UVC Disinfection: Proven by Science

Background

According to the Centers for Disease Control and Prevention (CDC), there are more than 700,000 hospital-acquired infections (HAIs) every year in the U.S., and more than 75,000 of those patients die as a result.1 With HAI rates increasing and more superbugs discovered each year, it is critical for hospitals to provide the cleanest environments possible to protect patients and staff from infections.

Since its inception in 2007, UVC disinfection has been proven by multiple studies to be an effective means of enhanced terminal room disinfection to help stop the spread of HAIs such as C. diff, MRSA, VRE, Ebola and many more. This paper outlines the first and only randomized clinical trial on UVC disinfection, the Benefits of Enhanced Terminal Room-Disinfection (BETR-D) study, its results as well as subsequent studies that have resulted from the BETR-D study.

How UVC Works

Ultraviolet light is a form of light, invisible to the human eye, that exists on the electromagnetic spectrum between X-rays and visible light. UVC wavelengths are between 200 and 300 nanometers, making them germicidal – meaning they are capable of inactivating microorganisms, such as bacteria, viruses and protozoa. The high energy from short wavelength UVC light is absorbed in the cellular RNA and DNA, damaging nucleic acids and preventing microorganisms from infecting and reproducing.

This absorption of UVC energy forms new bonds between nucleotides, creating double bonds or “dimers.” Dimerization of molecules, particularly thymine, is the most common type of damage incurred by UVC light in microorganisms. Formation of thymine dimers in the DNA of bacteria and viruses prevents replication and inability to infect. This quality makes UVC a chemical-free and environmentally-friendly method of disinfecting any space, but especially health care facilities, where germs and pathogens are prevalent.

Why Every Surface Matters

Germs and pathogens can live anywhere — in shadowed areas, low-use spaces such as room corners or around various surgical product tables — which is why every touchable surface should be a priority. Tru-D is the trusted choice for health care professionals because of its up to 99.9 percent efficancy that can only be accomplished through its method of UVC dose measurement.2,3 Multiple independent studies from epidemiological thought leaders and experts in disinfection and sterilization practices validate Tru-D as an effective, single placement approach proven to disinfect the entire room. This is accomplished by measuring the proper dose of UVC energy that reaches the walls and is reflected back to the center of the room.

History of the BETR-D Study

Researchers sought to determine UVC’s effectiveness at reducing the risk of acquisition and infection of four major superbugs. Tru-D was selected by Duke University and the BETR-D Research Team as the only automated disinfection system to be included in the first randomized clinical trial on UV disinfection after successful internal trials and because published, third-party data on Tru-D proved reliable, repeatable results. Also, Tru-D was the only robot that could guarantee an effective baseline of disinfection throughout the room due to its measurement capability with its patented Sensor360® technology.

Some initial studies were completed to determine the effectiveness of Tru-D against VRE, C. diff, MRSA and Acinetobacter in patient rooms. The data confirmed Tru-D was able to eliminate all four pathogens, including C. diff, in real-world settings.2,4

Results

The study found that among the four organisms – MRSA, VRE, Acinetobacter, and C. diff – using quaternary ammonium disinfectant plus UVC decreased the risk of acquisition by about 30 percent.

The BETR-D study confirmed that manual cleaning is not enough and that the environment plays a large role in the transmission of infections. Results proved that enhanced terminal room disinfection strategies that utilized Tru-D SmartUVC reduced the risk of acquisition and infection of target MDROs by a cumulative 30 percent among patients who entered the same room.

“Enhanced disinfection technology should be used. If you don’t already have it, you need it in your budgets. Minimally, you must add No Touch Technology to your manual cleaning practices upon discharge of a patient on contact or enteric contact isolation.” 5
– Dr. William A. Rutala, BETR-D researcher

Impacts on C. diff

When comparing reductions in the rate of C. diff between the bleach and bleach + UV study arms, there was an 18 percent reduction in the rate of C. diff. In the bleach group, the rate of C. diff was 35.9 per 10,000 exposure days over the course of the study, while in the bleach + UV arm, the rate was 29.5 per 10,000 exposure days. In spite of the fact that there was not a statistically significant reduction in the relative risk of transmission of C. diff, UV did demonstrate an impact on the acquisition of C. diff among patients.

“If you move to a more macro level, when you look at all the patients who come into the hospital, we actually did see the C. diff rate decrease by about 11%” 8 – Dr. Deverick Anderson, lead investigator of the BETR-D Study

Studies within the Study

As the BETR-D study is now published, subsequent studies utilizing the data collected during the BETR-D study have and will be released. A recent paper in Infection Control and Hospital Epidemiology details the implementation process of the BETR-D study.7 The new paper, Implementation Lessons Learned From the Benefits of Enhanced Terminal Room (BETR) Disinfection Study: Process and Perceptions of Enhanced Disinfection with Ultraviolet Disinfection Devices, discusses logistical and administrative processes utilized during the BETR-D trial and lessons learned that are pertinent to future utilization of UVC disinfection devices in other hospitals.

One of the biggest barriers for implementing UVC disinfection is “room under pressure,” or the urgency to turn a room for the next patient. The BETR-D study authors found this to be more of a perception than a reality. During a pretrial period, the researchers tracked the amount of time to get a patient to a room, and it was found there was always sufficient time to run a standard UVC cycle before the patient arrived.7 Moreover, the original BETR-D study concluded adding enhanced UVC disinfection only increased cleaning time by an average of four minutes.6

The authors noted that administrative leaders are often conflicted on whether or not to use UV disinfection due to the need to promptly admit patients waiting in the emergency department or waiting area. The study authors stated, “We believe that this conflict needs to be viewed as a safety issue because enhanced disinfection using UV devices is an evidence-based strategy to improve patient safety.” The authors further explained that when they tracked the amount of time required to bring a patient to a room labeled as “under pressure” they observed that, “In our experience, this pressure was related more to perception than an actual barrier to use of the UV device…there was always sufficient time to run a standard UV device cycle.”7

This most recent paper concluded that implementation of UV requires recognition and mitigation of two key barriers 1) timely and accurate identification of rooms requiring UV and 2) overcoming time constraints to allow EVS time to use UV.

The Future of UVC Disinfection

Tru-D’s basis of scientific evidence and widespread adoption throughout prestigious hospital systems continue to drive market acceptance of UV disinfection technology. As more evidence of UV disinfection’s efficacy becomes available, enhanced terminal room disinfection strategies will likely become a standard of care for all hospitals. In fact, following the BETR-D study, a total of 28 Tru-Ds have been purchased among the nine participating hospitals. Key researchers in infection control and hospital epidemiology continue to stress the importance of enhanced disinfection. And just as the researchers continue to purchase Tru-D and utilize it in their individual hospitals, they have validated this technology as a very important step forward for hospitals and is a very significant complement to hospitals’ infection reduction armamentarium.

“We need to say to our CFOs that we need these technologies, and we need to look at the data. The data shows a reduction in infections and we need to invest.” 5 – Dr. William A. Rutala, BETR-D researcher.

“We think it’s an important tool to have to prevent these infections from happening. All nine hospitals in the study have purchased these types of machines to continue to use even though the study has completed.” 8 – Dr. Deverick Anderson, lead investigator of the BETR-D study “Enhanced disinfection technology should be used. If you don’t already have it, you need it in your budgets. Minimally, you must add No Touch Technology to your manual cleaning practices upon discharge of a patient on contact or enteric contact isolation.” 5

– Dr. William A. Rutala, BETR-D researcher