1. Preventing Infections Using UV-C light “my story”
Rhonda Leitch, RN, BSN, CIC
Infection Prevention and Transfusion Safety Officer
McLaren Oakland
MSIPC Fall Conference 2015

2. McLaren Oakland is a 328-bed medical center that provides primary and specialty healthcare services to the greater Pontiac and Oakland County community. Founded in 1953, McLaren Oakland has grown to a full-fledged medical community that includes more than 300 physicians, an inpatient hospital with a range of services including cardiovascular care, cancer services, women’s health, minimally invasive robotic surgery, comprehensive orthopedic services, and a state-of-the-art Surgery Center. McLaren Oakland is also a verified trauma center and an accredited stroke center.

3. The Problem What to do? New to Infection Control (2002)
First year – 109 cases C. difficile
What is Clostridium difficile?
Increase LOS, (6-7 days)
Increase COST ($14,700)
What to do?

4. What is Clostridium difficile
CDC – resource, HICPAC guidelines Environmental Disinfection
2002 – APIC National Conference, Nashville, TN
Speaker, Chicago = “This spore is an Infection Prevention and Environmental Service Headache”

5. Stopping the Germs (limited resources)
Infection Prevention
Environmental Service

6. What else can We Do? Cleaning Early Identification Isolation
Monitoring, surveillance
Education
More Cleaning, Bleaching
All this helps – but it does stop – the BIG HEADACHE
Clostridium difficile and MDRO

7. Fall 2010 Ultraviolet – UV-C light
It can kill the germs, including spores
New clinical studies support multi-log reduction
UV-C

8. Room Decontamination with UV Radiation
INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY OCTOBER 2010, VOL. 31, NO. 10
ORIGINAL ARTICLE
Room Decontamination with UV Radiation
William A. Rutala, PhD, MPH; Maria F. Gergen, MT (ASCP); David J. Weber, MD, MPH _______________________________________________________________________________________________________
Room Decontamination with UVC
(Rutala, Gergen, Weber, ICHE 2010)
_______________________________________________________________________________________________________________
Organism
Direct (log 10 reduction)
Indirect (log 10 reduction)
MRSA
4.31
3.85
VRE
3.90
3.29
MDR-Acinetobacter
4.21
3.79
C. difficile
4.04
2.43

9. Plan and work flow – UV-C
Morning = treat Surgical Rooms, Patients being admitted by Surgery
Afternoon = treat Isolation Rooms being discharged or transferred
Nights = treat OR Rooms
UV-C

10. Trial, Monitoring, Compliance
6 month trial to test the effectiveness of UV-C light in a hospital setting
Finance showed – paid for machine in 8 months of reduced
C. diff cases
Surveillance by IP to assure compliance by Env. Service
Must be easy to use and not interfere with room turn-around-time
Compliance proves key necessity for the reduction of C. difficile and transmission of MDRO

11. CONCLUSION: The cycle time to complete UV-C decontamination varied between hospitals. The time variation was likely related to differences in the amount and type of materials in rooms and room design, layout, and size.
“UV-C emitters without built-in programs to measure the total dose of irradiation may either under or overestimate the time necessary to adequately disinfect patient rooms.”

12. only with the help of new Technology
So can two people hold back Emerging Diseases –
only with the help of new Technology
UV-C

