Tag Archives: C.difficile and UV Disinfecting

Mayo Clinic Pulsed Xenon UV Room Disinfection Study Reports 47% Reduction in C.diff. Infection Rates

 

Even with the world’s most robust infection prevention strategy and protocols, the Mayo Clinic wanted to further reduce its patients’ risk for contracting C.diff and conducted a controlled study to evaluate the effectiveness of Xenex Disinfection Systems’ pulsed xenon ultraviolet (UV) light room disinfection technology. The study, published in the American Journal of Infection Control, found that adding pulsed xenon UV disinfection to the hospital’s disinfection efforts resulted in a 47% reduction in C.diff infection rates on the intervention units that has been sustained for two years. In addition, the facility saw an increase in patient satisfaction scores for environmental cleanliness and a 52% reduction in Vancomycin-resistant enterococci (VRE) infection rates.

Based on the significant C.diff infection rate reductions in the intervention units, the Mayo Clinic expanded pulsed xenon UV room disinfection to 14 additional hospital units with high rates of C.diff infection utilizing 12 robots. This wide-scale implementation resulted in a facility-wide reduction in its Standardized Infection Rate (SIR) from 0.774 to 0.571. SIR rates are used by the Centers for Medicare & Medicaid Services (CMS) to calculate hospital reimbursement.

Many hospital patients, especially those on antibiotics, are susceptible to C.diff, which can live for up to five months on surfaces in the hospital. A person with C.diff may contaminate their hospital room and bathroom, leaving C.diff spores on the walls, handles and other high-touch surfaces. These spores can be easily transferred to the next patient or healthcare worker in that room. For this study, the Mayo Clinic deployed two Xenex LightStrike™ Germ-Zapping Robots™ that utilize intense pulsed xenon UV light to quickly destroy pathogens like C.diff and VRE that may be lurking on high-touch surfaces in a room, such as bedrails, tray tables and doorknobs. The robot is easy to use and does not require warm-up or cool-down time, so it’s easily transported from room to room.

In the controlled trial, the first of its kind using pulsed xenon UV disinfection technology, three hospital units (two hematology and bone marrow transplant units and one medical-surgical unit) were designated for pulsed xenon UV intervention, and three units with similar patient populations served as control units. Because of the high C.diff infection rates, all patient rooms on the targeted units were cleaned with bleach daily and at terminal cleaning. In addition to tracking C.diff infection rates, hand hygiene, isolation compliance, and antimicrobial usage were followed on all the units. The only difference in the infection control programs between the controlled units and intervention units was the addition of LightStrike pulsed xenon UV disinfection. LightStrike robots were used after terminal cleaning in 85% of all discharges on the targeted intervention units.

“The Mayo Clinic has a world class infection prevention program that is extremely well-run and well monitored. Their success in reducing C.diff rates is strong evidence that pulsed xenon UV room disinfection can be a very effective tool in a hospital’s infection prevention bundle,” said Dr. Mark Stibich, Chief Scientific Officer at Xenex. “This is very exciting research for several reasons. First, the hospital achieved and sustained lower C.diff rates. Second, hospitals may be confused about the different kinds of UV technologies and their effectiveness, especially after a previous study using mercury UV devices did not show a reduction in C.diff infection rates. This data – and the story of how the Mayo Clinic achieved success in a controlled trial – demonstrates that Xenex’s pulsed xenon UV disinfection technology should be added to the infection prevention bundle as standard of care to enhance patient safety.”

TO view this article in its entirety – please click on this link to be redirected:https://www.businesswire.com/news/home/20190220005745/en/Mayo-Clinic-Study-Reports-47-Reduction-C.diff

 

CLINICAL TRIAL IN PROGRESS 

Pulsed UV Xenon Disinfection to Prevent Resistant Healthcare Associated Infection

Recruitment Status : Recruiting

First Posted : November 21, 2017
Last Update Posted : November 27, 2018

ClinicalTrials.gov Identifier: NCT03349268

Information from the National Library of Medicine To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03349268

 

Contacts
Contact: Keith S. Kaye, MD, MPH 734-615-1901 keithka@med.umich.edu
Contact: Jolene E Daniel 734-615-1901 jolened@med.umich.edu

 

Locations
United States, Michigan
Detroit Medical Center Recruiting
Detroit, Michigan, United States, 48205
Contact: Paul Kilgore, MD    313-577-1215    paul.kilgore@wayne.edu
Sponsors and Collaborators
University of Michigan
Agency for Healthcare Research and Quality (AHRQ)
Xenex Disinfection Services LLC
Detroit Medical Center
Henry Ford Health System
TEMPVA Research Group, Inc.
Wayne State University
Investigators
Principal Investigator: Keith S. Kaye, MD, MPH University of Michigan

