The largest ever study of an automated room decontamination (ARD) device has just been presented at a conference in the USA. The CDC Epicenters funded collaboration between Duke, UNC and some other US hospitals evaluated the impact of a UVC room disinfection device compared with standard approaches to terminal room disinfection. The bottom line is that UVC disinfection reduces transmission. The study hypothesis was that if admission to a room previously occupied by a patient with a multidrug-resistant organism (MDRO) increases the chances of the incoming occupant acquiring that MDRO, then doing a better job of terminal disinfection ought to mitigate the increased risk. There is evidence from two other studies that this hypothesis makes sense: one study showed that improving conventional methods reduced the risk for the incoming occupant for MRSA (but not for VRE), and another study showed that patients admitted to rooms decontaminated using hydrogen peroxide vapour were 64% less likely to acquire an MDRO. UVC is an attractive approach because it is easier to implement and faster than hydrogen peroxide, and more reliable than conventional methods because it does not rely on the operator to assure distribution and contact time. Which is why the results of this landmark study are so crucial. The randomised study was performed over more than 2 years across 9 hospitals and included more than 25,000 exposed patients (admitted into a room where the previous occupant was known to have an MDRO). Each hospital performed a randomised sequence of different terminal room disinfection approaches: quaternary ammonium compound (QAC) disinfection (control group), bleach, QAC+UVC, and bleach+UVC. The primary outcome was the acquisition rate of a composite group of MDROs (MRSA, VRE, C. difficile, and MDR Acinetobacter species). Compared with the control group, patients admitted into a room decontaminated using UVC were significantly less likely to acquire an MDRO; this difference was 37% (p=0.03) when rooms were pre-cleaned using QAC, and 32% (p=0.01) when rooms were pre-cleaned using bleach (see Figure below). Surprisingly, patients admitted to rooms disinfected using bleach were not significantly less likely to acquire MDROs compared with the control group (p=0.08). Figure: The relative rate of MDROs follow enhanced terminal disinfection compared with a control method (QAC disinfection)
The powerful, randomised study design makes it very unlikely that these results are explained by anything other than the improved environmental reductions achieved by UVC compared with conventional methods. The take home message is this: UVC should now be used as an adjunct for the terminal disinfection of rooms vacated by patients known to be infected or colonised with an MDRO!
Share this article: