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Table of Contents
REVIEW ARTICLE
Year : 2020  |  Volume : 3  |  Issue : 1  |  Page : 8-12

Review of the efficacy of ultraviolet C for surface decontamination


Departments of Infection Control, King Saud University Medical City, Riyadh, Saudi Arabia

Date of Submission23-Apr-2019
Date of Decision28-Jun-2019
Date of Acceptance24-Jul-2019
Date of Web Publication06-Jan-2020

Correspondence Address:
Abba Amsami Elgujja
King Saud University Medical City, Riyadh
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JNSM.JNSM_21_19

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  Abstract 


Evidence has shown that the state of the patient care environment has a direct impact on heightening the risks of hospital-acquired infections among patients admitted in hospitals. Moreover in view of the suboptimal standard of cleanings by housekeeping staff, there has been the quest for a better approach to reliably disinfect environmental surfaces in health-care facilities. The ultraviolet light has been known for its antimicrobial property and has been used in water treatment, food processing, and in-duct cleaning of ventilations. A recent introduction of its use for surface decontamination has raised interest among health-care facilities. However, studies have shown that, in spite of its relative success in other applications, there is doubt in its efficacy in decontaminating shadowed areas of the room, and therefore, may not be seen as justifying its capital intensiveness.

Keywords: Environmental disinfection, surface decontamination, ultraviolet C, ultraviolet light technology


How to cite this article:
Elgujja AA, Altalhi HH, Ezreqat S. Review of the efficacy of ultraviolet C for surface decontamination. J Nat Sci Med 2020;3:8-12

How to cite this URL:
Elgujja AA, Altalhi HH, Ezreqat S. Review of the efficacy of ultraviolet C for surface decontamination. J Nat Sci Med [serial online] 2020 [cited 2020 Apr 2];3:8-12. Available from: http://www.jnsmonline.org/text.asp?2020/3/1/8/275169




  Introduction Top


The ultraviolet (UV) light is conventionally known for the effectiveness of its antimicrobial activity, but there is significant doubt about its relative effectiveness in surface disinfection. Currently, there is convincing evidence that contaminated surfaces in hospital settings increase the risk of the transmitting hospital-acquired infections to other patients. The old argument that the environment does not contribute to the transmission of infection is fast loosing credence as the plethora of evidence are abound suggesting that a new patient stands the risk of inheriting the pathogens left behind in a room by the previous occupant.[1] Hence, existing studies imply that improved environmental surface cleaning and decontamination can lower the rates of healthcare-associated infections.[2],[3],[4]

However, evidence have also shown that housekeeping practices of cleaning and disinfection of the environmental surfaces of even the best hospitals are suboptimal, and thereby missing out on nearly half of the high-risk environmental surfaces.[5] Therefore, the quality environmental cleaning depends on the operator, and there is evidence that manual cleaning can spread bacteria on surfaces.[6] This is more so as many hospitals outsource their housekeeping tasks of environmental surface disinfection to private companies which raises the question of whether they meet the acceptable standards. The local Saudi Arabian MERS-CoV guideline (which is the only one that dwelt on the use of UVC and hydrogen peroxide (H2O2) for surface decontamination) recommend using either of the two as a mandatory part of terminal cleaning.[7] It did not make a distinction between the two in terms of preference.

A quest for a better solution for environmental decontamination has led to the application of an old concept, the UV light, for decontamination of environmental surfaces. The UV light was well known for its antimicrobial effects and had been hitherto used for disinfection of water, food, and air ducts. Several UV light technology products are available in the market with even sporicidal label claim. Consequently, there is an increasing interest in novel and more efficient technological tools which can consistently decontaminate hospital's environmental surfaces.[8] This article reviews the efficacy of UVC in surface decontamination and compares it with H2O2 with a view to proffering a practical and more efficient disinfectant for hospital environmental surfaces.


