Pulsed Xenon Ultraviolet Disinfection 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.

Impact of a pulsed xenon disinfection system on hospital onset Clostridioides difficile infections in 48 hospitals over a 5-year period

BackgroundThe role of the environment in hospital acquired infections is well established. We examined the impact on the infection rate for hospital onset Clostridioides difficile (HO-CDI) of an environmental hygiene intervention in 48 hospitals over a 5 year period using a pulsed xenon ultraviolet (PX-UV) disinfection system.MethodsUtilization data was collected directly from the automated PX-UV system and uploaded in real time to a database. HO-CDI data was provided by each facility. Data was analyzed at the unit level to determine compliance to disinfection protocols. Final data set included 5 years of data aggregated to the facility level, resulting in a dataset of 48 hospitals and a date range of January 2015–December 2019. Negative binomial regression was used with an offset on patient days to convert infection count data and assess HO-CDI rates vs. intervention compliance rate, total successful disinfection cycles, and total rooms disinfected. The K-Nearest Neighbor (KNN) machine learning algorithm was used to compare intervention compliance and total intervention cycles to presence of infection.ResultsAll regression models depict a statistically significant inverse association between the intervention and HO-CDI rates. The KNN model predicts the presence of infection (or whether an infection will be present or not) with greater than 98% accuracy when considering both intervention compliance and total intervention cycles.ConclusionsThe findings of this study indicate a strong inverse relationship between the utilization of the pulsed xenon intervention and HO-CDI rates.

The effect of pulsed-xenon ultraviolet disinfection on surfaces contaminated with vancomycin-resistant Enterococci in a Japanese hospital

IntroductionRecently, a worldwide outbreak of vancomycin-resistant Enterococci (VRE) was reported. However, due to the low incidence of VRE infection and colonization, VRE contamination of hospital environments has not been fully investigated in Japan. MethodsSurfaces were swabbed, before and after manual cleaning and after pulsed xenon ultraviolet (PX-UV) disinfection, in five patient rooms that had been occupied by patients colonized with VRE. Difference in the number of VRE-positive samples and VRE colony forming units (CFUs), before and after disinfection, for each cleaning method was estimated. ResultsWe detected VRE contamination in 22/60 (37%) and 14/60 (23%) samples collected before and after manual cleaning, respectively. In contrast, VRE contamination was not detected in the samples collected after PX-UV disinfection. In addition, 3/5 (60%) spray nozzles of electric warm-water bidet toilet seats were found to be contaminated with VRE before terminal cleaning. Manual cleaning caused a significant decrease in the number of VRE CFUs compared with that before cleaning (P = 0.031). PX-UV disinfection also caused a significant decrease in the number of VRE CFUs compared to that of manual cleaning (P < 0.001). ConclusionWe identified hot spots of severe contamination, such as private bathrooms in patient rooms and areas around the bed of patients using diapers and required assistance. VRE contamination persisted even after terminal disinfection; PX-UV disinfection in addition to terminal disinfection was effective at eliminating VRE contamination. These results can be useful in controlling the spread of VRE infections in Japanese hospitals.

Combining pulsed xenon ultraviolet disinfection with terminal manual cleaning helps reduce the acquisition rate of methicillin-resistant Staphylococcus aureus

The clinical effectiveness of ultraviolet light (UV) disinfection remains unclear. This study aimed to investigate the effect of adding pulsed xenon UV (PX-UV) disinfection to the terminal cleaning protocol on the rate of methicillin-resistant Staphylococcus aureus (MRSA) acquisition at a Japanese hospital. The use of a PX-UV disinfection device was added to the manual terminal cleaning protocol applied after the discharge or transfer of patients treated in the intensive and high care units. We used a Poisson regression model to examine the incidence of MRSA acquisition, based on the study period, PX-UV intervention status, unit type, and the rate of consumption of alcohol-based hand rub (ABHR). Approximately 86% of the rooms in the intervention units were terminally disinfected with the PX-UV device. In the intervention units, the incidence of MRSA acquisition decreased from 3.56 per 1,000 patient-days in the nonintervention period to 2.21 per 1,000 patient-days in the intervention period. Moreover, the use of PX-UV disinfection decreased the risk of MRSA acquisition (incident rate ratio: 0.556; 95% confidence interval, 0.309-0.999; P = .0497). ABHR consumption did not affect the risk of MRSA acquisition. Adding PX-UV disinfection to terminal manual cleaning reduced the rate of MRSA acquisition.

