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No-Touch Disinfection Methods to Decrease Multidrug-Resistant Organism Infections: A Systematic Review and Meta-analysis

Published online by Cambridge University Press:  16 November 2017

Alexandre R. Marra ,
Marin L. Schweizer  and
Michael B. Edmond
Alexandre R. Marra*
Affiliation:
Office of Clinical Quality, Safety and Performance Improvement, University of Iowa Hospitals and Clinics, Iowa City, Iowa Division of Medical Practice, Hospital Israelita Albert Einstein, São Paulo, Brazil
Marin L. Schweizer
Affiliation:
Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa The Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa Division of General Internal Medicine, Department of Internal Medicine, Carver College of Medicine, Iowa City, Iowa
Michael B. Edmond
Affiliation:
Office of Clinical Quality, Safety and Performance Improvement, University of Iowa Hospitals and Clinics, Iowa City, Iowa Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
*
Address correspondence to Alexandre R. Marra, MD, University of Iowa Hospitals and Clinics, C51 GH, 200 Hawkins Drive, Iowa City, IA 52242 ([email protected]).
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Abstract

BACKGROUND

Recent studies have shown that using no-touch disinfection technologies (ie, ultraviolet light [UVL] or hydrogen peroxide vapor [HPV] systems) can limit the transmission of nosocomial pathogens and prevent healthcare-associated infections (HAIs). To investigate these findings further, we performed a systematic literature review and meta-analysis on the impact of no-touch disinfection methods to decrease HAIs.

METHODS

We searched PubMed, CINAHL, CDSR, DARE and EMBASE through April 2017 for studies evaluating no-touch disinfection technology and the nosocomial infection rates for Clostridium difficile, methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and other multidrug-resistant organisms (MDROs). We employed random-effect models to obtain pooled risk ratio (pRR) estimates. Heterogeneity was evaluated with I2 estimation and the Cochran Q statistic. Pooled risk ratios for C. difficile, MRSA, VRE, and MDRO were assessed separately.

RESULTS

In total, 20 studies were included in the final review: 13 studies using UVL systems and 7 studies using HPV systems. When the results of the UVL studies were pooled, statistically significant reduction ins C. difficile infection (CDI) (pRR, 0.64; 95% confidence interval [CI], 0.49–0.84) and VRE infection rates (pRR, 0.42; 95% CI, 0.28–0.65) were observed. No differences were found in rates of MRSA or gram-negative multidrug-resistant pathogens.

CONCLUSIONS

Ultraviolet light no-touch disinfection technology may be effective in preventing CDI and VRE infection.

Infect Control Hosp Epidemiol 2018;39:20–31

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 1 , January 2018 , pp. 20 - 31
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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References

