Systematic review on use, cost and clinical efficacy of automated decontamination devices

Abstract

Background More evidence is emerging on the role of surface decontamination for reducing hospital-acquired infection (HAI). Timely and adequate removal of environmental pathogens leads to measurable clinical benefit in both routine and outbreak situations. Objectives This systematic review aimed to evaluate published studies describing the effect of automated technologies delivering hydrogen peroxide (H202) or ultra-violet (UV) light on HAI rates. Methods A systematic review was performed using relevant search terms. Databases were scanned from January 2005 to March 2020 for studies reporting clinical outcome after use of automated devices on healthcare surfaces. Information collected included device type, overall findings; hospital and ward data; study location, length and size; antimicrobial consumption; domestic monitoring; and infection control interventions. Study sponsorship and duplicate publications were also noted. Results While there are clear benefits from non-touch devices in vitro, we found insufficient objective assessment of patient outcome due to the before-and-after nature of 36 of 43 (84%) studies. Of 43 studies, 20 (47%) used hydrogen peroxide (14 for outbreaks) and 23 (53%) used UV technology (none for outbreaks). The most popular pathogen targeted, either alone or in combination with others, was Clostridium difficile (27 of 43 studies: 63%), followed by methicillin-resistant Staphylococcus aureus (MRSA) (16 of 43: 37%). Many owed funding and/or personnel to industry sponsorship (28 of 43: 65%) and most were confounded by concurrent infection control, antimicrobial stewardship and/or cleaning audit initiatives. Few contained data on device costs and rarely on comparable costs (1 of 43: 2%). There were expected relationships between the country hosting the study and location of device companies. None mentioned the potential for environmental damage, including effects on microbial survivors. Conclusion There were mixed results for patient benefit from this review of automated devices using H202 or UV for surface decontamination. Most non-outbreak studies lacked an appropriate control group and were potentially compromised by industry sponsorship. Concern over HAI encourages delivery of powerful disinfectants for eliminating pathogens without appreciating toxicity or cost benefit. Routine use of these devices requires justification from standardized and controlled studies to understand how best to manage contaminated healthcare environments.

Is It Possible to Eradicate Carbapenem-Resistant Acinetobacter baumannii (CRAB) from Endemic Hospitals?

“…The evidence that seemed to support the use of new technologies, such as the peroxide or the UV rays, was recently disproved [ 43 , 44 , 45 ].…”

Ultraviolet-C radiation

“…UVC light falls between 200 and been able to demonstrate reductions in healthcare-associated infections (HAIs) or other infection rates, whereas some systematic reviews have concluded that the evidence is mixed or weak. [13][14][15][16][17][18] Inconsistent results can be attributed in part to the complex nature of infection transmission and other factors such as:…”

Does repeated exposure to hydrogen peroxide induce Candida auris resistance?

“…However, the daily efforts of healthcare workers and further consistent scientific research are needed to fuel that trend. To minimize the colonization by infectious microorganisms able to persist and thrive in the healthcare environment, new strategies for cleaning and disinfection are being proposed, but with variable success [1][2][3]. Yet, no matter how appealing the new methods and biocide candidates may sound, new insights over already known and extensively used biocides are certainly welcomed and may play a relevant role towards the effective prevention of HAIs.…”