The rise of drug-resistant organisms, deadly bacteria that have become impervious to most of the antibiotics available today, has spurred hospital officials to devote additional attention to the cleaning and disinfection of patient rooms. Despite their best efforts, however, many facilities have struggled to lower their infection rates.
That’s prompted some hospitals to shine a new light on the problem, namely, ultraviolet light.
In a bid to prevent infections and save money, hospitals around the country have deployed disinfecting robots that use UVC light to kill off germs that survive the standard room cleaning process.
Last month, St. Charles Bend began a 45-day trial of the Tru-D SmartUVC device, an R2-D2-like robot with long glass tubes that emit short-frequency ultraviolet C light that breaks up bacterial DNA.
“The UV light goes in all directions,” said Randy Barnes, director of hospitality services at St. Charles Bend. “It bounces off the walls at angles and it keeps doing that all around the room until it tells itself ‘I’ve killed all the spores,’ because it’s gotten to the proper intensity.”
After a patient is discharged and the cleaning staff completes a manual cleaning of the patient room, all the doors and drawers inside the room are opened, the mattress propped so that the light can reach areas normally in shadow. No one can be in the room when the device is activated, as the UV light will blister skin.
The door to the room is closed with a yellow safety chain drawn across it, the plastic protective covering of the device doubles as a warning sign. Tru-D is activated remotely with a smartphone-like device that is attached to the door, providing a digital readout of the disinfection process. The device will also sense if the door is being opened, and will automatically shut off the UV light.
Testing the device
During the pilot test, St. Charles will first disinfect all the patient rooms on the medical floor, and then will use Tru-D primarily to clean the isolation rooms where patients with particularly nasty bugs reside. Staff use special protocols in those rooms to prevent transmission of germs to other patient rooms, and the cleaning crew takes additional steps to disinfect the room after the patient leaves.
“When we get into an isolation room, we would normally clean it and then we’d bleach it,” Barnes said. “That second step is going to be replaced with Tru-D.”
The normal two-step process takes about 90 minutes, but with Tru-D, Barnes expects to get isolation rooms clean in 70. That could help speed turnover of rooms and help the hospital to relieve some of its overcrowding issues. With a high demand for patient beds, the hospital has struggled to move patients out of the emergency room on a timely basis, creating a backlog throughout the hospital system.
“It doesn’t replace cleaning,” said James Davis, an infection prevention analyst with ECRI, a firm that evaluates medical technology. “This goes on top of your standard process and gives you an added layer of security.”
Davis said the effectiveness of UV disinfection is very much dependent on the type of device used and the design of the patient room. That’s why ECRI recommends hospitals pilot test any device before purchasing.
The added benefit of UVC disinfection also depends on how well the hospital does with its manual cleaning process.
“If they’re doing a poor job cleaning and then they put the device there, they’re going to see a drastic reduction,” he said. “On the flip side, they can have a really good cleaning with manual practices but have (an infection) rate that they can’t seem to budge. They might see a reduction in these infections (with a UVC device.)”
But if a hospital skimps on the manual cleaning thinking that Tru-D will make up the difference, the device could, in the end, lead to higher infection rates.
“That’s the fear,” Davis said. “You can’t disinfect a surface if there’s dirt on it. The light doesn’t go through the dirt.”
Research studies, however, show that UVC can be very effective. A large randomized control trial conducted by researchers at Duke University Medical Center in Durham, North Carolina, tested Tru-D at nine hospitals of varying sizes. Adding UVC to standard disinfection reduced the number of infections by 30 percent. The device was particularly effective at killing methicillin-resistant Staphylococcus aureus, commonly known as MRSA, as well as vancomycin-resistant enterococci, or VRE.
The study did not show a reduction in Clostridium difficile transmission, although that may be because every room with a C.diff patient was first cleaned with bleach.
When researchers at the University of Pennsylvania added UVC disinfection to standard cleaning techniques, rates of C-diff transmission dropped by 25 percent over prior year levels. In rooms that were not treated with UVC, rates increased by 15 percent.
C-diff is a particularly difficult bacteria to kill and accounts for nearly a half million infections each year and 15,000 deaths.
“C-diff is smarter than we are,” Barnes said. “It changes its characteristics and its DNA to be resistant to whatever antibiotic we use. We’re now at a stage where we’re on our last antibiotic.”
The bacteria form spores that can live on surfaces for up to five months, requiring hospitals to use bleach in a manually intensive cleaning process that often has less than ideal results.
A study published last year found that when a hospital patient is given antibiotics, which can kill off healthy bacteria in the gut and allow C-diff to thrive, the following patient in the same hospital room has a 22 percent higher chance of being infected.
In 2016, St. Charles Bend had 33 cases of hospital-acquired C-diff, a rate 30 percent lower than similar hospitals nationwide.
And each C-diff infection costs a hospital an added $21,000.
Hospitals also have more direct incentives to reduce infections. Several years ago, Medicare stopped paying hospitals extra funds if patients had to be readmitted and started penalizing hospitals with high readmission rates. That made the cost of UVC robots much more justifiable and sparked new interest in an existing technology.
“They’ve been around for over a decade,” said Jeremy Suggs, manager of the health devices groups at ECRI. “It’s just more the last few years as the penalties for having hospital acquired infections or lack of reimbursement for those events have really been hitting hospitals that they’re more concerned about other ways to minimize the infections.”
The list price for a Tru-D is about $114,000, but hospitals like St. Charles that belong to a group-purchasing organization stand to get a sizable discount.
Barnes recently completed an analysis showing that the hospital would save some $297,000 over three years by reducing health care acquired infections even after accounting for the cost of the devices.
“That’s just pure revenue. That goes to the bottom line,” Barnes said. “Now you’ve reduced those health care acquired infections, and made the readmission process slower and the hospital safer.”
If the numbers pan out during the pilot test, the hospital would likely buy three of the devices, using them to clean hospital rooms throughout the day, and then disinfect operating rooms at night after the day’s surgeries are completed.
Barnes said the hospitals in Redmond, Madras and Prineville see too few patients to justify the cost.
“Madras had one C-diff (case) in the last six to eight months,” he said. “Whereas I get 15 a day.”