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Xie A, Sax H, Daodu O, Alam L, Sultan M, Rock C, Stewart CM, Perry SJ, Gurses AP. Environmental cleaning and disinfection in the operating room: a systematic scoping review through a human factors and systems engineering lens. Infect Control Hosp Epidemiol 2024:1-10. [PMID: 38477015 DOI: 10.1017/ice.2023.280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
OBJECTIVE To synthesize evidence and identify gaps in the literature on environmental cleaning and disinfection in the operating room based on a human factors and systems engineering approach guided by the Systems Engineering Initiative for Patient Safety (SEIPS) model. DESIGN A systematic scoping review. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched 4 databases (ie, PubMed, EMBASE, OVID, CINAHL) for empirical studies on operating-room cleaning and disinfection. Studies were categorized based on their objectives and designs and were coded using the SEIPS model. The quality of randomized controlled trials and quasi-experimental studies with a nonequivalent groups design was assessed using version 2 of the Cochrane risk-of-bias tool for randomized trials. RESULTS In total, 40 studies were reviewed and categorized into 3 groups: observational studies examining the effectiveness of operating-room cleaning and disinfections (11 studies), observational study assessing compliance with operating-room cleaning and disinfection (1 study), and interventional studies to improve operating-room cleaning and disinfection (28 studies). The SEIPS-based analysis only identified 3 observational studies examining individual work-system components influencing the effectiveness of operating-room cleaning and disinfection. Furthermore, most interventional studies addressed single work-system components, including tools and technologies (20 studies), tasks (3 studies), and organization (3 studies). Only 2 studies implemented interventions targeting multiple work-system components. CONCLUSIONS The existing literature shows suboptimal compliance and inconsistent effectiveness of operating-room cleaning and disinfection. Improvement efforts have been largely focused on cleaning and disinfection tools and technologies and staff monitoring and training. Future research is needed (1) to systematically examine work-system factors influencing operating-room cleaning and disinfection and (2) to redesign the entire work system to optimize operating-room cleaning and disinfection.
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Affiliation(s)
- Anping Xie
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Department of Anesthesia and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hugo Sax
- Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Oluseyi Daodu
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Lamia Alam
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Marium Sultan
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States
| | - Clare Rock
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - C Matthew Stewart
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Shawna J Perry
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States
- Department of Emergency Medicine, University of Florida, Jacksonville Medical Center, Jacksonville, Florida, United States
| | - Ayse P Gurses
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Department of Anesthesia and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States
- Johns Hopkins Whiting School of Engineering Malone Center for Engineering in Healthcare, Baltimore, Maryland, United States
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Nazeer MNM, Aholaakko TK. Using photon disinfection technologies for reducing bioburden in hospitals. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:818-825. [PMID: 37737852 DOI: 10.12968/bjon.2023.32.17.818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
BACKGROUND Environmental cleaning and disinfection is the basis of the prevention of healthcare-acquired infections (HAIs). AIM This study aimed to describe photon disinfection technologies (PDTs), report their impact on inactivating micro-organisms and preventing HAIs and to create recommendations for their implementation in hospital settings. METHODS An integrated literature review was completed to evaluate and report the impact of PDTs in hospital settings. The quality of 23 articles were assessed, their contents analysed and results reported according to the PICOT model. FINDINGS The microbiological impact of the PDT varied by micro-organism, settings and according to the used devices. It was crucial that environmental cleaning was completed before the disinfection. CONCLUSION The implementation of PDT in the hospital setting requires inquiry from the viewpoints of microbiological, environmental, occupational, technical and human safety. To enhance the safe implementation of PDTs, the construction and use of evidence-based global standards for PDT are crucial.