820. Impact of pulsed xenon ultraviolet (PX-UV) light disinfection for reduction of pathogens on high touch surfaces following hospitalization

BackgroundUltraviolet (UV) light disinfection following a manual terminal cleaning process for hospital rooms has been proposed as an additional method to reduce the bacterial burden on surfaces. The impact of UV light disinfection and the level of interdependence between the modalities remains unclear.MethodsSamples were collected from 5 high touch surfaces from 10 patients room following discharge prior to manual disinfection, following manual disinfection, and following pulsed xenon UV disinfection using Rodac contact plates (total 150 samples). Colonies were identified using MALDI-TOF mass spectrometry. The bacterial colony counts were recorded and analyzed as pathogenic or commensal organisms (based on CDC criteria) to assess the efficacy of the disinfection process.ResultsAverage colony counts for the rooms prior to disinfection, post disinfection, and post UV light were 185.8 CFU +/- SD 280, 43 CFU +/- 121, and 20 CFU +/- 36.7 respectively. The average drop in colony-forming units of the five high touch areas in patient’s rooms can be seen in table 1. Twelve commensal bacterial species were isolated: Bacillus species (sp.), Corynebacterium sp., Enhydrobacter sp., Kocuria sp., Lysinibacillus sp., Macrococcus sp., Micrococcus sp., Paenibacillus sp., Pantoea sp., Psychrobacter sp., Siccibacter sp., Coagulase negative staphylococcus. Seven pathogenic bacteria were isolated: Acinetobacter sp., Brucella sp., Proteus sp., Staphylococcus aureus, Escherichia sp., Enterococcus, and Pseudomonas aeruginosa. Reductions in the predominant bacterial species following disinfection modality are noted in table 2.Table 1: Colony forming units (CFUs) average Pre-disinfection (Pre-Dis), Post Disinfection (Post-Dis), and Post PX-UV Light (PX-UV). Table 2: Sub-analysis of commensal and pathogen isolation Pre-Disinfection (Pre-Dis), Post-Disinfection (Post-Dis), and Post PX-UV light (PX-UV). ConclusionA combination of manual disinfection and UV has shown a notable additional reduction in overall bacterial contamination of the patient rooms, including the majority of high touch areas as compared with manual disinfection alone. No additional reduction in commensal bacteria isolates was noted after UV light, however a further decrease in pathogenic bacteria (Acinetobacter and Enterococcus) was noted. UV light may be considered as an additional room disinfection method to reduce overall bacterial burden and pathogenic bacterial contamination of rooms as a comprehensive strategy to reduce nosocomial infections.Disclosures Mark Stibich, n/a, Xenex Germ-Zapping Robots (Board Member, Grant/Research Support) Chetan Jinadatha, MD, MPH, AHRQ (Research Grant or Support)Department of Veterans Affairs (Other Financial or Material Support, Owner: Department of Veterans Affairs. Licensed to: Xenex Disinfection System, San Antonio, TX)Inventor (Other Financial or Material Support, Methods for organizing the disinfection of one or more items contaminated with biological agents)NiH/NINR (Research Grant or Support)NSF (Research Grant or Support)Xenex Healthcare Services (Research Grant or Support)

196. Reducing bioburden in the operating room: manual cleaning and pulsed-xenon ultraviolet light disinfection produces significant reduction in colony forming units

