As an outbreak of COVID-19 mushroomed into a global pandemic, public reactions outside of the healthcare community ranged from panic buying to rebellion against recommended practices for protection and prevention. Within the healthcare community, however, reactions by clinicians and administrators alike ranged from frustration about product access to consternation about public reactions.
Arduous but not Sisyphean.
While clinicians and administrators continue to carry out their duties and responsibilities as the pandemic slogs on through the start of another year, they now more than ever must count and rely on Supply Chain expertise to evaluate devices, products and technologies to make more informed buying decisions.
As with any crisis or disaster, troubled times bring out the best and brightest in people but also draw out the dim and dishonorable who strive to capitalize on the misfortune of others for personal gain.
To help Healthcare Purchasing News readers become more informed purchasers of air and surface cleaning and disinfection devices and products, HPN recruited more than a dozen executives with varying backgrounds in infection prevention, medicine and sterile processing at 12 of the leading companies that supply ultraviolet light devices and equipment and advanced clinical formula disinfectants (products generally inaccessible to the general public and instead targeted for healthcare organizations) to share useful and valuable insights.
HPN specifically asked them to cut through the hyperbole and jargon cluttering the context of what truly informed buyers need to know to make the optimal decision for them and their facility(ies). Curiously, most of the experts provided recommendations and suggestions in sets of three or four without having been prompted for a precise number.
Counting the options
David St. Clair, Executive Chairman, Halosil International Inc., echoes a well-known refrain from a prominent clinical infection prevention figure. St. Clair posits four major ways of making patient care spaces safer from pathogens, and all are useful under different circumstances.
“As Dr. William Rutala is fond of saying, a ‘bundle’ approach is necessary to truly control the spread of infections in most settings,” St. Clair noted. Rutala, Ph.D., M.P.H., serves as Professor, Division of Infectious Diseases, Department of Medicine, and Director and Co-Founder, Statewide Program for Infection Prevention and Epidemiology at University of North Carolina School of Medicine, Chapel Hill. Back in May 2017, Rutala retired as Director, Hospital Epidemiology, Occupational Health and Safety Program at UNC Health Care System.
St. Clair stresses that disinfection can occur only after cleaning an area via four techniques.
1. Spraying, Waiting and Wiping. “As the most basic approach to disinfection, using an appropriate EPA-registered chemical disinfectant in a spray bottle or in a pre-soaked wipe is currently ‘the standard of care’ in most environments,” St. Clair indicated. “It can generally be used while a space is occupied by others without too much concern about exposing oneself or others to harmful vapors or chemicals, and often the disinfectants used can be quite inexpensive per unit volume.
“The caveats are that the only surfaces actually disinfected are those on which the chemical has been sprayed and has been allowed to sit, wet and undisturbed, for the necessary contact time of the disinfectant (1-10 minutes),” he continued. “Since that limitation is very real outside testing laboratories, this method generally results in less than 50 percent of pathogens being killed on surfaces.”
2. “Electrostatic” Spraying. “Using spray systems that electrically charge droplets of chemical disinfectants has become increasingly common in the last year,” St. Clair reflected. “These devices produce a cloud of droplets of varying sizes to try to envelope the targeted surfaces with a wet film that will stay wet for the required contact time of the disinfectant being used. Depending on the requirements of the disinfectant being used, the surfaces may need to be wiped down after the contact time. These devices, often called ‘electrostatic guns’ – and improperly called ‘foggers’ from time to time – are superior to normal spray bottles because they promote a wider distribution of the disinfectant than one could normally accomplish with a manual sprayer. So when properly used, electrostatic spraying is very likely to be more effective than manual spraying and wiping.”
But St. Clair expresses caution with two key alerts.
“The caveats with this technology are related to the fact that it is still a spray technology, so spending the time to allow all surfaces to actually get wet and stay wet for the required contact time is a challenge,” he indicated. “If one watches videos of people using these spray devices, often one sees the nozzles being waved around very quickly. That approach might give some observers a sense of protection, but in fact that would be a false sense of security – the disinfectant isn’t being allowed to function properly. One high-quality manufacturer of these devices that actually received a rare EPA registration for the electrostatic application of their disinfectant is required, according to the EPA ‘Master Label,’ to spend at least five seconds per square foot of surface area. So a simple conference table that is 10 feet long and five feet wide requires more than four minutes of spraying just to properly disinfect the top surface and parts of the underside.”
St. Clair urges the healthcare professional to protect himself or herself, too.
“The other major caveat with electrostatic spraying is that the person applying it is generally required to wear full [personal protective equipment] to reduce the inhalation and exposure risks from being near the cloud of small droplets,” he said. “Any ‘overspray’ might increase the possibility of helping to kill pathogens in the air, but the droplet sizes tend to settle relatively quickly. That overspray also then raises the risk whenever that approach is used in occupied common areas, for instance – bystanders can be exposed easily. And the ‘advanced clinical formulas’ used in institutional settings are more likely to be irritants than those chemical disinfectants found in consumer-oriented stores.”
3. UV/UV-C Light. “Properly built, modern UV/UV-C light fixtures and robots have proven to be very useful when one wants to sanitize (versus disinfect) many surfaces in a space in a relatively short period of time,” St. Clair observed. “The labor required to do so is minimal, and most systems have record-keeping capabilities that let the institution know how often the asset has been utilized. When supplied with sensors that can be spread around a room, the UV/UV-C dosage is more likely to be effective at sanitizing the spaces in complex rooms (with equipment, furniture, etc.).”
St. Clair acknowledges that UV/UV-C systems come with their own caveats, which generally include costs – both capital and maintenance, the trade-off between efficacy and material compatibility – especially in complex spaces, and in some cases, safety.
“The fact that UV/UV-C systems are not subject to regulation by the EPA or FDA mean that efficacy claims are often made that are limited to very specific and very simplified situations,” St. Clair cautioned. “The laws of physics apply – effectiveness is generally line-of-sight and diminishes by the square of the distance between the source and the target. Shadowed surfaces, including those surfaces that are essentially parallel to the light path, will get little or no benefit from the light. While there is potentially a little benefit from light bouncing off walls, etc., the distance issue then becomes paramount since the rays need to travel to the wall and bounce back some distance.”
St. Clair offers this example: “A surface three feet away will receive four times the energy of a surface six feet away, and nine times the energy of the surface nine feet away. That means that delivering enough energy to effectively kill pathogens at nine feet requires the surface three feet away to absorb or reflect nine times the energy needed to kill pathogens. That difference is what contributes to material compatibility issues, particularly with many types of plastics.
“UV/UV-C systems will sanitize surfaces – reduce the bio-load on many of them, with some surfaces being essentially devoid of viruses and vegetative bacteria (probably leaving spores) and some being essentially untreated, depending on the complexity of the surfaces in a room,” St. Clair assured. “By moving the light source(s) around a room a few times, the level of sanitation might well rise to disinfection – 99.99 percent – for pathogens other than spores, but then the advantage of time is greatly diminished and material incompatibility with devices and furniture in the room might become more of an issue.”