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Affiliation(s)
| | - Teija-Kaisa Aholaakko
- Principal Lecturer, Development Unit Education, Laurea University of Applied Sciences, Vantaa, Finland
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Szczesny G, Leszczynski P, Sokol-Leszczynska B, Maldyk P. Identification of human-dependent routes of pathogen's transmission in a tertiary care hospital. Jt Dis Relat Surg 2022; 33:330-337. [PMID: 35852191 PMCID: PMC9361096 DOI: 10.52312/jdrs.2022.556] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/08/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives
The purpose of the study was to validate the risk of patients' exposure to pathogenic flora carried on hands of students, visitors, and patients themselves, analyzing its density and genera and to compare them with the microflora of healthcare workers (HCWs). Patients and methods
Between May and June 2018, five groups of participants were included. Each group consisted of eight individuals. Palmar skin imprints were obtained from dominant hands of doctors, nurses, students, visitors, and patients in orthopedics ward. Imprints were incubated at 37°C under aerobic conditions, and colony-forming units (CFU) on each plate were counted after 24, 48, and 72 h. Microorganisms were identified. Results
Hands of doctors were colonized more often by Gram - positive non-spore-forming rods bacteria than hands of nurses (p<0.05). A higher number of Staphylococcus epidermidis CFUs was observed on doctors’ than on nurses’ hands (p<0.05), whereas Staphylococcus hominis was isolated from doctor’s and patients’ imprints, but was not from nurses’ and students’ imprints (p<0.05). Micrococcus luteus colonized patients’ hands more often than students’ (p<0.05), visitors’ hands than doctors’ (p<0.05), students’ than nurses’ (p<0.05), visitors’ than nurses’ (p<0.05) and patients’ hands (p<0.05). Staphylococcus aureus (S. aureus) was isolated only from one doctor and one nurse (203 and 10 CFUs/25 cm2 ). Imprints taken from the hands of patients, students and visitors were S. aureus-free. No methicillin-resistant S. aureus (MRSA), vancomycin-resistant enterococci, nor expanded spectrum betalactamase-positive or carbapenemase-positive rods were isolated. The number of Gram-negative rods was the highest on visitors' hands, significantly differing from the number on patient’s, doctor’s, nurse’s, and student’s hands. Spore-forming rods from genus of Bacillus were isolated from representatives of all tested groups. Bacillus cereus occurred more commonly on visitors’ hands than doctors’ hands (p<0.05). Conclusion
Patients, students, and visitors may play the causal role in the spread of pathogenic bacteria, particularly spore-forming rods. Our study results confirm the effectiveness of educational activities, that is the hospital's hand hygiene program among HCWs, patients, and visitors. Hand hygiene procedures should be reviewed to put much more effort into reducing the impact of all studied groups on the transmission of infectious diseases.
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Affiliation(s)
- Grzegorz Szczesny
- Department of Orthopedic Surgery and Traumatology, Medical University of Warsaw, 02-091 Warsaw, Poland.
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Kowalski W, Moeller R, Walsh TJ, Petraitis V, Passman FJ. Ultraviolet disinfection efficacy test method using bacteria monolayers. J Microbiol Methods 2022; 200:106541. [PMID: 35870538 DOI: 10.1016/j.mimet.2022.106541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 11/28/2022]
Abstract
Monolayers of bacterial cells of Staphylococcus aureus and Pseudomonas aeruginosa were inoculated on glass slide carriers using an automated inoculum spray deposition system. The use of bacterial monolayers allows for control of critical variables for testing and verification of light-based disinfection technologies. This approach avoids the variability associated with manual inoculation and high inoculum titers, which can engender clustering of cells and the associated photoprotection that clustering incurs. The use of glass slide carriers avoids problems caused by irregular microscopic surface features, which can impact the efficacy evaluation of light-based disinfection technologies. Scanning electron micrographic (SEM) imaging was used to verify the surface topography and the presence of monolayers. The spray deposition method produced a mean density of >106 colony forming units (CFU) per carrier. The inoculated carriers were exposed to ultraviolet light for 120 s from a focused multivector ultraviolet (FMUV) light system. A mean log CFU reduction of 4.8 was achieved for S. aureus (p < 0.0001). A mean log CFU reduction of 5.1 was achieved for P. aeruginosa (p < 0.0001). The test method presented herein will facilitate increased accuracy in the measurement of ultraviolet susceptibility rate constants.
