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St. Cloud VA HCS
Infection Prevention: Ultraviolet Disinfection Trial
Tina Schmidt, BSN, RN, CIC Infection Prevention Nurse
Paulette Masberg, BSN, RN MDRO Coordinator
January 2017
VETERANS HEALTH ADMINISTRATION
Ultraviolet (UV) Disinfection Trial
• Utilized TRU-D Ultraviolet (UV) Disinfection, Friday 12/16/2016, thru Friday 12/23/2016
• Locations:
– Operating Rooms
– Endoscopy
– Urology
– Community Living Center (CLC), Resident Rooms (Rms)
• Adenosine Triphosphate (ATP) swabbing Prior and Post TRU-D for Bioburden testing
• Environmental Swabbing Prior and Post TRU-D for organism testing
1
VETERANS HEALTH ADMINISTRATION
Pre & Post ATP Swab Results Measured by Relative Light Units (RLU),
Operating Rm 2 (Friday, 12/16/2016)
10796 90
3321 16 11 8
-22
-50
0
50
100
150
200
250
300
OmnicellKeyboard
TelephoneNurses
Station (back)
AnethesiaBreathing
TubeConnector
Room LightSwitch
OR overhead(exam) light
handle
OR Bed Boom OR WallPhone
ARCKeyboard
Re
lati
ve
Lig
ht
Un
its
(R
LU
)
Variance Pre Post Pass/Fail Threshold
VETERANS HEALTH ADMINISTRATION
Pre & Post ATP Swab Results Measured by Relative Light Units (RLU),
Endoscopy Rm 251 (Friday, 12/16/2016)
1,126
940
796 781
260 253202
15940
-93
-200
0
200
400
600
800
1000
1200
1400
E-pad Pen Olympusmonitor
Pole
DoorHandle
OmnicellKeyboard
Door LightSwitch
Tray Table Bed Rail lap TopKeyboard
Olympusscreen
Treatmentcart handle
Re
lati
ve
Lig
ht
Un
it (
RL
U)
Variance Pre Post Pass/Fail Threshold
VETERANS HEALTH ADMINISTRATION
Pre & Post ATP Swab Results Measured by Relative Light Units (RLU),
Operating Rm 1 (Monday, 12/19/2016)
488
74 42 36 17 6 0-1 -11 -57
-100
0
100
200
300
400
500
600
700
800
Room InnerDoor Knob
AnethesiaBreathing
TubeConnector
Boom TelephoneNursesStation
OR Bed ARCKeyboard
ORoverhead
(exam) lighthandle
Room LightSwitch
OmnicellKeyboard
Glidescope
Rela
tiv
e L
igh
t U
nit
(R
LU
)
Variance Pre Post Pass/Fail Threshold
VETERANS HEALTH ADMINISTRATION
Pre & Post ATP Swab Results Measured by Relative Light Units (RLU),
Urology Rm 246 (Monday, 12/19/2016)
255
182
163
96 91
3827 8 -1 -2
-50
0
50
100
150
200
250
300
DesktopComputer
Mouse
VS MonitorHandle
Door Handle OlympusMonitorScreen
Bed handHeld Controls
(right)
SiemensRotator Ball
SiemensKeyboard
Door LightSwitch
Olympusscreen (touch
pad keys)
TreatmentCart Handle
Re
lati
ve
Lig
ht
Un
it (
RL
U)
Variance Pre Post Pass/Fail Threshold
VETERANS HEALTH ADMINISTRATION
Pre & Post ATP Swab Results Measured by Relative Light Units(RLU),
CLC 49-1 Rm 122B (Tuesday, 12/20/2016)
731
471
199165
90 67 54 19-26 -58
-200
0
200
400
600
800
1000
1200
1400
Bed RailHandle
Interior DoorKnob
Wall call light(green
button)
Top DrawerHandle
Bed ControlButtons
Trapeze Bar O2 regulator(green knob)
PhoneButtons
BulletinBoard
Thum Tac
Re
lati
ve
Lig
ht
Un
it (
RL
U)
Variance Pre Post Pass/Fail Threshold
12
CLC 49-1, Room 122B. The nurse call light grew 2 colonies: GPR and GNR
pre TRU-D. The bed buttons grew 2 colonies: GPR and GNR pre TRU-D.