Understanding exactly how a UV/UV-C light system was tested is critical when listening to kill-rate claims, according to St. Clair. “If a 99.99 percent kill rate is claimed, what exactly did that test environment look like? Were the biological indicators placed perpendicular to the light or parallel to it – or in shadows, and how far away were they? Then consider the surfaces and spaces in which you will use the lights – how real-world were the tests for your environment?” he asked.
4. Fogging & HPV. St. Clair considers aerosolizing (fogging) or vaporizing a disinfectant in an enclosed space “the newest regulated disinfection technologies – and the most efficacious for ‘whole room disinfection.’
“Depending on whether the approval being sought is ‘sporicidal’ or ‘sterilant,’ either the EPA or the FDA [is] involved in setting the parameters of [Good Laboratory Practice] testing used,” he said. “The highest kill rate normally assigned by the agencies – if reduced to percentages – is 99.9999 percent of bacterial spores. They do not allow a claim of 100 percent.”
Fogging differs from spraying in significant ways, according to St. Clair, starting with droplet size. “Typically, a true fogger will dispense a reasonably uniform plume of chemical droplets under 10 microns; electrostatic sprayers droplets are about 40 microns or larger,” he noted. “That size difference allows a number of advantageous things to happen: Concentration of active ingredients in increasingly small droplets as the water in the disinfectant evaporates before the droplet falls; the potential vaporization of an active ingredient to aid in the destruction of the pathogens and to penetrate into crevices; and the ability to kill pathogens on all surfaces while keeping all those surfaces in the space dry.”
St. Clair indicates that fogging systems are often referred to as “dry mist foggers” for a reason.
“The close interaction between a fogger and its disinfectant is the reason that the EPA will only register a combination of a specific machine design and a specific disinfectant – both the fogger and the disinfectant matter,” he clarified. “Vendors cannot legally claim that their fogger, for instance, has a 99.9999 percent kill rate against spores when using any disinfectant unless the EPA registered that unique combination. That requirement allows customers to be comfortable that the efficacy of a fogging system will deliver the results they seek.”
Meanwhile, just as the three EPA-registered fogging systems that use a hydrogen peroxide-based disinfectant, hydrogen peroxide vapor (HPV) systems are able to claim a 99.9999 percent kill (inactivation) against spores and other pathogens, St. Clair continued. “HPV systems use highly concentrated hydrogen peroxide as a source of vapor that fills a room without creating an aerosol of any type. Like the fogging systems, they rely on a specific formulation of the disinfectant to create reliable results.”
Purchasers should pay close attention to the expected “turnaround time” for spaces being treated, St. Clair advises. “Since the most common systems all rely on hydrogen peroxide and all create a vapor at some level, the space being treated has to remain closed until it’s either actively vented to the outside or until the H2O2 vapor has naturally broken down into oxygen and water vapor. But in that time, essentially all surfaces in that space have been totally disinfected without any significant labor beyond the normal cleaning of the space,” he added.
As with any investment in devices, products and technology, cost must be taken into account.
The UV/UV-C systems are typically the most expensive to purchase and to operate, according to St. Clair, followed by the HPV systems, both in terms of equipment, maintenance and consumables. While a wide range of system prices across vendors exists, the fogging systems are significantly less expensive on average than the UV/UV-C and HPV systems. Most – but not all – electrostatic sprayers are much cheaper than the fogging systems and can use a wide variety of disinfectants with different characteristics and costs, he continued. Not surprisingly, the spray-and-wipe approach is cheapest – and the least effective overall – especially if one doesn’t count labor costs, he added.
Still, a modular strategy makes the most sense, according to St. Clair.
“In total, the tradeoffs tend to be overall efficacy, cost and time – not of a specific disinfectant, but as a result of its application in a space,” he summarized. “Low-risk and occupied spaces might need only manual spray and wipe, larger spaces that can’t be easily isolated might benefit most from an electrostatic sprayer approach, ‘normal’ hospital rooms and spaces might be best sanitized with a quick UV/UV-C treatment, and terminal disinfection of isolation rooms, [operating rooms] and the like might be best with fogging or HPV treatment.”
Being instinctual
An informed buyer should start with the fundamentals, suggests Sam Guzman, Global Sales Director, Healthcare, American Ultraviolet Co.
First, define the goal of the project. “Are they looking at air disinfection, surface disinfection, or a combination of both?” Guzman questioned.
Second, where are they looking to apply UVC technology? This may span patient rooms, ORs, common areas, HVAC systems, etc. Within that framework, Guzman encourages asking if there are any time constraints? “If they are looking at a patient room in a high turnover hospital with a full census, they will want to minimize the cycle time,” he indicated. “A powerful mobile unit or a fixed mounted system would keep the cycle times short. If they are looking at a patient room at a long-term care facility, they might not be under such a time crunch and a smaller mobile unit might be a more economical choice.”
Third, will the space be occupied when using the UVC equipment? Examples include the use of upper air UVC disinfection equipment in a patient intake area or waiting room or the use of a mobile unit after the terminal cleaning of a patient room, using a fixed mounted system during an orthopedics procedure in an OR, or adding a UVC lamp array to the buildings heating and cooling (HVAC) system, he explains.
Fourth, focus on the targeted pathogens of concern. “You will find different pathogens in different places,” Guzman said. “In an HVAC system, we might look to target Aspergillus Niger or black mold growing on a cooling coil or an airborne pathogen, such as influenza or SARS CoV-2, in the return or supply airstream. Both types of pathogens can be found in an HVAC unit and they require a different dosage level of energy for deactivation. In some cases when sized properly they can achieve both goals with the same equipment.
“In a patient room or an OR they might look to target MRSA, C-diff, Candida Auris, influenza, or these days SARS CoV-2,” he continued. “Viruses tend to require a lower UVC dose than bacteria, which tends to require a lower dose when compared to spore forming pathogens and spores. So they would look to target the worst of the lot with the understanding that you are delivering sufficient energy to destroy the pathogens requiring a lower dose on the way to achieving the lethal dose for the toughest ones.”
Research ties that bind
“Carefully evaluate the scientific literature validating that the technology is effective,” Hahn said. “Don’t be misled by marketing brochures or white papers. Make sure you have access to peer-reviewed and published studies validating the manufacturer’s claims. As far as efficiency, look at the cost-per-room disinfected. LightStrike robots disinfect dozens of rooms per day, bringing the cost per room disinfected to about $3. Check references: What kind of service do they provide? Make sure the vendor will provide not just technical support but offer your facility recommendations on how to incorporate the UV device into a comprehensive disinfection program with best practices. Where you run the robot is as important as how often you run it.”
“Beware of studies that are company-funded or have conflicts of interest,” Brewer advised. “Also, it is important to consider a device’s limitations, such as distance, as well as the potential need to move the device to multiple positions to reach every surface. Many UVC device manufacturers claim efficacy within a certain distance limitation, leaving the potential for harmful germs and pathogens to be left behind. Multiple studies have found that a measured dose of UVC that can compensate for room variables, such as size, shape, and contents of the room, can destroy up to 99.9 percent of pathogens left behind after manual cleaning.”