13. Preventing the Transmission of Clostridium difficile Using UV-C Light
Rhonda Leitch RN, BSN, CIC; Infection Control Epidemiologist
Collaboration between the Environmental Services Department and Infection Control
ABSTRACT
BACKGROUND
RESULTS
Healthcare acquired infections (HAIs) can lead to
increased morbidity
increased mortality
cost to the patient and hospital
increased length of stay
Studies suggest contaminated environmental surfaces can contribute to
transmission of HAIs
One of the most problematic HAIs organism is Clostridium difficile
can be attributed to 20-25% of incidences of antibiotic associated diarrhea
C. difficile is an anaerobic, spore forming, gram positive bacillus
spores can live on environmental surfaces for up to five months
The Environmental Service department and Infection Control at McLaren – Oakland conducted a quality improvement (QI) project using UV-C light to determine if this method of enhanced disinfection could reduce hospital acquired infections (HAIs) without interruption of patient flow. HAIs can lead to increased morbidity, mortality, and cost to the patient and hospital, and has contributed to increased length of stay. Studies suggest that contaminated environmental surfaces can contribute to the transmission of HAIs (5) For the QI project; all members of the Environmental Service Department (ES) staff were trained in the operation of the UV-C light. After the patients discharge or transfer from an isolation room the ES staff terminally cleaned the room and then used the UV-C light. As an added measure to examine the bacterial counts of common HAIs, microbial sample plates were prepared using organisms of Staphylococcus aureus, Klebsiella pneumonia, and Acinetobacter baumanii by the Microbiology Lab who monitored the results before and after exposure to UV-C light. The plates were placed in highly touched locations throughout the patient room and bathroom. Additionally, tracking the rooms being treated with UV-C light was an essential part of the QA project to monitor enhanced cleaning compliance to reduce resistant organism transmission.
Results of the QI project included findings of decreased bacterial counts on the sample plates and a decrease in the incidence of hospital acquired Clostridium difficile. In the six months post-trial of UV-C light usage, one case occurred in areas where the light was used and five cases where it was not. Clostridium difficile can cost an average of $14,805 of additional charges per case. The cost of the six cases added charges of $88,830. The QI project using UV-C light for patient room cleaning showed a decrease in the incidence of HAI Clostridium difficile with a charge difference of $236,880. Use of the UV-C light showed no interruption in the flow of patient admissions. In conclusion, disinfection with UV-C light may significantly reduce environmental bacterial contamination and, thereby, protect the next patient housed in an isolation room.
Six months post-trial of UV-C light usage,
one case occurred in areas where the light was used
five cases where UV-C light was not used
total of six cases occurred with added charges of $88,830
DESIGN AND METHODS
Design: The UV-C light was used on all isolation rooms at the end of terminal cleaning. Bar codes were applied to all the doorways for tracking purposes. To support disinfection results microbial sample were prepared using organisms of Staph. aureus, Klebsiella pneumoniae. and Acinetobacter ban. by the Microbiology Lab who monitored the results before and after exposure to UV-C light. The plates were placed in highly touched locations throughout the patient room and bathroom
Methods: All members of the Environmental Service Department (ES) staff was trained in the operation of the UV-C light. The staff was instructed to perform a terminal cleaning as protocol and then to treat all isolations rooms using the UV-C light after the patient was discharged or transferred.
IRS 3200 – iPT (Infection Prevention Technologies)
CULTURE RESULTS
UV-C --- IRS 3200
IRS 3200 – iPT (Infection Prevention Technologies)
INTRODUCTION
The IRS 3200 with Ster-Trak TM service documentation system is a complete solution for automated disinfection and documentation for healthcare facilities. It uses the highest intensity UV-C field available and multipoint sensing technology to automatically treat spaces in one step, eliminating human error from manual chemical or manual ultraviolet based methods. The Ster-Trak TM service documentation accurately documents deployment and productivity. It also serves as a crucial protocol enforcement tool to ensure use in critical area’s in real time.
A quality assurance (QI) project was conducted in to determine if the
enhanced disinfection method of a UV-C light for patient room cleaning could reduce the incidence of Clostridium difficile without interruption patient flow
In the 12 months before UV-C use, there were 36 cases of HAI C.
difficile
The average added charge of $14,805 per case for a total of $532,980
added charges per year.
Six months pre-trial of UVC-light, there were 22 cases of HAI
C. difficile with a total of $325,710 added charges and an average
added LOS of 7.3 days.
* The average turn-around time per patient room was 15 minutes.
Steri-Trak™ service documentation system
9012B
MRSA 2/7
MRSA 3/15
MRSA 7/18
T 7/27
T 10/4
MRSA 10/12
C D 11/14
T 11/18
T 12/23
9013
T 2/1
9014B
MRSA 2/10
ACINET 3/2
VRE 11/15
T 12/1
T 12/28
9015
T 6/20
T 7/6
9016B
T 7/11
MRSA VRE 9/6
T 10/15
MRSA 12/1
T 12/2
C D 12/5
T 12/5
T 1/1
9017
9018B
C D 5/27
T 6/13
MRSA 11/3
MRSA 11/15
T 12/7
C D 1/2
T 1/7
9019
T 12/13
9020B
ACINE 5/27
T 6/9
MRSA 7/21
T 12/24
T 1/20
9021
9022B
T 6/21
pseu acinet 9/7
MRSA 10/6
T 11/14
T 11/17
T 11/20
T 12/19
9023
9024B
T 7/4
T 10/31
T 11/21
ACINE 12/12
C D 12/19
MRSA 12/30
REFERENCES
5. Boyce JM, Havill NL, Moore BA.Terminal decontamination of patient rooms using an
automated mobile UV light unit.Infect Control Hosp Epidemiol. 2011
Aug;32(8):737-42; discussion
12. Hota B.Contamination, disinfection, and cross-colonization: are hospital surfaces
reservoirs for nosocomial infection?Clin Infect Dis Oct 15;39(8):
Epub 2004 Sep 27.