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

Abstract

Health care–associated transmission of Clostridium difficile has been well documented in long-term acute care facilities. This article reports on 2 interventions aimed at reducing the transmission risk: multidisciplinary care teams and no-touch pulsed-xenon disinfection. C difficile transmission rates were tracked over a 39-month period while these 2 interventions were implemented. After a baseline period of 1 year, multidisciplinary teams were implemented for an additional 1-year period with a focus on reducing C difficile infection. During this time, transmission rates dropped 17% (P = .91). In the following 15-month period, the multidisciplinary teams continued, and pulsed-xenon disinfection was added as an adjunct to manual cleaning of patient rooms and common areas. During this time, transmission rates dropped 57% (P = .02). These results indicate that the combined use of multidisciplinary teams and pulsed-xenon disinfection can have a significant impact on C difficile transmission rates in long-term care facilities. Health care–associated transmission of Clostridium difficile has been well documented in long-term acute care facilities. This article reports on 2 interventions aimed at reducing the transmission risk: multidisciplinary care teams and no-touch pulsed-xenon disinfection. C difficile transmission rates were tracked over a 39-month period while these 2 interventions were implemented. After a baseline period of 1 year, multidisciplinary teams were implemented for an additional 1-year period with a focus on reducing C difficile infection. During this time, transmission rates dropped 17% (P = .91). In the following 15-month period, the multidisciplinary teams continued, and pulsed-xenon disinfection was added as an adjunct to manual cleaning of patient rooms and common areas. During this time, transmission rates dropped 57% (P = .02). These results indicate that the combined use of multidisciplinary teams and pulsed-xenon disinfection can have a significant impact on C difficile transmission rates in long-term care facilities. It has been repeatedly demonstrated in the literature that the health care environment suffers from widespread contamination and extended survival of multidrug-resistant organisms.1Kramer A. Schwebke I. Kampf G. How long do nosocomial pathogens persist on inanimate surfaces? A systematic review.BMC Infect Dis. 2006; 6: 130Crossref PubMed Scopus (1570) Google Scholar A number of studies have linked this environmental contamination to an increased risk of health care–associated infections (HAIs).2Carling P.C. Huang S.S. Improving healthcare environmental cleaning and disinfection: current and evolving issues.Infect Control Hosp Epidemiol. 2013; 34: 507-513Crossref PubMed Scopus (62) Google Scholar, 3Otter J.A. Yezli S. Salkeld J.A. French G.L. Evidence that contaminated surfaces contribute to the transmission of hospital pathogens and an overview of strategies to address contaminated surfaces in hospital settings.Am J Infect Control. 2013; 41: S6-S11Abstract Full Text Full Text PDF PubMed Scopus (294) Google Scholar For example, a positive culture for Clostridium difficile from a prior room occupant has been found to put the subsequent patient at 2.35 times greater risk of acquiring the same infection.4Shaughnessy 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: 201-206Crossref PubMed Scopus (235) Google Scholar Because there is no direct contact between the 2 patients, this prior room occupancy risk can is attributable to environmental acquisition.5Huang S.S. Datta R. Platt R. Risk of acquiring antibiotic-resistant bacteria from prior room occupants.Arch Intern Med. 2006; 166: 1945-1951Crossref PubMed Scopus (395) Google Scholar Interventions to address HAIs in long-term acute care (LTAC) facilities have posed unique challenges for infectio