Recognize functional aims
UV devices occupy two general classes – one covers surfaces and the other air, according to David Kirschman, M.D., President and CEO, Aerobiotix Inc. Because they are “quite different,” hospitals need to explore them in-depth, he added.
“Surface UV systems are for terminal cleaning of surfaces in unoccupied spaces, such as patient room turnover,” Kirschman described. “Air UV systems are for continuous disinfection of occupied spaces, such as during a surgical procedure. It is critical to avoid systems [that] can expose room occupants to UV rays. Surface UV systems require an operator, so hospitals need to budget for that. Air UV systems run autonomously, so no specific operator is needed.
“Hospitals need to look for the devices with the best clinical data and experience in an acute care environment,” he continued. “An additional layer of security should be considered by using UV-C in areas of high potential SARS-Cov-2 load, particularly near symptomatic patients and/or aerosol-generating procedures. Hospitals should look for technologies [that] have been specifically tested against SARS-Cov-2, either on surfaces or in air.”
As healthcare organizations evaluate these devices, they must concentrate on certain critical questions geared toward facility needs, Hendee recommends.
The first homes in on location for use. “UV light is dramatically affected by distance,” he said. “The UV system’s capacity must be compared to the physical space(s) in which it will be used. Also, UV light is less effective when it is not direct. Shadowing due to the physical space design, the equipment that may be present in the room, and where the UV system can be placed within the space can all create ‘shadowing’ that will reduce disinfection efficacy. [Consequently], multiple cycles may need to be run or extra emitters could be required to reach all surfaces effectively.”
The second involves the UV light’s position in the larger cleaning and disinfecting puzzle.
“As with other disinfection processes, initial cleaning must be thorough for the disinfection to take place,” Hendee noted. “This is because UV does not easily penetrate soils that remain on surfaces. [UV light] should be considered a complement to a quality manual cleaning process and not a magic pill.”
The third relies on vendor service. “What kind of support does the UV system manufacturer offer their customers? Companies supplying technical support and educational support for all those involved in utilizing the system should be considered,” he added.
Know your priorities
“From a safety perspective, healthcare organizations should assess if the ultraviolet device allows for operation in occupied spaces and whether it produces an ozone byproduct,” Hoffman said. “Some UV lamps – such as those used for tanning – radiate energy in the UV-A and/or UV-B range and over extended periods may have adverse health consequences for exposed persons. UV lamps that are designed to emit radiation at 184.9 nanometers (nm) produce ozone, which is hazardous to humans even at low concentrations.” Hoffman joined Vidashield after serving as a Clinical Instructor in the Division of Infectious Diseases at the University of North Carolina’s School of Medicine in Chapel Hill.
“From an efficacy perspective, UV-C devices should operate at a peak wavelength of 253.7 nm to optimally neutralize pathogens,” she continued. “Since 1997, CDC/NIOSH has conducted and funded studies to determine the ability of upper-room ultraviolet germicidal irradiation (UVGI) systems to kill or inactivate airborne mycobacteria in a simulated healthcare room. These studies have shown that a properly designed and maintained upper-room UVGI system may be effective in killing or inactivating hardy environmental TB bacteria. In response to the COVID-19 pandemic, the CDC has recommended use of upper-room UVGI as an adjunct to increasing ventilation efficiency for SARS-CoV-2 in dental settings. Multiple studies have shown that one upper-room UVGI system can eradicate aerosolized particles of viruses, bacteria and molds (bioaerosols) in the air, preventing fallout of viable pathogens onto surfaces.”
When analyzing for efficiency, upper-room UVGI systems that run independently and continuously 24/7/365 are the most efficient, Hoffman indicates. “This utilizes a human factor engineering strategy because it removes the reliance on turning on and off and location or placement of the system, helps reduce the unintentional shut-off of the system or blocking of the directional flow,” she added.
Acknowledge the obvious
To combat the airborne COVID-19 using technology, Bryan Stone, M.D., Nephrologist and Chief Medical Officer, RxAir, urges healthcare organizations to set logical priorities.
“Any indoor environment, no matter how well the air and surfaces are disinfected, is contaminated immediately when a person enters and talks, coughs or breathes,” Stone said emphatically. “Time and money are best spent on efforts and technologies that can disinfect the air in occupied spaces on a continual basis without risk to the occupants. Certain UV light air purifiers are uniquely suited to this purpose.”
Stone recommends distinct parameters that any UV light air purifiers under consideration for purchase in healthcare institutions must include: They should be FDA-cleared as Class II Medical Devices, be manufactured under ISO 9000 quality systems to ensure the device is safe and performs as described and be tested in independent laboratory tests for effectiveness against target pathogens. He further emphasizes that RxAir UV-C light Air Purifiers meet all three of these criteria. “There are myriad new devices on the market as the result of COVID that have not undergone these critical steps,” he warned.
“Simply passing virus-laden air past a UV light does not guarantee viral inactivation,” Stone continued. “The virus must maintain close proximity to the UV bulb for a period of time for inactivation. Many small UV light air purifiers rapidly pass air over small, weak UV bulbs, which may not provide the length of exposure to be effective. It is important that UV lights in the 254um wavelength that are to be used in occupied spaces be shielded from the users as they can be harmful to the skin and eyes. Shielded lights enable the units to continue cleaning the air as occupants expel [it], thereby reducing the risk of inhalation and viral load.”
UV light air purification be considered a complementary prevention protocol used in conjunction with social distancing, wearing masks and frequent hand washing, Stone further suggests. “While the UV light air purifiers work continuously to inactivate airborne viruses, users are cautioned that it is unlikely to sufficiently act upon pathogens exhaled by an infected person who is mere inches or a few feet away,” he added.
Make a checklist
Larinda Becker, Senior Director of Marketing – Infection Prevention, Diversey Inc. encourages informed buyers – clinically, economically and operationally – to explore seven key areas and glean answers to more than 20 critical questions.
1. Efficacy. Do cycle times enable effective patient flow? Does the device kill pathogens of concern in realistic contact times? Does the device effectively direct energy to both horizontal and vertical surfaces?
2. Safety. Does the device have multiple safety features to ensure staff, patients and visitors are shielded from UV-C energy?
3. Portability. Is the device easy to transport within and between facilities, or does it require special handling? Is the device compact enough to both use and store in tight spaces? Does the unit weight allow all staff to handle the unit easily?
4. Durability. Will the device stand up to repeated use associated with terminal / discharge cleaning and transport? Are the device and bulbs protected during transport and storage?
5. Usability. Is the devise easy to set up, reposition and operate? Are the cycle times required short enough to incorporate into the discharge workflow process? Can the device be stored at the point of use to reduce transport time?