BACKGROUND CONTEXT Though techniques for sterilizing surgical tools and supplies have steadily improved, current standards for operating room (OR) disinfection have become antiquated – providing continued convenience for pathogenic organisms and surgical site infections. Pulsed-xenon ultraviolet (PX-UV) disinfection is an opportunity for standardized, touch-free disinfection that may serve as a supplement to manual terminal cleaning. The combination of manual and PX-UV disinfection may provide the greatest reduction in OR bioburden, as measured by colony-forming units (CFUs), and frequency of site contamination. Here, the bioburden and site contamination of ORs following manual cleaning and PX-UV disinfection are explored. PURPOSE Determine impact of manual vs manual and PX-UV disinfection on CFUs in spine operating suites. STUDY DESIGN/SETTING N/A PATIENT SAMPLE N/A OUTCOME MEASURES N/A METHODS Fifteen ORs were sampled at three different time points – before terminal manual cleaning, after terminal manual cleaning, and after PX-UV. For each OR, at each time point, five high-touch surfaces were cultured using a Tryptone Soy Agar touch plate. A total of 225 samples were acquired. Samples were incubated for 24 hours and the number of colony-forming units reported. Distinct colonies were identified. Descriptive statistics and Rank Sum Testing with a Bonferroni correction were used to analyze results. RESULTS There was a 26.8% reduction of CFUs after manual cleaning (p>0.8014) and an 81.0% reduction of CFUs after PX-UV (p = 0.0086). Overall, the combination of manual and PX-UV disinfection resulted in an 86.10% reduction in CFUs (p = 0.004). The frequency of sites with CFUs prior to cleaning was 26.7%. There was no change in frequency of sites with CFUs after manual cleaning. Following PX-UV cleaning, the frequency of sites with CFUs reduced to 8.0%, which is a 70.0% reduction in sites with CFUs. Interestingly, the frequency of sites with an increase in CFUs after manual cleaning was 20.0%. There was no occurrence of an increase in CFUs after PX-UV disinfection. CONCLUSIONS The combination of PX-UV with manual cleaning yields the greatest reduction in OR bioburden as measured by CFUs. Manual cleaning alone resulted in a low reduction of CFUs and no change in the frequency of site contamination. Though some individual sites demonstrated elimination of CFUs following manual cleaning, there were a number of sites that had an increase in CFUs. This may represent cross contamination due to the inconsistent nature of manual terminal cleaning. The use of PX-UV disinfection resulted in a significant reduction in CFUs when compared to both the pre- and postmanual cleaning time points. PX-UV disinfection also yielded a reduction in the frequency of site contamination. This reduction in both bioburden and contaminated sites may contribute to a decreased risk of surgical site infection. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Effectiveness of pulsed xenon ultraviolet disinfection for Clostridioides (Clostridium) difficile surface contamination in a Japanese hospital

Contaminated environmental surfaces are important sources of transmission for healthcare-associated pathogens, including Clostridioides (Clostridium) difficile. The effectiveness of manual bleach cleaning and pulsed xenon ultraviolet (PX-UV) disinfection on C. difficile contamination of hospital room high-touch surfaces in Japan was evaluated. The environmental surfaces of 20 C. difficile infection (CDI) isolation rooms were sampled immediately after CDI patients were discharged or transferred. High-touch surfaces were sampled before and after either bleach cleaning or PX-UV disinfection in addition to nonbleach cleaning. Changes in the number of C. difficile-positive samples and bacterial counts for each cleaning method were assessed. Overall, 286 samples were collected (bleach cleaning, 144 samples; PX-UV disinfection, 142 samples). Before cleaning, the positive rates of C. difficile were 27.8% and 31.0% in bleach cleaning and PX-UV disinfection, respectively. Both bleach cleaning and PX-UV disinfection significantly reduced overall C. difficile-positive samples (P = .018 and P = .002, respectively) and C. difficile colony-forming unit counts (P = .002 and P = .001, respectively). PX-UV disinfection in addition to manual nonbleach cleaning effectively reduces C. difficile contamination from high-touch surfaces. Further studies are warranted to evaluate the effect of PX-UV disinfection on CDI rates in Japanese hospitals.

Efficacy of pulsed xenon ultraviolet disinfection of multidrug-resistant bacteria and Clostridioides difficile spores.

