A new study conducted at Cambridge Health Alliance (CHA), a Harvard Medical School teaching affiliate, demonstrated that pulsed xenon ultraviolet light disinfection can significantly decrease operating room (OR) contamination of surfaces and air. The study, presented during the Association for Professionals in Infection Control and Epidemiology (APIC) annual meeting, showed that Xenex Healthcare Services’ pulsed xenon ultraviolet light room disinfection system reduced surface contamination in the OR by 81 percent, and air contamination by 46 percent. The study also showed that between-case contamination in the OR continued to rise from case to case with standard cleaning, but was reduced to almost zero when the Xenex device was used between cases.
There is evidence that environmental contamination and insufficient surface disinfection contribute to the transmission of pathogens associated with healthcare associated infections (HAI). Among HAI, surgical site infections are the most expensive to treat. Research shows that hospital cleaning teams using standard cleaning practices frequently do not disinfect all of a room’s surfaces, with more than half of the surfaces remaining neglected, leaving behind dangerous pathogens such as Clostridium difficile (C. diff), methicillin-resistant S. aureus MRSA, vancomycin-resistant enterococci (VRE) and Acinetobacter baumannii. However, since surgical site infections are the most expensive HAI to treat, there is keen interest in standardizing environmental disinfection to optimize the OR environment and overcome variability in the performance of standard cleaning practices.
Lou Ann Bruno-Murtha, DO, medical director of infection prevention and division chief of infectious diseases at Cambridge Health Alliance, as well as assistant professor of medicine at Harvard Medical School, was the study’s lead author. In “Decreasing Operating Room Contamination of Surfaces and Air with Pulsed Xenon Ultraviolet Disinfection (PX-UVD),” Bruno-Murtha and her colleagues evaluated the effects of pulsed xenon ultraviolet disinfection by comparing bacterial contamination on surfaces and in the air of ORs after standard cleaning and a quick clean (defined as cleaning the table and visibly soiled areas), followed by PX-UVD.
“We know that contamination of surfaces and air in the operating room may pose an infection risk to patients, so we wanted to evaluate the effect of pulsed xenon UV disinfection on OR hygiene,” says Bruno-Murtha. “Enhanced disinfection has been shown to reduce the contamination levels in ORs at terminal clean. We wanted to see if these results could be replicated for between-case cleaning. We demonstrated that while between-case contamination continued to rise from case to case with standard cleaning, it was reduced to almost zero with the pulsed xenon UV disinfection device. This suggests that enhanced disinfection in a busy OR could improve patient safety. Further investigation, however, is necessary to determine whether UV disinfection can reduce surgical site infections.”
The Xenex “robot” uses pulsed xenon to deliver ultraviolet (UV) light throughout patient rooms, operating rooms (ORs), equipment rooms, emergency rooms, intensive care units (ICUs) and public areas to destroy viruses, bacteria and bacterial spores in just 5-10 minutes per room. Designed for ease of use and portability, a hospital’s environmental services staff can operate the Xenex device without disrupting hospital operations or requiring the use of expensive chemicals. A Xenex device can disinfect over 30 rooms per day, so hospitals use them continuously to reduce contamination levels throughout their facilities.
For the study, 12 surfaces in two ORs, including the anesthesia keyboard, anesthesia cart, anesthesia controls, intravenous infusion pole, overhead lamp, bed control, Bair hugger control, floor, nurse’s mouse, cautery power control, inside door surface and Mayo stand, were sampled before and after between-case standard cleaning. Four 5-minute PX-UV treatment cycles were performed at standardized locations in the OR, based upon mapping conducted by Xenex personnel utilizing a UV-C radiometer (International Light Technologies 1700) to determine the optimal treatment time. Two devices were utilized simultaneously to reduce total room treatment time to 10 minutes. Airborne contamination was measured by placing five 9cm blood agar (TSA II) settle plates near the operative field for eight hours during cases and for eight hours following the terminal clean on two separate days. Air sampling was repeated after a quick clean plus PX-UVD between cases and following the terminal clean plus PX-UVD. The study showed that Xenex reduced surface contamination by 81 percent, and air contamination by 46 percent.
“Many professional societies recognize the role that the OR environment plays in surgical site infections. With this study, CHA has demonstrated that hospitals can make their ORs cleaner and safer for their patients,” says Mark Stibich, PhD, chief scientific officer for Xenex. “This study proves that utilizing Xenex’s room disinfection system can eliminate pathogens in the OR. The study also shows that PX-UVD is fast enough for between-case use and it’s able to disinfect the air in the room, which isn’t possible with traditional cleaning methods.”