No-touch Technologies Research Articles

Lowering the Acquisition of Multidrug-Resistant Organisms (MDROs) With Pulsed-xenon (LAMP) Study: A Cluster-Randomized, Controlled, Double-Blinded, Interventional Crossover Trial.

Environmental disinfection is essential for reducing spread of healthcare-associated infections (HAIs). Previous studies report conflicting results regarding the effects of ultraviolet (UV) light in reducing infections. This trial evaluated the impact of adding pulsed-xenon UV (PX-UV) to standard terminal cleaning in reducing environmentally implicated HAIs (eiHAIs). The Lowering the Acquisition of MDROs with Pulsed-xenon (LAMP) trial was conducted in 2 hospitals (15 inpatient wards) utilizing a cluster-randomized, controlled, double-blinded, interventional crossover trial comparing standard terminal cleaning followed by either PX-UV (intervention arm) or sham (control arm) disinfection. The primary outcome was incidence of eiHAIs from clinical microbiology tests on the fourth day of stay or later or within 3 days after discharge from the study unit. EiHAIs included clinical cultures positive for vancomycin-resistant enterococci, extended-spectrum beta-lactamase-producing Escherichia coli or Klebsiella pneumonia, methicillin-resistant Staphylococcus aureus, and Acinetobacter baumannii, and stool polymerase chain reaction (PCR) positive for Clostridiodes difficile. Between 18 May 2017 and 7 January 2020, 25 732 patients were included, with an incidence of 601 eiHAIs and 180 954 patient-days. There was no difference in the rate of eiHAIs in the intervention and sham arms (3.49 vs 3.17 infections/1000 patient-days, respectively; RR, 1.10; 95% CI, .94-1.29; P = .23). Study results were similar when stratified by eiHAI type, hospital, and unit type. The LAMP study failed to demonstrate an effect of the addition of UV light disinfection following terminal cleaning on reductions in rates of eiHAIs. Further investigations targeting hospital environmental surfaces and the role of no-touch technology to reduce HAIs are needed. Clinical Trials Registration. ClinicalTrials.gov identifier: NCT03349268; R01HS024709.

More High-Quality Evidence Curbing Our Enthusiasm for Enhanced Terminal Decontamination of Hospital Rooms With No-Touch Technologies: Is It Lights Out for UV-C?

More High-Quality Evidence Curbing Our Enthusiasm for Enhanced Terminal Decontamination of Hospital Rooms With No-Touch Technologies: Is It Lights Out for UV-C?

Comparison of clinical effect and postopertaive incisions between No-touch technique and traditional retractor in treating calcaneal fracture

To compare clinical efficacy of No-touch technique and traditional retractor in treating calcaneal fracture. Clinical data of 74 calcaneal fracture patients with closed Sanders typeⅡ to Ⅳ were retrospectively analyzed from July 2019 to June 2021. According to different treatment methods, the patients were divided into No-touch group and conventional group, 37 patinets in each group. In No-touch group, there were 25 males and 12 females, aged from 19 to 70 years old with an average of (42.64±14.16) years old;17 patients were typeⅡ, 14 patinets with type Ⅲ, 6 patients with type Ⅳ according to Sanders fracture classification;three 2.0 mm Kirschner wires were implanted into the talus body, talus neck, and cuboid bone, and the flap was turned upward to expose the operation area. In conventional group, there were 30 males and 7 females, aged from 19 to 67 years old with an average of (41.56±11.38) years old;17 patients with typeⅡ, 12 patients with type Ⅲ, 8 patients with type Ⅳ according to Sanders fracture classification;the operation was completed by exposing the operation area with traditional retractor. Operation time, postoperative incision complications, postoperaive American Orthopedic Foot and Ankle Society (AOFAS) ankle hind foot score at 6 months between two groups were compared. Seventy-four patients were followed up, and follow-up time in No-touch group ranged from 6 to 17 months with an average of(9.57±2.72) months, while in conventional group ranged from 6 to 16 months with an averge of(9.14±2.71) months, and no difference in follow-up between two groups (P>0.05). Operation time in No-touch group (55.67±7.94) min was shorter than that in conventional group (70.16±9.41) min (P<0.05);four patients in No-touch group occurred incision complications, while 8 patients in normal group, and had statistically difference(P<0.05). Daily activities and support, maximum walking distance (block), ground walking, limited degree of flexion, extension and valgus, foot alignment and total score of AOFAS scores in No-touch group was significantly higher than that of conventional group (P<0.05). There were no significant difference in pain degree, abnormal gait and ankle hind foot stability between two groups(P>0.05). According to AOFAS score, 19 patients got excellent result, 16 good and 2 poor in No-touch group;while 9 excellent, 24 good, and 4 poor in conventional group, and no difference between two groups (P>0.05). Compared with traditional retractor in treating calcaneal fracture, No-touch technology could significantly shorten operation time, reduce incidence of postopertive complications, while two methods could improve excellent and good rate of ankle joint function recovery after operation.