Contamination of healthcare environments by multidrug-resistant organisms (MDRO) and Clostridioides difficile is a risk for healthcare-associated infections. The efficacy of pulsed xenon ultraviolet (PX-UV) disinfection in healthcare environments has been described previously. However, there are few reports about PX-UV disinfection in Japan. The aim of this study was to investigate invitro the efficacy of PX-UV disinfection of MDRO and C. difficile spores commonly isolated in Japanese hospitals. We investigated reductions in microbial counts after exposure to PX-UV of the following clinically-isolated organisms on seeding agar plates: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus faecium, carbapenemase-producing Klebsiella pneumoniae, extended spectrum β-lactamase-producing Escherichia coli, multidrug resistant Acinetobacter baumannii, and C. difficile spores. We also visually assessed the attenuation of disinfection by shielding of MRSA and carbapenemase-producing K. pneumoniae from PX-UV exposure. PX-UV disinfection for 5min induced >5-log colony-forming units (CFU)/cm2 growth inhibition of all the MDRO. PX-UV disinfection for 15min induced >3-log CFU/cm2 growth inhibition of C. difficile spores. Where a plate was shielded from PX-UV exposure the bacteria showed confluent growth, but no colonies were observed on unshielded (exposed) parts of the plates. This study shows the efficacy of PX-UV disinfection against clinical MDROs. C. difficile spores were more resistant to PX-UV disinfection than vegetative bacteria. Further evaluation of the efficacy of PX-UV disinfection in reducing the contamination of real-world surfaces and the incidence of healthcare-associated infections is needed.

Portable pulsed xenon ultraviolet light disinfection in a teaching hospital animal laboratory in China

An animal laboratory in a teaching hospital is a possible cause of cross infection. We aimed to assess the infection control in our animal laboratory and evaluate the disinfectant effects of a portable pulsed xenon ultraviolet (PX-UV) machine. Samples were taken from the surface of research tables, other high touch places, such as doorknobs, weighing scales, and handles of trolleys, and from air in the barrier system pre- and post-manual cleaning and post-PX-UV disinfection. The bacteria types were identified. We found that routine manual cleaning significantly reduced bacterial colony form unit (CFU)/cm2 (P = .02), and the median of CFU/cm2 reduced from 0.5 pre-cleaning to zero post-cleaning. PX-UV disinfection also significantly reduced residual bacterial counts (P = .002), with the highest counts 10 pre-PX-UV disinfection and 1 afterwards. Without manual cleaning, PX-UV disinfected surfaces significantly (P < .001), median count 6 pre-PX-UV disinfection and zero afterwards. PX-UV significantly reduced bacterial colony counts in the air with the median count falling from 6 to zero (P < .001). Some of the 21 species of pathogens we identified in the current study are pathogenic, resistant to antibiotics, and able to cause nosocomial infections and zoonosis. PX-UV reduced counts of most of the pathogens. PX-UV is an effective agent against these pathogens.

Clinical and microbiological effect of pulsed xenon ultraviolet disinfection to reduce multidrug-resistant organisms in the intensive care unit in a Japanese hospital: a before-after study

BackgroundNo-touch environmental disinfection using ultraviolet devices has been highlighted in the past several years to control the transmission of multidrug-resistant organisms (MDROs). However, its effectiveness in non-US healthcare settings is yet to be examined. This study aimed to evaluate the effectiveness of disinfection by portable pulsed xenon ultraviolet (PX-UV) devices in controlling transmission of MDROs in a non-US healthcare setting.MethodsAll patients admitted in the intensive care unit in a 629-bed tertiary referral hospital in Japan from August 2016 to February 2019 were enrolled. During the study period, PX-UV disinfection was added to manual terminal cleaning after every patient transfer/discharge. For microbiological evaluation, surfaces were selected for sampling by contact plates before/after manual cleaning and after PX-UV. After overnight incubation, colonies on the plates were counted.ResultsThe incidence of newly acquired methicillin-resistant Staphylococcus aureus (MRSA) declined significantly (13.8 to 9.9 per 10,000 patient days, incidence rate ratio 0.71, p = 0.002), as well as that of newly acquired drug-resistant Acinetobacter (48.5 to 18.1, 0.37, p < 0.001). The percent reduction of the microbiological burden by manual cleaning was 81%, but a further 59% reduction was achieved by PX-UV.ConclusionsPX-UV is effective in further reducing the microbial burden and controlling MDROs in a non-US healthcare setting.