STUDY DESCRIPTION:

Brief Summary:

The objective is to conduct a prospective, sham controlled, double-blinded, interventional crossover trial to compare standard terminal cleaning plus PX-UV (intervention) with standard terminal cleaning plus sham PX-UV (control) with crossover at 12 months, following a 6-month washout period. Outcome measures include the rates of HAIs, as well as the recurrence of genetically identical clinical strains of HAIs among patients on study units. The study will be conducted in 2 hospitals covering 16 total hospital units at Detroit Medical Center. Our central hypothesis is that the addition of PX-UV to standard terminal cleaning will be associated with a significant reduction in the rate of HAIs, as well as a reduction in the recovery of genetically identical strains of MDROs. The impact of PX-UV disinfection on rates of HAIs on study units will be determined by comparing rates of HAIs on a) study units where PX-UV is added to standard terminal cleaning practices to b) units where a sham UV disinfection system is added to standard terminal cleaning; and by comparing rates of HAIs on the same medical ward during each of two 12-month phases of a crossover study (one phase when a PX-UV device is added and one when a sham device is added to standard terminal cleaning).

The long-term goal of this project is to establish the efficacy of terminal cleaning plus PX-UV in reducing rates of HAIs due to the following multi-drug resistant organisms (MDROs): C. difficile, vancomycin-resistant enterococci (VRE), Klebsiella pneumoniae and Escherichia coli producing extended-spectrum beta-lactamases (ESBLs), methicillin-resistant Staphylococcus aureus (MRSA) and Acinetobacter baumannii.

At the conclusion of the proposed project, novel data will be generated from this rigorously controlled study regarding the effectiveness of PX-UV in reducing HAIs in a representative, real-world healthcare setting.

To learn more about this Clinical study in progress – please click on the following link to be redirected to clinicaltrials.gov

https://clinicaltrials.gov/ct2/show/NCT03349268?cond=Clostridium+Difficile&draw=5&rank=240

 

 

Reviewing the Benefits Of Enhanced Terminal Room (BETR-D) Disinfection Study, C.difficile Infection Rates Unchanged

c-diff

If you are concerned about C. difficile Infections being battled in Hospitals today review the Abstract and Scientific evidence from the 2015  BETR-D Study

“….adding UV light to bleach in rooms linked to C. difficile had no effect, ” Dr. Deverick J. Anderson, MD, MPH, FIDSA, FSHEA reported

 

MedPage Today  http://www.medpagetoday.com/meetingcoverage/idweek/54043

Adding ultraviolet light or bleach plus UV light also showed a trend toward a reduced risk, Anderson said at the IDWeek meeting, held in 2015 jointly by the Infectious Diseases Society of America (IDSA), the HIV Medicine Association (HIVMA), the Society for Healthcare Epidemiology of America (SHEA), and the Pediatric Infectious Diseases Society (PIDS).

On the other hand, the benefit of what Anderson called “enhanced terminal disinfection” varied among the four pathogens, methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococcus (VRE), multidrug-resistant (MDR) acetinobacter, and Clostridium difficile.

   What was the BETR-D Study?

The BETR-Disinfection study was performed over 28 months in 9 study hospitals from 4/2012 to 7/2014.

  • Each hospital used four strategies for terminal room disinfection in a randomized sequence.
  • Each strategy was used for 7-month study arms, including a 1 month wash-in period.
  • Two of these strategies used a UV-C emitting device.
  • Standard cleaning involved the use of a quaternary ammonium (reference group A). Three enhanced cleaning strategies were evaluated and compared to the reference: quaternary ammonium + UV-C (B), bleach (C), and bleach + UV-C (D).Of  note, bleach was used for daily and terminal disinfection of all known C. difficile rooms, regardless of study arm.
  • Study cleaning strategies were employed in seed rooms, defined as a room containing a patient on contact precautions for infection or colonization due to the following 4 target MDROs was discharged: MRSA, VRE, C. difficile, or MDR Acinetobacter.
  • The next patient in the room was considered an exposed patient.
  • Primary outcome was the clinical incidence of all target MDROs in patients exposed for at least 24 hours, defined as the first positive culture of a MDRO a) during exposure to the seed room, if positivity occurred ≥48 hr post-admission to the seed room, or b) in the 90 days following seed room exposure for MRSA, VRE, and MDR-Acinetobacter and 28 days for C. difficile.
  • Rates were calculated as outcome/10,000 exposure days using intention-to-treat and per protocol principles

To read the study Abstract in its entirety please click on the following link:

https://idsa.confex.com/idsa/2015/webprogram/Paper53062.html

A study of a large cluster-randomized trial, adding bleach to the standard quaternary ammonium cleaning significantly reduced the risk of transmission of four organisms that cause healthcare-associated infections

A Cluster Randomized, Multicenter Crossover Study with 2×2 Factorial Design to Evaluate the Impact of Enhanced Terminal Room Disinfection on Acquisition and Infection Caused by Multidrug-Resistant Organisms (MDRO)

Anderson and colleagues in the Duke Infection Control Outreach Network tested the four cleaning strategies over 28 months in nine hospitals, with hospitals switching strategies every 7 months.

