Advertisement

Clostridium difficile infections before and during use of ultraviolet disinfection

      Background

      We previously reported a significant decrease in hospital-acquired (HA) Clostridium difficile infection (CDI) coincident with the introduction of pulsed xenon ultraviolet light for room disinfection (UVD). The purpose of this study was to evaluate CDI cases in greater detail to understand the effect of UVD.

      Methods

      CDI rates (HA and community acquired [CA]), CDI patient length of stay, room occupancy, and number of days between a CDI case in a room and an HA CDI case in the same room were studied for the first year of UVD compared with the 1-year period pre-UVD.

      Results

      Compared with pre-UVD, during UVD, HA CDI was 22% less (P = .06). There was a 70% decrease for the adult intensive care units (ICUs) (P < .001), where the percentage of room discharges with UVD was greater (P < .001). During UVD, CA CDI increased by 18%, and length of stay of all CDI cases was lower because of the greater proportion of CA CDI. No significant difference was found in days to HA CDI in rooms with a prior CDI occupant.

      Conclusion

      These data suggest that UVD contributed to a reduction in ICU-acquired CDI where UVD was used for a larger proportion of discharges. Evaluation of UVD should include data for hospitalized CA CDI cases because these cases may impact the HA CDI rate.

      Key Words

      To read this article in full you will need to make a payment

      References

        • Loo V.G.
        • Poirier L.
        • Miller M.A.
        • Oughton M.
        • Libman M.D.
        • Michaud S.
        • et al.
        A predominantly clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality.
        N Engl J Med. 2005; 353: 2442-2449
        • Gerding D.N.
        • Muto C.A.
        • Owens Jr., R.C.
        Measures to control and prevent Clostridium difficile infection.
        Clin Infect Dis. 2008; 46: S43-S49
        • Abbett S.K.
        • Yokoe D.S.
        • Lipsitz S.R.
        • Bader A.M.
        • Berry W.R.
        • Tamplin E.M.
        • et al.
        Proposed checklist of hospital interventions to decrease the incidence of healthcare-associated Clostridium difficile infection.
        Infect Control Hosp Epidemiol. 2009; 30: 1062-1069
        • McFarland L.V.
        • Mulligan M.E.
        • Kwok R.Y.
        • Stamm W.E.
        Nosocomial acquisition of Clostridium difficile infection.
        N Engl J Med. 1989; 320: 204-210
        • McFarland L.V.
        What's lurking under the bed? Persistence and predominance of particular Clostridium difficile strains in a hospital and the potential role of environmental contamination.
        Infect Control Hosp Epidemiol. 2002; 23: 639-640
        • Riggs M.M.
        • Sethi A.K.
        • Zabarsky T.F.
        • Eckstein E.C.
        • Jump R.L.
        • Donskey C.J.
        Asymptomatic carriers are a potential source for transmission of epidemic and nonepidemic Clostridium difficile strains among long-term care facility residents.
        Clin Infect Dis. 2007; 45: 992-998
        • Bobulsky G.S.
        • Al-Nassir W.N.
        • Riggs M.M.
        • Sethi A.K.
        • Donskey C.J.
        Clostridium difficile skin contamination in patients with C. difficile-associated disease.
        Clin Infect Dis. 2008; 46: 447-450
        • Trillis 3rd, F.
        • Eckstein E.C.
        • Budavich R.
        • Pultz M.J.
        • Donskey C.J.
        Contamination of hospital curtains with healthcare-associated pathogens.
        Infect Control Hosp Epidemiol. 2008; 29: 1074-1076
        • Vajravelu R.K.
        • Guerrero D.M.
        • Jury L.A.
        • Donskey C.J.
        Evaluation of stethoscopes as vectors of Clostridium difficile and methicillin-resistant Staphylococcus aureus.
        Infect Control Hosp Epidemiol. 2012; 33: 96-98
        • Guerrero D.M.
        • Nerandzic M.M.
        • Jury L.A.