REFERENCES

1. Magill, SS, Edwards, JR, Bamberg, W, Beldavs, ZG, Dumyati, G, Kainer, MA, Lynfield, R, Maloney, M, McAllister-Hollod, L, Nadle, J, Ray, SM, Thompson, DL, Wilson, LE, Fridkin, SK. Emerging Infections Program Healthcare-Associated Infections and Antimicrobial Use Prevalence Survey Team. Multistate point-prevalence survey of health care-associated infections. N Engl J Med 2014;370:1198–1208.Google Scholar
2. Zimlichman, E, Henderson, D, Tamir, O, Franz, C, Song, P, Yamin, CK, Keohane, C, Denham, CR, Bates, DW. Health care-associated infections: a meta-analysis of costs and financial impact on the US health care system. JAMA Intern Med 2013;173:2039–2046.CrossRefGoogle ScholarPubMed
3. Huang, SS, Datta, R, Platt, R. Risk of acquiring antibiotic-resistant bacteria from prior room occupants. Arch Intern Med 2006;166:1945–1951.CrossRefGoogle ScholarPubMed
4. Weber, DJ, Rutala, WA, Miller, MB, Huslage, K, Sickbert-Bennett, E. Role of hospital surfaces in the transmission of emerging healthcare-associated pathogens: norovirus, Clostridium difficile, and Acinetobacter species. Am J Infect Control 2010;38:S25–S33.CrossRefGoogle Scholar
5. Shaughnessy, MK, Micielli, RL, DePestel, DD, Arndt, J, Strachan, CL, Welch, KB, Chenoweth, CE. Evaluation of hospital room assignment and acquisition of Clostridium difficile infection. Infect Control Hosp Epidemiol 2011;32:201–206.CrossRefGoogle ScholarPubMed
6. Mitchell, BG, Dancer, SJ, Anderson, M, Dehn, E. Risk of organism acquisition from prior room occupants: a systematic review and meta-analysis. J Hosp Infect 2015;91:211–217.Google Scholar
7. Kramer, A, Schwebke, I, Kampf, G. How long do nosocomial pathogens persist on inanimate surfaces? A systematic review. BMC Infect Dis 2006;6:130.Google Scholar
8. Dancer, SJ. Controlling hospital-acquired infection: focus on the role of the environment and new technologies for decontamination. Clin Microbiol Rev 2014;27:665–690.Google Scholar
9. Wenzel, RP, Edmond, MB. Infection control: the case for horizontal rather than vertical interventional programs. Int J Infect Dis 2010;14(S1):S3–S5.Google Scholar
10. Weber, DJ, Anderson, D, Rutala, WA. The role of the surface environment in healthcare-associated infections. Curr Opin Infect Dis 2013;26:338–344.Google Scholar
11. Carling, PC, Parry, MF, Bruno-Murtha, LA, Dick, B. Improving environmental hygiene in 27 intensive care units to decrease multi-drug-resistant bacterial transmission. Crit Care Med 2010;38:1054–1059.CrossRefGoogle Scholar
12. Leas, BF, Sullivan, N, Han, JH, Pegues, DA, Kaczmarek, JL, Umscheid, CA. Environmental cleaning for the prevention of healthcare-associated infections. Rockville, MD: Agency for Healthcare Research and Quality (US); 2015 Aug. Report no.: 15-EHC020-EF.Google Scholar
13. Boyce, JM. Modern technologies for improving cleaning and disinfection of environmental surfaces in hospitals. Antimicrob Resist Infect Control 2016;5:10.Google Scholar
14. Doll, M, Morgan, DJ, Anderson, D, Bearman, G. Touchless technologies for decontamination in the hospital: a review of hydrogen peroxide and UV devices. Curr Infect Dis Rep 2015;17:44.Google Scholar
15. Weber, DJ, Rutala, WA, Anderson, DJ, Chen, LF, Sickbert-Bennett, EE, Boyce, JM. Effectiveness of ultraviolet devices and hydrogen peroxide systems for terminal room decontamination: focus on clinical trials. Am J Infect Control 2016;44(5 Suppl):e77–e84.Google Scholar
16. Weber, DJ, Kanamori, H, Rutala, WA. “No touch” technologies for environmental decontamination: focus on ultraviolet devices and hydrogen peroxide systems. Curr Opin Infect Dis 2016;29:424–431.Google Scholar
17. Moher, D, Liberati, A, Tetzlaff, J, Altman, DG, The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Plos Med 2009;6:e1000097.CrossRefGoogle ScholarPubMed