After TRU-D disinfection there was no growth noted on the plate.
VETERANS HEALTH ADMINISTRATION
Pre & Post ATP Swab Results Measured by Relative Light Units(RLU),
CLC 49-1 Rm 123 (Tuesday, 12/20/2016)
3,624
539388 130 102 81 75 61 57 46
0
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
4,500
InteriorDoor Knob
Nurse Call(wall mount)
Bed ControlButtons
Bed Rail PhoneButtons
BulletinBoard
Top DrawerHandle
YellowThumb Tac
o2 regulatorKnob
TrapezeBar
Re
lati
ve
Lig
ht
Un
its
(R
LU
)
Variance Pre Post Pass/Fail Threshold
VETERANS HEALTH ADMINISTRATION
Pre & Post ATP Swab Results Measured by Relative Light Units(RLU),
Dental Procedure Rm (Wednesday, 12/21/2016)
547
393
163 150 138121
66 43 40 160
100
200
300
400
500
600
700
Inner RoomDoor
Handle
KeyboardMouse
Right ArmBoard
TelephoneKeypad
Alaris Pump DCIInternational
Drill Tool
Tray Table VS Monitor(Grey Knob)
DCIInternationalH20 Flush
Tool
Exam LightHandle
Re
lati
ve
Lig
ht
Un
its
(R
LU
)
Variance Pre Post Pass/Fail Threshold
VETERANS HEALTH ADMINISTRATION
Pre & Post ATP Swab Results Measured by Relative Light Units(RLU),
Operating Rm 3 (Thursday, 12/22/2016)
455
228
9683
26 19 13 9 7 00
50
100
150
200
250
300
350
400
450
500
OR Bed AnethesiaBreathing
TubeConnector
Room InnerDoor Knob(going to
clean core)
OmnicellKeyboard
Boom ARCKeyboard
ORoverhead
(exam) lighthandle
Glidescope Room LightSwitch
OR WallPhone
Re
lati
ve
Lig
ht
Un
its
(R
LU
)
Variance Pre Post Pass/Fail Threshold
VETERANS HEALTH ADMINISTRATION
Pre & Post ATP Swab Results Measured by Relative Light Units(RLU),
Operating Rm 2 (Friday, 12/23/2016)
24
95
64
33 30 19 12 11 8 8 10
50
100
150
200
250
300
AnethesiaBreathing
TubeConnector
Boom OmnicellKeyboard
ARCKeyboard
OR Bed ORoverhead
(exam) lighthandle
OR WallPhone
Room LightSwitch
Glidescope Room InnerDoor Knob(going to
clean core)
Re
lati
ve
Lig
ht
Un
its
(R
LU
)
Variance Pre Post Pass/Fail Threshold
VETERANS HEALTH ADMINISTRATION
Pre & Post ATP Swab Results Measured by Relative Light Units(RLU),
Endoscopy Rm 251 (Wednesday, 12/21/2016)
25
1,480
435390 368 359
144 143 53 44 90
100
200
300
400
500
600
700
800
900
1000
1100
1200
1300
1400
1500
1600
1700
1800
Exam LightHandle
Lap TopMouse
Grab Barback of Bed
Interior DoorHandle
Bed Controls Light Switchby Door
EPAD Pen Omnicellkeyboard
LaptopKeyboard
OlympusTouchscreen
Re
lati
ve
Lig
ht
Un
its
(R
LU
)
Variance Pre Post Pass/Fail Threshold
No Environmental Cultures obtained due to lack of swab availability.
