• Users Online: 506
  • Print this page
  • Email this page


 
 
Table of Contents
ORIGINAL ARTICLE
Year : 2020  |  Volume : 2  |  Issue : 2  |  Page : 37-40

Evaluation of an ultraviolet light device for disinfection of operation theater in a tertiary care hospital – Preliminary study


1 Department of Hospital Administration, A. J. Institute of Hospital Administration, Mangalore, Karnataka, India
2 Department of Microbiology, A. J. Institute of Medical Sciences and Research Centre, Mangalore, Karnataka, India

Date of Submission24-Feb-2022
Date of Decision23-Mar-2022
Date of Acceptance24-Mar-2022
Date of Web Publication14-Apr-2022

Correspondence Address:
Dr. Suneetha Raghu
Department of Hospital administration, AJ Institute of Hospital Management, Mangalore, Karnataka
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/QAIJ.QAIJ_3_22

Rights and Permissions
  Abstract 


Transmission of potential microorganisms from the external environment to patients is one of the growing concerns, especially in operation theaters (OTs) where there is increased contact between patient and care provider's hands and environmental surfaces. Approximately 50% of surfaces are not adequately disinfected during between-case or terminal cleaning, and can harbor pathogenic organisms such as Pseudomonas spp, Acinetobacter spp, and Klebsiella spp. Hence, adequate disinfection of OTs is very essential. Recent advances have shown that ultraviolet (UV) light devices have been shown to decrease OTs' pathogen burden. The research was carried out in an advanced tertiary care hospital; the objective was to study whether UV rays can effectively reduce the burden of pathogenic microorganisms (Clostridium difficile and methicillin-resistant Staphylococcus aureus) and other multidrug-resistant organisms. The study also incorporated to assess whether the UV rays can effectively reduce surgical site infection (SSIs) rates and to know the implication of UV technology usages. Experimental research design was collected primary data. Samples from six operation rooms were collected for quantitative culturing using swabs and thioglycolate broth and Gluco broth culture bottles. The study found that UV disinfection was highly effective in all the six OTs.

Keywords: Disinfection process, operation theater, ultraviolet device


How to cite this article:
Raghu S, Marla AP, Bhandary R. Evaluation of an ultraviolet light device for disinfection of operation theater in a tertiary care hospital – Preliminary study. QAI J Healthc Qual Patient Saf 2020;2:37-40

How to cite this URL:
Raghu S, Marla AP, Bhandary R. Evaluation of an ultraviolet light device for disinfection of operation theater in a tertiary care hospital – Preliminary study. QAI J Healthc Qual Patient Saf [serial online] 2020 [cited 2022 Dec 9];2:37-40. Available from: https://www.QAIJ.org/text.asp?2020/2/2/37/343312




  Introduction Top


Infection risk to patients from contaminated hospital environments is very high. It is also widely recognized that the hospital environment may facilitate the transmission of several health-care-associated pathogens. Ultraviolet (UV) lights provide rapid, effective inactivation of microorganisms through a physical process. When pathogenic organisms are exposed to the germicidal wavelengths of UV light, they are rendered incapable of reproducing and infecting.[1] Transmission of potential microorganisms from the external environment to patients is one of the growing concerns, especially in operation theaters (OTs) where there is increased contact between patient and care provider's hands and environmental surfaces. Approximately 50% of surfaces are not adequately disinfected during between-case or terminal cleaning, and can harbor pathogenic organisms such as Pseudomonas spp, Acinetobacter spp, and Klebsiella spp.[2],[3] Hence, adequate disinfection of OTs is very essential. Recent advances have shown that UV light devices can decrease OTs' pathogen burden.

Although it has been proved that UV light effectively reduces contamination in hospital, there are very little studies regarding their effectiveness in Indian hospitals. Hence, this study was planned to investigate the effectiveness of UV rays in hospital disinfection, especially in OTs. These microorganisms which may be experimentally or naturally contaminated with epidemiologically important pathogens will risk the patients as well as the health-care providers. Hence, the present study was done to assess the effectiveness of UV light in reducing the microbial burden.

