title: Evaluation of an ultraviolet room disinfection protocol to decrease nursing home microbial burden, infection and hospitalization rates.
abstract: The focus of nursing home infection control procedures has been on decreasing transmission between healthcare workers and residents. Less evidence is available regarding whether decontamination of high-touch environmental surfaces impacts infection rates or resident outcomes. The purpose of this study was to examine if ultraviolet disinfection is associated with changes in: 1) microbial counts and adenosine triphosphate counts on high-touch surfaces; and 2) facility wide nursing home acquired infection rates, and infection-related hospitalization.
  
  
  
  The study was conducted in one 160-bed long-term care facility. Following discharge of each resident, their room was cleaned and then disinfected using a newly acquired ultraviolet light disinfection device. Shared living spaces received weekly ultraviolet light disinfection. Thirty-six months of pretest infection and hospitalization data were compared with 12 months of posttest data. Pre and posttest cultures were taken from high-touch surfaces, and luminometer readings of adenosine triphosphate were done. Nursing home acquired infection rates were analyzed relative to hospital acquired infection rates using analysis of variance procedures. Wilcoxon signed rank tests, The Cochran's Q, and Chi Square were also used.
  
  
  
  There were statistically significant decreases in adenosine triphosphate readings on all high-touch surfaces after cleaning and disinfection. Culture results were positive for gram-positive cocci or rods on 33% (n = 30) of the 90 surfaces swabbed at baseline. After disinfectant cleaning, 6 of 90 samples (7.1%) tested positive for a gram-positive bacilli, and after ultraviolet disinfection 4 of the 90 samples (4.4%) were positive. There were significant decreases in nursing home acquired relative to hospital-acquired infection rates for the total infections (p = .004), urinary tract infection rates (p = .014), respiratory system infection rates (p = .017) and for rates of infection of the skin and soft tissues (p = .014). Hospitalizations for infection decreased significantly, with a notable decrease in hospitalization for pneumonia (p = .006).
  
  
  
  This study provides evidence that the pulsed-xenon ultraviolet disinfection device is superior to manual cleaning alone for decreasing microbes on environmental surfaces, as well as decreasing infection rates, and the rates of hospitalization for infection. Results suggest that placing a stronger emphasis on environmental surface disinfection in long-term care facilities may decrease nursing home acquired infections.
authors.affiliation: University of Wisconsin-Milwaukee, 1921 East Hartford Avenue, Milwaukee, WI, 5321, USA. ckovach@uwm.edu.
authors.forename: Christine R
authors.initials: CR
authors.lastname: Kovach
authors.affiliation: Department of Architecture, Uludag University, 16059 Görükle, Bursa, Turkey.
authors.forename: Yavuz
authors.initials: Y
authors.lastname: Taneli
authors.affiliation: University of Wisconsin-Milwaukee, 1921 East Hartford Avenue, Milwaukee, WI, 5321, USA.
authors.forename: Tammy
authors.initials: T
authors.lastname: Neiman
authors.affiliation: Jewish Home and Care Center, 1414 N. Propect Avenue, Milwaukee, WI, 53202, USA.
authors.forename: Elaine M
authors.initials: EM
authors.lastname: Dyer
authors.affiliation: Jewish Home and Care Center, 1414 N. Propect Avenue, Milwaukee, WI, 53202, USA.
authors.forename: Alvin Jason A
authors.initials: AJ
authors.lastname: Arzaga
authors.affiliation: University of Wisconsin-Milwaukee, 1921 East Hartford Avenue, Milwaukee, WI, 5321, USA.
authors.forename: Sheryl T
authors.initials: ST
authors.lastname: Kelber
mesh_terms: D058491:Bacterial Load / Q000528:radiation effects*; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control* / Q000628:therapy; D004203:Disinfection / Q000379:methods*; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015146:Midwestern United States; D009735:Nursing Homes; D017063:Outcome Assessment, Health Care; D014466:Ultraviolet Rays; D014978:Xenon
chemical_list: D014978:Xenon
keywords: Environment; Infection; Long-term care; Nursing home; Pneumonia; Prevention