  Role of Ultraviolet Light in Decontamination of the Environment Top


UV light is electromagnetic radiation containing 265-nm wavelengths that are not long enough to be visible to the eyes. At this wavelengths, UV is capable of inducing mutation to bacteria, viruses, and other microorganisms due to its effects on the molecular structures of the pathogens. Its action results in destroying the structural bonds in the DNA of the pathogens, with a resultant rendering of the pathogens harmless or thereby inducing a bacteriostatic action on the pathogens.[9]

UV light is conventionally used for both air disinfection and water purifications,[10] and recently, to inactivate microorganisms on surfaces. The novel application of UV gamma irradiation is the use of UV light technologies to disinfect environmental surfaces in vacant rooms. These technologies come as moveable or fixed units to disinfect an entire vacant room.[9]

Some studies[8],[11],[12] have evaluated the effectiveness of using UV technologies for disinfecting patient rooms in hospitals [Table 1]. All of these studies cited have variously reported that UV light can, significantly, decrease the bio-burden of common multidrug-resistant as well as spore-forming pathogens including MRSA, Acinetobacter spp.,[20] VRE, Mycobacteria, Ebola virus,[21] and Clostridium difficile.[22] on contaminated environmental surfaces in the health-care settings by up to 4 log.[6]
Table 1: Studies on the effectiveness of ultraviolet C

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  the Pitfalls of Ultraviolet Technologies for Environmental Surface Disinfections Top


Studies[19],[20] have shown that the UV light can reduce the microbial load on environmental surfaces, and can potentially contribute to reducing infection rates, in conjunction with other infection control measures like improved housekeeping practices. However, UV light is not without its own drawbacks when applied for environmental surface decontamination. For instance, concerns have been raised about its effectiveness in shadowed areas. In some of the models evaluated in the studies, items that are not in direct line of the light have a lower inactivation rate as compared to those in direct line of the light. That necessitates multiple-position or multiple-machine decontamination process. A study has suggested that using a reflective coated wall could reduce the time limit by about 50%, but it did not further increase its log reduction capability.[23]

Furthermore, the presence of organic matter on the environmental surface can decrease the lethal effect of the UV radiation on pathogens.[24] Accordingly, none of the studies or reviews suggests that UV light technology can be used as a stand-alone measure, but perhaps, as a supplement to the existing housekeeping practices. This requires that the surface must be physically cleaned before applying the UV light as an adjunct. This is in addition to its other disadvantage that the room must be vacated before using the technology because of its effects on, among others, the skin of humans (cutaneous inflammation),[25] of some adverse inflammatory responses, including the creation of inflammatory mediators, and changes to vascular responses.[26] The UV light also has effects on the eyes and visual systems,[27] including potential changes to the cornea, pterygium, and acute photokeratitis (snow blindness), among others.[28]


  Discussion: Ultraviolet C Versus Hydrogen Peroxide Top


An alternative surface disinfectant with similar antimicrobial action, including sporicidal property, is the vaporized H2O2 that destroys pathogens, including spores by degrading the bacterial cell.[29] H2O2, which is commercially available in a range of concentrations from 3% to 90%, is also considered eco-friendly, as it can quickly disintegrate into harmless by-products: water and oxygen.[30] Published literature have attributed good antimicrobial activity to H2O2 and have confirmed its biocidal activity against a wide range of pathogens, including bacteria, yeasts, fungi, viruses, and spores.[5] It also has an additional advantage of overcoming the drawbacks arising from the use of UVC; The ability to reach all nooks and corners of the room, including part of the air vents when the air conditioners are not operating.[31]

When compared to its peers, for example, glutraldehyde, peracetic acid, and orthophthaldehyde, it has far better favorable chemical characteristics, including its use as a sterilant (at the concentration of 6%–25%, and a contact time of 6 h), and has a high level of disinfection claim (sporicidal). In addition, it has a longer reuse life (2 days), a long shelf life (2 years), it does not require activation, and has a good materials compatibility.[5]

Furthermore, a study, in which a new activated H2O2 wipe disinfectant was used to disinfect high-touch surfaces in patient rooms has demonstrated that 99% of surfaces yielded <2.5 colony-forming units/cm, 75% yielded no growth.[32]

Analyzing [Table 2], it could be deduced that both the UV and the H2O2 technologies can be used for room surfaces and equipment decontamination because of their broad-spectrum antimicrobial activity against pathogens, including C. difficile for. Furthermore, in both cases, the room must be vacant prior to decontamination, they do not remove dust and stains, and hence, proper cleaning must be completed before the disinfection as part of a terminal cleaning (as the room should remain vacant prior using the UV technology).
Table 2: Comparing the merits and demerits of ultraviolet light and hydrogen peroxide for surface disinfection

