Role of pulsed-xenon ultraviolet light in reducing healthcare-associated infections: a systematic review and meta-analysis

Dong, Zhilong; Zhou, Na; Liu, Guijuan; Zhao, Li

doi:10.1017/s095026882000148x

Cited by 13 publications

(6 citation statements)

References 43 publications

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“…Moreover, due to the variability in the included methodologies of included articles and the variability in the available information for specific WRD types and micro-organisms, firm conclusions regarding the differences of in situ efficacy of the four systems may not be drawn. The observation that all WRD systems lead to a reduction in both environmental outcomes as clinical outcomes is coherent with those made in other reviews [109][110][111][112].…”

Section: Discussionsupporting

confidence: 85%

The in situ efficacy of whole room disinfection devices: a literature review with practical recommendations for implementation

Starre

Cremers-Pijpers

Rossum

et al. 2022

Antimicrob Resist Infect Control

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Background Terminal cleaning and disinfection of hospital patient rooms must be performed after discharge of a patient with a multidrug resistant micro-organism to eliminate pathogens from the environment. Terminal disinfection is often performed manually, which is prone to human errors and therefore poses an increased infection risk for the next patients. Automated whole room disinfection (WRD) replaces or adds on to the manual process of disinfection and can contribute to the quality of terminal disinfection. While the in vitro efficacy of WRD devices has been extensively investigated and reviewed, little is known about the in situ efficacy in a real-life hospital setting. In this review, we summarize available literature on the in situ efficacy of WRD devices in a hospital setting and compare findings to the in vitro efficacy of WRD devices. Moreover, we offer practical recommendations for the implementation of WRD devices. Methods The in situ efficacy was summarized for four commonly used types of WRD devices: aerosolized hydrogen peroxide, H2O2 vapour, ultraviolet C and pulsed xenon ultraviolet. The in situ efficacy was based on environmental and clinical outcome measures. A systematic literature search was performed in PubMed in September 2021 to identify available literature. For each disinfection system, we summarized the available devices, practical information, in vitro efficacy and in situ efficacy. Results In total, 54 articles were included. Articles reporting environmental outcomes of WRD devices had large variation in methodology, reported outcome measures, preparation of the patient room prior to environmental sampling, the location of sampling within the room and the moment of sampling. For the clinical outcome measures, all included articles reported the infection rate. Overall, these studies consistently showed that automated disinfection using any of the four types of WRD is effective in reducing environmental and clinical outcomes. Conclusion Despite the large variation in the included studies, the four automated WRD systems are effective in reducing the amount of pathogens present in a hospital environment, which was also in line with conclusions from in vitro studies. Therefore, the assessment of what WRD device would be most suitable in a specific healthcare setting mostly depends on practical considerations.

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Section: Discussionsupporting

confidence: 85%

The in situ efficacy of whole room disinfection devices: a literature review with practical recommendations for implementation

Starre

Cremers-Pijpers

Rossum

et al. 2022

Antimicrob Resist Infect Control

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“…A recent systematic review suggested that the use of PX-UV disinfection in addition to the standard disinfection procedures may help reduce the incidence of CDI and MRSA, but not of vancomycin-resistant Enterococci spp (VRE) infection. 11 However, there are a limited number of reports on the clinical effect of PX-UV disinfection, and the findings of the previous studies are inconsistent. 11 A multicenter, randomized controlled study could not show that using a cleaning protocol that combined standard terminal chemical cleaning with the use of a UV device in high-risk rooms occupied by the patients harboring multidrug-resistant organisms and C difficile significantly decreased the risk of MRSA acquisition.…”

Section: Discussionmentioning

confidence: 99%

“…11 However, there are a limited number of reports on the clinical effect of PX-UV disinfection, and the findings of the previous studies are inconsistent. 11 A multicenter, randomized controlled study could not show that using a cleaning protocol that combined standard terminal chemical cleaning with the use of a UV device in high-risk rooms occupied by the patients harboring multidrug-resistant organisms and C difficile significantly decreased the risk of MRSA acquisition. 16 In addition, combining UV-based disinfection with standard terminal cleaning resulted in a significant reduction in the hospital-wide risk of CDI and VRE acquisition but not of MRSA.…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9][10] In addition, a recent systematic review reported that the PX-UV disinfection method was associated with a significantly reduced rate of C. difficile infection (CDI) (incidence rate ratio [IRR]: 0.73, 95% confidence interval [CI]: 0.57-0.94), and methicillin-resistant Staphylococcus aureus (MRSA) infections (IRR: 0.79, 95% CI: 0.64-0.98). 11 However, the quality of evidence is low, and the effect of PX-UV disinfection method on reducing the rate of healthcare-associated acquisition of multidrug-resistant organisms and C. difficile remains controversial.…”

Section: Introductionmentioning

confidence: 99%

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

Kitagawa

Mori

Kawano

et al. 2021

American Journal of Infection Control

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Background: 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. Methods: 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). Results: 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. Conclusions: Adding PX-UV disinfection to terminal manual cleaning reduced the rate of MRSA acquisition.

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“…These short cycles allow for more rooms per day to be disinfected, covering more square footage within a healthcare facility. A meta-analysis of studies on the use of PX-UV for enhanced disinfection showed a significant reduction in the rates of HO-CDI acquisition (incidence rate ratio 0.73; 95% CI 0.57–0.94) [ 16 ]. In many of the included studies, disinfection with PX-UV was intended for all patient rooms on specific targeted units, not only isolation rooms.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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Background The 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. Methods Utilization 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. Results All 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. Conclusions The findings of this study indicate a strong inverse relationship between the utilization of the pulsed xenon intervention and HO-CDI rates.

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Role of pulsed-xenon ultraviolet light in reducing healthcare-associated infections: a systematic review and meta-analysis

Cited by 13 publications

References 43 publications

The in situ efficacy of whole room disinfection devices: a literature review with practical recommendations for implementation

The in situ efficacy of whole room disinfection devices: a literature review with practical recommendations for implementation

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

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

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