Ultraviolet-C Light Evaluation as Adjunct Disinfection to Remove Multi-Drug Resistant Organisms

Abstract

Abstract Background Our objective was to determine if the addition of UV-C light to daily and discharge patient room cleaning reduces healthcare-associated infection rates of vancomycin-resistant enterococci (VRE) and Clostridioides difficile (C. difficile) in immunocompromised adults. Methods We performed a cluster randomized crossover control trial in four cancer and one solid organ transplant in-patient units at the Johns Hopkins Hospital, Baltimore, Maryland. For study year one, each unit was randomized to intervention of UV-C light plus standard environmental cleaning or control of standard environmental cleaning, followed by a 5-week washout period. In study year two, units switched assignments. The outcomes were healthcare-associated rates of VRE or C. difficile. Statistical inference used a two-stage approach recommended for cluster-randomized trials with <15 clusters/arm. Results 302 new VRE infections were observed during 45,787 at risk patient-days. The incidence in control and intervention groups was 6.68 and 6.52 per 1,000 patient-days respectively; the unadjusted incidence rate ratio (IRR) was 0.98 (95% confidence interval [CI], 0.78 − 1.22; P=0.54). There were 84 new C. difficile infections observed during 26,118 at risk patient-days. The incidence in control and intervention periods was 2.64 and 3.78 per 1000 patient-days respectively; the unadjusted IRR was 1.43 (95% CI, 0.93 − 2.21; P=0.98). Conclusions When used daily and at post discharge in addition to standard environmental cleaning, UV-C disinfection did not reduce VRE or C. difficile infection rates in cancer and solid organ transplant units.