        • Jinno S.
        • Chang S.
        • Donskey C.J.
        Acquisition of spores on gloved hands after contact with the skin of patients with Clostridium difficile infection and with environmental surfaces in their rooms.
        Am J Infect Control. 2012; 40: 556-558
        • Jury L.A.
        • Guerrero D.M.
        • Burant C.J.
        • Cadnum J.L.
        • Donskey C.J.
        Effectiveness of routine patient bathing to decrease the burden of spores on the skin of patients with Clostridium difficile infection.
        Infect Control Hosp Epidemiol. 2011; 32: 181-184
        • Sethi A.K.
        • Al-Nassir W.N.
        • Nerandzic M.M.
        • Bobulsky G.S.
        • Donskey C.J.
        Persistence of skin contamination and environmental shedding of Clostridium difficile during and after treatment of C. difficile infection.
        Infect Control Hosp Epidemiol. 2010; 31: 21-27
        • Jinno S.
        • Kundrapu S.
        • Guerrero D.M.
        • Jury L.A.
        • Nerandzic M.M.
        • Donskey C.J.
        Potential for transmission of Clostridium difficile by asymptomatic acute care patients and long-term care facility residents with prior C. difficile infection.
        Infect Control Hosp Epidemiol. 2012; 33: 638-639
        • Shaughnessy M.K.
        • Micielli R.L.
        • DePestel D.D.
        • Arndt J.
        • Strachan C.L.
        • Welch K.B.
        • et al.
        Evaluation of hospital room assignment and acquisition of Clostridium difficile infection.
        Infect Control Hosp Epidemiol. 2011; 32: 201-206
        • Kim K.H.
        • Fekety R.
        • Batts D.H.
        • Brown D.
        • Cudmore M.
        • Silva Jr., J.
        • et al.
        Isolation of Clostridium difficile from the environment and contacts of patients with antibiotic-associated colitis.
        J Infect Dis. 1981; 143: 42-50
        • Cohen S.H.
        • Gerding D.N.
        • Johnson S.
        • Kelly C.P.
        • Loo V.G.
        • McDonald L.C.
        • et al.
        Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the society for healthcare epidemiology of America (SHEA) and the infectious diseases society of America (IDSA).
        Infect Control Hosp Epidemiol. 2010; 31: 431-455
        • Mayfield J.L.
        • Leet T.
        • Miller J.
        • Mundy L.M.
        Environmental control to reduce transmission of Clostridium difficile.
        Clin Infect Dis. 2000; 31: 995-1000
        • Carling P.C.
        • Von Beheren S.
        • Kim P.
        • Woods C.
        • Healthcare Environmental Hygiene Study Group
        Intensive care unit environmental cleaning: an evaluation in sixteen hospitals using a novel assessment tool.
        J Hosp Infect. 2008; 68: 39-44
        • Eckstein B.C.
        • Adams D.A.
        • Eckstein E.C.
        • Rao A.
        • Sethi A.K.
        • Yadavalli G.K.
        • et al.
        Reduction of Clostridium Difficile and vancomycin-resistant Enterococcus contamination of environmental surfaces after an intervention to improve cleaning methods.
        BMC Infect Dis. 2007; 7: 61
        • Sitzlar B.
        • Deshpande A.
        • Fertelli D.
        • Kundrapu S.
        • Sethi A.K.
        • Donskey C.J.
        An environmental disinfection odyssey: evaluation of sequential interventions to improve disinfection of Clostridium difficile isolation rooms.
        Infect Control Hosp Epidemiol. 2013; 34: 459-465
        • Guerrero D.M.
        • Carling P.C.
        • Jury L.A.
        • Ponnada S.
        • Nerandzic M.M.
        • Donskey C.J.
        Beyond the Hawthorne effect: reduction of Clostridium difficile environmental contamination through active intervention to improve cleaning practices.
        Infect Control Hosp Epidemiol. 2013; 34: 524-526
        • Kundrapu S.
        • Sunkesula V.
        • Jury L.A.
        • Sitzlar B.M.
        • Donskey C.J.