'Do N3ot Flush Feminine Products!' The Environmental History, Biohazards and Norms Contained in the UK Sanitary Bin Industry Since 1960

Abstract The sanitary bin and warnings such as 'Do Not Flush Feminine Products!' have become a feature of women's public bathrooms throughout Britain. Begun in the 1950s by family-owned companies such as Personnel Hygiene Services and Cannon Hygiene, and developed into large corporate systems, these items and their cleaning structures have expanded into nearly every university, hospital, office, café, school and gym in the country. This article examines the three historical phases of sanitary bin technology and its meanings. First, the pioneering phase when the bin was needed to tackle the problems of flushing menstrual products and unpopular incinerators, and was developed and popularised by creative entrepreneurs. Second, the environmental phase when campaigners, especially the Women's Environmental Network, boosted the industry as they called for more regulations regarding menstrual product waste in the 1970s and 1980s, leading to the popularisation of the bin exchange and cleaning services now commonplace throughout the UK. Third, the high-tech phase of the 2000s, when the industry sought to reinvent the object by adding no-touch technology, more chemicals and aesthetic innovations. This article thus presents the sanitary bin in its historical context for the first time, and argues that it reveals changing attitudes towards menstruation, the environment and bathroom politics.

Virucidal efficacy of an ozone-generating system for automated room disinfection

Besides conventional prevention measures, no-touch technologies based on gaseous systems have been introduced in hospital hygiene for room disinfection. The whole-room disinfectant device Sterisafe Pro, which creates ozone as a biocidal agent, was tested for its virucidal efficacy based on Association Française de Normalisation Standard NF T 72-281:2014. All test virus titres were reduced after 150 and 300 min of decontamination, with mean reduction factors ranging from 2.63 (murine norovirus) to 3.94 (simian virus 40). These results will help to establish realistic conditions for virus inactivation, and assessment of the efficacy of ozone technology against non-enveloped and enveloped viruses.

A paper-based electrochemical sensor for H2O2 detection in aerosol phase: Measure of H2O2 nebulized by a reconverted ultrasonic aroma diffuser as a case of study

The outbreak of COVID-19 is caused by high contagiousness and rapid spread of SARS-CoV-2 virus between people when an infected person is in close contact with another one. In this overall scenario, the disinfection processes have been largely improved. For instance, some countries have approved no-touch technologies by vaporizing disinfectants such as hydrogen peroxide, with the overriding goal to boost the safety of the places. In the era of sustainability, we designed an electrochemical paper-based device for the assessment of hydrogen peroxide nebulized by a cost-effective ultrasonic aroma diffuser. The paper-based sensor was fabricated by modifying via drop-casting a filter paper-based screen-printed electrode with a dispersion of carbon black-Prussian Blue nanocomposite, to assess the detection of hydrogen peroxide at −0.05 V vs Ag/AgCl. The use of paper-based modified screen-printed electrode loaded with phosphate buffer allowed for monitoring the concentration of hydrogen peroxide in aerosol, without any additional sampling instrument to capture the nebulized solution of hydrogen peroxide at a concentration up to 7% w/w. Hydrogen peroxide, a reconverted ultrasonic aroma diffuser, and the paper-based electrochemical sensor assisted by smartphone have demonstrated how different low-cost technologies are able to supply an useful and cost-effective solution for disinfection procedures.

Evaluation of No-Touch Technologies for Decontamination of Toys in Pediatric Healthcare Settings.

