How a layered approach to disinfection can help organizations ensure a clean environment

Becker’s Healthcare recently spoke with Alice Brewer, director of clinical affairs for Tru-D SmartUVC, and Debra Hagberg, director of clinical affairs for PDI Healthcare, about what hospitals can do to bring their cleaning and disinfection protocols in line with best practices. Their observations suggest healthcare may be at the threshold of a new era for disinfection techniques.

Tru-D SmartUVC is a pioneer in the UVC disinfection space, providing health care facilities with patented Sensor360® technology that calculates the precise dose of UVC energy needed to disinfect a space.

PDI Healthcare, which acquired Tru-D SmartUVC in 2019, offers products that are designed to help you Be The Difference® in improving patient outcomes and reducing costs through evidence-based products designed specifically for the health care environment.

The COVID-19 pandemic brought new attention to cleaning practices

Over the past two years, public-facing organizations of all kinds — including food, retail and commercial establishments, as well as schools, nursing homes and government-run services — have reinforced their cleaning and disinfection practices. This trend has been especially pronounced in hospitals and throughout healthcare, where spaces and surfaces are being cleaned more thoroughly than ever before.

“It used to be that [cleaning staff] focused on thoroughly cleaning patient rooms and procedural areas, but now we’re seeing a lot more attention being paid to public spaces such as waiting rooms, bathrooms and cafeterias,” Ms. Brewer said.

Within hospitals, the environmental services teams are critical to a successful and robust disinfection program. They must work in tandem with healthcare professionals and nursing to make decisions on purchasing new solutions or updating existing protocols.

The experience of the pandemic has also spurred interest in enhanced cleaning technologies in other parts of healthcare, such as doctors’ offices, clinics and ambulatory surgery centers (ASCs). “ASCs are on the rise,” Ms. Brewer said. “We’re seeing more and more people having surgery in an outpatient setting, but the same concerns exist surrounding the cleanliness of the environment. So [ASC leaders] are becoming more interested in applying the technology in those spaces, to make sure that their operating rooms are clean and there are no microorganisms left behind.”

For optimal cleanliness, a layered approach to disinfection works best

Manual disinfection — the standard, manual approach to cleaning in hospitals — leads to as much as 50 percent of surfaces in a hospital room being missed, Ms. Brewer said. “There’s no one easy solution, no one quick fix to eliminate every organism. So you really have to bundle or layer different interventions together,” she said. “Using a layered approach with multiple strategies accounts for gaps in practice and ensures that you haven’t missed anything.”

Ms. Hagberg added, “There are always new products and technologies coming out, and what one hopes they will do is address longstanding issues. Some longstanding issues within environmental cleaning and disinfection include gaps in the disinfection methods as well as an ability to meet the frequency of disinfection that’s required to cover areas of concern.”

A layered approach to disinfection provides a solution to these issues as it “covers all the bases,” thanks to incorporating three distinct mechanisms of action:

  • Chemical manual disinfection, characterized by using chemical saturated surface wipes (the conventional approach)
  • Enhanced UVC cleaning (UVC) that uses UVC light to inactivate viruses and bacteria by disrupting the structure of the organism (the technology underlying the Tru-D technology’s “smart” solution)
  • Continuously active disinfectant (CAD) that is applied to a surface, leaving a layer of disinfectant that provides continuous antimicrobial action against microorganisms on surfaces for 24 hours.* This third approach to disinfection is a novel technology that enhances the traditional method of manual disinfection.

Tru-D SmartUVC and PDI as a combined company is able to provide customers with that layered approach completely internally, with our own broad portfolio of products,” Ms. Brewer said. “We go all the way from surface wipes to UVC disinfection to now continuously active disinfecting of surfaces, so customers don’t have to shop from different companies — they can get it all in one place.”

A layered approach is a game-changer for enhanced disinfection

A multi-strategy, layered approach to disinfection can drastically reduce the presence of organisms on hard, non-porous surfaces in health care settings because of the complementary routes to elimination it involves. For example, whereas chemical manual disinfection is commonly used throughout the day on surfaces such as terminals and nurse stations, UVC disinfection provides greater effectiveness on surfaces that may be difficult to clean by hand and also for terminal disinfection of rooms.

Ms. Brewer explained that UVC cleaning technology in healthcare settings is not new but that its use in hospital rooms and operating rooms dates back only about 15 years and is still relatively novel. “Two years ago, we had to explain a lot what UVC did and why it was being used in healthcare. But since the pandemic, it’s become much more commonly sought-after as a strategy for keeping surfaces clean.”

Ms. Hagberg traced further the evolution of the layered disinfection approach. “One of the more recently introduced innovations to the market is an EPA-registered disinfectant product that has continuously active disinfection (CAD). This product has a specific claim against SARS-CoV-2 within a one-minute contact time, as well as a continuous disinfection activity against specific bacteria* that cause the majority of healthcare associated infections.”

CAD technologies not only support a layered approach to cleaning surfaces but also facilitate disinfection of the surrounding environment for 24 hours on surfaces to which it is applied. This is nowhere more relevant than in healthcare, where the environment can harbor organisms for days, weeks or even months.

“There are lots of opportunities for contamination and recontamination of these environmental surfaces, so it’s really difficult to disinfect surfaces as often as necessary,” Ms. Hagberg said. “A continuously active disinfectant protects surfaces for 24 hours, effectively killing specific organisms* within five minutes of them contaminating surfaces. This type of technology certainly can lower the bioburden that’s on those surfaces over a defined period.”

Practicality and partnerships are key to dissipating innovation skepticism

One of the toughest challenges when it comes to implementing a new technology in healthcare is permeating the wall of skepticism that naturally surrounds innovation. For good reason, healthcare professionals are not easily susceptible to marketing claims, so often the first question that arises is whether a new solution lives up to its claims. To surmount that initial hurdle, scientific evidence in the form of EPA-registration information, vendor-performed or peer-reviewed scientific studies are crucial.

Another, no less important challenge in healthcare settings, is proving that an innovation has been created with an understanding of how it fits into existing workflows, whether it requires any substantial changes to those workflows and how easy it would be for end users to adopt and adapt to it. In this context, ensuring education and training for proper product or technology use is also essential.

Champions of layered disinfection can overcome staff acceptance by providing evidence of its effectiveness and workability, but the effort that goes into doing so is significant. That is where partnering with solution vendors — Tru-D SmartUVC and PDI, in this case — makes all the difference.

“It is becoming increasingly important to use products that come with support in the form of process optimization, utilization data and industry expertise,” Ms. Brewer said. “You don’t want a company to just drop off a product and you never see [them] again. You really want somebody who’s going to partner with you to achieve those disinfection goals because that’s the best way to make sure that implementation is successful over the long term.”


Multifactorial challenges require multifactorial solutions, and that is how the layered approach to disinfection works. “Most healthcare-associated infections are multifactorial and [addressing them] would benefit from a layered approach to disinfection,” Ms. Hagberg said.

The partnership between Tru-D SmartUVC and PDI brings an integrated solution to disinfection within reach of any healthcare organization. It offers both a diverse range of surface disinfectants along with the technology of UVC. The PDI/Tru-D SmartUVC team offers services to support the implementation of the layered strategy: field sales team members that walk customers through operationalizing the strategy in their organization, marketing and communications support, scientific experts and a responsive customer service team that ensures a successful post-sale customer journey.

“Through the combination of all these, we assist customers with education, provide consultation and help with implementation,” Ms. Hagberg said. “This is how we provide credibility to the product and services we offer and bring value to our customers.”

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