90% in the last 20 years in the region.*

In this article we look into some of the extra weapons that can be used in the fight against HCAIs

Automated room disinfection works alongside manual cleaning

Contaminated surfaces in a healthcare setting can increase the risk of a patient contracting an infection. Conventional cleaning and disinfection methods go some way to reduce this risk but as these processes are very manual, assurance is difficult. Variation may be caused by the materials, chemicals and the operators used in the process.

For this reason, automated room disinfection (or decontamination) devices are increasingly being considered as an adjunct to manual cleaning as they can be an effective way to reduce the risk of infection even further than cleaning can alone.

Automated room disinfection (ARD) devices don’t clean; they simply disinfect. So they’ll never replace the important step of cleaning and mechanically removing dirt, dust and debris. Rather, room disinfection is an additional step that takes place after a room has been cleaned.

Hydrogen Peroxide or UV-C Technology? Understanding the Difference

When choosing an automated room disinfection device there are several factors to consider:

Efficacy – does the device kill the target pathogens?
Speed – how long will a room/area be out of action while the device is in operation?
Ease of use – is it a simple, easily replicable disinfection process?
Validation – how can you prove the device has done its job after an application?
Storage and transport – is the device safe and easy to store and move around the site?
Safety – what are the risks of operating the device and how are they mitigated?
Material compatibility – will the disinfection process damage the fabric of the building or the equipment in the room?
Cost – the total cost of the ARD service must consider the cost of the device, its consumables and the labour required to deliver the service.

ARD devices fall into two main categories, those that disperse gaseous hydrogen peroxide, and those that emit ultraviolet C (UV-C) light.

Hydrogen peroxide vapour (HPV) devices are seen by the infection control community as the gold standard in terms of clinical efficacy. Devices that emit UV-C light are newer to the market and are gaining in popularity.

What HPV and UV-C devices are available?

The following table summarises the key differences.

Most efficient solution for...

EFFICACY

Both HPV and UV-C devices reduce bacterial contamination, including spores, more significantly than cleaning can alone, but HPV is significantly more effective. UV-C is significantly less effective for areas of the room that are out of the direct line of the light(5)

HPV

SPEED

When using HPV the area needs preparation in order to prevent the gaseous vapour leaving the room. What’s more, the vapour needs time to disperse and settle. With UV-C the area is only out of action for as long as the light itself is emitting and no special room preparation is needed. A single room can be turned around in less than 30 minutes with UV-C but takes approximately 2 1/2 hours with HPV

UV-C

EASY OF USE

Both HPV and UV-C devices can be used by a single operative with simple training but UV-C is easier to use because it has no consumables and no special room preparation is needed. When using HPV the room being decontaminated needs to be sealed with tape to avoid the vapour escaping and smoke detectors need to be switched off

UV-C

VALIDATION

On-board computers are standard on all devices to log the deployments and confirm successful cycles

EITHER

STORAGE AND TRANSPORT

All devices are built to be robust and possible for a single person to move them. HPV devices require chemical cartridges that must be stored. Storage of replacement bulbs may be required for UV-C machines

EITHER

SAFETY

Because strong chemicals are used in HPV devices they are higher risk. All devices come with safety features

UV-C

MATERIAL COMPATABILITY

A lot of testing has been done on the material compatibility of both HPV and UV-C devices and the risk is low. HPV is a vapour so all vents and doors must be sealed off to avoid the gas escaping into surrounding environments and smoke detectors must be switched off

UV-C

COST

Generally HPV devices are less expensive than UV-C devices but when you factor in the consumable costs of HPV (the chemical cartridges and room sealing equipment) the cost differential erodes. Cost analysis shows that with intensive usage i.e. When used proactively, UV-C becomes more cost effective

EITHER

A reactive or proactive service? Understanding the difference

There are two ways in which automated room disinfection devices are used.

REACTIVELY to control infection

Your infection prevention and control team should specify the use of an automated desinfection device in response to specific infections. This may be for a single room, a number of rooms or a multi bedded bay and the deployment will need to happen quickly.

In order to respond to this need as quickly as possible, an on-site automated room desinfection device should be utilised by a fully trained operational team as and when required. The objective of this reactive activity is to control the spread of an infection.

PROACTIVELY to prevent infection

Using an on-site automated room desinfection device, fully trained operational teams should complete a scheduled program of room desinfection which has been developed in collaboration with the cleaning and IPC teams.

The objective of this proactive activity is to work alongside the cleaning processes to reduce the overall levels of pathogens and therefore prevent infections.

A proactive approach to automated room disinfection will achieve the greatest reduction in infections. For this reason, a combined proactive & reactive service is the ideal model. The exact room disinfection programme should be developed in collaboration with cleaning and infection prevention and control teams.

Sources

*Nagaraja A, Visintainer P, Haas JP, Menz J, Wormser GP, Montecalvo MA. Clostridium difficile infections before and during use of ultraviolet disinfection. Am J Infect Control. 2015.

*Jinadatha C, Villamaria FC, Ganachari-Mallappa N, et al. Can pulsed xenon ultraviolet light systems disinfect aerobic bacteria in the absence of manual disinfection? Am J Infect Control. 2015.

*Prevalence of infections and antimicrobial use in the acute-care hospital setting in the Middle East: Results from the first point-prevalence survey in the region. https://www.ijidonline.com/article/S1201-9712(20)32198-6/fulltext

* AHRQ's Healthcare-Associated Infections Program. https://www.ahrq.gov/hai/index.html

*The enemy within - healthcare-associated infections https://www.practical-patient-care.com/features/featurethe-enemy-within---healthcare-associated-infections-5756120/