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Affiliation(s)
| | - Ralf Moeller
- German Aerospace Center (DLR e.V.), Institute of Aerospace Medicine, Radiation Biology Department, Aerospace Microbiology Research Group, Cologne, Germany
| | - Thomas J Walsh
- Infectious Diseases Translational Research Laboratory, Transplantation-Oncology Infectious Diseases Program, Weill Cornell Medicine of Cornell University, New York City, NY, USA
| | - Vidmantas Petraitis
- Infectious Diseases Translational Research Laboratory, Transplantation-Oncology Infectious Diseases Program, Weill Cornell Medicine of Cornell University, New York City, NY, USA
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Scott R, Joshi LT, McGinn C. Hospital surface disinfection using ultraviolet germicidal irradiation technology: A review. Healthc Technol Lett 2022; 9:25-33. [PMID: 35662749 PMCID: PMC9160814 DOI: 10.1049/htl2.12032] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 04/09/2022] [Accepted: 05/05/2022] [Indexed: 11/19/2022] Open
Abstract
Ultraviolet germicidal irradiation (UVGI) technologies have emerged as a promising alternative to biocides as a means of surface disinfection in hospitals and other healthcare settings. This paper reviews the methods used by researchers and clinicians in deploying and evaluating the efficacy of UVGI technology. The type of UVGI technology used, the clinical setting where the device was deployed, and the methods of environmental testing that the researchers followed are investigated. The findings suggest that clinical UVGI deployments have been growing steadily since 2010 and have increased dramatically since the start of the COVID-19 pandemic. Hardware platforms and operating procedures vary considerably between studies. Most studies measure efficacy of the technology based on the objective measurement of bacterial bioburden reduction; however, studies conducted over longer durations have examined the impact of UVGI on the reduction of healthcare associated infections (HCAIs). Future trends include increased automation and the use of UVGI technologies that are safer for use around people. Although existing evidence seems to support the efficacy of UVGI as a tool capable of reducing HCAIs, more research is needed to measure the magnitude of these effects and to establish recommended best practices.
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Affiliation(s)
- Robert Scott
- Department of Mechanical, Manufacturing, and Biomedical EngineeringTrinity College DublinDublinIreland
| | | | - Conor McGinn
- Department of Mechanical, Manufacturing, and Biomedical EngineeringTrinity College DublinDublinIreland
- Akara RoboticsDublinIreland
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Debnath S, Islam M. Disinfection chain: A novel method for cheap reusable and chemical free disinfection of public places from SARS-CoV-2. ISA TRANSACTIONS 2022; 124:176-181. [PMID: 33832708 PMCID: PMC8006197 DOI: 10.1016/j.isatra.2021.03.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 02/21/2021] [Accepted: 03/26/2021] [Indexed: 06/12/2023]
Abstract
Recently, Governments of several countries are taking steps to unlock their countries from the lockdown state to avoid the adverse effect on economy. Disinfection chains of Ultraviolet (UV)-C lamps supported by holding stands have been placed between the space of object columns for exposure-based disinfection. These chains can be folded easily for carrying purpose. Also, the length of the system can be varied depending upon the requirement. This simple system may be used for cheap, reusable and chemical free disinfection of public places. This system is also suitable to destroy the airborne viruses. But the process of disinfection must be performed in absence of human to avoid the harmful effect of UV rays on skin.
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Affiliation(s)
- Sushanta Debnath
- Department of Electrical Engineering, Gomati District Polytechnic, Udaipur, Tripura, 799013, India.
| | - Mohiul Islam
- Department of ECE, CMR College of Engineering & Technology, Hyderabad, Telangana, 501401, India.
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Effectiveness of ultraviolet light for disinfection in the OR. AORN J 2022; 115:P11. [PMID: 35213046 DOI: 10.1002/aorn.13638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Debnath S. Low Cost Homemade System to Disinfect Food Items from SARS-CoV-2. J Med Syst 2020; 44:126. [PMID: 32474656 PMCID: PMC7261208 DOI: 10.1007/s10916-020-01594-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/21/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Sushanta Debnath
- Department of Electrical Engineering, Gomati District Polytechnic, Udaipur, Tripura, 799013, India.