The effect of pulsed xenon ultraviolet light disinfection on healthcare-associated Clostridioides difficile rates in a tertiary care hospital

Ultraviolet (UV) light has destructive activity against pathogenic bacteria including Clostridioides difficile spores. Portable pulsed-xenon UV disinfecting devices were implemented for terminal room cleaning in 6 units of our academic hospital with high C. difficile infection (CDI) rates. CDI rates were measured in a 9-month period before and a 9-month period after device implementation. Despite documented administration of UV disinfection for 87% of terminal room cleaning, no impact on CDI rates was detected.

Effect of pulsed xenon ultraviolet disinfection on methicillin-resistant Staphylococcus aureus contamination of high-touch surfaces in a Japanese hospital

The hospital environment is an important source of multidrug-resistant organisms such as methicillin-resistant Staphylococcus aureus (MRSA). Here, we evaluated the efficacy of pulsed xenon ultraviolet (PX-UV) disinfection in addition to manual cleaning in a Japanese hospital. Environmental samples were collected from inpatient rooms that had been occupied for at least 48 hours by patients infected or colonized with MRSA. High-touch surfaces from 11 rooms were sampled before and after manual cleaning and then after PX-UV disinfection. Changes in bacterial counts and in the number of aerobic bacteria (AB)- and MRSA-positive samples between sampling points were assessed. The time taken to complete PX-UV treatment of patient rooms was also recorded. A total of 306 samples were collected. PX-UV disinfection resulted in a significant decrease in abundance of AB and MRSA (mean colony-forming units 14.4 ± 38.7 to 1.7 ± 6.1, P < .001 and 1.1 ± 3.9 to 0.3 ± 2.0, P < .001, respectively) and in the number of AB- and MRSA-positive samples (58.8%-28.4%, P = .001 and 19.6%-3.9%, P < .001, respectively) compared with manual cleaning. The median time of in-room use of the PX-UV device was 20 minutes. The addition of PX-UV disinfection to the manual cleaning process significantly reduced AB and MRSA contamination of high-touch surfaces in hospital inpatient rooms.

Evaluation of a pulsed xenon ultraviolet light device for reduction of pathogens with biofilm-forming ability and impact on environmental bioburden in clinical laboratories.

Biofilm-forming organisms can persist on surfaces in hospital clinical laboratories and potentially lead to nosocomial infections. Therefore, effective decontamination procedures are essential for reducing infections. In this study, we investigated an alternative to often ineffective manual cleaning methods, a pulsed xenon ultraviolet (PX-UV) light device. We evaluated PX-UV effect on biofilm formation ability of pathogens and also evaluated PX-UV effectiveness on environmental bioburden in clinical laboratories. We selected and identified P. aeruginosa PA47, Staphylococcus aureus B1, and K. pnenumoniae CR52 from clinic isolates. Biofilm-forming ability and effectiveness of PX-UV in killing these biofilm forming strains on surfaces was evaluated. The central laboratory, the clinical microbiology laboratory, and the clinical immunology laboratory were chosen for testing environmental bioburden. Air samples and high-touch surface specimens in the three laboratories were obtained before and after routine manual cleaning, and after 6 min of PX-UV disinfection. The cultured microbes were then identified with MALDI- TOF-MS. We found that P. aeruginosa PA47, Staphylococcus aureus B1, and K. pnenumoniae CR52 were able to form robust biofilms, and that PX-UV significantly reduced colony counts of these strains on all surfaces tested. PX-UV reduced the bioburden of air samples and eliminated bioburden on surfaces. All microbes identified in the clinical laboratories were pathogenic and consisted of cocci, rods, and fungi. The PX-UV device effectively reduced pathogens with biofilm-forming ability on surfaces, and the environmental bioburden was also significantly reduced by PX-UV. PX-UV is a viable option for protecting staff and decreasing rates of laboratory-acquired infections.

