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SA teaching hospital cuts CRE superbug transmission with novel UV intervention

South Africa’s only private teaching hospital has published research showing that ultraviolet (UV) room decontamination technology, paired with manual cleaning protocols, can decrease the transmission of Carbapenem-resistant Enterobacterales (CRE) by 23% in a hospital setting.

The novel study results from researchers at the Wits University Donald Gordon Medical Centre (WDGMC) appeared in Journal of Hospital Infection.

The team from WDGMC, the first private teaching hospital in SA, demonstrated the reduction in CRE transmission after a 26-month study and the sustained use of a UV room decontamination device (UVDI-360 Room Sanitizer, provided by US-based manufacturer UVDI and eHealthGroup Infection Control) as an adjunct to standard cleaning, including the use of bleach and quaternary ammonium disinfectants, across the 210-bed hospital.

The intervention included broad UV room decontamination across five high-risk patient units (including critical care, oncology, transplant and gastrointestinal surgery rooms) during a 12-month period after a 12-month baseline and two-month, wash-in period.

“Our study indicated that enhanced environmental hygiene utilising UV room decontamination technology in the hospital can help prevent the transmission of Carbapenem-resistant Enterobacterales, an especially challenging set of multidrug-resistant organisms,” said lead investigator Dr Warren Lowman, clinical microbiologist and infection prevention and control specialist at WDGMC.

The UV room decontamination device was implemented in three usage scenarios: terminal cleaning after patient discharge, terminal cleaning after patient transfer and, in a novel treatment, occupied rooms where the patient had an existing MDRO infection and was moved during device use. For each scenario, the UV device was operated with five-minute treatment cycles, the number of which varied per room setting and size.

CRE refers to a broader set of microorganisms that demonstrate resistance to at least one of the Carbapenem antibiotics. Recent published surveillance studies in South Africa have indicated a CRE infection crude mortality rate of nearly 40%.

“This research underlines WDGMC’s steadfast commitment to patient and staff safety through the use of novel infection prevention protocols,” said Dr Sue Tager, CEO, WDGMC. “In the ongoing fight to prevent the transmission of superbugs, both in and beyond Africa, these results provide hope and concrete proof that effective solutions exist.”

Study results

The novel application and effect of an ultraviolet light decontamination strategy on the healthcare acquisition of carbapenem-resistant Enterobacterales in a hospital setting

W. Lowman, HR Etheredge, P. Gaylard, J. Fabian.

Published in the Journal of Hospital Infection on 1 March 2022

Summary

Background
The role of the hospital environment as contributory to healthcare acquisition of multidrug-resistant organisms (MDROs) is increasingly recognised. Ultraviolet light decontamination can minimise the environmental bioburden, thereby potentially reducing healthcare acquisition. This effect has been demonstrated for typical environmental MDROs, e.g. meticillin-resistant Staphylococcus aureus, vancomycin-resistant entero-cocci, and Clostridioides difficile; however, its role in reducing carbapenem-resistant Enterobacterales (CRE) incidence rates is unclear.

Aim
To evaluate the impact of continuous ultraviolet light (C-UV) on healthcare acquisition rates of CRE.

Methods
A 26-month pragmatic, prospective interventional study with addition of C-UV decontamination to standard cleaning was conducted in units at high risk for CRE acquisition. Introduction of C-UV followed a 12 month baseline period, with a two-month wash-in period. Implementation included terminal decontamination at discharge and a novel in-use protocol, whereby rooms occupied for ≥48 h were decontaminated during the course of the patients' in-hospital stay. Incidence density rates of CRE during the intervention period were compared to the baseline period using interrupted time series regression. Rates were adjusted for ward/admission prevalence and analysed according to C-UV protocol.

Findings
The in-use C-UV protocol demonstrated a significant negative association with the incidence density rate of CRE when adjusting for CRE admission rate (P = 0.0069). CRE incidence density rates decreased significantly during the intervention period (P = 0.042). Non-intervention units demonstrated no change in incidence density rates when adjusting for ward and/or admission prevalence.

Conclusion
C-UV decontamination can potentially reduce healthcare acquisition of CRE when implemented with an in-use protocol.

 

Journal of Hospital Infection article – The novel application and effect of an ultraviolet light decontamination strategy on the healthcare acquisition of carbapenem-resistant Enterobacterales in a hospital setting (Open access)

 

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UV-emitting LED lights found to kill a coronavirus — Israeli proof of concept study

 

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New hyper-resistant superbug poses significant threat

 

 

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