Objectives of the study

  • To study whether UV rays can effectively reduce burden of pathogenic microorganism.
  • To study whether the use of UV rays can effectively reduce surgical site infection (SSIs) rates.



  Methods and Materials Top


Source of data

The primary data will be collected from all exposed surfaces in the operation rooms (ORs) receiving UV disinfection. Six ORs are used to collect the data. The room is not occupied while systems are operating.

Study design

This was an experimental study.

Sample size and sampling technique

Samples from 6 ORs will be collected for quantitative culturing using swabs and thioglycolate broth and Gluco broth culture bottles. Before starting disinfection with UV rays, one culture swab is taken from each OR. During this study period, cleaning will be continued by a dedicated OT staff. After standard manual chemical clean, OT high-touch surfaces were cultured. Then, ORs were disinfected with a UV device for 20 min duration. In between, three culture swabs are taken at time intervals of 10, 15, and 20 min, respectively, from each OR to study the minimum time required for effective disinfection. All exposed surfaces in the ORs received UV disinfection. The room is not occupied while systems are operating. The 4-UV systems disinfection system was used for a 20-min cycle.[4],[5]

The funding for this project was provided by the management of the respective tertiary care research center



According to the laboratory, aerobic and anaerobic analysis infection risk was very low with the presence of an HEFA filter. A significant body of scientific research has proven the ability of UV lights to inactivate an extensive list of pathogenic microorganisms. UV device (light) prevents microorganisms from reproducing by damaging its nucleic acids. UV disinfection is a non-chemical process and does not leave any residuals and it has demonstrated efficacy against pathogenic organisms.


  Analysis and Results Top


[Table 1] and [Table 2] explain that samples from 6 ORs were collected for quantitative culturing using swabs and thioglycolate broth and Gluco broth culture bottles. Before starting disinfection with UV rays, one culture swab was taken from each OR. During this study period, cleaning will be continued by a dedicated OT staff. 4 UV disinfection systems were present in each OT and cultured, After standard manual chemical clean. OTs were disinfected with a UV device for 20 min duration. In between, three culture swabs are taken at time intervals of 10, 15, and 20 min, respectively, from each OT to study the minimum time required for effective disinfection. All exposed surfaces in the ORs received UV disinfection. The room was not occupied while the systems are operating. The 4-UV systems were disinfected simultaneously for a 20-min cycle. All ORs were given this treatment on a nightly basis. No additional programs aimed at reducing infection control.

Hence, the microbiological report shows that genus Bacillus was seen in aerobic analysis of pre-exposure OT-6. There was no growth in post exposure. This shows the effectiveness of the UV device disinfection with the continuous High-Efficiency Particulate Air (HEPA) filtration of all OTs.
Table 1: Microbiological investigation report - aerobic analysis for six operation theaters (pre- and post-ultraviolet disinfection)

Click here to view
Table 2: Microbiological investigation report - anaerobic analysis for six operation theaters (pre- and post-ultraviolet disinfection)

Click here to view


[Table 3] shows that there was no microorganism present on different surfaces of OT, after the post exposure of UV Disinfection in both aerobic and anaerobic analyses. Twelve months' data between January 2018 and December 2018 were not shown any growth of microorganisms on different surfaces in the OT. UV device disinfection can effectively prevent the growth of microorganisms and maintain a clean and pathogen-free environment across the hospital. UV device disinfection also reduces manual work and staff fatigue. The presence of HEPA filter and regular surface cleaning of OT has helped in maintaining a sterile environment of OT. Fumigation has been stopped after the installation of UV light.
Table 3: Microbiological investigation both aerobic and anaerobic analysis of postexposure of ultraviolet disinfection on different surfaces of operation theaters (January 2018 to December 2018)

Click here to view


[Graph 1] shows SSI rate in numbers from January 2018 to December 2018. 25 SSI patients were found from January 2018 to December 2018 for overall 5991 surgery patients. This can understand the impact of postoperative care of these patients after shifting from the OT to the respective department. Following and maintaining the effective disinfection policy everywhere in the hospital is very important to prevent SSI.