        Daily disinfection of high-touch surfaces in isolation rooms to reduce contamination of healthcare workers' hands.
        Infect Control Hosp Epidemiol. 2012; 33: 1039-1042
        • Donskey C.J.
        Preventing transmission of Clostridium difficile: is the answer blowing in the wind?.
        Clin Infect Dis. 2010; 50: 1458-1461
        • Weber D.J.
        • Rutala W.A.
        Understanding and preventing transmission of healthcare-associated pathogens due to the contaminated hospital environment.
        Infect Control Hosp Epidemiol. 2013; 34: 449-452
        • Nerandzic N.M.
        • Cadnum J.I.
        • Pultz M.J.
        • Donsky 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
        • Rastogi V.K.
        • Wallace L.
        • Smith L.S.
        Disinfection of Acinetobacter baumannii- contaminated surfaces relevant to medical treatment facilities with ultraviolet C light.
        Mil Med. 2007; 172: 1166-1169
        • Rutala W.A.
        • Gergen M.F.
        • Weber D.J.
        Room decontamination with UV radiation.
        Infect Control Hosp Epidemiol. 2010; 31: 1025-1029
        • Boyce J.M.
        • Havill N.L.
        • Moore B.A.
        Terminal decontamination of patient rooms using an automated mobile UV light unit.
        Infect Control Hosp Epidemiol. 2011; 32: 737-742
        • Nerandzic M.M.
        • Cadnum J.L.
        • Eckart K.E.
        • Donskey C.J.
        Evaluation of a hand-held far-ultraviolet radiation device for decontamination of Clostridium difficile and other healthcare-associated pathogens.
        BMC Infect Dis. 2012; 12: 120
        • Sitzlar B.
        • Vajravelu R.K.
        • Jury L.
        • Donskey C.J.
        • Jump R.L.
        Environmental decontamination with ultraviolet radiation to prevent recurrent Clostridium difficile infection in 2 roommates in a long-term care facility.
        Infect Control Hosp Epidemiol. 2012; 33: 534-536
        • Stibich M.
        • Stachowiak J.
        • Tanner B.
        • Berkheiser M.
        • Moore L.
        • Raad I.
        • et al.
        Evaluation of a pulsed-xenon ultraviolet room disinfection device for impact on hospital operations and microbial reduction.
        Infect Control Hosp Epidemiol. 2011; 32: 286-288
        • Haas J.P.
        • Menz J.
        • Ortiz P.
        • Montecalvo M.A.
        Implementation and impact of ultraviolet environmental disinfection in an acute care setting.
        Am J Infect Control. 2014; 42: 586-590
        • Rosner B.
        Fundamentals of Biostatistics.
        6th ed. Duxbury Press, Belmont, CA2006
      1. New York State Department of Health. Hospital-acquired infections: New York State 2013. Available from: https://www.health.ny.gov/statistics/facilities/hospital/hospital_acquired_infections/2013/docs/hospital_acquired_infection.pdf. January 31, 2015.

        • Dubberke E.R.
        • Reske K.A.
        • Olsen M.A.
        • McMullen K.M.
        • Mayfield J.L.
        • McDonald L.C.
        • et al.
        Evaluation of Clostridium difficile –associated disease pressure as a risk factor for C. difficile–associated disease.
        Arch Intern Med. 2007; 167: 1092-1097
        • Eyre D.W.
        • Cule M.L.
        • Wilson D.J.
        • Griffiths D.
        • Vaughan A.
        • O'Connor L.
        • et al.
        Diverse sources of C. difficile infection identified on whole-genome sequencing.
        N Engl J Med. 2013; 369: 1195-1205
      2. Xenex. Reducing healthcare associated infections (HAIs): not all UV light is the same. Available from: http://www.xenex.com/article/reducing-healthcare-associated-infections-hais-uv-light. January 31, 2015.

        • Nerandzic M.M.
        • Thota P.
        • Sankar C.T.
        • Jencson A.
        • Cadnum J.L.
        • Ray A.J.
        • et al.
        Evaluation of a pulsed xenon ultraviolet disinfection system for reduction of healthcare-associated pathogens in hospital rooms.
        Infect Control Hosp Epidemiol. 2015; 36: 192-197