Intensive environmental cleaning may lead to decreased Clostridium difficile infection (CDI) rates, and several new devices have become available to assist with environmental cleaning. The objective of this study was to determine the effect of pulsed xenon ultraviolet device (PX-UV) disinfection of patient rooms on the incidence of hospital-acquired CDI.
A before-after study design was used at a 1250 bed tertiary care facility. A PX-UV light disinfection unit was used after routine discharge cleaning in rooms of patients with a positive C. difficile toxin assay between 1/20/14 - 8/31/14. On 3/17/14, this was expanded to PX-UV use after discharge cleaning on all rooms on 4 patient care areas (2 ICUs, 2 oncology floors) with the highest CDI rates in the hospital. Hospital-acquired CDI incidence density (cases per 1000 patient-days) for the 2 years before and 8 months during the intervention were compared using chi-square analysis (EpiInfo 7, CDC).
210 CDI patients were identified, resulting in 351 opportunities for room disinfection at discharge or patient transfer, of which 207 (59%) were treated with PX-UV. Compliance with CDI room treatment did not differ by time of day or day of week (weekday compliance was 60% vs. 55% on weekends; p=0.47; day shift compliance was 61% vs. 53% on night shift; p=0.21). Compliance with PX-UV in CDI rooms was higher during the first half versus the second half of the study (70% vs. 59%, p <0.01). Of the 3032 patients discharged from the 4 high CDI rate units, 1771 (58%) rooms were treated with PX-UV. Hospital-wide CDI rates were not statistically different between the study periods [475 cases of hospital-acquired CDI/ 631,008 patient days (rate = 0.75 cases/1000 pt days) pre-intervention vs. 134 cases/ 210,191 patient days (rate = 0.63) post-intervention; incidence rate ratio (IRR) = 0.85; p = 0.09; Figure] or on the 4 patient care areas with high CDI rates (154 cases, rate = 2.15 cases/1000 pt days pre-intervention vs. 43 cases, rate = 1.61 post intervention; IRR = 0.75, p = 0.09).
Overall compliance with use of the PX-UV system was 60%. Compliance with use was decreased in the second half of the study. There was no significant difference in CDI infection rates with use of the PX-UV light disinfection system.
Figure: Hospital-wide C. difficile Infection Incidence, by Study Period
W. Buol, None
D. Johnson, None
A. Bradley, None
K. Woeltje, None
E. R. Dubberke, rebiotix: Consultant and Investigator , Consulting fee and Research support
sanofi-pasteur: Grant Investigator , Research grant
pfizer: Consultant , Consulting fee
Merck: Consultant and Investigator , Consulting fee and Research support
D. K. Warren, None