Effect of enhanced ultraviolet germicidal irradiation in the heating ventilation and air conditioning system on ventilator-associated pneumonia in a neonatal intensive care unit

Abstract

Objective: The objective of this study was to test the hypothesis that enhanced ultraviolet germicidal irradiation (eUVGI) installed in our neonatal intensive care unit (NICU) heating ventilation and air conditioning system (HVAC) would decrease HVAC and NICU environment microbes, tracheal colonization and ventilator-associated pneumonia (VAP).Study Design: The study was designed as a prospective interventional pre-and post-single-center study. University-affiliated Regional Perinatal Center NICU. Intubated patients in the NICU were evaluated for colonization, and a high-risk sub-population of infants <30 weeks gestation ventilated for X14 days was studied for VAP. eUVGI was installed in the NICU's remote HVACs. The HVACs, NICU environment and intubated patients' tracheas were cultured pre-and post-eUVGI for 12 months. The high-risk patients were studied for VAP (positive bacterial tracheal culture, increased ventilator support, worsening chest radiograph and X7 days of antibiotics).Result: Pseudomonas, Klebsiella, Serratia, Acinetobacter, Staphylococcus aureus and Coagulase-negative Staphylococcus species were cultured from all sites. eUVGI significantly decreased HVAC organisms (baseline 500 000 CFU cm À2 ; P ¼ 0.015) and NICU environmental microbes (P<0.0001). Tracheal microbial loads decreased 45% (P ¼ 0.004), and fewer patients became colonized. VAP in the highrisk cohort fell from 74% (n ¼ 31) to 39% (n ¼ 18), P ¼ 0.04. VAP episodes per patient decreased (Control: 1.2 to eUVGI: 0.4; P ¼ 0.004), and antibiotic usage was 62% less (P ¼ 0.013).Conclusion: eUVGI decreased HVAC microbial colonization and was associated with reduced NICU environment and tracheal microbial colonization. Significant reductions in VAP and antibiotic use were also associated with eUVGI in this single-center study. Large randomized multicenter trials are needed.

Pilot study of sources and concentrations of size-resolved airborne particles in a neonatal intensive care unit

“…The air in the test room was deemed to be well mixed, based on the supply air-flow rate, position of ceiling-mounted air delivery and exhaust devices and the physical dimensions of the room. 7 …”

“…In a few other studies where NICU air quality parameters were monitored, microbes in airborne particles were assessed using culturing methods, and the mechanical ventilation system and renovation activities were assessed as potential sources. Ryan et al [7] found that enhanced ultraviolet germicidal irradiation of HVAC cooling coils significantly decreased the number of culturable microbes in the HVAC system and in the NICU, in air and on surfaces. The reduced environmental loads were linked, in turn, to decreases in tracheal microbial colonization of infants, and reductions in ventilator-associated pneumonia.…”

Microbial reduction in the NICU: seeing the light

“…Tracheal aspirate colonization, VAP and antibiotic use did decrease significantly too, but seemed to mostly level off after the first month of exposure to eUVGI. 12 Among the limitations of the study are the facts that the intervention was not randomized or blinded to the caregivers. Although the investigators mention that several practices remained unchanged, other clinical practices such as earlier extubation did increase during the study period, 12 which could impact on the results.…”

“…12 Among the limitations of the study are the facts that the intervention was not randomized or blinded to the caregivers. Although the investigators mention that several practices remained unchanged, other clinical practices such as earlier extubation did increase during the study period, 12 which could impact on the results. In addition, data on presence of concomitant nosocomial sepsis and/or necrotizing enterocolitis during the study, which would influence antibiotic use in the NICU, were not available.…”

“…The source of VAP is mostly secondary to endogenous oropharyngeal colonization and exogenous sources such as ventilator circuits, humidifiers and endotracheal tubes. 3 In the article by Ryan et al, 12 an innovative approach was taken to impact on the exogenous sources of microorganisms that could potentially colonize the airway and contribute to VAP. The investigators hypothesized that enhanced-ultraviolet germicidal irradiation (eUVGI; also called the Pathogen Control System, Vigilair Systems, North Tonawanda, NY, USA) placed in the NICU heating ventilation and air conditioning system would decrease heating ventilation and air conditioning and NICU environmental and neonatal tracheal microbial loads and VAP.…”