VETERANS HEALTH ADMINISTRATION
Pre & Post ATP Swab Results Measured by Relative Light Units(RLU),
CLC 50-2 (Wednesday, 12/21/2016)
26
767
130
85 72 64 41 10 8 7
-44
-100
0
100
200
300
400
500
600
700
800
Sink Handle(HOT)
DrawerHandle (top)
Light Switchby Bathroom
Telephonekeypad
Door Handle(inner)
Bed RailHandle
VCR PowerButton
Bed ControlButtons
Lift ControlButtons
Nurse/TVControl
Re
lati
ve
Lig
ht
Un
its
(R
LU
)
Variance Pre Post Pass/Fail Threshold
VETERANS HEALTH ADMINISTRATION
Pre & Post ATP Swab Results Measured by Relative Light Units(RLU),
Urology Rm 244 (Wednesday, 12/21/2016)
27
3,088
885
525448
312 283 101 83 27 250
100200300400500600700800900
1,0001,1001,2001,3001,4001,5001,6001,7001,8001,9002,0002,1002,2002,3002,4002,5002,6002,7002,8002,9003,0003,1003,2003,3003,4003,500
COWKeyboard
Tele HealthPhone
BladderScan Touch
Screen
Door Handle(interior)
EPAD Pen COW Mouse StethescopeBell
Head Rest Light switch(by door)
Bed
Re
lati
ve
Lig
ht
Un
its
(R
LU
)
Variance Pre Post Pass/Fail Threshold
VETERANS HEALTH ADMINISTRATION
UV Disinfection Trial : ATP Swapping Summary
• 130 total ATP swabs performed (10 swabs before TRU-D, and 10 swabs after TRU-D per room)
• 121 ATP swabs out of the total 130 ATP swabs showed a reduction in bioburden (as measured by relative light units (RLU) after the use of TRU-D.
• 9 swabs showed an increase in bioburden
• 1 of the nine was inadvertently re-touched after TRU-D before post-ATP swab, which would increase the RLU.
• 121/130=93% reduction in RLU
32
VETERANS HEALTH ADMINISTRATION
UV Disinfection Trial: Environmental Swabbing Summary
• 40 environmental swabs were performed (2-4 swabs before TRU-D and 2-4 swabs after TRU-D per room). Endoscopy Room 251 on 12/21/2016 did not have environmental swabbing performed due to swab supply availability at the time.
• 23 of the 40 environmental swabs grew organisms before the use of TRU-D
• 40 out of 40 environmental swabs showed no growth after the use of TRU-D
• 51 total colonies were identified out of the total 40 environmental swabs obtained before the use of TRU-D UV Disinfection.
• Gram-positive Cocci, Gram positive rods, Gram negative coccobacilli, Gram-positive diplococci and GPCR were identified pre TRU-D
• 0 colonies grew after the use of TRU-D UV Disinfection.
33
VETERANS HEALTH ADMINISTRATION
UV Disinfection (TRU-D) Cycle Time & Ease of Use
• Varies with:
– Size of Room
– How Much/Type equipment is in the room
– Disinfection time ranged from 21 minutes, to 1 hour 20minutes
• Ease of Use:
– Room prepped by opening drawers and pulling equipment away from walls (<5 min)
– Device tells you if placement is ideal or a move is recommended.
– Staff can set up the device to alert you by cell phone when disinfection is complete
– Staff able to perform other duties while UV cycle is running
– Automatically turns off when someone enters the room (safety device)
34
VETERANS HEALTH ADMINISTRATION
Acquisition Costs
• Currently on FSS Contract V797P-4135B
• Procurement Cost is $88,605 per machine
– Includes training, manuals, 1 yr parts/service warrenty and first year service agreement
• Service contract costs for follow on years is $8,950 per machine.
– Includes bulb replacement
– Includes upgrades
• Life Expectancy is 7+ years
– Tru-D has machines still in use since being put purchased in 2007
• $.059 Cost per Outpatient Visit at St Cloud spread out over seven years
– 365,925 Outpatient Visits at St Cloud yearly
– $151K for acquisition of machine and service contracts.
35
VETERANS HEALTH ADMINISTRATION
Conclusion
• Our data confirms that UV Disinfection (TRU-D) can decrease the bioburden of important pathogens in real-world settings as demonstrated by the operating rooms, Endoscopy Suites, urology procedure rooms, and the CLC.
• Our data also confirms that UV Disinfection (TRU-D) effectively eliminated all colony growth that was present on our environmental surfaces prior to the utilization of TRU-D.
• After using UV Disinfection (TRU-D) the environmental swabs showed “no colony growth”.
• Routine use of UV disinfection is a feasible addition to current infection control and EMS measures, and may help reduce rates of healthcare associated infections and ensure our Veterans a clean, safe environment for their healthcare.
36