6. Affordability. What is the acquisition cost of the device? What are the operating costs (parts, labor, etc.)? What is the total cost to run – including the device, labor and time that the room is out of service? What are the options for acquisition (purchase, lease, rent)? What are the expected service/maintenance costs once purchased? Is a warranty / service contract provided? How long? How much?
7. Manufacturer support. Does the manufacturer provide tools to demonstrate the effectiveness of the device? What training and tools are provided to ensure smooth operationalization? What reporting tools are provided? What is the ongoing support for service and any repair?
Identify parameters, pathogen targets for exposure
“This provides a general frame of reference for the amount of exposure time and the power of the UV source required to effectively disinfect each area,” Olsen noted. “When considering air and surface disinfection, is the healthcare organization taking the ‘shadowing’ effect into account – the effect of dead spots where the UV rays might not be within line of sight? They’ll want to work with a reputable company that can custom design their UV disinfection solution to guarantee complete coverage of the affected area.
“How safe is the UV solution?” Olsen continued. “A UV solution that is environmentally friendly by being chemical-free and mercury-free, while not producing ozone are all important factors to consider when assessing the environmental impact of their disinfection objectives. Lastly, how long has the supplier been in business? What is the warranty period for their proposed solution? Is the supplier infringing on any patents that could drag the healthcare organization into a patent dispute? The supplier should also provide a complete safety profile for their solution. Careful thought as to the vendor’s experience with UV technology assures the healthcare organization will be in good hands and will provide an effective, safe, licensed and guaranteed solution.”
Getting to the surface
Because airborne bacteria and viruses eventually fall to surfaces if left untreated, choosing the optimal hospital-grade disinfectant is akin to the order of cleaning before disinfection: It’s not rocket science.
Regardless of unique circumstances, Homan highlights three considerations for selecting the appropriate chemical disinfectant.
“First, ensure that there are well-designed studies that support its use in a clinical setting,” she said. “Second, consider the organisms of highest concern in your facility and ensure that any disinfectant you are considering using has kill claims against these organisms. And third, ensure that it can kill them within a reasonable contact time. These three considerations will ensure that you are using an effective product. Beyond that, material compatibility and ease of use are also important. Note that any chemical disinfectant must also be EPA-registered for the intended use to be used in a healthcare setting.”
For Noreen Costelloe, Director, Marketing, Ruhof Corp., the decision for healthcare professionals represents a matter of time.
“In light of the emergence and spread of COVID-19 chemical surface disinfectants need to be effective in a short period of time,” Costelloe told HPN. “Busy healthcare professionals don’t have time to wait 10 minutes for a surface spray to kill SARS-CoV-2. [They] should look for products with kill times of no more than one minute. In addition, healthcare professionals would be wise to use a ‘multi-purpose’ formulation that not only works against viruses but is also effective against a broad-spectrum of pathogenic microorganisms, including bacteria, antibiotic resistant bacteria, fungi, mold and mildew. All the better if the product also cleans and deodorizes.”
“First, the treatment (contact time/dwell time) should be short enough to be acceptable to a facility, as time is of the essence when it comes to room turnover,” Stowe said. “Second, a facility should ensure that the disinfectant kills the most epidemiologic important pathogens that are pertinent in healthcare, including SARS-CoV-2 – the virus that causes COVID-19. This will ensure that the surfaces are safe for patients, visitors and staff. Finally, it’s important to ensure that the product itself is easy to use. Ready-to-use disinfectant wipes are excellent for rapid room turnover and ensure thoroughness of surface cleaning, because there is no mixing of chemicals or the need for clean fabric cloths. You can simply pull the wipe out of the package to quickly and effectively clean and disinfect hard, nonporous surfaces.”
Caveat COVID-19
Clearing the air and surface on cleaning and disinfection devices, products
When COVID-19 emerged as a recognized and serious threat to human health and life, clinicians and administrators scrounged for existing devices, products and technology capable of killing this pathogen, which was learned could be lethal to many.
If they couldn’t locate effective solutions on the shelves and in stock, they scrambled for alternatives in the pipeline and searched for those in development.
But experts contend that clinicians and administrators not only must be vigilant but also diligent in finding and using the right product for the right reasons and in the right way. They need to avoid the blame game as they prove the claim game.
Eleven executives share with Healthcare Purchasing News some of the misconceptions about UV/UV-C light devices and advanced clinical formula chemical disinfectant products in terms of how they work to clean and disinfect the air and/or surfaces if used properly.
UV/UV-C light devices
Be reasonable with expectations, diverse with solutions, according to Sam Guzman, Global Sales Director, Healthcare, American Ultraviolet Co.
“A common misconception is that installing UVC equipment, and/or chemicals for that matter, are going to solve all of the problems and be a ‘silver bullet,’” Guzman said. “As a UVC equipment manufacturer I wish I could say that was true, but it is not. We work with our clients to provide layers of protection. One layer may be in their HVAC system, it may be a mobile UVC robot to take from room to room, it may be Upper Air disinfection fixtures in a populated space, or a fixed mounted system for use after the terminal clean. No matter what the application is, we never recommend UVC as a stand-alone solution. Proper hand hygiene, manual cleaning of surfaces to remove fluids and tissue, keeping the proper humidity levels and using the proper MERV-rated particle filters are all layers of protection that help to lower the risk of transmission.”
Remember, you get what you pay for.
“Another common misconception is that a $49 or $99 dollar ‘gizmo’ purchased online will do the same job as a commercial/industrial system or fixture will do,” Guzman indicated. “You just can’t escape physics! In order to deactivate the pathogens, you have to deliver the proper dose of UVC energy, and that formula is very simple. The dose delivered is a function of the intensity of the source (corrected for the distance to the target) over time. Most of these products are very vague in their description, and many claim high levels of disinfection for large areas and spaces with a low or even non-existent UVC output. Radiometers and low-cost dose indicator cards can be used to verify UVC output and the amount of energy delivered to a surface.”
Be careful with ozone.
“Unfortunately, some systems being sold are using ozone-generating lamps as well as UVC, and although ozone is a useful disinfectant, in too high a concentration level for an extended period of time it is harmful to humans and can damage lung tissue,” Guzman warned. “Not all UVC lamps generate ozone, but some do, so the buyer should consult with the manufacturer to confirm the products they select do not generate ozone.”
Recognize the technology’s limitations, no matter how slight, advises David St. Clair, Executive Chairman, Halosil International Inc.
“The biggest misconception regarding UV/UV-C lights is that they are as efficacious as advanced clinical formula disinfectants,” St. Clair told HPN. “While [they have the] ability to sanitize many surfaces in a room quite quickly, there will likely be many areas that have not been treated at all – shadowed areas in particular. The difference between a 99 percent efficacy and a 99.9999 percent efficacy available with chemicals is that 10,000 times more of the pathogen remains in the space. With UV/UV-C, there will be surfaces that have received a 99.99 percent result and others that probably haven’t even approached 90 percent efficacy.”