The goal was to see if they could reduce the overall incidence of the targeted pathogens among patients using a room immediately after a patient known to be colonized or infected by one of the four occupied it. A second primary endpoint was the effect on C. difficile.

He noted that all rooms in which a patient had had C. difficile were cleaned with bleach, so the comparisons were actually between quaternary ammonium and bleach and the same approach adding UV light.

All told, the study had 23,272 patients potentially exposed to a pathogen — they spent at least 24 hours in one of the “seed” rooms where the previous patient had been identified as having one of the pathogens.

Patients in seed rooms became cases if they developed colonization or infection by the pathogens linked to their rooms, as long as they had no history of the pathogen in the previous year and no evidence of community acquisition, he said.

In the four arms, Anderson reported:

  • There were 115 cases in 22,426 exposure days in the standard cleaning arm, for a rate of 51.3 cases per 10,000 exposure days.
  • In the arm adding ultraviolet, there were 76 cases in 22,389 exposure days for a rate of 33.9
  • When bleach was added, there were 101 cases in 24,261 exposure days, for a rate of 41.6.
  • And when both bleach and UV were added, there were 131 cases in 28,757 exposure days, for a rate of 45.6.

The reductions, compared with standard cleaning, were 30%, 15% and 9%, respectively, but only the addition of UV light to quaternary ammonium reached statistical significance (P=0.036).

There were too few cases of MDR acetinobacter to quantify, he said, but it was possible to judge the effect of the various interventions on the other three pathogens.

For MRSA, adding UV light to quaternary ammonium reduced the risk of transmission by 22%, but the difference from standard cleaning fell short of statistical significance. The other two interventions made no difference.

For VRE, on the other hand, all three test strategies reduced the risk of transmission by about 60% — 59% for UV, 57% for bleach, and 64% for bleach plus UV. However, Anderson said, the UV arm was just short of statistical significance, while the other two were significantly different from standard cleaning (P=0.049 and P=0.003, respectively).

But adding UV light to bleach in rooms linked to C. difficile had no effect, Anderson reported.

Note: Not all UV disinfecting products are the same– in the way they are scientifically developed, manufactured, and utilized in the healthcare industry.  It is favorable for Hospital and Healthcare facility decision-makers to ask some tough questions when it comes to evaluating UV technologies. The gold standard for assessing new technologies is to evaluate peer-reviewed literature published and also cited in The Lancet publication.  Please click on the The Lancet article link below to retrieve additional information focused on the BETR-D study.

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31588-4/abstract

Findings

31 226 patients were exposed; 21 395 (69%) met all inclusion criteria, including 4916 in the reference group, 5178 in the UV group, 5438 in the bleach group, and 5863 in the bleach and UV group. 115 patients had the primary outcome during 22 426 exposure days in the reference group (51·3 per 10 000 exposure days). The incidence of target organisms among exposed patients was significantly lower after adding UV to standard cleaning strategies (n=76; 33·9 cases per 10 000 exposure days; relative risk [RR] 0·70, 95% CI 0·50–0·98; p=0·036). The primary outcome was not statistically lower with bleach (n=101; 41·6 cases per 10 000 exposure days; RR 0·85, 95% CI 0·69–1·04; p=0·116), or bleach and UV (n=131; 45·6 cases per 10 000 exposure days; RR 0·91, 95% CI 0·76–1·09; p=0·303) among exposed patients. Similarly, the incidence of C difficile infection among exposed patients was not changed after adding UV to cleaning with bleach (n=38 vs 36; 30·4 cases vs 31·6 cases per 10 000 exposure days; RR 1·0, 95% CI 0·57–1·75; p=0·997).

The BETR-D study was supported by the CDC

 

Cdiffradio.com

Cdiffradio.com

 

 

 

Listen to Deverick J. Anderson, MD, MPH, FIDSA, FSHEA discuss UV Intervention Addressing C. difficile and Other Pathogens   July 2016

https://www.voiceamerica.com/episode/94128/uv-intervention-addressing-c-difficile-and-other-pathogens

 

 

*PLEASE NOTE – The C Diff Foundation does not endorse any products, medications,  and/or clinical study in progress. All website postings are strictly for informational purposes only.