Reducing Clostridium difficile Infection Among Hematology-Oncology Patients Using Ultraviolet Germicidal Irradiation for Terminal Room Disinfection

Abstract

Setting: Three adult hematology-oncology units with a total of 75 private and 7 semiprivate rooms in a 695bed tertiary care hospital. UVGI deployment:  Targeted CDI or contact precautions rooms for UVGI using an electronic patient flow system (NaviCare, Hill-Rom).  Following terminal room cleaning with bleach, UVGI (Optimum-UV, Clorox Healthcare) was deployed for two 8-minute cycles on either side of the patient bed with the bathroom door left open.  Two UVGI units and no additional Environmental Service personnel or resources were utilized for this evaluation. Measurements:  C. difficile detected by toxin A/B and GDH immunoassay; indeterminate results confirmed by PCR for toxin gene; NHSN GIT definition.  Compared rates of healthcare onset CDI on study units and non-study units:  Baseline period (P1, Jan.-Dec. 2013) vs. Intervention period (P2, Feb. 2014-Jan. 2015)  Calculated rate ratios and a mixed-effects Poisson regression model with random effects for unit and time in months. Background: •Clostridium difficile forms spores that are resistant to many disinfectants and can persist in the hospital environment for months. • During 2013 (baseline period, Jan.-Dec. 2013), there were 87 cases of hospital onset C. difficile infection (CDI) among patients on three Hematology/Oncology units—a rate 5 times higher than that for all other inpatient units combined. • Cases of CDI continued to occur despite targeted evidence-based interventions and EVS process improvements, including use of bleach for daily and terminal room cleaning of CDI rooms, process monitoring and feedback of cleaning effectiveness. • We performed a 12-month pre/post evaluation of terminal room disinfection using ultraviolet wavelength C germicidal irradiation (UVGI) on C. difficile infection (CDI) rates and room turn-around. Process Improvement: Weekly reporting of UVGI deployment and room cleaning metrics Redeployment of additional Environmental Services associates to second shift (3-11 pm) and cross-training to improve UVGI deployment during peak discharge times. Deployment of a second UVGI unit during Sep. 2014. Feedback and recognition of associates deploying UVGI.