No-touch technologies could be useful to decontaminate shared toys in healthcare settings. A high-level disinfection cabinet and electrostatic sprayer were effective against methicillin-resistant Staphylococcus aureus (MRSA), bacteriophage MS2, and Clostridioides difficile spores on toys. An ultraviolet-C light box was less effective but reduced MRSA and bacteriophage MS2 by >2 log10.

Efficacy of pulsed-xenon ultraviolet light on reduction of Mycobacterium fortuitum.

Objectives:Hospitals and healthcare facilities rely largely on isolation and environmental disinfection to prevent transmission of pathogens. The use of no-touch technology is an accepted practice for environmental decontamination in medical care facilities, but little has been published about the effect of ultraviolet light generated by a portable pulsed-xenon device use on Mycobacteria. We used Mycobacterium fortuitum which is more resistant to ultraviolet radiation and less virulent than Mycobacterium tuberculosis, to determine the effectiveness of portable pulsed-xenon devices on Mycobacterium in a laboratory environment.Methods:To determine the effectiveness of pulsed-xenon devices, we measured the bactericidal effect of pulsed-xenon devices on Mycobacterium fortuitum.Results:In five separate experiments irradiating an average of 106 organisms, the mean (standard deviation) log-kill at 5 min was 3.98 (0.60), at 10 min was 4.96 (0.42), and at 15 min was 5.64 (0.52).Conclusions:Our results demonstrate that using pulsed-xenon devices is a highly effective modality to reduce microbial counts with this relatively ultraviolet germicidal irradiation–resistant mycobacterium in a time-dependent manner.

Potential antimicrobial effects of photocatalytic nanothecnologies in hospital settings.

Recently, several advanced technologies have been considered to reduce the microbial load in hospital environments and control Healthcare Associated Infections (HAIs) incidence. New strategies for preventing HAIs have continuously evolved, including enforcement of hygiene procedures by novel liquid biocides or no-touch technologies, self-disinfecting surfaces coated by heavy metals or light-activated photosensitizers such as Titanium Dioxide (TiO2) nanoparticles. Review publications concerning the use of photocatalytic systems in hospital setting, focusing on products based on TiO2. Specific keywords combinations were analitically searched in PubMed and Scopus databases. Starting 80s-90s, over 2000 papers report "in vitro" studies on antimicrobial activity of TiO2 photocatalysis on several microorganisms including bacteria, viruses, fungi, yeasts, and antibiotic resistant strains. Besides, at least 4 selected papers addressed the potentials of this approach by "in field" studies, showing a widespread pool of applications in hospital and healthcare settings. However, the low number of available experiences and their heterogeneity represent major limitations to achieve a comprehensive final overview on effectiveness and feasibility of these technologies. Photocatalytic systems based on TiO2 represent a promising strategy for hospital hygiene and HAI prevention. Additional "in field" studies are desirable in a next future to further evaluate and exploit this novel and interesting health technology.

Environmental effectiveness of pulsed-xenon light in the operating room

Manual cleaning and disinfection of the operating room (OR) environment may be inadequate due to human error. No-touch technologies, such as pulsed-xenon ultraviolet light (PX-UV), can be used as an adjunct to manual cleaning processes to reduce surface contamination in the OR. This article reports the cumulative results from 23 hospitals across the United States that performed microbiologic validation of PX-UV disinfection after manual cleaning. We obtained samples from 732 high-touch surfaces in 136 ORs at 23 hospitals, after manual terminal cleaning, and again after PX-UV disinfection (n = 1464 surface samples). Samples were enumerated after incubation, and the results are reported as total colony-forming units (CFU). The average CFU after manual cleaning ranged from 5.8 to 34.37, and after PX-UV, from 0.69 to 6.43. With manual cleaning alone, 67% of surfaces were still positive for CFUs; after PX-UV disinfection, that number decreased to 38% of all sampled surfaces-a 44% reduction. When comparing manual cleaning to PX-UV, the reduction in CFU count was statistically significant. When used after the manual cleaning process, the PX-UV device significantly reduced contamination on high-touch surfaces in the OR.

Norovirus and Clostridium difficile outbreaks: squelching the wildfire.

