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The Questions: Automated room disinfection

The Questions: Automated room disinfection. Research Agenda. Sarah Simmons, MPH CIC Xenex Disinfection Technologies. Does the environment matter?. Manual cleaning is insufficient Prior room occupancy risk Interaction with hand hygiene Known benefit from enhanced cleaning. Research Agenda.

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The Questions: Automated room disinfection

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  1. The Questions:Automated room disinfection Research Agenda Sarah Simmons, MPH CIC Xenex Disinfection Technologies

  2. Does the environment matter? • Manual cleaning is insufficient • Prior room occupancy risk • Interaction with hand hygiene • Known benefit from enhanced cleaning Research Agenda

  3. Types of No-Touch Disinfection • Hydrogen Peroxide Vapor • Mercury-based Ultraviolet Light • Xenon-based Ultraviolet Light Research Agenda

  4. Hydrogen Peroxide Vapor • Produces and disperses a vapor of hydrogen peroxide (H2O2) • Creates Oxygen radicals that react with cell walls • Room must be sealed during the process Research Agenda -OH -OH O2- O2- -OH HO2 O2- -OH HO2 HO2 HO2 O2-

  5. Ultraviolet Systems Research Agenda

  6. Photodimerization Bonds DNA/RNA together, preventing cell replication Research Agenda

  7. Photosplitting Breaks the phosphate backbone of the DNA Research Agenda

  8. Photohydration Inserts water molecules into DNA bases, causing functional damage Research Agenda

  9. Photohydration Creates bonds between protein molecules, resulting in structural damage, including the lysing of the cell wall Research Agenda

  10. Does it work? • What does it kill? • Where does it kill? • How long to kill? Research Agenda

  11. Target Organisms • C. difficile spores (NAP1) • Acinetobacterbaumannii • Methicillin-resistant S. aureus(MRSA) • Feline calicivirus (norovirus surrogate) • Vancomycin-resistant Enterocci (VRE)

  12. Is it better than/dependent on housekeeping? • End game: what does the next patient experience? • Is there an improvement over housekeeping? • Is there a dependence on housekeeping? Research Agenda

  13. How should it be used? • How? • Where? • When? • How often? Research Agenda

  14. UV Mapping – One Position

  15. UV Mapping – Two Positions

  16. UV Mapping – Three Positions

  17. UV Mapping - conclusion Multiple positions is the correct way to use UV for room disinfection.

  18. Hydrogen Peroxide

  19. Do I have to disinfect the same way if I use it? • Clean as long? • Still use bleach? • Changes in inspection? Research Agenda

  20. What about ORs? • Consequences of SSIs • Doubles the risk of death after surgery • Five fold increased risk for readmission • 60% more likely to require ICU care • LOS increases 6 days Research Agenda

  21. What about ORs? • Overall Cleaning Compliance 47% • Anesthesia Medication Cart 38% • Anesthesia Knobs 25% • IV Poles 55% • Bed Controls 64% • Floor 93% Research Agenda

  22. What about ORs? • Additional assurance? • Quick clean? • Between cases? • Terminal Cleaning? Research Agenda

  23. Does it matter to patient outcomes? • HAI reductions? Research Agenda

  24. Where should I use it? • Select isolation? • All isolation? • Select units? • All discharges? • Central processing? Research Agenda

  25. What about RME, unused supplies and curtains? • RME • Validating • Tracking • Unused supplies • Assurance • Labor • billing • Curtains • Disinfection goal? • Curtain types Research Agenda

  26. Do patients like it? • Complaints? • Compliments? Research Agenda

  27. What data do you need? • What level of disinfection? • What level of proof? Research Agenda

  28. Could clonal typing help? • Need for outcome measure • ID sources of infection • ID clusters • Proof of effectiveness? Research Agenda

  29. What’s my goal anyway? • Reduce rates? • Additional protection for high-risk units? • Outbreak response? • Bio-preparedness? Research Agenda

  30. What else should I think about? • How are the technologies different? • Decontamination effectiveness • Cost per room • Cycle time • Operators • Access to rooms • Environmental friendliness • Infection rate impact Research Agenda

  31. Carling P, Parry M, Rupp M, Po J, Dick B, Von Beheren S. Improving Cleaning of the Environment Surrounding Patients in 36 Acute Care hospitals. • Shaughnessy M, Micielli R, DePestel D, Arndt J, Strachan C, Welch K, Chenoweth C. Evaluation of Hospital Room assignment and acquisition of Clostridium difficile infection. Infection Control and Hospital Epidemiology. Vol .32, No. 3, March 2011 • Datta R, Platt R, Yokoe D, Huang S. Environmental Cleaning Intervention and Risk of Acquiring Multidrug-Resistant Organisms From Prior Room Occupants. Arch Intern Med. 2011;171(6):491-494 • Drees M, Snydman D, Schmid C, Barfoot L, Hansjosten K, Vue P, Cronin M, Nasrway S, Golan Y. Prior Environmental Contaminaiton Increases the Risk of Acquisition of Vancomycin-Resistant Enterococci. Clin Infect Dis.2008;46(5):678-685 • Huang S, Datta R, Platt R. Risk of Acquiring Antibiotic-Resistant Bacteria From Prior Room Occupants. Arch Intern Med. 2006;166(18):1945-1951. • Nseir S, Blazejewski C, Lubret R, Walet F, Courcol R, Dorocher A. Risk of acquiring multidrug-resistant Gram-negative bacilli from prior room occupants in the intensive care unit. ClinMicrobiolInfect. 2011 Aug;17(8):1201-8 • Dubberke E, Reske K, Noble-Wang J, Thomson A, Killgore G, Mayfield J, Camins B, Woeltje K, McDonald J, McDonald L, Fraser V. Prevalence of Clostridium difficile environmental contamination and strain variability in multiple healthcare facilities. Am J Infect Control. 2007 Jun: 35(5):315-8. • C Edminston, et al. Molecular Epidemiology of Microbial Contamination in the Operating Room Environment: Is there a risk of infection? Surgery. 2005;138(4):573-582. • R Loftus, et al. Transmission of Pathogenic Bacterial Organisms in the Anesthesia Work Area. Anesthesiology 2008; 109(3):399-407. • Kowalski, W. (2009). Ultraviolet Germicidal Irradiation Handbook. New York: Springer. References

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