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Collingwood Hospital first in Canada to have self-sanitizing Patient Rooms
BradfordToday reports on Collingwood hospital first in Canada to have self-sanitizing patient rooms
By Erika Engel
UV light, ozonated water, copper-infused surfaces, and titanium dioxide have all come together to make Canada's first self-sanitizing patient room and bathroom at Collingwood General and Marine Hospital.
There's copper in them there walls.
Collingwood General and Marine Hospital (CGMH) has opened the first of five self-sanitizing rooms, and will be the first hospital in Canada to use copper-infused panels on the walls in its hallways and patient rooms to prevent bacteria growth.
Copper is naturally anti-bacterial and copper surfaces prevent bacteria growth.
The made-over patient room is located on the medical floor, and it's packed with the latest technology in sanitization from the UV lights on the ceiling to the copper-infused toilet seat in the bathroom.
Norah Holder, CGMH president and CEO, said Collingwood's hospital is the first in Canada to combine all of the self-sanitizing elements into one patient room and bathroom.
The bacteria-fighting technology includes copper-infused high touch surfaces like the bed rail, the door handles and pulls, the toilet seat, and the toilet handle. There's UV lights on the ceiling that run on a disinfecting cycle when the patient is in the bathroom or outside the room, and there are plastic panels on the bottom half of the wall coated in titanium dioxide, which reacts with UV light to kill bacteria. In the bathroom a no-touch sink is engineered to prevent splashing and delivers ozonated water. Ozone has been proven to have an oxidizing, antiseptic, and germicidal effect. More UV lights in the bathroom activate after every use, bathing the room in UV light, which destroys the cell wall of bacteria, spores, and fungus.
The next rooms completed will have copper-infused panels covering the bottom half of the walls.
According to John Widdis, manager of operations and maintenance at CGMH, Collingwood will be the first hospital to use these panels as they are new to the market.
He said the technology doesn't take away the need for cleaning, rather it mitigates the bacteria load on surfaces in the room. Rooms will still be cleaned once every 24-hours at minimum.
Swab tests showed bacteria counts in the range of 7,000 to 8,000 in a typical room. After the self-sanitizing technology was installed, the same swab tests are showing bacteria counts in the range of 30-50.
Dr. Michael Lisi, chief of staff at CGMH, said he's "thrilled" to see CGMH become a leader in infection control technology locally, provincially, and nationally.
"This technology is really going to provide benefits in terms of patient safety, and safety of staff and visitors," said Lisi. "I can have faith in such technology to provide the best level of care for our patients. This will help with improving outcomes and getting patients back to their families safely."
CGMH has been testing some of the technology in its emergency department already. Widdis said he wanted to start with the one public washroom in the department once he watched the constant flow of people using the facility. The bathroom was cleaned once every 1.5 hours, but in between there would be eight or so people using it.
When the emergency department was renovated in 2016, Widdis had an ozone sink and some other self-sanitizing technology installed in the bathroom. Staff sinks were also replaced with models that delivered ozone water.
Since then, the hospital has seen the lowest rates of C-Difficile occurrences in recent history.
Lisi said the rates are the lowest they've been in six years. Widdis said the rates went down almost as soon as the changes were made in the emergency department.
"[Infection control] is a very significant component," said Lisi. "It's something all hospitals struggle with … C-Difficile can be life ending in elderly and those whose immune systems are not strong enough."
Widdis has been at CGMH for 29 years and he's seen hospitals and researchers work to battle hospital acquired infection rates over the course of his career.
In the beginning, said Widdis, it was done with chemicals, later it was bleach and hydrogen peroxide on surfaces. Before the UV lights, copper infused materials, and ozone water sinks, the last innovation was a "bomb" that would vaporize hydrogen peroxide to sanitize surfaces.
"We still use some of them," said Widdis, adding the chemicals have moved to more earth-friendly compounds. "These are just more weapons we use in our fight against hospital acquired infections."
The technology now installed on the medical floor will also continue to work against mutating strains of bacteria.
Widdis said staff decided to start installing the technology on the medical floor because it's where patients would be isolated in cases of infection.
"If we have an outbreak, which we haven't in years, this is the floor where we run into the most trouble," said Widdis.