Gastrointestinal outbreaks in the healthcare setting cause increased morbidity and mortality in an already vulnerable population. Optimization of infection prevention measures can be a challenge in healthcare settings. This review describes new literature that may change the traditional infection prevention approach to such outbreaks. Asymptomatic carriers of both norovirus and Clostridium difficile can pose risk of transmission to others and the environment. Rapid recognition and diagnosis can decrease the extent of an outbreak. No-touch technologies for environmental disinfection are new and effective tools. Infection prevention consultant services and systems redesign can augment efforts to control baseline infection rates and outbreaks. Antimicrobial stewardship continues to be essential to prevent C. difficile infection. New approaches are needed to stem the tide of norovirus and C. difficile clusters and outbreaks in healthcare settings. Accurate recognition, testing, and implementation of infection prevention measures can be supported with rapid testing modalities, access to updated guidelines and no-touch disinfection systems. The work-environment culture should be carefully assessed and restructured using human engineering models to promote effective infection prevention practices. Antimicrobial stewardship initiatives are needed at the bedside and at national levels.

A model for choosing an automated ultraviolet-C disinfection system and building a case for the C-suite: Two case reports.

Environmental disinfection has become the new frontier in the ongoing battle to reduce the risk of health care-associated infections. Evidence demonstrating the persistent contamination of environmental surfaces despite traditional cleaning and disinfection methods has led to the widespread acceptance that there is both a need for reassessing traditional cleaning protocols and for using secondary disinfection technologies. Ultraviolet-C (UV-C) disinfection is one type of no-touch technology shown to be a successful adjunct to manual cleaning in reducing environmental bioburden. The dilemma for the infection preventionist, however, is how to choose the system best suited for their facility among the many UV-C surface disinfection delivery systems available and how to build a case for acquisition to present to the hospital administration/C-suite. This article proposes an approach to these dilemmas based in part on the experience of 2 health care networks.

Environmental Biodecontamination: When a Procedure Performed by the Nursing Staff has an Economic Impact in ICU Rooms

Objective: The transmission of hospital-acquired infections most commonly occurs by means of healthcare workers coming into contact with contaminated surfaces or patients during routine care and the lack of or poor implementation of hygiene procedures. We present this study to assess the efficacy of a new environmental infection control system, managed by a nurse in charge of infection control, in terms of safety, clinical outcome and hospital/healthcare costs. Methods: The following is an observational retrospective study performed at University Hospital of Catania; containing data on HAI infections from years 2013 and 2014, before and after a new disinfection procedure was introduced. The procedure used a no-touch technology for the indoor environment, using micronebulized hydrogen peroxide and silver cations. Cases of infections concerned adult inpatients with hospitalization time being greater than three days. The efficacy of the procedure was evaluated by comparing the decrease in number of infections, related deaths, and changes in antimicrobial load, whereas economic impact of the new procedure was assessed by a cost-effectiveness analysis. User satisfaction and environmental safety issue were also addressed. Results: A total of 489 patients were hospitalized in the ICU between January 1, 2013 and December 31, 2014. The introduction of the procedure coincided with a significant decrease overall in infection-related deaths, as well as hospital days (16.95 ± 20.46 (mean ± SD) to 11.55 ± 10.03 (mean ± SD: p value <0.05). Bacterial load in samples from CVC and from broncho-alveolar lavage decreased, as well. The incremental cost-effective ratio resulted in € 807.80 to be added for each infection-related death avoided. Conclusion: We demonstrated that HyperDRYMist technology with hydrogen peroxide and silver cations is effective, safe and cost-effective without evidence of safety risk. Biodecontamination performed by motivated and experienced nurses could be useful in reducing microbial load and nosocomial infections. The system can contribute to improving the ICU patient's final outcome.

Management of porcelain aorta and calcified great vessels in coronary artery bypass grafting with off-pump and no-touch technology

A 69-year-old woman presented with postinfarct unstable angina and decreased ventricular function secondary to significant left main coronary artery stenosis in combination with total right coronary artery occlusion. We did successful off-pump coronary revascularization in this patient with severely calcified ascending aorta and great vessels, subtotal aortobiiliac stenoses, a history of previous stroke, and right carotid endarterectomy.