title: Impact of Ultraviolet Germicidal Irradiation for No-Touch Terminal Room Disinfection on Clostridium difficile Infection Incidence Among Hematology-Oncology Patients.
abstract: OBJECTIVE To evaluate the impact of no-touch terminal room no-touch disinfection using ultraviolet wavelength C germicidal irradiation (UVGI) on C. difficile infection (CDI) rates on inpatient units with persistently high rates of CDI despite infection control measures. DESIGN Interrupted time-series analysis with a comparison arm. SETTING 3 adult hematology-oncology units in a large, tertiary-care hospital. METHODS We conducted a 12-month prospective valuation of UVGI. Rooms of patients with CDI or on contact precautions were targeted for UVGI upon discharge using an electronic patient flow system. Incidence rates of healthcare-onset CDI were compared for the baseline period (January 2013-December 2013) and intervention period (February 2014-January 2015) on study units and non-study units using a mixed-effects Poisson regression model with random effects for unit and time in months. RESULTS During a 52-week intervention period, UVGI was deployed for 542 of 2,569 of all patient discharges (21.1%) on the 3 study units. The CDI rate declined 25% on study units and increased 16% on non-study units during the intervention compared to the baseline period. We detected a significant association between UVGI and decrease in CDI incidence (incidence rate ratio [IRR], 0.49; 95% confidence interval [CI], 0.26-0.94; P=.03) on the study units but not on the non-study units. The impact of UVGI use on average room-cleaning time and turnaround time was negligible compared to the baseline period. CONCLUSIONS Targeted deployment of UVGI to rooms of high-risk patients at discharge resulted in a substantial reduction of CDI incidence without adversely impacting room turnaround. Infect Control Hosp Epidemiol 2016;1-6.
authors.affiliation: 1Division of Infectious Diseases,Perelman School of Medicine at the University of Pennsylvania,Philadelphia,Pennsylvania.
authors.forename: David A
authors.initials: DA
authors.lastname: Pegues
authors.affiliation: 1Division of Infectious Diseases,Perelman School of Medicine at the University of Pennsylvania,Philadelphia,Pennsylvania.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Han
authors.affiliation: 2Department of Healthcare Epidemiology,Infection Prevention and Control,Hospital of the University of Pennsylvania,Philadelphia,Pennsylvania.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Gilmar
authors.affiliation: 3Operations Improvement,Hospital of the University of Pennsylvania,Philadelphia,Pennsylvania.
authors.forename: Brooke
authors.initials: B
authors.lastname: McDonnell
authors.affiliation: 4Department of Environmental Services,Hospital of the University of Pennsylvania,Philadelphia,Pennsylvania.
authors.forename: Steven
authors.initials: S
authors.lastname: Gaynes
mesh_terms: D016360:Clostridioides difficile / Q000302:isolation & purification / Q000528:radiation effects; D003015:Clostridium Infections / Q000517:prevention & control*; D003428:Cross Infection / Q000517:prevention & control*; D004203:Disinfection / Q000379:methods*; D004780:Environment, Controlled; D006405:Hematology; D006801:Humans; D015994:Incidence; D065186:Interrupted Time Series Analysis; D016522:Oncology Service, Hospital; D015143:Philadelphia; D011446:Prospective Studies; D012044:Regression Analysis; D012621:Seasons; D014466:Ultraviolet Rays