title: Effect of enhanced ultraviolet germicidal irradiation in the heating ventilation and air conditioning system on ventilator-associated pneumonia in a neonatal intensive care unit.
abstract: OBJECTIVE
  The objective of this study was to test the hypothesis that enhanced ultraviolet germicidal irradiation (eUVGI) installed in our neonatal intensive care unit (NICU) heating ventilation and air conditioning system (HVAC) would decrease HVAC and NICU environment microbes, tracheal colonization and ventilator-associated pneumonia (VAP).
  
  
  METHODS
  The study was designed as a prospective interventional pre- and post-single-center study. University-affiliated Regional Perinatal Center NICU. Intubated patients in the NICU were evaluated for colonization, and a high-risk sub-population of infants <30 weeks gestation ventilated for ≥ 14 days was studied for VAP. eUVGI was installed in the NICU's remote HVACs. The HVACs, NICU environment and intubated patients' tracheas were cultured pre- and post-eUVGI for 12 months. The high-risk patients were studied for VAP (positive bacterial tracheal culture, increased ventilator support, worsening chest radiograph and ≥ 7 days of antibiotics).
  
  
  RESULTS
  Pseudomonas, Klebsiella, Serratia, Acinetobacter, Staphylococcus aureus and Coagulase-negative Staphylococcus species were cultured from all sites. eUVGI significantly decreased HVAC organisms (baseline 500,000 CFU cm(-2); P=0.015) and NICU environmental microbes (P<0.0001). Tracheal microbial loads decreased 45% (P=0.004), and fewer patients became colonized. VAP in the high-risk cohort fell from 74% (n=31) to 39% (n=18), P=0.04. VAP episodes per patient decreased (Control: 1.2 to eUVGI: 0.4; P=0.004), and antibiotic usage was 62% less (P=0.013).
  
  
  CONCLUSIONS
  eUVGI decreased HVAC microbial colonization and was associated with reduced NICU environment and tracheal microbial colonization. Significant reductions in VAP and antibiotic use were also associated with eUVGI in this single-center study. Large randomized multicenter trials are needed.
authors: Department of Pediatrics, Neonatology, University at Buffalo, State University of New York, Women and Children's Hospital of Buffalo, Buffalo, NY 14127, USA. rryan@upa.chob.edu
authors: R M
authors: RM
authors: Ryan
authors: G E
authors: GE
authors: Wilding
authors: R J
authors: RJ
authors: Wynn
authors: R C
authors: RC
authors: Welliver
authors: B A
authors: BA
authors: Holm
authors: C L
authors: CL
authors: Leach
mesh_terms: D000389:Air Conditioning; D003428:Cross Infection / Q000517:prevention & control; D006361:Heating; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control*; D011446:Prospective Studies; D014132:Trachea / Q000382:microbiology*; D014466:Ultraviolet Rays; D012122:Ventilators, Mechanical / Q000382:microbiology*