18. Stroup, DF, Berlin, JA, Morton, SC, Olkin, I, Williamson, GD, Rennie, D, Moher, D, Becker, BJ, Sipe, TA, Thacker, SB. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA 2000;283:2008–2012.Google Scholar
19. Aboelela, SW, Saiman, L, Stone, P, Lowy, FD, Quiros, D, Larson, E. Effectiveness of barrier precautions and surveillance cultures to control transmission of multidrug-resistant organisms: a systematic review of the literature. Am J Infect Control 2006;34:484–494.Google Scholar
20. Cohen, CC, Cohen, B, Shang, J. Effectiveness of contact precautions against multi-drug-resistant organism transmission in acute care: a systematic review of the literature. J Hosp Infect 2015;90:275–284.Google Scholar
21. Alderson, PGS, Higgins, JPT. editors Assessment of study quality. Cochrane reviewer’s handbook 4.2.3 [Updated November 2004]. Chichester, UK: John Wiley & Sons; 2004.Google Scholar
22. Harris, AD, Lautenbach, E, Perencevich, E. A systematic review of quasi-experimental study designs in the fields of infection control and antibiotic resistance. Clin Infect Dis 2005;41:77–82.Google Scholar
23. Boyce, JM, Havill, NL, Otter, JA, McDonald, LC, Adams, NM, Cooper, T, Thompson, A, Wiggs, L, Killgore, G, Tauman, A, Noble-Wang, J. Impact of hydrogen peroxide vapor room decontamination on Clostridium difficile environmental contamination and transmission in a healthcare setting. Infect Control Hosp Epidemiol 2008;29:723–729.CrossRefGoogle Scholar
24. 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–e101.Google Scholar
25. Cooper, T, O’ Leary, Yezli, S, Otter, JA. Impact of environmental decontamination using hydrogen peroxide vapour on the incidence of Clostridium difficile infection in one hospital Trust. J Hosp Infect 2011;78:238–240.Google Scholar
26. Green, C, Pamplin, JC, Chafin, KN, Murray, CK, Yun, HC. Pulsed-xenon ultraviolet light disinfection in a burn unit: Impact on environmental bioburden, multi-drug resistant organism acquisition and healthcare associated infections. Burns 2017;43:388–396.Google Scholar
27. Horn, K, Otter, JA. Hydrogen peroxide vapor room disinfection and hand hygiene improvements reduce Clostridium difficile infection, methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and extended-spectrum β-lactamase. Am J Infect Control 2015;43:1354–1356.Google Scholar
28. Levin, J, Riley, LS, Parrish, C, English, D, Ahn, S. The effect of portable pulsed xenon ultraviolet light after terminal cleaning on hospital-associated Clostridium difficile infection in a community hospital. Am J Infect Control 2013;41:746–748.Google Scholar
29. Manian, FA, Griesnauer, S, Bryant, A. Implementation of hospital-wide enhanced terminal cleaning of targeted patient rooms and its impact on endemic Clostridium difficile infection rates. Am J Infect Control 2013;41:537–541.Google Scholar
30. McCord, J, Prewitt, M, Dyakova, E, Mookerjee, S, Otter, JA. Reduction in Clostridium difficile infection associated with the introduction of hydrogen peroxide vapour automated room disinfection. J Hosp Infect 2016;94:185–187.Google Scholar
31. Bernard, H, Little, J. The impact of ultraviolet (UV) disinfection system coupled with evidence-based interventions on the incidence of hospital onset Clostridium difficile (HO-C-Diff). Am J Infect Control 2015;43:S27.Google Scholar
32. Miller, R, Simmons, S, Dale, C, Stachowiak, J, Stibich, M. Utilization and impact of a pulsed-xenon ultraviolet room disinfection system and multidisciplinary care team on Clostridium difficile in a long-term acute care facility. Am J Infect Control 2015;43:1350–1353.Google Scholar