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However, H2O2 is a relatively better choice for the following reasons:

  1. There is no prospective (known to authors) clinical study to show that UV light decontamination can decrease the rates of hospital-acquired infections. Clinical trials have shown that using the H2O2 for surface disinfection can decrease the rates of hospital-acquired infections
  2. No reported study that suggests that UVC is effective in shadowed areas, even when the room contents have been moved away from the walls. H2O2 can be conveniently used for disinfecting room with complex equipment and furniture without necessarily moving the contents away around
  3. H2O2 has no harmful residue. Hydrogen Peroxide is converted into oxygen and water with conducive environmental impact
  4. The automated dispersal system ensures uniform distribution in the room, including all corners, crannies, and openings, including even air vents
  5. At the concentration of 3%, it can be safely and effectively used as an intermediate level surface and semi-critical items disinfectant.



  Recommendations Top


  1. Making a choice


    1. As can be seen in this review, a better alternative to UVC for surface decontamination is the vaporized H2O2 in the concentration of 3%–6% which can permeate its sporicidal property in all areas of the room, including shadows and ventilation ducts
    2. Apart from using it for decontaminating inanimate environmental surfaces, H2O2 vapors can be effectively used for high-level disinfection of medical devices such as soft contact lenses, ventilators, and endoscopes. Furthermore, it can also be used for spot-disinfecting fabrics in patients' rooms[5]
    3. Manual terminal cleaning of patient rooms using neutral detergent according to the standard hospital protocol should always precede the use of H2O2
    4. Apply the H2O2 vapor according to the manufacturer's recommendations.


  2. If the choice is for UVC, then follow these steps[9]


    1. UV light systems can be used as an additional measure when performing terminal room decontamination
    2. The use of UV light systems for environmental decontamination should only be undertaken following completion of a manual clean as residual dirt can reduce efficacy
    3. Before a UV light system being considered, an assessment of the area to be decontaminated must be undertaken to ensure the area can be sealed and the use of UV light made safe
    4. UV light systems must only be used in an area which has been cleared of all patients and staff. No entry to the decontamination area is allowed once the decontamination process has commenced
    5. Manufacturers' instructions for use must be followed to reduce the risk of sub-optimal UV light dosage on microorganisms. This could result in the mutation of the remaining microbes
    6. UV light systems in use must be maintained in good working order and a system of programmed maintenance in place with documented evidence
    7. A quality assurance mechanism should be in place to monitor the functionality of the UV light system using samples before and after cleaning
    8. UV light systems should not be used for routine cleaning
    9. Risk assessments should be in place for possible exposure of staff or patients to UV light
    10. Ensure appropriate time is given to the UV light decontamination process. Use of UV light systems will increase the overall decontamination time for cleaning. Additional time should be included in cleaning specification guidance [Table 2].



  Conclusions Top


Although both UVC and H2O2 are broad-spectrum antimicrobial agents that are used for room surfaces and equipment decontamination, for their effect against pathogens, including C. difficile, in both cases, the room must be completely vacated before decontamination. However, H2O2 is a relatively better choice for the following reasons:{Table 2}

  1. There is no prospective clinical study that demonstrates that UV room disinfection can reduce the rate of healthcare-associated infections.[13] One retrospective study showed a decrease in rates, but other infection prevention measures were also implemented along with the use of UV light. Some studies have shown that the use of H2O2 for surface disinfection can reduce the rate of healthcare-associated infections[19]
  2. None of the studies suggest that UVC is effective in shadowed areas, even when the equipment and furniture are moved around
  3. H2O2 can be used for disinfecting rooms that contain complex equipment and furniture without moving them around. The automated dispersal system ensures uniform distribution in the room, including all corners, crannies, and openings, including event air vents
  4. H2O2 has no residue the HP is converted into oxygen and water with conducive environmental impact.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Introduction
Role of Ultravio...
the Pitfalls of ...
Discussion: Ultr...
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