Efficacy of pulsed-xenon ultraviolet light for disinfection of high-touch surfaces in an Ecuadorian hospital

BackgroundHospital environment in patient care has been linked on healthcare-associated infections (HAI). No touch disinfection technologies that utilize pulsed xenon ultraviolet light has been recognized to prevent infection in contaminated environments. The purpose of this study was: 1) to evaluate the effectiveness of pulsed-xenon ultraviolet light (PX-UV) disinfection for the reduction of bacteria on environmental surfaces of Hospital General Enrique Garcés, and 2) to evaluate the in-vitro efficacy against multi-drug resistance microorganisms.MethodsThis was a quality-improvement study looking at cleaning and disinfection of patient areas. During the study, a total of 146 surfaces from 17 rooms were sampled in a secondary 329-bed public medical center. Microbiological samples of high-touch surfaces were taken after terminal manual cleaning and after pulsed xenon ultraviolet disinfection. Cleaning staff were blinded to the study purpose and told clean following their usual protocols. For positive cultures PCR identification for carbapenemase-resistance genes (blaKPC, blaIMP, blaVIM, and blaNDM) were analyzed and confirmed by sequencing. The total number of colony forming units (CFU) were obtained and statistical analyses were conducted using Wilcoxon Rank Sum tests to evaluate the difference in CFU between terminal manual cleaning and after pulsed xenon ultraviolet disinfection.ResultsAfter manual disinfection of 124 surfaces showed a total of 3569 CFU which dropped to 889 CFU in 80 surfaces after pulsed xenon disinfection (p < 0.001). Overall, the surface and environmental contamination was reduced by 75% after PX-UV compared to manual cleaning and disinfection. There were statistically significant decreases in CFU counts of high touch surfaces in OR 87% (p < 0.001) and patient rooms 76% (p < 0.001). Four rooms presented serine carbapenemases blaKPC, and metallo beta-lactamases blaNDM, blaVIM, blaIMP. confirmed by PCR and sequencing. The in-vitro testing with endemic strains found that after five minutes of pulsed xenon ultraviolet exposure an 8-log reduction was achieved in all cases.ConclusionThis study is one of the first of its kind in an Ecuador Hospital. We found that pulsed-xenon ultraviolet disinfection technology is an efficacious complement to the established manual cleaning protocols and guidelines in the significant reduction of MDRO.

A trial of pulsed xenon ultraviolet disinfection to reduce Clostridioides difficile infection

An intervention was designed to test whether the addition of an ultraviolet (UV) disinfection step after terminal cleaning would be helpful in reducing Clostridium difficile infection (CDI) rates in a real-world situation. This study was a quasi-experimental design using 3 units as intervention units for the intervention and 3 similar units as control units. Intervention units 2 hematology and bone marrow transplant units and one medical-surgical unit at a large teaching hospital in the Midwest. UV disinfection was added after patient discharge and terminal cleaning in the intervention units. At baseline, CDI rates in the intervention and control arms were similar. During the 6 months of UV disinfection, the CDI rate in the intervention units decreased to 11.2 per 10,000 patient days, compared with 28.7 per 10,000 patient days in the control units (P = .03). In addition, the intervention units also saw a reduction in vancomycin-resistant enterococci acquisition. The addition of UV disinfection to the terminal cleaning resulted in a reduction in CDI that has been sustained over several months 2 years.

513. Effectiveness of Pulsed Xenon Ultraviolet Light Disinfection System to Decrease Clostridium difficile Infections at the South Texas Veterans Health Care System

