Assessment of focused multivector ultraviolet disinfection withshadowless delivery using 5-point multisided sampling ofpatientcare equipment without manual-chemical disinfection

Published:November 27, 2018DOI:


      The aim of this study was to evaluate the performance of a focused multivector ultraviolet (FMUV) system employing shadowless delivery with a 90-second disinfection cycle for patient care equipment inside and outside the operating room (OR) suite without manual-chemical disinfection.


      A 5-point multisided sampling protocol was utilized to measure the microbial burden on objects inside and outside the OR environment in a 3-phase nonrandomized observational study. Surface sampling was performed pre- and postdisinfection in between cases (IBCs) to assess the performance of manual-chemical disinfection. FMUV system performance was separately assessed pre- and postdisinfection before the first case and IBCs. Additionally, visibly clean high-touch objects were sampled outside the OR, and the microbial burden reductions after FMUV disinfection were quantified without manual-chemical disinfection.


      Manual-chemical disinfection reduced the active microbial burden on sampled objects IBCs by 52.8%-90.9% (P < .05). FMUV reduced the active microbial burden by 92%-97.7% (P < .0001) before the firstcase and IBCs combined, and 96.3%-99.6% (P < .0001) on objects outside the OR without chemical disinfection.


      Five-point multisided sampling proved effective for assessing disinfection performance on all exterior sides of equipment. FMUV produced significant overall reductions of the microbial burden on patient care equipment in all study phases and independent of manual cleaning and chemical disinfection.

      Key Words

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

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Infection Control
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Rupp ME
        • Adler A
        • Schellen M
        • Cassling K
        • Fitzgerald T
        • Sholtz L
        • et al.
        The time spent cleaning a hospital room does not correlate with the thoroughness of cleaning.
        Infect Control Hosp Epidemiol. 2013; 34: 100-102
      1. Wood A, Conner R. Guideline for environmental cleaning. In: Conner R, editor.Guidelines for perioperative practice. Denver (CO): AORN Inc; 2018. p.7-28.