SSIs are the second-most common cause of health-care-associated infections. These complications of surgical procedures cause considerable morbidity. The source of SSIs may be endogenous or exogenous, which includes surgical personnel, the operating room environment (including air), and tools, instruments, and materials brought to the sterile zone during an operation. By maintaining a sterile environment in OT, we can control a major part of exogenous infections. Aseptic technique is a set of specific practices and procedures performed under carefully controlled conditions with the goal of minimizing contamination by pathogens. The study shows that SSI rate was variable in different months. Hence from this study, we can understand that disinfection of OT is not only important but also continuous and high quality of postoperative care is very essential. And by route cause analysis technique, it was understood that the OT environment was not a primary cause for these SSIs in our study.

Usage of ultraviolet disinfection implication

UV device has been proven effective against a broad spectrum of microorganisms. Bacteria are generally easier to inactivate than viruses, with fungi and spores being even harder to inactivate with UV.

  • UV is a chemical-free process
  • UV requires no transportation, storage, or handling of toxic or corrosive chemicals – a safety benefit for plant operators and the surrounding community
  • UV is highly effective at inactivating a broad range of microorganisms – including chlorine-resistant pathogens
  • UV can be used to break down toxic chemical contaminants while simultaneously disinfecting.[6],[7],[8]


Safety during usage: UV rays emits radiation; hence it is not safe to be in the room while UV C disinfection is taking place.


  Discussion Top


The present study shows that genus Bacillus was seen in aerobic analysis of preexposure OT-6. and there was no growth in post-exposure. 4-UV disinfection system was present in OT and cultured. Then, ORs were disinfected with a UV device for 20-min duration. In between, three culture swabs are taken at time intervals of 10, 15, and 20 min, respectively, from each OR to study the minimum time required for effective disinfection. This shows the effectiveness of the UV device disinfection with the continuous HEPA filtration of all OTs.[9],[10],[11],[12] A similar study done by Hadded et al. on the effectiveness of pulsed xenon UV disinfection system to decrease bacterial contamination in operating rooms has shown the result that cleaning of surfaces with 2 min cycle of disinfection using the above-said method eliminated at least 70% more bacterial load after manual cleaning which shows that the present study result proved concurrently with other studies. The researcher took samples from five high-touch surfaces in 30 ORs after manual cleaning and after PX-UV intervention mimicking between-case cleaning, and repeated samples were taken after 1-min, 2-min, and 8-min PX-UV cycle and were cultured using tryptic soy agar contact plates. A similar result was also seen in the study which suggested that on frequently touched surfaces, PX-UV significantly reduced the frequency of positive Clostridium difficile, VRE, and methicillin-resistant Staphylococcus aureus (MRSA) culture results.[2],[13],[14] The present study highlights the mutation period of the microorganism. However, noting the limitation, the research recommends further research on a large scale to fill the research gap.

Recommendation

UV disinfection is the most advanced weapon to reduce the health-care-associated infection. There should be a follow-up in the hospital for disinfecting all the surfaces prone to infection. Regular audit in this regard is recommended.

Limitation

The duration of UV light exposure to the microorganism is seen as a limitation to some extent in the present study. This is due to the factor that the amount of time to generate mutation works only where it reaches an optimum amount of light intensity and distance, so if the microorganism in a shadow would be free of the UV light and disinfection process may not occur.


  Conclusion Top


UV rays are very effective in killing a large number of pathogenic organisms of bacterial, viral, and fungi commonly seen in operating theaters such as pseudomonas, Clostridium difficile, MRSA, and VRE.

However, there is no significant evidence to prove that UV Device can only kill microorganisms effectively. Still, large studies with more number of samples in different settings are needed. Large-scale clinical trials are necessary to confirm the same in different hospital settings.

There is a need to explore more on this study. As far as this study can focus on to prevent high infections like COVID-19 and with the result, we can encourage the use of UV rays in all health-care settings as an effective disinfectant.