Background Clostridium difficile is the leading pathogen implicated in healthcare-associated infections. C. difficile spores can survive for months on surfaces, allowing for transmission between patients; thus, environmental disinfection is a cornerstone for C. difficile infection (CDI) prevention. Pulsed xenon ultraviolet (PX-UV) light disinfection effectively eliminates C. difficile spores from surfaces and can be used as an adjunct to manual cleaning; however, few studies have evaluated the effects of this technology on healthcare facility-onset CDI (HO-CDI) rates. The objective of this study was to compare HO-CDI rates prior to and post-implementation of PX-UV disinfection in an acute care hospital.MethodsThis was a quasi-experimental study in the South Texas Veterans Health Care System (STVHCS), San Antonio, Texas from 2011 to 2018. The PX-UV system was implemented beginning January 1, 2013. HO-CDI rates were calculated as CDI cases per 10,000 patient-days. Rates were compared between the pre-PX-UV period (2011–2012) and post-PX-UV period (2013–2018) using the conditional maximum likelihood estimate of rate ratio. The association between number of beds cleaned and HO-CDI incidence was evaluated using Pearson correlation.ResultsDuring the 2-year preintervention period, the HO-CDI rate was 9.09 per 10,000 patient-days compared with 9.44 per 10,000 patient days in the postintervention period (RR 1.038; 95% CI 0.817 – 1.328) (P = 0.7703). HO-CDI rates peaked in 2015 (13.60 per 10,000) and declined steadily thereafter through 2018 (6.86 per 10,000). There was not a significant correlation between number of beds cleaned and HO-CDI incidence (R=0.3713; 95% CI −0.0597–0.6856; P = 0.0889).ConclusionPX-UV disinfection did not significantly reduce HO-CDI rates in the first 5 years of use; however, more recent data demonstrate HO-CDI rates lower than that of the preintervention period.Disclosures All authors: No reported disclosures.

Effect of pulsed xenon ultraviolet room disinfection devices on microbial counts for methicillin-resistant Staphylococcus aureus and aerobic bacterial colonies

Inadequate environmental disinfection represents a serious risk for health care-associated infections. Technologic advancements in disinfection practices, including no-touch devices, offer significant promise to improve infection control. We evaluated one such device, portable pulsed xenon ultraviolet (PX-UV) units, on microbial burden during an implementation trial across 4 Veterans Affairs hospitals. Environmental samples were collected before and after terminal room cleaning: 2 facilities incorporated PX-UV disinfection into their cleaning protocols and 2 practiced manual disinfection only. Specimens from 5 high-touch surfaces were collected from rooms harboring methicillin-resistant Staphylococcus aureus (MRSA) or aerobic bacteria colonies (ABC). Unadjusted pre-post count reductions and negative binomial regression modeled PX-UV versus manual cleaning alone. Seventy samples were collected. Overall, PX-UV reduced MRSA and ABC counts by 75.3% and 84.1%, respectively, versus only 25%-30% at control sites. Adjusting for baseline counts, manually cleaned rooms had significantly higher residual levels than PX-UV sites. Combined analyses revealed an incident rate ratio of 5.32 (P = .0024), with bedrails, tray tables, and toilet handrails also showing statistically superior PX-UV disinfection. This multicenter study demonstrates significantly reduced disinfection across several common pathogens in facilities using PX-UV devices. Clinical impact of laboratory reductions on infection rates was not assessed, representing a critical future research question. However, such approaches to routine cleaning suggest a practical strategy when integrated into daily hospital operations.

Impact of pulsed xenon ultraviolet disinfection on surface contamination in a hospital facility\u2019s expressed human milk feed preparation area

BackgroundExpressed human milk (EHM) feed preparation areas represent a potential source of unintentional nosocomial infection. Daily disinfection of environmental surfaces remains an essential intervention to mitigate nosocomial infections. The inefficiency of conventional cleaning and disinfection contributes to an increased risk for the acquisition of multi-drug resistant pathogens. “Non touch” technologies such as the pulsed xenon ultraviolet (PX-UVD) light device have documented sustained reduction in surface bacterial colonization and reduced cross contamination.MethodsThe impact of a PX-UVD on surface colony forming units per square centimeter (cfu/cm2) in feed preparation areas was evaluated following its implementation as standard care. A quasi-experimental study was performed documenting bacterial colonization from 6 high risk feed preparation areas in a community care hospital in South Africa. Pre and post conventional cleaning neutralizing rinse swabs were collected fortnightly over a 16 week control period prior to the introduction of the PX-UVD and compared to a matching set of samples for the PX-UVD period.ResultsA 90% reduction in total surface bioburden was noted from the control period (544 cfu/cm2) compared to the corresponding PX-UVD period (50 cfu/cm2). Sub -analysis of both the Pre-clean Control: Pre-clean PX-UVD counts as well as the Post-clean Control: Post-clean PX-UVD counts noted significant improvements (p < 0.001). A statistically significant improvement was noted between pre-and post-cleaning total surface bioburden following exposure to the PX-UVD (p = 0.0004). The introduction of the PX-UVD was associated with a sustained reduction in the pre clean bioburden counts with a risk trend (per week) 0.19, (95% CI [0.056, 0.67], p = 0.01).DiscussionThe use of a PX-UVD as adjunct to standard cleaning protocols was associated with a significant decrease in surface bioburden. The study demonstrated the inefficiency of conventional cleaning. Persistence of potentially pathological species in both periods highlights current health sector challenges.

