st. cloud va hcs - tru-d...

St. Cloud VA HCS

Infection Prevention: Ultraviolet Disinfection Trial

Tina Schmidt, BSN, RN, CIC Infection Prevention Nurse

Paulette Masberg, BSN, RN MDRO Coordinator

January 2017

VETERANS HEALTH ADMINISTRATION

Ultraviolet (UV) Disinfection Trial

• Utilized TRU-D Ultraviolet (UV) Disinfection, Friday 12/16/2016, thru Friday 12/23/2016

• Locations:

– Operating Rooms

– Endoscopy

– Urology

– Community Living Center (CLC), Resident Rooms (Rms)

• Adenosine Triphosphate (ATP) swabbing Prior and Post TRU-D for Bioburden testing

• Environmental Swabbing Prior and Post TRU-D for organism testing

1


Pre & Post ATP Swab Results Measured by Relative Light Units (RLU),

Operating Rm 2 (Friday, 12/16/2016)

10796 90

3321 16 11 8

-22

-50

0

50

100

150

200

250

300

OmnicellKeyboard

TelephoneNurses

Station (back)

AnethesiaBreathing

TubeConnector

Room LightSwitch

OR overhead(exam) light

handle

OR Bed Boom OR WallPhone

ARCKeyboard

Re

lati

ve

Lig

ht

Un

its

(R

LU

)

Variance Pre Post Pass/Fail Threshold



Endoscopy Rm 251 (Friday, 12/16/2016)

1,126

940

796 781

260 253202

15940

-93

-200

0

200

400

600

800

1000

1200

1400

E-pad Pen Olympusmonitor

Pole

DoorHandle

OmnicellKeyboard

Door LightSwitch

Tray Table Bed Rail lap TopKeyboard

Olympusscreen

Treatmentcart handle

Re

lati

ve

Lig

ht

Un

it (

RL

U)




Operating Rm 1 (Monday, 12/19/2016)

488

74 42 36 17 6 0-1 -11 -57

-100

0

100

200

300

400

500

600

700

800

Room InnerDoor Knob

AnethesiaBreathing

TubeConnector

Boom TelephoneNursesStation

OR Bed ARCKeyboard

ORoverhead

(exam) lighthandle

Room LightSwitch

OmnicellKeyboard

Glidescope

Rela

tiv

e L

igh

t U

nit

(R

LU

)




Urology Rm 246 (Monday, 12/19/2016)

255

182

163

96 91

3827 8 -1 -2

-50

0

50

100

150

200

250

300

DesktopComputer

Mouse

VS MonitorHandle

Door Handle OlympusMonitorScreen

Bed handHeld Controls

(right)

SiemensRotator Ball

SiemensKeyboard

Door LightSwitch

Olympusscreen (touch

pad keys)

TreatmentCart Handle

Re

lati

ve

Lig

ht

Un

it (

RL

U)



Pre & Post ATP Swab Results Measured by Relative Light Units(RLU),

CLC 49-1 Rm 122B (Tuesday, 12/20/2016)

731

471

199165

90 67 54 19-26 -58

-200

0

200

400

600

800

1000

1200

1400

Bed RailHandle

Interior DoorKnob

Wall call light(green

button)

Top DrawerHandle

Bed ControlButtons

Trapeze Bar O2 regulator(green knob)

PhoneButtons

BulletinBoard

Thum Tac

Re

lati

ve

Lig

ht

Un

it (

RL

U)


12

CLC 49-1, Room 122B. The nurse call light grew 2 colonies: GPR and GNR

pre TRU-D. The bed buttons grew 2 colonies: GPR and GNR pre TRU-D.

After TRU-D disinfection there was no growth noted on the plate.



CLC 49-1 Rm 123 (Tuesday, 12/20/2016)

3,624

539388 130 102 81 75 61 57 46

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

InteriorDoor Knob

Nurse Call(wall mount)

Bed ControlButtons

Bed Rail PhoneButtons

BulletinBoard

Top DrawerHandle

YellowThumb Tac

o2 regulatorKnob

TrapezeBar

Re

lati

ve

Lig

ht

Un

its

(R

LU

)




Dental Procedure Rm (Wednesday, 12/21/2016)

547

393

163 150 138121

66 43 40 160

100

200

300

400

500

600

700

Inner RoomDoor

Handle

KeyboardMouse

Right ArmBoard

TelephoneKeypad

Alaris Pump DCIInternational

Drill Tool

Tray Table VS Monitor(Grey Knob)

DCIInternationalH20 Flush

Tool

Exam LightHandle

Re

lati

ve

Lig

ht

Un

its

(R

LU

)




Operating Rm 3 (Thursday, 12/22/2016)

455

228

9683

26 19 13 9 7 00

50

100

150

200

250

300

350

400

450

500

OR Bed AnethesiaBreathing

TubeConnector

Room InnerDoor Knob(going to

clean core)

OmnicellKeyboard

Boom ARCKeyboard

ORoverhead

(exam) lighthandle

Glidescope Room LightSwitch

OR WallPhone

Re

lati

ve

Lig

ht

Un

its

(R

LU

)




Operating Rm 2 (Friday, 12/23/2016)

