Why UV Equipment Isn’t the Panacea for Infection Control

WRITTEN BY: Bryan Atnip and Bruce Alperin

UV Disinfection Healthcare-acquired infections (HAIs) not only put patients’ lives at risk but also cost U.S. hospitals financially and damage their reputation within the community.

In fact, 1 in 25 U.S. patients acquire at least one HAI during their hospital stay1, or an estimated 1.7 million infections annually.2 The most common hospital-acquired condition reported by U.S. patients in the 2017 Becker Hospital Review was by far infection; about 10 percent reported having a bloodstream infection after surgery.

Hospitals are held financially responsible for the additional costs of HAIs. The Centers for Medicare and Medicaid Services penalizes hospitals for high HAIs rates by cutting Medicare reimbursement payments. In 2015, more than 700 hospitals had reduced payments.

Insurance companies can also refuse to reimburse hospitals for HAIs when the hospital is to blame for the infection. The average cost to hospitals per HAI is $15,000, and a 2013 JAMA study found U.S. hospitals spent $9.8 billion each year fighting HAIs.

UV DISINFECTION: A PARTIAL SOLUTION

The good news is hospitals can gain control of and drive down infection rates by becoming more proactive about their infection control process. By actively preventing HAIs, they can reduce their costs while providing safer environments and better outcomes for patients.

One way hospitals have started to do this is by incorporating ultraviolet (UV) light equipment—such as Tru-D SmartUVC—into their infection control process. This technology can kill bacteria, spores, molds, viruses and other pathogens. It works by emitting UV-C light, which has a wavelength in the germicidal range. Tests have shown it can result in 99.9 percent elimination of harmful germs.

However, UV equipment is intended to augment, not replace, hospital employees who physically clean, sanitize and disinfect the environment. This technology alone is not enough to prevent infections. UV technology use is limited to confined areas that can be sealed off by doors, windows or screens; no patients or hospital personnel can be in the area. Additionally, UV technology can add up to 40 minutes per room to turn around which, if not properly managed, may negatively affect patient throughput and satisfaction. When compared to the potential added cost for an environment related infection, the added treatment time may be warranted to assure patient safety.

UV equipment must be part of a broader, comprehensive approach to infection prevention. It cannot eliminate the necessary physical removal of soils and debris within the clinical environment. Physical cleaning of each room requires people.

A HOLISTIC APPROACH TO INFECTION CONTROL SUCCESS

According to the World Health Organization, lack of standardized procedures and lack of knowledge of infection prevention and control measures are contributing factors for higher infection rates. Aramark embraces a standardized, infection prevention protocol based on staff training, technology, and quality assurance.

IMPLEMENTING A REPUTABLE, SCALABLE PROCESS

The key to a robust and successful infection prevention process is a standardized model with on-site instructors who provide comprehensive training. Too often, hospital training of environmental services (ESS) staff simply entails watching a cleaning video followed by a quiz. But this level of training is not adequate to truly reduce infection rates. ES staff must be properly trained in strict infection prevention and control protocols. In addition they should know how to prepare a room for UV equipment use and operate the equipment from start to finish.

Aramark’s model is called the SpaceCare QLSM - System and is a comprehensive program for routine daily and weekly cleaning. It includes step-by-step instructions on how to properly clean each area in the hospital. One part of the program teaches hospital ES technicians to recognize high-touch points—such as light switches, telephones and door handles—and how to properly use disinfectants to clean these areas. Also, ES technicians learn how to properly prepare a room for Tru-D SmartUVC and operate the system from start to finish.

Whether choosing an outsource partner or revamping your internal training program, ensure an instructor executes the cleaning protocol by systematically cleaning a patient’s room and explaining each step along the way to the trainee. Then, the trainee should clean the patient’s room according to the protocol and explain why each step is done, while the instructor observes and provides feedback.

ASSURING QUALITY

Another critical part of a proper infection prevention is having quality assurance and quality control measures in place. A sound ES program should include elements of human (direct observation) and technology (ATP bioluminescence; fluorescent marketing) to drive infection control.

For direct observation, instructors assure ES staff are following established cleaning protocol. Feedback and corrective action occurs real-time to prevent mistakes from proliferating. Technology should also be embraced to confirm cleanliness that cannot be readily observed. ATP bioluminescence involves swabbing a cleaned surface and placing the swab in an illuminator, which then measures the microbial load on the swab. Fluorescent marking involves applying a transparent, fluorescent gel to surfaces before room cleaning. After the room cleaning, any remaining fluorescent gel can be detected with a black light.

These quality measures can be used to evaluate ES staff and identify points of retraining if necessary. The goal is to educate the ES technician and make sure each room is thoroughly and properly cleaned every time. Consistency in cleaning not only serves to reduce the environment as a contributor to HAIs but also elevates patient and visitor perception of service quality as they observe a consistent cleaning process each and every day. Since the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey asks a patient’s perception of whether his or her room was kept clean, and seeing a person clean the room may influence a patient’s answer.

Once they’ve been trained, ES staff can execute the standardized infection prevention protocol and use UV equipment to enhance the cleaning process. The outcome is an effective first-line defense against environment related HAIs.

To learn more about standardizing your hospital’s infection prevention program—from cleaning high-touch areas to supplemental UV equipment—contact Aramark today.

  1. Magill SS, Edwards JR, Bamberg W, et al. Multistate Point-Prevalence Survey of Health Care–Associated Infections. New England Journal of Medicine. 2014; 370:1198-1208.
  2. Klevens RM, Edwards JR, Richards CL Jr, et al. Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Public Health Rep. 2007;122:160-166.

About the Authors

As the Client Solutions Director, Bryan Atnip (CHESP, RLLM, RESD) designs tailored client solutions for our Healthcare Sector. Bryan works with a diverse development team that continuously researches the market, partners with manufacturers and listens to Aramark facilities customers and operations teams to develop unique solutions for environmental services, maintenance and operations, patient logistics and laundry operations.  

Bruce Alperin (LEED AP) is the Associate Vice President of Marketing for Facility Services.  Bruce monitors industry trends and developments, and works closely with the Aramark solutions team to bring new innovations to market.

Topics: infection control, HAI, healthcare acquired infection

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