Evaluation of a pulsed xenon ultraviolet disinfection system to decrease bacterial contamination in operating rooms

BackgroundEnvironmental cleanliness is one of the contributing factors for surgical site infections in the operating rooms (ORs). To decrease environmental contamination, pulsed xenon ultraviolet (PX-UV), an easy and safe no-touch disinfection system, is employed in several hospital environments. The positive effect of this technology on environmental decontamination has been observed in patient rooms and ORs during the end-of-day cleaning but so far, no study explored its feasibility between surgical cases in the OR.MethodsIn this study, 5 high-touch surfaces in 30 ORs were sampled after manual cleaning and after PX-UV intervention mimicking between-case cleaning to avoid the disruption of the ORs’ normal flow. The efficacy of a 1-min, 2-min, and 8-min cycle were tested by measuring the surfaces’ contaminants by quantitative cultures using Tryptic Soy Agar contact plates.ResultsWe showed that combining standard between-case manual cleaning of surfaces with a 2-min cycle of disinfection using a portable xenon pulsed ultraviolet light germicidal device eliminated at least 70% more bacterial load after manual cleaning.ConclusionsThis study showed the proof of efficacy of a 2-min cycle of PX-UV in ORs in eliminating bacterial contaminants. This method will allow a short time for room turnover and a potential reduction of pathogen transmission to patients and possibly surgical site infections.

Does Pulsed-Xenon Ultraviolet Disinfection Add Additional Value to Manual Cleaning?

Background Novel disinfection tools have been used to supplement standard hospital cleaning protocols. This study was conducted to determine whether the addition of Pulsed Xenon Ultraviolet disinfection (PX-UV) increased the effectiveness of manual cleaning with four different environmental cleaning and disinfecting agents and how their performance compared with the industry standard of sodium hypochlorite 10%.Methods Research staff collected 600 pre-clean, post-clean, and post-clean + PX-UV environmental samples of aerobic bacterial colonies (ABC) and MRSA from five high touch surfaces (bedrail, call button, toilet seat, bathroom grab rail, tray table). The PX-UV device was used three times - one 5 minute cycle on each side of the patient bed and one 5 minute cycle in the restroom.ResultsWilcoxon signed-rank tests showed post-clean ABC counts were significantly different from post-clean + PX-UV clean counts for soap and water (P < 0.001), quaternary ammonium compound (P < 0.001), and hydrogen peroxide (P < 0.001), but not for sodium hypochlorite 10% (P = 0.78). A negative binomial mixed regression model showed that post-clean + PX-UV ABC counts for Soap and water were 8.6 times higher than post-clean ABC counts for sodium hypochlorite 10% solution, holding all other factors constant, P = 0.001. Post-clean ABC counts for QAC + UV were 6 times higher than post-clean ABC counts for sodium hypochlorite 10% solution, holding all other factors constant, P = 0.004. A Kruskal–Wallis test indicated there was no statistically significant difference in MRSA counts between cleaning chemicals at post-clean (P = 0.1563) or post-clean + UV (P = 0.337), indicating that the cleaning chemicals performed equally well at each stage. UV further statistically significantly lowered MRSA counts beyond the post-clean level only for the quaternary ammonium compound group (P = 0.0073).Conclusion The addition of PX-UV significantly improves disinfection for soap and water, hydrogen peroxide, and quaternary ammonium compound, but not for sodium hypochlorite 10%. This improvement does not bring microbial levels to those seen when using sodium hypochlorite 10% alone.Disclosures C. Jinadatha, Xenex Healthcare Services: CRADA, Research support