A new soldier in the war against HAIs: UV robots

What you need to know about UV light disinfection.

This content is sponsored by Xenex.

About one in 20 hospitalized patients in the United States experience a healthcare-associated infection, and many of them don't survive: An estimated 75,000 hospital patients with HAIs died during their hospitalization in 2011, according to the Centers for Disease Control and Prevention.

In addition to HAIs being costly to patient safety, they are also expensive for hospitals and health systems. A 2009 report from the CDC estimated that the overall annual direct medical costs of HAIs to U.S. hospitals fall somewhere between $28.4 billion and $45 billion.

Armed with those statistics — as well as the treat of losing Medicare reimbursement due to high hospital-acquired condition rates — many hospitals and health systems are doubling down on their infection prevention strategies to limit the number of HAIs in their facilities. For instance, many are revisiting hand hygiene compliance programs, while still others turned to making uniforms out of antimicrobial fabrics to help stem the spread of infection.

Other hospitals have gone high-tech and turned to robots to help prevent HAIs — ultraviolet light-emitting robots. UV-C light, a part of the UV spectrum, can kill pathogens like C. diff and methicillin-resistant Staphylococcus aureus that cause HAIs. The light passes through the cell walls of bacteria, viruses and other microorganisms, which then absorb the energy into their DNA, RNA and proteins. This fuses the DNA and deactivates it, meaning the germ is no longer infectious.Xenex OR Purple

Germ-zapping robots that emit this lethal light are still fairly new in the hospital environmental cleaning setting. "I think it's still up and coming," says Mark Stibich, PhD, chief scientific officer and founder of Xenex, which offers a pulsed xenon UV room disinfection system. "It's in the early stage in the market. There's still confusion on how it's deployed and how to use it."

How it works

In the case of Xenex's UV robot, cleaning a normal patient room will take roughly 15 minutes after the room is "visibly clean," according to Dr. Stibich. Generally, the process starts with the robot cleaning the patient's bathroom for about five minutes while the housekeepers clean the rest of the room. Then, after raising the bed rails and opening cabinets to expose the surfaces to the light, the housekeeper would move the robot to one side of the bed and run it for five minutes. The process is then repeated with the robot on the other side of the bed.

The process only takes 15 minutes because of the patented technology Xenex uses in its UV light robots: pulsed xenon UV. The most familiar form of UV is produced by mercury vapor lamps, but a lamp using this technology would take an hour or more to clean a normal patient room. Additionally, mercury UV only causes one type of damage to the DNA of germs, while pulsed xenon UV causes four types of cellular damage. Combined, this makes pulsed xenon UV more effective and efficient than mercury UV light for hospital disinfection.

Advantages of UV disinfection

Adding UV disinfection to the usual terminal cleaning protocol has several advantages to the standard manual cleaning procedures alone. Some benefits include:

  • Lower infection rates. Westchester Medical Center in Valhalla, N.Y., saw the rate of HAIs caused by multidrug-resistant organisms and C. diff drop 20 percent after implementing pulsed xenon UV disinfection (despite only treating 22 percent of their overall discharges) according to a study in the American Journal of Infection Control.
  • More effective than manual cleaning. Even when pulsed xenon UV light is used alone, it is more effective in killing MRSA than manual cleaning. One study in BMC Infectious Diseases showed pulsed xenon UV light was more effective than manual cleaning for MRSA, as colony counts were lower after a room was exposed to pulsed xenon than when it was cleaned manually.
  • Cleaner air. When Cambridge (Mass.) Health Alliance, a three-hospital system, implemented pulsed xenon UV light to disinfect OR surfaces, not only did bacterial contaminations on surfaces decrease, there was also a 50 percent decrease in air contamination as well, one case study found.
  • Elimination of human error. Sometimes, housekeepers feel pressure to turn over rooms quickly and may not clean everything as thoroughly as they should due to that pressure — they could miss cleaning up to 50 percent of surfaces, according to Dr. Stibich. "Human errors leave patients open to infection risk," he says. "UV light removes human error."

For hospitals seeking to add a UV light robot to their HAI-fighting arsenal, Dr. Stibich provides the following tips:

1. Know the technology. "Don't assume everything is the same," says Dr. Stibich. As laid out above, there are major differences between mercury UV light and pulsed xenon UV light that should be considered before a robot is purchased.

2. Make an evidence-based decision. Dr. Stibich recommends looking at the available data and studies before choosing a particular robot. Specifically, he says officials should examine what the robot has done in real-world settings to reduce the spread of HAIs and clean the environment more effectively.

3. Consider the additional help offered. Implementing a UV disinfection routine will mean a change in workflow for housekeepers and other hospital workers, which could be confusing and lead to the technology being used improperly. "We saw early on, as you put a process in place at a hospital, it's a big deal," says Dr. Stibich. "We don't want to see our robot left in a closet because of operational or logistical problems." So, the company has infection preventionsists on staff who can go on-site to train staff and answer any questions.

For hospital officials on the fence about adding UV disinfection to their environmental cleaning repertoire, Dr. Stibich says to look to the facts. "We have the evidence that it will reduce risk and increase patient safety," he says. "Hospitals should be doing everything they possibly can to reduce infection rates. [UV light] has a clinical benefit and a financial benefit. It's really the whole package."

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