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Kyle E. Clinical Issues-May 2020. AORN J 2020; 111:558-566. [PMID: 32343383 DOI: 10.1002/aorn.13036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Using Failure Modes and Effects Analysis to improve special-order implant procurement Key words: Failure Modes and Effects Analysis (FMEA), implant procurement, special-order implant, risk profile number (RPN), interdisciplinary teamwork. Heat stress among perioperative personnel Key words: heat stress, environmental conditions, task performance, surgical tasks, OR temperature. Venous thromboembolism prevention for bariatric surgery patients Key words: venous thromboembolism (VTE), prophylactic measures, bariatric surgery, risk factors, prevention protocol. Disinfecting case carts using ultraviolet light systems Key words: environmental cleaning, decontamination, case cart, ultraviolet (UV) light system, pulsed xenon.
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Sunshine WL. Using Ultraviolet Light Technology to Enhance Cleaning in Health Care Settings. AORN J 2020; 111:486-489. [PMID: 32343390 DOI: 10.1002/aorn.13017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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11
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Armellino D, Goldstein K, Thomas L, Walsh TJ, Petraitis V. Comparative evaluation of operating room terminal cleaning by two methods: Focused multivector ultraviolet (FMUV) versus manual-chemical disinfection. Am J Infect Control 2020; 48:147-152. [PMID: 31796341 DOI: 10.1016/j.ajic.2019.10.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/07/2019] [Accepted: 10/07/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND This non-randomized comparative observational study evaluated the performance of a standard manual-chemical disinfection process with an automated process employing focused multivector ultraviolet (FMUV) light technology during operating room (OR) terminal cleaning. METHODS An Association of periOperative Registered Nurses terminal cleaning protocol was modified to incorporate the use of automated FMUV technology that allows workers to occupy the room during operation. This modified protocol was compared with a standard manual-chemical cleaning and disinfection protocol. Equipment surfaces were pre-sampled before and after terminal cleaning. A total of 165 objects were sampled in each process using a 5-point multisided sampling method. RESULTS The parallel process employing FMUV reduced the active microbial burden by 96.5% from baseline (P < .0001), which was over 2.5 times better than the standard process. The standard terminal manual-chemical disinfection process reduced the active microbial burden on sampled objects by 38.4% from baseline (P < .0001). CONCLUSIONS The data demonstrates that the performance of standard manual-chemical disinfection alone is variable in a live clinical setting even under the most ideal conditions. By comparison, automated FMUV treatment incorporated in a parallel process consistently produced thorough and significant reductions of microbial contamination levels on all visibly clean patient care equipment.
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Armellino D, Walsh TJ, Petraitis V, Kowalski W. Assessing the Feasibility of a Focused Multivector Ultraviolet System Between Surgery Cases with a Parallel Protocol for Enhanced Disinfection Capabilities. Am J Infect Control 2019; 47:1006-1008. [PMID: 30904373 DOI: 10.1016/j.ajic.2019.02.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 02/12/2019] [Accepted: 02/12/2019] [Indexed: 11/17/2022]
Abstract
A focused multivector ultraviolet (FMUV) light system was used in a parallel process with manual chemical disinfection during operating room (OR) turnovers to assess the impact on cleaning time. The average time to disinfect an OR using only chemical wipes and mops was 19.0 minutes (n = 68); for the FMUV process, the average time was 18.8 minutes (n = 61). The mean cleaning times were equivalent within a 7% margin (P < .17), and total turnover time was not significantly affected.
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Affiliation(s)
| | - Thomas J Walsh
- Infectious Diseases Translational Research Laboratory, Weill Cornell Medicine, Cornell University, New York, NY
| | - Vidmantas Petraitis
- Infectious Diseases Translational Research Laboratory, Weill Cornell Medicine, Cornell University, New York, NY
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