Work is continuing to outfit four more patient rooms and renovate hallways to include fresh paint and copper-infused panels on the walls. There are also plans in the works to outfit all hospital bathrooms with copper-infused toilet seats, high touch areas, ozone sinks and UV light.
For rooms not equipped with UV lights yet, the hospital has two portable towers with UV lights that can be used to disinfect any room.
Holder is looking forward to using this and even newer self-sanitizing technology in the future hospital build.
The CGMH foundation raised $1 million for the project through the Tree of Life campaign held at Christmas and other initiatives.
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bacteria disinfection germicidal hospital infection patient room sanitize
UV Disinfection: A Comparative Technology Review of Continuous UVC & Pulsed Xenon UV
Infection Prevention: Environmental Cleaning and Practical Infection Control
By Barry Hunt, Class 1 Inc., Canada
Recent events in the US healthcare industry have combined to create a rush by healthcare facilities toward the adoption of technology for total room disinfection. Events include: 1) changes to the Affordable Care Act that reduced CMS and insurer compensation to hospitals due to high rates of Healthcare Acquired Infections (HAIs); 2) elimination of CMS and insurer reimbursements to hospitals for individual patient healthcare costs if and when a patient develops an HAI; 3) a number of peer-reviewed publications of total room disinfection systems used at terminal discharge demonstrating successful reductions of either bioburden or HAIs or both; 4) presenter advocacy at recent infection prevention professional conferences including American Prevention and Infection Control (APIC) and Society of Healthcare Epidemiology of America (SHEA); 5) industry innovation; and 6) industry promotion.
In the ensuing market competition between hydrogen peroxide vapor (HPV) fogging and UV total room disinfection systems, UV appears to be the leader in the U.S., likely for reasons of speed, safety and ease of use19. Well-trained housekeeping staff can completely disinfect 20 to 50 patient rooms per day depending on the speed of the mobile UV system chosen. The faster the disinfection system, the faster the room turnaround, and the greater the improvement in hospital revenue; the less EVS staff time required, the lower the hospital operational costs; and there is no risk to staff or patients of exposure to residual aerosol disinfectant.
Of the two types of energy-based disinfection systems being marketed today, UVC has been a proven technology for disinfecting air, water and instruments for over a century2,3. UVC is a narrow spectrum technology operating at a frequency of 254 nm, very close to the optimal germicidal frequency (263 nm to 266 nm) for bacterial and viral disinfection.
PX light is a broad-spectrum technology developed in the 1950s primarily for flash photography. PX does however include some germicidal UV in its range of emitted light frequencies.
Narrow spectrum UVC emitters are relatively efficient at generating germicidal UV with a known range of efficiency from 24% to 38%. That means a bulb rated for 100 W input power from one manufacturer may emit 24 W of germicidal UV, while a 100 W bulb from another device manufacturer may produce as much as 38 W of germicidal radiation. Technologies known to impact this range include tubing materials, and temperature management. Further optimization of emission of UV energy onto surfaces can be accomplished with reflectance technology.
By contrast, PX bulbs are relatively inefficient at generating germicidal UV with a published efficiency of just 9%. Much of the input energy is wasted as heat and visible light, rather than being converted to germicidal UV. Consequently, for any given input power, a UVC lamp will emit approximately 4 times more germicidal UV than its PX counterpart.
Given the example of a typical US hospital receptacle that supplies up to 2000 watts of electrical power, the maximum germicidal UV output of a PX device can only be 180 Watts (9 % x 2000 watts = 180 watts), whereas a UVC device can generate 760 Watt of germicidal UV (38% x 2000 watts = 760 watts).
Disinfection efficiency is a direct function of the delivered germicidal UV power and exposure time. Therefore, it becomes quite clear that UVC can disinfect up to 4 times faster, or 4 times more, than a PX device from a single emitter using the same power (760 watts / 180 watts = 4.2X).
UVC constants have been published for all bacteria and viruses allowing easy calculation of time and power required for deactivation with germicidal UV. Disinfection constants vary greatly with the organism. In general, vegetative bacteria are deactivated very quickly, spores require a lot more time.
At a UVC energy dose of 400 mJ/cm2, all known epidemiologically important pathogens (EIP), including Clostridium difficile spores, are rendered inert. Germicidal UV creates thymine-thymine dimers and thymine-cytosine dimers of neighboring molecules on strands of DNA and RNA, preventing organism replication.
The higher the emitted energy of the device, the faster the target energy dose is reached, and the faster the disinfection cycle. For example, if the device emitted 400 mJ/cm2/minute at the target distance, only one minute of operation would be required for disinfection. If the device emitted 40 mJ/cm2/minute (more commonly expressed as 0.667 mJ/cm2/s i.e. 0.667 mW/cm2) at the target distance, then 10 minutes would be required to achieve the same disinfection dose.
Life Cycle / Maintenance:
The life of a PX bulb is counted by the number of pulses it can sustain before the electrodes are destroyed. Typical published values for PX life-cycle range from 1 to 10 million pulses. Assuming an average life cycle of 5 million pulses, and a flash rate of 3 times per second, (the value reported by one PX manufacturer), this will only result in an expected life of 463 hours. (5 million / 3 = 1.67 million seconds = 463 hrs.) Given that a typical disinfection cycle lasts 15 minutes according to one PX manufacturer, this means that the PX lamp will need to be replaced after 1,852 cycles. Assuming the PX unit is used 20 times per day, then the PX lamps will need to be replaced every 3 months.
By comparison, the published life expectancy of a typical UVC lamp is between 10,000 and 17,000 hours. For at least one manufacturer, that could mean bulb replacement as little as every 5 years.
Operational & Proximity Safety:
Because of their inherent high temperature flash operating mode, PX lamp surfaces become extremely hot (1000 oC) and may become a fire hazard or cause severe injuries if accidentally touched after discharge (similar to a burnt flash bulb from a 1950s flash camera). In addition, the gas pressure that builds up inside the hot lamp becomes pressurized to several atmospheres and can explode violently projecting glass debris. This may be the reason at least one PX manufacturer retracts the PX lamps into a protective canister immediately after discharge.
Viewing Safety:
UVC can be safely and comfortably viewed from behind glass. UVC does not penetrate glass or plastics. This allows high visibility of the disinfection process in glass-walled areas like ICU.
Conversely, PX devices discharge an intensely bright fast-paced strobe of visible light. Staff need to be trained to protect patients, visitors and staff from accidentally viewing the device through glass while in operation. This may require installation of additional curtains or blinds, as well as training of EVS staff and clinical staff working in commonly glassed areas such as ICU. Even casual contact walking beside partially covered glass can subject passersby to discomfort from the intense white light flash.
At least one PX manufacturer promotes the fact their product does not contain mercury. True. Conversely, UVC lamps do contain a tiny amount of mercury, the same as every fluorescent lamp used throughout hospitals, commercial and industrial buildings and residences all over the world. The amount of gaseous mercury that could be released from a broken UVC lamp in a hospital is much too low to create a health risk. Many manufacturers also encapsulate their lamps in a protective Teflon sleeve that both eliminates any possible release of mercury vapor and serves to protect occupants from exposure to fragments of broken glass in the event of breakage.
Optimization:
All light energy, whether visible or invisible, UV or non-UV, UVC or PX, follows an inverse square law. If the distance from the point source to the target doubles, the energy decreases to 25%. Conversely, if the distance to target is halved, the energy density quadruples. Thus whether using 9% efficient PX or 38% efficient UVC, using two emitters instead of one would cut the distance to target for all surfaces in half and would reduce the room disinfection time by 75%.
A further effectiveness optimization strategy would be to locate the two emitters equidistant on either side of the patient bed with an overlap pattern of UV emission and set to achieve a Log6 reduction on the most distant outer wall surface. This would double the germicidal UV in the vicinity of the patient bed between the emitters, the most critical area in the room, and provide up to a Log12 reduction. Adding additional emitters would shorten room disinfection time even further but the law of diminishing returns would suggest two to three emitters is optimum.
Both UVC and PX have been shown to dramatically reduce bioburden and HAIs. However, UVC appears to be 4 times more energy efficient than PX, and 4 times faster or more effective than PX. UVC appears to provide 10 times longer lamp life and dramatically lower life cycle costs than PX. UVC does not expose staff to the risk of contact with excessively high temperature, or exploded lamps that PX may. UVC can be safely and comfortably viewed while in operation from behind glass or plastic whereas PX presents a risk of temporary blinding or discomfort for passersby.
All germicidal UV systems can substantially shorten room disinfection times and optimize room turnaround using two or three emitters.
UVC appears to offer significant technological, operational, safety and cost advantages over PX. Perhaps that is why UVC is the predominant air, water and surface disinfection technology used in all other industries. There are millions of UVC installations worldwide and no apparent movement afoot in any industry to switch from UVC to PX. The market share for UVC in other industries is likely in the order of 99.99%. Perhaps we should pause to consider that context, as well as the safety, operation, efficiency, efficacy, life-cycle and maintenance costs, when we consider our options for germicidal UV surface disinfection for healthcare.
Koutchma,T., Orlovska,M.,Zhu,Y., UV light for fruits and fruit products, Agriculture and Agri-Food Canada, Guelph Food Research Center,. p.69, table 2.2.
Schaefer,R., Grapperhaus, M. New Surface Discharge Pulsed UV light source C-1,Third International Congress on Utraviolet Technologies, Whistler, 2005.
Schaefer,R., Grapperhaus, M., Schaefer, I., Linden,K. Pulsed UV lamp Performance and Comparison with UV Mercury Lamps Environ. Eng. Sci. Vol. 6 pp. 303-310 , 2007.
Nerandzic, M., Thota,P., et ali, Evaluation of a Pulsed Xenon Ultraviolet Disinfection System for Reduction of Healthcare-Associated Pathogens in Hospital Rooms. Infection Control & Hospital Epidemiology, February 2015, Vol.36, no.2.
Reed, N.G. The History of Ultraviolet Germicidal Irradiation for Air Disinfection Public Health Rep. 2010 Jan-Feb; 125(1): 15–27.
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Block, S.S. Disinfection, Sterilization, and Preservation Lippincott Williams & Wilkins 5th Edition 2001
Hurst, C.J. Modelling Disease transmission and its prevention by disinfection Cambridge University Press 1996
Bolton, J.R., Cotton, C.A. The Ultraviolet Disinfection Handbook American Water Works Association 2008
Huang, S.S., Datta, R., Platt, R. 2006. Risk of acquiring antibiotic-resistant bacteria from prior room occupants. Archives of Internal Medicine. 166(18), 1945-1951.
Drees, M., Snydman, D.R., Schmid, C.H., Barefoot, L., Hansjosten, K., Vue, P.M., Cronin, M., Nasraway, S.A., Golan, Y. 2008. Prior environmental contamination increases the risk of acquisition of vancomycin-resistant enterococci. Clinical Infectious Diseases. 46(5), 678-685.
Hamel, M., Zoutman, D., O'Callaghan, C. 2010. Exposure to hospital roommates as a risk factor for health care-associated infection. American Journal of Infection Control. 38(3), 173-181.
Otter, J.A., Yezli, S., Salkeld, J.A., French G.L. 2013. Evidence that contaminated surfaces contribute to the transmission of hospital pathogens and an overview of strategies to address contaminated surfaces in hospital settings. American Journal of Infection Control. 41(5 Suppl), S6-S11.
Huslage, K., Rutala, W.A., Gergen, M.F., Sickbert-Bennett, E.E., Weber, D.J. 2013. Microbial assessment of high-, medium-, and low-touch hospital room surfaces. Infection Control & Hospital Epidemiology. 34(2), 211-212.
Stiefel, U., Cadnum, J.L., Eckstein, B.C. Guerrero, D.M., Tima, M.A., Donskey, C.J. 2011. Contamination of hands with methicillin-resistant Staphylococcus aureus after contact with environmental surfaces and after contact with the skin of colonized patients. Infection Control & Hospital Epidemiology. 32(2), 185-187.
Morgan, D.J., Rogawaski, E., Thom, K.A., Johnson, J.K., Perencevich, E.N., Shardell, M., Leekha, S., Harris, A.D. 2012. Transfer of multidrug-resistant bacteria to healthcare workers' gloves and gowns after patient contact increases with environmental contamination. Critical Care Medicine. 40(4), 1045-1051.
Hayden, M.K., Blom, D.W., Lyle, E.A., Moore, C.G., Weinstein, R.A. 2008. Risk of hand or glove contamination after contact with patients colonized with vancomycin-resistant enterococcus or the colonized patients' environment. Infection Control & Hospital Epidemiology. 29(2), 149-154.