Don’t eliminate manual cleaning, asserts Alice Brewer, MPH, CIC, CPHQ, FAPIC, Clinical Affairs Director, Tru-D SmartUVC, which is part of PDI Healthcare.
“While a measured dose of UVC light has been shown to be effective against SARS-CoV-2, manual cleaning is still critical,” Brewer noted. “UVC disinfection should be used in conjunction with manual cleaning in order to ensure a germ-free healthcare environment. UVC is effective at destroying pathogens, but it’s important to remember that humans should not be in the room during a UVC cycle as it can cause eye and skin irritation. However, it’s perfectly safe to view a UVC device through glass.”
Differentiate between UV capabilities, advises Karen Hoffman, R.N., CIC, FSHEA, FAPIC, Infection Preventionist Consultant, Vidashield UV24, a division of Medical Illumination.
“Multiple myths and misconceptions are circulating about the role of UV radiation against SARS-CoV-2,” Hoffman cautioned. “It is important to highlight that sunlight, UV-A irradiation and tanning beds, UV-A and UV-B irradiation, are mostly ineffective against SARS-CoV-2, the causative agent of COVID-19. In contrast, recent evidence has demonstrated that UV-C can neutralize coronaviruses including SARS-CoV-2. The effectiveness of UV-C is dependent on distance and time of exposure from the pathogen to the UV source. It is important that for upper-room UVGI that the UV-C chamber have design features that allow for air intake and out-exhaust baffles to maximize the distance and time for exposure and prevent recirculation in the chamber. UV-C can be useful in the disinfection of air and surfaces against bacteria, molds and viruses – including coronaviruses, but the application must have a proven design that can demonstrate effectiveness during use. The Vidashield UV24 System is an upper-room UVGI that has shielded UV-C lamps with a combination high efficiency filter and baffle design for optimal bioaerosol elimination.” Hoffman joined Vidashield after serving as a Clinical Instructor in the Division of Infectious Diseases at the University of North Carolina’s School of Medicine in Chapel Hill.
Understand how UV light technology works, recommends Bryan Stone, M.D., Nephrologist and Chief Medical Officer, RxAir.
“A UV light device’s effectiveness for disinfection is governed by the intensity and wavelength of the UV light(s), and the duration the pathogens stays in close proximity to the UV light,” Stone said. “Users should select a device that has been tested and proven effective in independent lab tests to effectively process the volume of air for the space where it is being used. A small unit that is rated for an 800-cu.-ft. room will not deliver the disinfection needed for a 4,800-cu.-ft. room. It will inactivate pathogens in the air running through it, but will leave a large amount of contaminated air to circulate. Trusted brands, such as RxAir, share independent lab test results that are relevant to effectiveness against an array of targeted pathogens and the size of area being treated, to enable an educated purchasing decision.
“Location of the device is very important,” Stone continued. “A free-standing air purification device should be placed at least two feet in all directions from any wall or obstacle that may block air flow. Tucking it into a corner or between two pieces of furniture will impede the device from processing air from the entire room, leaving pockets of contaminated air to linger around the room.”
Comprehend why UV light technology works the way it does, according to Irene Hahn, Senior Vice President, Sales & Marketing, Xenex Disinfection Services.
“Not all UV light is the same, and it’s very important to understand the differences between the various products,” Hahn noted. “Germicidal UV light ranges from 200-315nm and different pathogens are vulnerable to UV light at different wavelengths. The [Xenex] LightStrike robot uses pulsed xenon to create intense bursts of UV light that covers the entire germicidal spectrum so it deactivates pathogens where they are most susceptible. Wavelength and intensity are what impacts the speed of disinfection.”
“Another misconception is how UV disinfection works,” Hahn added. “If the UV light doesn’t touch an object, then it’s not disinfecting it. One of our best practices is to run the robot in multiple positions – once on each side of the bed in a patient room – while flipping over high-touch objects like nurse call buttons and remote controls between cycles so that you disinfect both sides of those objects. Another question we get frequently is about materials damage caused by UV light. The high-intensity bursts of UV light generated by LightStrike robots do not damage surfaces or materials in a room.”
Beware of the stampede for quick fixes without proof, warned David Kirschman, M.D., President and CEO, Aerobiotix Inc.
“COVID-19 has created a ‘gold rush’ of disinfection technologies [that] may not have been adequately tested, including some UV devices,” he told HPN. “Unsubstantiated claims can create misconceptions around the use of technologies, like the use of very short exposure times or ineffectively low-power devices. It is important for hospitals to utilize high-quality products that have strong track records and published data in clinical environments.”
Remember the proper order of events and perform due diligence, according to Larinda Becker, Senior Director of Marketing – Infection Prevention, Diversey Inc.
“UV/UV-C light devices don’t replace cleaning and disinfection. Look for efficacy data to demonstrate performance and understand the application method.”
Don’t overlook efficacy, reliability and safety concerns about the various technologies, advises Mike Olsen, Chief Marketing Officer, Far-UV Sterilray.
“The pandemic has exposed a number of suppliers offering ‘cure-alls’ without regard to either safety or efficacy,” Olsen warned. “Most technologies that are on the market can provide some level of disinfection but may not rise to the standards set forth by the CDC or, even more importantly, are not safe for human exposure. Unlike other UVC technologies, Far-UV 222nm technology has proven to be safe for human exposure and much more powerful than 254nm UVC in destroying pathogens.
“Another misconception is that vendors who provide such technologies are competent in the area of disinfection despite having only been in business less than a year or two,” Olsen continued. “Healthcare organizations really need to understand who they are working with and what level of expertise their vendor provides. There is another misconception that once this pandemic slows – either through vaccines, herd immunity or the passage of time – that our problems will be over. Nothing could be further from the truth. The importance of implementing proper disinfection strategies is crucial to ensuring a pandemic of this scale never occurs again.”
Advanced clinical formula chemical disinfectant products
Recognize the range and reach of certain product types, according to Linda Homan, R.N., CIC, Senior Manager, Clinical Affairs, Ecolab Healthcare.
“The COVID-19 pandemic has brought the importance of environmental hygiene to the forefront as a critical infection prevention measure,” Homan observed. “Some healthcare organizations are looking for technology that allows them to clean and disinfect large areas quickly. Importantly, high-touch objects are still the most important areas to focus on when performing surface disinfection because that is where the highest risk of environmental contact with COVID-19 occurs. But if you are considering incorporating technology, such as fogging or misting devices, to disinfect large surface areas, there are some important things to consider.
- “In examining the product’s EPA-registered label, look for fogging use directions,” Homan noted. “If the use directions are only labeled as ‘Non-Public Health,’ ‘adjunct treatment’ or ‘Deodorizing’ the product does not have approvals for fogging as a disinfectant. Products with deodorizing fogging claims are relatively common, but no data has been generated or submitted to the EPA to prove disinfection of viruses or other pathogens for these products. This means that any proposed application of the product as a fog or mist for disinfection, virus kill, etc. is a violation of the Federal Insecticide, Fungicide, and Rodenticide Act. The product may have other use directions, such as coarse spray, that are approved for use against SARS-CoV-2.”