Financial support and sponsorship

The funding for this project was provided by the management of the respective tertiary care research centre.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
El Haddad L, Ghantoji SS, Stibichs M, Fleming JB, Segal C, Ware KM et al. Evaluation of a pulsed xenon ultraviolet disinfection system to decrease bacterial contamination in operating rooms. BMC Infect Dis. 2017 Oct 10;17 (1):672-676.  Back to cited text no. 1
    
2.
Dancer SJ. Controlling hospital-acquired infection: focus on the role of the environment and new technologies for decontamination. ClinMicrobiol Rev. 2014 Oct;27(4):665-90.  Back to cited text no. 2
    
3.
Nerandzic MM, Cadnum JL, Eckart KE, Donskey CJ. Evaluation of a hand-held far-ultraviolet radiation device for decontamination of Clostridium difficile and other healthcare-associated pathogens. BMC Infect Dis. 2012 May 16;12:120  Back to cited text no. 3
    
4.
Nerandzic MM, Thota P, Sankar C T, Jencson A, Cadnum JL, Ray AJ et al. Evaluation of a pulsed xenon ultraviolet disinfection system for reduction of healthcare-associated pathogens in hospital rooms. Infect Control HospEpidemiol. 2015 Feb;36(2):192-197.  Back to cited text no. 4
    
5.
Fornwalt L, Riddell B. Implementation of innovative pulsed xenon ultraviolet (PX-UV) environmental cleaning in an acute care hospital.Risk ManagHealthc Policy. 2014 Jan 22;7:25-28.  Back to cited text no. 5
    
6.
Jinadatha C, Quezada R, Huber TW, Williams JB, Zeber JE, Copeland LA. Evaluation of a pulsed-xenon ultraviolet room disinfection device for impact on contamination levels of methicillin-resistant Staphylococcus aureus.BMC Infect Dis. 2014 Apr 7; 14:187-193.  Back to cited text no. 6
    
7.
Jinadatha C, Villamaria FC, Restrepo MI, Ganachari-Mallappa N, Liao IC, Stock EM, et al. Is the pulsed xenon ultraviolet light no-touch disinfection system effective on methicillin-resistant Staphylococcus aureus in the absence of manual cleaning? Am J Infect Control? 2015 Aug;43 (8):878-881.  Back to cited text no. 7
    
8.
Boyce JM. Modern technologies for improving cleaning and disinfection of environmental surfaces in hospitals.Antimicrob Resist Infect Control. 2016 Apr 11;5:1-10  Back to cited text no. 8
    
9.
Katara G, Hemvani N, Chitnis S, Chitnis V, Chitnis DS. Surface disinfection by exposure to germicidal UV light. Indian J Med Microbiols. 2008 Jul-Sep;26(3):241-42.  Back to cited text no. 9
    
10.
Sampathkumar P, Folkert C, Barth JE, Nation L, Benz M, Hesse A, et al. A trial of pulsed xenon ultraviolet disinfection to reduce Clostridioides difficile infection. Am J Infect Control. 2019 Apr;47(4):406-08.  Back to cited text no. 10
    
11.
Jinadatha C, Villamaria FC, Ganachari-Mallappa N, Brown DS, Liao IC, Stock EM et al. Can pulsed xenon ultraviolet light systems disinfect aerobic bacteria in the absence of manual disinfection? Am J Infect Control. 2015 Apr 1;43(4):415-7.  Back to cited text no. 11
    
12.
Anderson DJ, Gergen MF, Smathers E, Sexton DJ, Chen LF, Weber DJ et al. Decontamination of targeted pathogens from patient rooms using an automated Ultraviolet-C-emitting device. Infect Control HospEpidemiol. 2013 May;34(5):466-71.  Back to cited text no. 12
    
13.
Memarzadeh F, Olmsted RN, Bartley JM. Applications of ultraviolet germicidal irradiation disinfection in health care facilities: effective adjunct, but not stand-alone technology. Am J Infect Control. 2010 Jun;38(5 Suppl 1):S13-24.  Back to cited text no. 13
    
14.
Rutala WA, Weber DJ. Disinfectants used for environmental disinfection and new room decontamination technology. Am J Infect Control. 2013 May;41(5 Suppl):S36-41.  Back to cited text no. 14
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
   Abstract
  Introduction
   Methods and Mate...
  Analysis and Results
  Discussion
  Conclusion
   References
   Article Tables

 Article Access Statistics
    Viewed1482    
    Printed64    
    Emailed0    
    PDF Downloaded138    
    Comments [Add]    

Recommend this journal