24

95

64

33 30 19 12 11 8 8 10

50

100

150

200

250

300

AnethesiaBreathing

TubeConnector

Boom OmnicellKeyboard

ARCKeyboard

OR Bed ORoverhead

(exam) lighthandle

OR WallPhone

Room LightSwitch

Glidescope Room InnerDoor Knob(going to

clean core)

Re

lati

ve

Lig

ht

Un

its

(R

LU

)




Endoscopy Rm 251 (Wednesday, 12/21/2016)

25

1,480

435390 368 359

144 143 53 44 90

100

200

300

400

500

600

700

800

900

1000

1100

1200

1300

1400

1500

1600

1700

1800

Exam LightHandle

Lap TopMouse

Grab Barback of Bed

Interior DoorHandle

Bed Controls Light Switchby Door

EPAD Pen Omnicellkeyboard

LaptopKeyboard

OlympusTouchscreen

Re

lati

ve

Lig

ht

Un

its

(R

LU

)


No Environmental Cultures obtained due to lack of swab availability.



CLC 50-2 (Wednesday, 12/21/2016)

26

767

130

85 72 64 41 10 8 7

-44

-100

0

100

200

300

400

500

600

700

800

Sink Handle(HOT)

DrawerHandle (top)

Light Switchby Bathroom

Telephonekeypad

Door Handle(inner)

Bed RailHandle

VCR PowerButton

Bed ControlButtons

Lift ControlButtons

Nurse/TVControl

Re

lati

ve

Lig

ht

Un

its

(R

LU

)




Urology Rm 244 (Wednesday, 12/21/2016)

27

3,088

885

525448

312 283 101 83 27 250

100200300400500600700800900

1,0001,1001,2001,3001,4001,5001,6001,7001,8001,9002,0002,1002,2002,3002,4002,5002,6002,7002,8002,9003,0003,1003,2003,3003,4003,500

COWKeyboard

Tele HealthPhone

BladderScan Touch

Screen

Door Handle(interior)

EPAD Pen COW Mouse StethescopeBell

Head Rest Light switch(by door)

Bed

Re

lati

ve

Lig

ht

Un

its

(R

LU

)



UV Disinfection Trial : ATP Swapping Summary

• 130 total ATP swabs performed (10 swabs before TRU-D, and 10 swabs after TRU-D per room)

• 121 ATP swabs out of the total 130 ATP swabs showed a reduction in bioburden (as measured by relative light units (RLU) after the use of TRU-D.

• 9 swabs showed an increase in bioburden

• 1 of the nine was inadvertently re-touched after TRU-D before post-ATP swab, which would increase the RLU.

• 121/130=93% reduction in RLU

32


UV Disinfection Trial: Environmental Swabbing Summary

• 40 environmental swabs were performed (2-4 swabs before TRU-D and 2-4 swabs after TRU-D per room). Endoscopy Room 251 on 12/21/2016 did not have environmental swabbing performed due to swab supply availability at the time.

• 23 of the 40 environmental swabs grew organisms before the use of TRU-D

• 40 out of 40 environmental swabs showed no growth after the use of TRU-D

• 51 total colonies were identified out of the total 40 environmental swabs obtained before the use of TRU-D UV Disinfection.

• Gram-positive Cocci, Gram positive rods, Gram negative coccobacilli, Gram-positive diplococci and GPCR were identified pre TRU-D

• 0 colonies grew after the use of TRU-D UV Disinfection.

33


UV Disinfection (TRU-D) Cycle Time & Ease of Use

• Varies with:

– Size of Room

– How Much/Type equipment is in the room

– Disinfection time ranged from 21 minutes, to 1 hour 20minutes

• Ease of Use:

– Room prepped by opening drawers and pulling equipment away from walls (<5 min)

– Device tells you if placement is ideal or a move is recommended.

– Staff can set up the device to alert you by cell phone when disinfection is complete

– Staff able to perform other duties while UV cycle is running

– Automatically turns off when someone enters the room (safety device)

34


Acquisition Costs

• Currently on FSS Contract V797P-4135B

• Procurement Cost is $88,605 per machine

– Includes training, manuals, 1 yr parts/service warrenty and first year service agreement

• Service contract costs for follow on years is $8,950 per machine.

– Includes bulb replacement

– Includes upgrades

• Life Expectancy is 7+ years

– Tru-D has machines still in use since being put purchased in 2007

• $.059 Cost per Outpatient Visit at St Cloud spread out over seven years

– 365,925 Outpatient Visits at St Cloud yearly

– $151K for acquisition of machine and service contracts.

35


Conclusion

• Our data confirms that UV Disinfection (TRU-D) can decrease the bioburden of important pathogens in real-world settings as demonstrated by the operating rooms, Endoscopy Suites, urology procedure rooms, and the CLC.

• Our data also confirms that UV Disinfection (TRU-D) effectively eliminated all colony growth that was present on our environmental surfaces prior to the utilization of TRU-D.

• After using UV Disinfection (TRU-D) the environmental swabs showed “no colony growth”.

• Routine use of UV disinfection is a feasible addition to current infection control and EMS measures, and may help reduce rates of healthcare associated infections and ensure our Veterans a clean, safe environment for their healthcare.

36

st. cloud va hcs - tru-d...

Documents