- “A disinfectant product can be used for fogging applications only if it contains use directions for fogging application on the EPA master label,” she continued. “Disinfectant products must be used according to the directions for use on the product label, and it is a violation of Federal Law to use them for off-label applications or uses.
- “Some products contain fogging use directions for non-public health organisms such as spoilage and odor-causing bacteria, but do not claim efficacy against public health bacteria or viruses, including SARS-CoV-2,” Homan warned. “Always read the label instructions carefully to ensure the disinfectant has the correct label claims for the organisms of concern in your facility.”
Discern label claims carefully, urges Halosil’s St. Clair.
“The most harmful misunderstanding with regard to chemical disinfections is the confusion that surrounds the different technologies available,” he noted. “Unfortunately, many vendors encourage that confusion to make their own products sound as good or better than competing products using different technologies. Examples might be vendors of electrostatic guns calling their products foggers so they don’t [have] to talk about the need to take the time to actually wet all surfaces, or fogger vendors making kill claims without EPA registrations for use with a third-party’s disinfectant.”
Follow the product usage instructions to the letter, asserts Caitlin Stowe, MPH, CPH, CIC, CPHQ, VA-BC, Clinical Affairs Research Manager, PDI Healthcare.
“I would say that there are two big misconceptions about chemical disinfectants: Surface coverage and treatment time,” she indicated. “It’s very important to ensure that an adequate amount of the chemical is used on the surface. This can be done by following the instructions for use on the package and ensuring that the surface is thoroughly coated with the disinfectant through spraying or wiping. The second misconception is the treatment time. It’s vital to ensure that you are allowing the disinfectant to sit on the surface for the entire treatment time as defined by the product label to ensure the pathogens listed on label are being killed.”
Armed to fight with liquid and light
In COVID-19 era, what choices kill viruses with biggest bite?
When it comes to cleaning and disinfecting the air and/or surfaces, healthcare organizations may face a number of choices within two primary categories – UV/UV-C light technology and advanced clinical formula disinfectant products. For clarification: By “advanced clinical formula” Healthcare Purchasing News refers to products the general public typically cannot buy in stores but generally are accessible to healthcare organization professionals only.
HPN asked a small group of cleaning and disinfection product experts to highlight some of the advantages that UV/UV-C light devices offer for air and/or surface cleaning and disinfection and some of the advantages that advanced clinical formula disinfectants offer for surfaces. Here’s what they shared.
Advantages of UV/UV-C light devices for air and/or surfaces
Sam Guzman, Global Sales Director, Healthcare, American Ultraviolet Co.
“The main advantages of using UVC equipment are [that] it is a safe effective and low-maintenance intervention. Reputable manufacturers will always include safety as part of the product design and installation. Motion and heat sensors, door interlock switches, and mounting and installation instructions should always be used to make user and occupant safety the priority. UVC systems and equipment have been shown to be effective at destroying viruses, bacteria, spore formers and other pathogens in a myriad of published and peer reviewed studies. Upper air UVC systems, mobile UVC disinfection units, and fixed mounted UVC systems for air and surface disinfection have been used for decades to control the spread of TB, C-diff, MRSA, and other DNA/RNA-based pathogens in healthcare facilities around the world. What we are seeing now is the adaptation of this technology to locations like schools, office buildings, hotels, restaurants and other public spaces where the potential for transmission is high.”
David St. Clair, Executive Chairman, Halosil International Inc.
- Time to sanitize – not disinfect – a space.
- Probably helps kill some pathogens that are airborne, especially if air is passed through a special-built chamber
Alice Brewer, MPH, CIC, CPHQ, FAPIC, Clinical Affairs Director, Tru-D SmartUVC, which is part of PDI Healthcare
“UVC is a chemical-free, environmentally friendly method of providing enhanced, terminal room disinfection. It has been shown by studies to be effective against SARS-CoV-2, C. diff, MRSA, and other deadly pathogens that can affect patient outcomes.”
Karen Hoffman, R.N., CIC, FSHEA, FAPIC, Infection Preventionist Consultant, Vidashield UV24, a division of Medical Illumination
“UV-C devices are a rapidly effective means of efficiently destroying bacteria, viruses and mold spores. UV-C irradiation works by destroying DNA of bacteria and molds preventing them from replicating and eventually leading to the cell’s death. For SARS-COV-2, UV-C has been shown to destroy the outer protein coating of the virus. UV-C devices, like the Vidashield UV24 System, are particularly effective as it combines upper-room UVGI with a MERV 6 filter. The Vidashield UV24 System increases ventilation by four air-exchanges per hour that will capture and neutralize bioaerosols thereby improving air quality and preventing the fallout of viable pathogens onto surfaces. The Occupational Safety and Health Administration (OSHA) recognizes that upper-room UVGI systems are an effective engineering control because they capture and inactivate airborne bioaerosols. In the hierarchy of controls, OSHA recommends engineering controls as the most important control measures to use because they are designed to eliminate the risk at the source without relying on additional competency or compliance from humans.”
Bryan Stone, M.D., Nephrologist and Chief Medical Officer, RxAir
“Humans breathe approximately 26,000 times per day, so addressing the air-borne coronaviruses is paramount. UV-C light air purifiers, such as RxAir, offer an additional way to reduce risk that requires no action by room occupants once the unit is turned on. They offer the advantage of being non-contact, non-intrusive and don’t inhibit the occupants’ movements. Patients and employees aware of the units are more likely to appreciate that the institution is taking extra steps to protect their health and are unlikely to object to their use as they don’t require any effort or inconvenience on their part.
“UV-C light is effective against a broad array of pathogens, including viruses, bacteria, molds, and fungi.
“’Filtering the supply air removes contaminants from the outside air and return air but does not necessarily create a sterile environment nor does it control pathogens at the source. Recirculation units employing filters and ultraviolet (UV) lights are often placed in critical locations, such as isolation rooms, to augment the ventilation system. Increasingly, hospitals are resorting to unitary or stand-alone air cleaning devices to help bring outbreaks under control and to reduce airborne contaminants around patients who disseminate pathogens. The effectiveness of UV systems in controlling TB has been well established and is acknowledged by the CDC and other organizations. (CDC 2005)’ 1
“Based on tests showing the effectiveness of UV against coronaviruses and other pathogens, including pneumonia, which is a common complication of COVID-19, UV light air purifiers may play a valuable role for reducing risk of COVID transmission via airborne means.
“UV Light Air purifiers are low maintenance. Chemical disinfectants require custodial staff to apply them, and they have chemical laden bottles and rinse waters that may pose environmental hazards for disposal. The RxAir and most UV light air purifier units can simply be turned on and left to operate unattended for an extended period. For RxAir 400, the bulb cartridge needs to be replaced every one to two years. There is no other maintenance.