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Nerandzic, M., Cadnum, J.L., Pultz, M.J., Donskey, C.J. Evaluation of an automated ultraviolet radiation device for decontamination of Clostridium difficile and other healthcare-associated pathogens in hospital rooms. BMC Infect Dis. 2010 ; 10: 197
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Andersen, D., Chen L. F., Weber D.J., Moehring R.W., Lewis S.S., Triplett P., Blocker M., Becherer P., Schwab J.C., Knelson L.P., Lokhnygina Y. Rutala W., Sexton D.J., CDC Epicenters Program, Duke Infection Control Outreach Network, Duke University Medical Center, University of North Carolina Health Care, High Point Regional Health System, Alamance Regional Health Center, Rex Healthcare, Chesapeake Regional Healthcare, Duke University. 2015 The Benefits of Enhanced Terminal Room (BETR) Disinfection Study: A Cluster Randomized, Multicenter Crossover Study with 2×2 Factorial Design to Evaluate the Impact of Enhanced Terminal Room Disinfection on Acquisition and Infection Caused by Multidrug-Resistant Organisms (MDRO). SHEA Featured Abstract Society of Healthcare Epidemiology of America, IDWeek October 9, 2015, San Diego, California.
disinfection germicidal HAI hospital infection UVC
Sanuvox releases the ASEPT.2X mobile UV sterilization system to help reduce nosocomial infections in hospital environments.
The ASEPT.2X mobile UV sterilization system uses a primary and secondary unit to sterilize high-touch surfaces with ultraviolet 'C' energy controlling (6 log reduction) drug-resistant microorganisms, such as MRSA and C. diff. in less than 10 minutes in a standard patient hospital room. The two-unit operation dramatically lowers the sterilization time typically associated with UV sterilization, while achieving exceptional deactivation rates by minimizing shadow areas through the use of the two-unit system.
Studies show that even with the best terminal cleaning practices, an operating or patient room can remain the source of many potential harmful drug-resistant microorganisms as manual cleaning effectively cleans less than 50% of surfaces. In the US it is estimated that HAIs (Hospital Acquired Infections) result in 1.7 million infections and 99,000 deaths costing the healthcare system between 28 to 33 billion dollars annually. Statistics show that one in every 20 patients admitted to a US hospital falls victim to an infection they contracted while there.
UV sterilization (UVC 254nm wavelength) has been used in hospitals for decades. Commercially available mobile UV systems are used to sterilize the patient room in the terminal cleaning process. However, the limitation to UV sterilization is that it is a "line-of-sight" technology. UV sterilization is ineffective in shadowed areas where the light cannot reach. This can include the other side of high-touched areas, such as a remote or call button or the other side of a bed or bed rail. As such, conventional UV systems require multiple positioning within a room to lessen the chances of shadow areas that block the sterilizing ability of the UV light. In doing so, time and resources are spent moving the system around the room and preparing the room for additional treatments.
The ASEPT.2X mobile UV sterilization system has been tested by ATS Labs in Minnesota (USA) to show a 99.9999% reduction in MRSA and C. diff. in less than 5 minutes around high-touched areas close to the patient bed, and under 10 minutes throughout the rest of the room. The ASEPT.2X is also being evaluated in one of the nation's leading teaching hospitals.
The now readily available ASEPT.2X includes many firsts incorporated into a mobile system. Some features include a total of eight infrared motion detectors (360 degree protection around each of the two units) that will shut the units down should any personnel enter the room during the sterilization process. Wi-Fi communication between both primary and secondary units controlled and monitored by any smart device while logging all sterilization cycles.
According to Normand Brais, Ph.D., Founder and VP Engineering at Sanuvox, "The ASEPT.2X UV system helps eliminate the one limitation in UV sterilization, shadows. By maintaining a closer proximity to high-touched areas and reducing shadow areas by treating both sides of the patient bed and surrounding areas, Sanuvox is able to deliver an elegant solution in reducing HAIs while increasing productivity." The idea is to make the ASEPT.2X easily accessible to virtually any medical facility looking to implement the system.
Although single UV systems can sell for well over US$100,000, Sauvox believes that with every unit in operation, it can save lives and wanted the systems priced right to do so. As such, a fully equipped two-unit ASEPT.2X system will sell for considerably less, making the unit readily available to most who are looking into the technology."
disinfection germicidal hospital infection nosocomial sterilization
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