        • Penno K
        • Jandarov RA
        • Sopirala MM
        Effect of automated ultraviolet C-emitting device on decontamination of hospital rooms with and without real-time observation of terminal room disinfection.
        Am J Infect Control. 2017; 45: 1208-1213
        • Boyce JM
        • Havill NL
        • Dumigan DG
        • Golebiewski M
        • Balogun O
        • Rizvani R
        Monitoring the effectiveness of hospital cleaning practices by use of an adenosine triphosphate bioluminescence assay.
        Infect Control Hosp Epidemiol. 2009; 30: 678-684
        • Armellino D
        Minimizing sources of airborne, aerosolized, and contact contaminants in the OR environment.
        AORN J. 2017; 106: 494-501
        • Rutala WA
        • Weber DJ
        Monitoring and improving the effectiveness of surface cleaning and disinfection.
        Am J Infect Control. 2016; 44: e69-e76
        • Weber DJ
        • Rutala WA
        • Anderson DJ
        • Chen LF
        • Sickbert-Bennett EE
        • Boyce JM
        Effectiveness of ultraviolet devices and hydrogen peroxide systems for terminalroom decontamination: focus on clinical trials.
        Am J Infect Control. 2016; 44: e77-e84
        • Fornwalt L
        • Ennis D
        • Stibich M
        Influence of a total joint infection control bundle on surgical site infection rates.
        Am J Infect Control. 2016; 44: 239-241
        • Catalanotti A
        • Abbe D
        • Simmons S
        • Stibich M
        Influence of pulsed-xenon ultraviolet light-based environmental disinfection on surgical site infections.
        Am J Infect Control. 2016; 44: e99-101
        • Anderson DJ
        • Knelson LP
        • Moehring RW
        • Lewis SS
        • Weber DJ
        • Chen LF
        • et al.
        Implementation lessons learned from the benefits of enhanced terminal room (BETR) disinfection study: process and perceptions of enhanced disinfection with ultraviolet disinfection devices.
        Infect Control Hosp Epidemiol. 2018; 39: 157-163
        • Anderson DJ
        • Gergen MF
        • Smathers E
        • Sexton DJ
        • Chen LF
        • Weber DJ
        • et al.
        Decontamination of targeted pathogens from patient rooms using an automated ultraviolet-C-emitting device.
        Infect Control Hosp Epidemiol. 2013; 34: 466-471
        • Jelden KC
        • Gibbs SG
        • Smith PW
        • Hewlett AL
        • Iwen PC
        • Schmid K
        • et al.
        Comparison of hospital room surface disinfection using a novel ultraviolet germicidal irradiation (UVGI) generator.
        J Occup Environ Hyg. 2016; 13: 690-698
        • Jinadatha C
        • Villamaria FC
        • Ganachari-Mallappa N
        • Brown DS
        • Liao I-C
        • Stock EM
        • et al.
        Can pulsed xenon ultraviolet light systems disinfect aerobic bacteria in the absence of manual disinfection?.
        Am J Infect Control. 2015; 43: 415-417
        • Wong T
        • Woznow T
        • Petrie M
        • Murzello E
        • Muniak A
        • Kadora A
        • et al.
        Postdischarge decontamination of MRSA, VRE, and Clostridium difficile isolation rooms using 2 commercially available automated ultraviolet-C-emitting devices.
        Am J Infect Control. 2016; 44: 416-420
        • Simmons S
        • Dale C
        • Holt J
        • Passey D
        • Stibich M
        Environmental effectiveness of pulsed-xenon light in the operating room.
        Am J Infect Control. 2018; 46: 1003-1008
        • Anderson DJ
        • Chen LF
        • Weber DJ
        • Moehring RW
        • Lewis SS
        • Triplett PF
        • et al.
        Enhanced terminal room disinfection and acquisition and infection caused by multidrug-resistant organisms and Clostridium difficile (the benefits of enhanced terminal room disinfection study): a cluster-randomised, multicentre, crossover study.
        Lancet. 2017; 389: 805-814
        • Marra AR
        • Schweizer ML
        • Edmond MB
        No-touch disinfection methods to decrease multidrug-resistant organism infections: a systematic review and meta-analysis.
        Infect Control Hosp Epidemiol. 2018; 39: 20-31
        • Link T
        • Kleiner C
        • Mancuso MP
        • Dziadkowiec O
        • Halverson-Carpenter K
        Determining high touch areas in the operating room with levels of contamination.
        Am J Infect Control. 2016; 44: 1350-1355
        • Richard RD
        • Bowen TR
        What orthopaedic operating room surfaces are contaminated with bioburden? A study using the ATP bioluminescence assay.
        Clin Orthop Relat Res. 2017; 475: 1819-1824
        • Munoz-Price LS
        • Birnbach DJ
        • Lubarsky DA
        • Arheart KL
        • Fajardo-Aquino Y
        • Rosalsky M
        • et al.
        Decreasing operating room environmental pathogen contamination through improved cleaning practice.
        Infect Control Hosp Epidemiol. 2012; 33: 897-904
        • Balkissoon R
        • Nayfeh T
        • Adams KL
        • Belkoff SM
        • Riedel S
        • Mears SC
        Microbial surface contamination after standard operating room cleaning practices following surgical treatment of infection.
        Orthopedics. 2014; 37: e339-e344
        • Nottingham M
        • Peterson G
        • Doern C
        • Doll M
        • Masroor N
        • Sanogo K
        • et al.
        Ultraviolet-C light as a means of disinfecting anesthesia workstations.
        Am J Infect Control. 2017; 45: 1011-1013
        • Rutala WA
        • Gergen MF
        • Weber DJ
        Room decontamination with UV radiation.
        Infect Control Hosp Epidemiol. 2010; 31: 1025-1029
        • El Haddad L
        • Ghantoji SS
        • Stibich M
        • Fleming JB
        • Segal C
        • Ware KM
        • et al.
        Evaluation of a pulsed xenon ultraviolet disinfection system to decrease bacterial contamination in operating rooms.
        BMC Infect Dis. 2017; 17: 672
        • Green C
        • Pamplin JC
        • Chafin KN
        • Murray CK
        • Yun HC
        Pulsed-xenon ultraviolet light disinfection in a burn unit: impact on environmental bioburden, multidrug-resistant organism acquisition and healthcare associated infections.
        Burns. 2017; 43: 388-396