© 2012. confidential. xenex healthcare services llc. every room. every time.™ the questions:...

© 2012. Confidential. Xenex Healthcare Services LLC. EVERY ROOM. EVERY TIME.™

The Questions:Automated room disinfection

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Sarah Simmons, MPH CICXenex Disinfection TechnologiesRe

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Does the environment matter?

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• Manual cleaning is insufficient• Prior room occupancy risk• Interaction with hand hygiene• Known benefit from enhanced

cleaning

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Types of No-Touch Disinfection

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• Hydrogen Peroxide Vapor

• Mercury-based Ultraviolet Light

• Xenon-based Ultraviolet Light

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Hydrogen Peroxide Vapor

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• Produces and disperses a vapor of hydrogen peroxide (H2O2)

• Creates Oxygen radicals that react with cell walls

• Room must be sealed during the process

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-OHO2

-HO2

HO2

HO2

O2-

O2-

-OH

-OH

-OHO2

-

HO2


Ultraviolet Systems

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Mercury UV (Hg UV) Pulsed Xenon (PX-UV)

Continuous Light Pulsed Light

253.7 nm 200-280 nm

Photodimerization PhotodimerizationPhotohydrationPhotosplittingPhotocrosslinking


Photodimerization

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Bonds DNA/RNA together, preventing cell replication


Photosplitting

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Breaks the phosphate backbone of the DNA


Photohydration

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Inserts water molecules into DNA bases, causing functional damage


Photohydration

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Creates bonds between protein molecules, resulting in structural damage, including the lysing of the cell wall


Does it work?

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• What does it kill?• Where does it kill?• How long to kill?

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Target Organisms

• C. difficile spores (NAP1)

• Acinetobacter baumannii

• Methicillin-resistant S. aureus (MRSA)

• Feline calicivirus (norovirus surrogate)

• Vancomycin-resistant Enterocci (VRE)

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Is it better than/dependent on housekeeping?

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• End game: what does the next patient experience?

• Is there an improvement over housekeeping?

• Is there a dependence on housekeeping?

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How should it be used?

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• How?• Where?• When?• How often?Re

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UV Mapping – One Position

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UV Mapping – Two Positions

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UV Mapping – Three Positions

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UV Mapping - conclusion

Multiple positions is the correct way to use UV for room disinfection.

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Hydrogen Peroxide

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Do I have to disinfect the same way if I use it?

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• Clean as long?• Still use bleach?• Changes in inspection?

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What about ORs?

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Consequences of SSIs• Doubles the risk of death after surgery•Five fold increased risk for readmission•60% more likely to require ICU care•LOS increases 6 days

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What about ORs?

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Overall Cleaning Compliance 47%•Anesthesia Medication Cart 38%•Anesthesia Knobs 25%•IV Poles 55%•Bed Controls 64%•Floor 93%

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What about ORs?

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• Additional assurance?• Quick clean?• Between cases?• Terminal Cleaning?Re

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Does it matter to patient outcomes?

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• HAI reductions?

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Where should I use it?

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• Select isolation?• All isolation?• Select units?• All discharges?• Central processing?

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What about RME, unused supplies and curtains?

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• RME• Validating• Tracking

• Unused supplies• Assurance • Labor• billing

• Curtains• Disinfection goal?• Curtain types

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Do patients like it?

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• Complaints?• Compliments?

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What data do you need?

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• What level of disinfection?• What level of proof?

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Could clonal typing help?

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• Need for outcome measure• ID sources of infection• ID clusters• Proof of effectiveness?Re

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What’s my goal anyway?

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• Reduce rates?• Additional protection for high-risk

units?• Outbreak response?• Bio-preparedness?

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What else should I think about?

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• How are the technologies different?• Decontamination effectiveness• Cost per room• Cycle time• Operators• Access to rooms• Environmental friendliness• Infection rate impact

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• Carling P, Parry M, Rupp M, Po J, Dick B, Von Beheren S. Improving Cleaning of the Environment Surrounding Patients in 36 Acute Care hospitals.

• Shaughnessy M, Micielli R, DePestel D, Arndt J, Strachan C, Welch K, Chenoweth C. Evaluation of Hospital Room assignment and acquisition of Clostridium difficile infection. Infection Control and Hospital Epidemiology. Vol .32, No. 3, March 2011

• Datta R, Platt R, Yokoe D, Huang S. Environmental Cleaning Intervention and Risk of Acquiring Multidrug-Resistant Organisms From Prior Room Occupants. Arch Intern Med. 2011;171(6):491-494

• Drees M, Snydman D, Schmid C, Barfoot L, Hansjosten K, Vue P, Cronin M, Nasrway S, Golan Y. Prior Environmental Contaminaiton Increases the Risk of Acquisition of Vancomycin-Resistant Enterococci. Clin Infect Dis.2008;46(5):678-685

• Huang S, Datta R, Platt R. Risk of Acquiring Antibiotic-Resistant Bacteria From Prior Room Occupants. Arch Intern Med. 2006;166(18):1945-1951.

• Nseir S, Blazejewski C, Lubret R, Walet F, Courcol R, Dorocher A. Risk of acquiring multidrug-resistant Gram-negative bacilli from prior room occupants in the intensive care unit. Clin Microbiol Infect. 2011 Aug;17(8):1201-8

• Dubberke E, Reske K, Noble-Wang J, Thomson A, Killgore G, Mayfield J, Camins B, Woeltje K, McDonald J, McDonald L, Fraser V. Prevalence of Clostridium difficile environmental contamination and strain variability in multiple healthcare facilities. Am J Infect Control. 2007 Jun: 35(5):315-8.

• C Edminston, et al. Molecular Epidemiology of Microbial Contamination in the Operating Room Environment: Is there a risk of infection? Surgery. 2005;138(4):573-582.

• R Loftus, et al. Transmission of Pathogenic Bacterial Organisms in the Anesthesia Work Area. Anesthesiology 2008; 109(3):399-407.

• Kowalski, W. (2009). Ultraviolet Germicidal Irradiation Handbook. New York: Springer.

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