“A HEPA filter air purifier can be highly effective when first purchased, but the HEPA filter and carbon pre-filters must be replaced timely, often as frequently as every couple months, or the unit will not perform properly. The cost and maintenance of filter replacements can be substantial.
“UV-C light air purifiers are safe. Units which have shielded UV lights, such as the RxAir, are completely safe for use in occupied rooms to work continuously to reduce risk by inactivating viruses and other pathogens. UV-C light devices have no chemicals, residues or odors that may harm or be offensive to users. There is nothing that can accidently be ingested.
“UV-C air purifiers that have been proven effective in laboratory tests to inactivate more than 99 percent of airborne viruses, such as RxAir, reduce the number of active viruses that fall to surfaces, further reducing risk of contact contamination.”
Irene Hahn, Senior Vice President, Sales & Marketing, Xenex Disinfection Services
“Studies have shown that surfaces are missed and not disinfected during the manual cleaning process; however, this doesn’t imply manual cleaning isn’t still necessary. UV disinfection provides repeatable disinfection that elevates disinfection after manual cleaning. Some of the advantages of using pulsed xenon UV light is that the LightStrike robots do not require warm-up or cool-down time, do not damage materials or surfaces in a room, and can disinfect dozens of rooms per day – per robot.”
David Kirschman, M.D., President and CEO, Aerobiotix Inc.
“UV-C is a gold standard technology [that] has been used for over a century to kill environmental pathogens, going back to tuberculosis sanitariums. It avoids the use of chemicals in the environment, which all have some level of toxicity. With UV-C devices, the environmental treatment is stable and repeatable, unlike other disinfection technologies, which vary depending on human factors.”
Larinda Becker, Senior Director of Marketing – Infection Prevention, Diversey Inc.
“There is no substitute for proper cleaning and disinfection. Pathogens are invisible and need to be removed. Manual cleaning and disinfection is often inadequate, creating increased risk for transmission of pathogens.
“Studies have shown that the environment can act as a reservoir in healthcare settings. Pathogens can live on surfaces for days, weeks and even months. Unfortunately, data has also shown that cleaning and disinfection of patient rooms, operating rooms and shared patient equipment is suboptimal. Previous studies have demonstrated that less than 50 percent of patient room surfaces (Carling, 2008), and less than 25 percent of operating room surfaces are properly cleaned and disinfected during terminal cleaning (Jefferson, 2011). It has been demonstrated that a patient entering a room that was previously occupied by a colonized or infected patient has significantly higher odds of contracting that illness (Otter, 2013). Residual pathogens left on surfaces may be a cause of concern.
“In addition, a UV-C disinfection device has been implemented across many facilities globally, adding UV-C disinfection for added assurance. Variation in cleaning process is a cause of concern, and there has been a stronger demand for adjunct technologies, such as UV-C disinfection devices, to help reduce variation and risk to ensure a safe environment for staff, patients, residents and visitors.
“[UV/UV-C light devices] provide a chemical-free application and are indiscriminate about the surfaces it impacts. It achieves all surfaces where the light shines.”
Mike Olsen, Chief Marketing Officer, Far-UV Sterilray
“Not all UV light is created equal. It is important to distinguish differences between the various UV wavelengths when evaluating their strengths and weakness. As for Far-UV Sterilray 222nm products, the treatment of affected areas becomes a matter of configuring a disinfection solution by means of a layered approach. Starting with HVAC systems, Far-UV Sterilray 222nm solutions can disinfect every cubic inch of air in facility at the prescribed HVAC exchange rate. When coupled with line-of-sight fixtures, a healthcare organization can disinfect the air with people present at – literally – the speed of light. [This] means that a crowded nurse station or even a major league stadium can provide for real-time air disinfection with people nearly sitting on top of each other.
“Surface disinfection requires a slightly different approach with Far-UV technology. Because surfaces take longer to disinfect than the air more deliberate calculations need to be made regarding the proper configuration of a Far-UV-based disinfection solution. Finally, non-line-of-sight surfaces may need a hand-wand for periodic disinfection by maintenance personnel. Regardless of the application, no special safety gear is required for use with Far-UV Sterilray products as they are a dry, chemical-free, hazard-free disinfection solution.
Advantages of advanced clinical formula chemical disinfectant products for surfaces
Linda Homan, R.N., CIC, Senior Manager, Clinical Affairs, Ecolab Healthcare
“Hospital-use disinfectant products, such as one-step disinfectants with sporicidal activity, ensure that surfaces are cleaned and disinfected. UV/UV-C disinfection can be a valuable adjunct to chemical disinfection but cannot replace the manual cleaning and disinfection steps that must be taken. When applied according to their instructions for use, hospital use disinfectant products are all you need to ensure that surfaces are cleaned and disinfected.”
David St. Clair, Executive Chairman, Halosil International Inc.
• “Greatest efficacy, both on a spot basis and for true ‘whole-room disinfection.’
• “Far less expensive than alternatives, especially for very high efficacy levels and have options that: Disinfect to a 99.9999 percent efficacy on all surfaces, including the ‘nooks and crannies’ of complex rooms; never wet surfaces, so [they] have superior material compatibility; and fogging and HPV probably help kill airborne pathogens because the air is filled with disinfectants.”
Caitlin Stowe, MPH, CPH, CIC, CPHQ, VA-BC, Clinical Affairs Research Manager, PDI Healthcare
“There are quite a few advantages for ready-to-use (RTU) chemical disinfectants. First, they are widely used in every setting of healthcare and allow for widespread compliance of cleaning and disinfection of surfaces. Second, it’s very easy to teach someone when and how to use a RTU chemical disinfectant – whether it’s in a spray or wipe format – so it’s easy to implement new or additional products or processes. Third, RTU chemical disinfectants can be used in spaces that may be hard to clean or disinfect as the format of the disinfectant allows for easy accessibility. This ensures thorough cleaning and disinfection of even the hardest-to-reach surfaces and equipment.”
Larinda Becker, Senior Director of Marketing – Infection Prevention, Diversey Inc.
“Generally, there is a process of both disinfection and removal of pathogens from the surfaces. This ensures that soils on surfaces are addressed where pathogens may be present or hiding.”
1 Kowalski, V., “Supplemental Air Purification for Hospitals and Health Care Facilities”, https://www.rxair.com/lab-results/supplemental-air-purification-for-hospitals-and-health-care-facilities/.
Space-age technology can confirm COVID-19, other virus kills
To clean and disinfect the air and surfaces, healthcare professionals recognize they generally can choose between two categories of products – advanced “clinical strength” chemical disinfectants and ultraviolet-C light devices in a variety of forms – from ceiling mounts to roving robots to hand-held wands.
Beth Krah, CEO, The Krah Corp. dba activTek Health Solutions, thinks that may be too limiting and questions whether chemical disinfectants or UV-C light is the optimal solution during and after the COVID-19 era.
What if there’s a third choice?
“We work with the knowledge and technology we have available at any given time,” Krah told Healthcare Purchasing News. “But technology has come a long way since treating with UV-C and chemicals.”
