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Background: Manual cleaning and disinfection of the operating room (OR) environment may be inadequate due to human error. No-touch technologies, such as pulsed-xenon ultraviolet light (PX-UV), can be used as an adjunct to manual cleaning processes to reduce surface contamination in the OR. This article reports the cumulative results from 23 hospitals across the United States that performed microbiologic validation of PX-UV disinfection after manual cleaning

Methods: We obtained samples from 732 high-touch surfaces in 136 ORs at 23 hospitals, after manual terminal cleaning, and again after PX-UV disinfection (n = 1464 surface samples). Samples were enumerated after incubation, and the results are reported as total colony-forming units (CFU).

Results: The average CFU after manual cleaning ranged from 5.8 to 34.37, and after PX-UV, from 0.69 to 6.43. With manual cleaning alone, 67% of surfaces were still positive for CFUs; after PX-UV disinfection, that number decreased to 38% of all sampled surfaces—a 44% reduction. When comparing manual cleaning to PX-UV, the reduction in CFU count was statistically significant.

Conclusion: When used after the manual cleaning process, the PX-UV device significantly reduced contamination on high-touch surfaces in the OR.

 

Surgical Site Infection (SSIs)

A surgical site infections (SSIs) is an infection that occurs after surgery in the part of the body where the surgery took place. The SSIs occurring within 30 days after a surgical operation (or within one year if an implant is left in place after the procedure) and affecting either the incision or deep tissue at the operation site. These infections may be superficial or deep incisional infections, or infections involving organs or body spaces.  Prevalence study conducted in 2011 found that SSIs are the most common hospital associated infection (HAIs), representing 22% of all reported cases. Patients who develop a SSIs will spend additional days in the hospital, and because additional days will increase costs for both the patient and the hospital providing the care from $11,874 to $34,670. (Source: Control and

 

Causes of Surgical Site Infections

  1. Non-sterile Instruments
  2. Patient Factors
  3. Environmental Contamination

Environmental transmission can occur from direct contact with the environment (air or surface) or indirectly from hands that were contaminated by the environment. This interaction of environment and transmission risk could be further complicated in the operating theater, where constant movement of staff members causes air turbulence that disturbs pathogens present on surfaces, causing them to aerosolize. Once the pathogens are in the air, they can resettle onto sterile surgical. instruments, previously cleaned surfaces, or even the open surgical wound.

The relationship between contamination of the Operating Room (OR) environment and increased risk of infection acquisition may be due to a variety of factors:

  1. Duration of time the patient is in the OR
  2. Total number of patients in the OR each day
  3. Scheduling of known infected patients for the end of the day
  4. Complexity of the perioperative environment.

 

  1. Responsible Pathogens

 

 

Pulsed Xenon Ultraviolet

  1. These lamps utilize xenon gas to generate broad-spectrum, high-intensity UV light.
  2. Pulsed xenon technology emits light throughout the germicidal spectrum, ranging from 200 to 320nm.
  3. Pulsed xenon emits UV throughout the germicidal spectrum, and will deactivation of pathogens by inducing thymine dimers with optimum efficiency.

 

 

 

How’s Pulsed Xenon deactive the bacteria?

Four primary mechanisms of cellular damage:

  1. Photohydration: pulling water molecules into the DNA that prevents transcription
  2. Photosplitting, breaking the backbone of the DNA
  3. Photodimerization: improper fusing of DNA bases
  4. Photocrosslinking: which causes abnormal bonding activity in proteins, cell wall damage and potential cell lysis.

 

 

 

Key Strengths of this study:

  1. The large number of samples provide stronger conclusions.
  2. This study demonstrated PX-UV efficacy across a large cross-section of hospitals, each with varying levels of persistent environmental contamination on multiple surfaces à demonstrate efficacy at different levels.

 

The Limitation of this study:

  1. NOT speciate the environmental samples to determine whether the CFUs were pathogenic bacteria commonly associated with SSIs.
  2. NOT examine the threshold for transfer of contamination via aerosolization.
  3. NOT have information on the specific disinfectants that hospitals used, and the manual cleaning was not standardized across hospitals
  4. NOT sample the OR floors, which are likely contaminated prior to manual cleaning and PX-UV.

 

Conclussion

  1. From multiple analysis interpretations, that PX-UV can improves OR surface disinfection beyond standard manual cleaning practice alone.
  2. PX-UV can serve as a useful adjunct for maintaining high-touch surface cleanliness during nightly OR terminal cleaning practice.