33. Mitchell, BG, Digney, W, Locket, P, Dancer, SJ. Controlling methicillin-resistant Staphylococcus aureus (MRSA) in a hospital and the role of hydrogen peroxide decontamination: an interrupted time series analysis. BMJ Open 2014;4:e004522.CrossRefGoogle Scholar
34. Pegues, DA, Han, J, Gilmar, C, McDonnell, B, Gaynes, S. Impact of ultraviolet germicidal irradiation for no-touch terminal room disinfection on Clostridium difficile infection incidence among hematology-oncology patients. Infect Control Hosp Epidemiol 2017;38:39–44.Google Scholar
35. Vianna, PG, Dale, CR Jr, Simmons, S, Stibich, M, Licitra, CM. Impact of pulsed xenon ultraviolet light on hospital-acquired infection rates in a community hospital. Am J Infect Control 2016;44:299–303.Google Scholar
36. Haas, JP, Menz, J, Dusza, S, Montecalvo, MA. Implementation and impact of ultraviolet environmental disinfection in acute care setting. Am J Infect Control 2014;42:586–590.Google Scholar
37. Napolitano, NA, Mahapatra, T, Tang, W. The effectiveness of UV-C radiation for facility-wide environmental disinfection to reduce healthcare-acquired infections. Am J Infect Control 2015;43:1342–1346.Google Scholar
38. Nagaraja, A, Visintainer, P, Haas, JP, Menz, J, Wormser, GP, Montecalvo, MA. Clostridium difficile infections before and during use of ultraviolet disinfection. Am J Infect Control 2015;43:940–945.Google Scholar
39. McMullen, K, Wood, H, Buol, W, Johnson, D, Bradley, A, Dubberke, E, Woeltje, K, Warren, D. Impact of a pulsed xenon ultraviolet light (PX-UV) light room disinfection system on Clostridium difficile infection rates. Infectious Diseases Society of America website. https://idsa.confex.com/idsa/2015/webprogram/Handout/POSTER240_1714.pdf. Published 2015. Accessed October 16, 2017.Google Scholar
40. Passaretti, CL, Otter, JA, Reich, NG, Myers, J, Shepard, J, Ross, T, Carroll, KC, Lipsett, P, Perl, TM. An evaluation of environmental decontamination with hydrogen peroxide vapor for reducing the risk of patient acquisition of multi-drug-resistant organisms. Clin Infect Dis 2013;56:27–35.Google Scholar
41. Anderson, DJ, Chen, LF, Weber, DJ, Moehring, RW, Lewis, SS, Triplett, PF, Blocker, M, Becherer, P, Schwab, JC, Knelson, LP, Lokhnygina, Y, Rutala, WA, Kanamori, H, Gergen, MF, Sexton, DJ, CDC Prevention Epicenters Program. 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.Google Scholar
42. Sampathkumar, P, Nation, L, Folkert, C, Wentink, JE, Zavaleta, KW. A trial of pulsed xenon ultraviolet disinfection to reduce C. difficile infection. Am J Infect Control 2016;44:S30–S31.Google Scholar
43. Weber, DJ, Rutala, WA. The role of environment in transmission of Clostridium difficile infection in healthcare facilities. Infect Control Hosp Epidemiol 2011;32:207–209.Google Scholar
44. Shams, AM, Rose, LJ, Edwards, JR, Cali, S, Harris, AD, Jacob, JT, LaFae, A, Pineles, LL, Thom, KA, McDonald, LC, Arduino, MJ, Noble-Wang, JA. Assessment of the overall and multidrug-resistant organism bioburden on environmental surfaces in healthcare facilities. Infect Control Hosp Epidemiol 2016;37:1426–1432.CrossRefGoogle ScholarPubMed
45. Carling, PC, Parry, MF, Von Boheren, SM, Healthcare Environmental Hygiene Study Group. Identifying opportunities to enhance environmental cleaning in 23 acute care hospitals. Infect Control Hosp Epidemiol 2008;29:1–7.Google Scholar
46. Dubberke, ER, Olsen, MA. Burden of Clostridium difficile on the healthcare system. Clin Infect Dis 2012;55(Suppl):S88–S92.Google Scholar
47. Cosgrove, SE. The relationship between antimicrobial resistance and patient outcomes: mortality, length of hospital stay, and health care costs. Clin Infect Dis 2006;42(Suppl):S82–S89.Google Scholar
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