Krah highlights her reasoning and shares her thoughts with HPN about a “Space Age” option.
HPN: Why might UV-C light nor chemical disinfectants not be an optimal solution?
KRAH: “Both require downtime of the area, areas need to be unoccupied for treatment, bulbs are very expensive, chemicals are as well and often leave a residue behind. Bulbs will only get what they see – for a long enough time to treat it. Some companies want you to purchase more than one robot for optimal performance – and may run up to $100,000 each. Some have options to catch shadow areas but cannot realistically reach every nook and cranny effectively. Yes, they’re better than not doing anything and can reduce infection rates, but the Infection Control and healthcare communities as a whole are now looking for something that can be used real-time, constantly, without the need to shut down an area for treatment.
“ActivePure treats hard and soft surfaces, textiles and the air space around us 24/7. Instead of reacting after someone is found to have a certain virus, prevent them instead. Reaction to infections always costs more than prevention.”
You mentioned that with the two prominent choices aeration times are necessary because of the toxicity and staffer training may be key issues. But does that mean this third option eliminates the need for aeration delays and staffer training?
“When ActivePure is installed into the HVAC system – as well as our portable models – this dry hydrogen peroxide (DHP) is carried out into the environment via the air current and reaches everywhere the air goes. It is attracted to the contaminant and goes out on a search-and-destroy mission to neutralize pathogens, spores, molds, toxins, carcinogens, etc. With the proper coverage in a facility, there would be no need for training anyone other than the maintenance staff on how to replace the ActivePure cell once a year – something that anyone can do within minutes. Because ActivePure – or DHP in general – is much more effective at aggressively killing contaminants, we may find this preventive alternative much more cost effective and effective at providing a health-promoting environment for all staff and patients.”
How and why does this third option work?
“ActivePure capitalizes on a reaction between a UV bulb and titanium dioxide to create a dry hydrogen peroxide cleaning agent that literally explodes the shell of contaminants on contact, killing them. It also provides a true healthy environment for facilities and allows them additional LEED Certification points. This is Green technology, without chemicals or toxins, and we are members of the U.S. Green Building Council. It’s very healthy to breathe 24/7, and many patients with COPD or other respiratory issues breathe better and sleep better because of it. [ActivePure] also kills contaminants that cause odors, so it helps with that as well. Too often, our elderly population might refuse to enter a hospital because they’ve heard that ‘the hospital is where you go to die.’ Wouldn’t it be something if we could truly offer a health-promoting environment throughout the entire facility consistently?”
What is the idea behind actually killing pathogens on contact as opposed to just deactivating them? Why does an “immediate kill” matter and a deactivation not suffice – even in the short-term if a bed or room were needed more quickly?
“An immediate kill as opposed to a deactivation that can take 10 to 20 minutes is important in a busy hospital when patients are waiting in the hallway while a room is being treated. The less time it takes for disinfection, the better it is for the patient and hospital staff. It reduces the amount of time needed by staff to accomplish [cleaning and disinfection] and reduces the amount of chemicals and toxins in the environment. Misting systems often require exact measuring of chemicals and sometimes are not measured properly. The influx of COVID-19 cases definitely brought infection control to the forefront of everyone’s mind, and the desire to implement technology became more urgent.”
What makes this “Space Technology?”
“ActivePure is Certified Space Technology and was inducted into the Space Technology Hall of Fame in 2017. It has recently been tested in a bio-level 3 and 4 [Food and Drug Administration]-certified lab to kill live SARS-CoV-2 virus, which causes COVID-19. NASA currently uses ActivePure, which has proven to reduce MRSA, Staph, C. Diff, H1N1 and the Norovirus – and the fact that you can get additional LEED Certification points for using it.”
How does NASA’s use qualify for use in clinical/healthcare/medical settings? Just like NASCAR served as a prep/test venue for selling automobiles how does NASA serve as a prep venue for clinical, healthcare and medical development?
“I don’t think NASA necessarily acts as a prep venue for healthcare, but they did create the precursor to this technology (photocatalytic oxidation or PCO technology) and the fact that they are utilizing ActivePure specifically gives the technology validity. ActivePure Technologies LLC, ActivePure’s manufacturer, took this PCO technology and improved on it to create something much more aggressive and effective. The proof is in the many university studies that have been done to test effectiveness on surfaces and in the air, as well as our customers who have tested effectiveness with their hospital’s Infection Control department. At activTek Health Solutions, our customers include country and hospital EMS systems nationwide.” [Editor’s Note: ActivePure Technologies LLC formerly was known as Electrolux Corp. USA.]
If ActivePure’s product has been around for more than 10 years and PCO technology has been around for nearly 20 years, why do you think it has taken so long to reach healthcare for appropriate use? Is COVID-19 the impetus? Something else?
“As of 2018, any technology or practice that is new to healthcare typically takes about 17 years with a 15 percent rate of implementation, and less than 1 percent of new knowledge actually goes into practice.” [Editor’s Note: Krah references “Healthcare Think-A-Thon 2018 at the Center for Health Innovation and Implementation Science, Indiana University, https://hii.iu.edu.]
“When I investigated ActivePure in 2009 and its proven ability in eliminating pathogens, I was determined to bring this technology to healthcare. Hospital-acquired Infections cost tens of thousands of lives. (See https://www.ahrq.gov/topics/healthcare-associated-infections-hais.html). ActivePure is a great way to provide a healthy environment and help protect patients and staff from the pathogens, [volatile organic compounds] and toxins that surround them 24/7.
“Many hospitals will wait for manufacturers to provide randomized clinical trials in hospital settings to prove how much the infection rate decreased. We started trials with the Cleveland Clinic in January and should have the results in two years. (See https://www.activepure.com/wp-content/uploads/2021/01/12-16-2020-Clinical-Trial-toStudy-Impact-of-ActivePure-Technology-on-Surgical-Site-Infection.pdf).
“In 2018, William Rutala, Ph.D., MPH, well-known in the Infection Control community, [spoke] about this type of technology: ‘Because we are not effectively removing the contaminants on a daily basis from patient rooms and those contaminants in those rooms can be a mechanism of transfer of pathogens from the surfaces to patients and can, of course, increase risk of transmission of healthcare associated infections. We would like to have a continually active room decontamination system, so essentially, it continually inactivates organisms, and it doesn't interfere with patient care. All people can enter. Staff can enter, patients can be there, and of course, visitors can enter.’ [Editor’s Note: Krah references Rutala’s Disinfection & Sterilization web site here: Disinfection & Sterilization - By William A. Rutala, Ph.D., M.P.H. (disinfectionandsterilization.org).]
“’What we’re looking for essentially, is a dilute hydrogen peroxide, a concentration of hydrogen peroxide that kills micro-organisms but is not harmful for patients, or of course, staff. How do you get a concentration of hydrogen peroxide that’s very low? There’s various technologies that take Oxygen out of the air, you take water out of the air and you make hydrogen peroxide.’ ActivePure is such a technology.”
