Monday, November 30, 2020

What to Consider When Purchasing an Ultraviolet Light Disinfection Device

Ultraviolet light disinfection, or ultraviolet germicidal irradiation (UVGI), is a fast-growing and invaluable option for preventing the spread of hospital acquired infections. Since the pandemic of Coronavirus Disease 2019 (COVID-19) caused by the novel coronavirus SARS-CoV-2, more consumers are interested in purchasing ultraviolet light products to disinfect surfaces in the home, office, transit, and other commercial spaces. This demand led to more UV manufacturing companies quickly forming to take advantage of the “opportunity.” While we encourage the utilization of this quick, reliable, chemical-free disinfection method, there is a combination of misconceptions and a lack of technical know-how that can lead to purchasing ineffective devices. Today, with so many UV light options on the market, how do you know what to choose? Here are some factors to consider when purchasing an ultraviolet light disinfection device.

PAY ATTENTION TO WAVELENGTH
Some products sold now that claim to be germicidal are actually the wrong wavelength. Ultraviolet light is divided into UV-A, UV-B and UV-C rays. UV-A radiation is less hazardous than UV-B but is also significantly (approximately 1000 times) less effective than either UV-B or UV-C radiation at inactivating bacteria or viruses. It is the wavelengths in the UV-C spectrum (200-280 nm) which offer the greatest germicidal potential. The peak germicidal output is found at 265 nm, however most high-output UV-C devices produce light at the 254 nm wavelength. UV-B takes significantly much more time to reach the killing capacity of UV-C.  As UV-C light makes contact with pathogens, photolytic processes damage the DNA or RNA code, triggering lethal mutations that prevent them from reproducing properly, causing cell death.

THE THREE Ds: DOSE, DISTANCE, AND DIRECTION
The degree of inactivation by ultraviolet light is directly related to the UV-C dose applied. The UV-C dose is the product of intensity and exposure time. Light needs to contact surfaces at the correct intensity for the correct length of time to get the right dosage necessary to achieve the log reduction needed for inactivation of your target organism. When analyzing a UV-C device, compare the intensity of each unit at a certain distance. This will remove the subjective claims such as effective, fast, etc. with specific and quantifiable claims like “Device X” has an intensity of 180 microwatts per cm2 at an 8-foot distance. Many of the UV-C lamps sold for non-commercial or home use have a very low intensity, so it will require a longer exposure on a given surface area to provide effective inactivation of a bacteria or virus. 

UV-C can only inactivate organisms if they are directly exposed to the light. Therefore, the disinfection of surfaces may not be effective if the UV-C light is blocked or shaded, creating shadowed or hidden areas. Similarly, consider the size of the space or the equipment you are disinfecting because as distance from the lamp increases, effectiveness against microorganisms decreases. You may need to choose a light that is tall or angled to best reach areas of concern. Additionally, you may also consider the use of multiple lights at different angles and heights to maximize exposure.  If only utilizing one light, it may be necessary to relocate it to multiple locations in order to maximize UV-C exposure of surfaces within the space.

HANDHELD UV-C WANDS
Some ultraviolet light companies sell handheld wands for swiping over surfaces to kill organisms. Such products are easy to find on sites like Amazon and eBay, and their product descriptions are definitely alluring. However, problems with the wands outweigh any potential disinfection benefits. Regardless of the product, UV-C should not be exposed to skin or eyes as it will inflict a severe “sunburn”. If wands are to be effective, they would need to put out enough UV-C intensity to be very hazardous to the operator. If the wand has a low enough output to be safe for operator presence, it would be too low to effectively kill organisms. Regardless of output, the operator needs to have very precise timing hovering over surfaces in order for a wand to be effective at all. For that reason, ClorDiSys does not sell or recommend the use of UV-C handheld wands.

THE IMPORTANCE OF QUARTZ GLASS
Most glass and plastics have limited to no permeability, blocking the UV-C from disinfecting the surfaces and items on the other side. Quartz glass is the best material for bulbs and any shelving within an ultraviolet light device as it will transmit UV light from 180 nm to 400 nm right through it.  This characteristic allows UV-C to shine optimally and disinfect surfaces sitting on quartz glass shelving, rather than prevent those surfaces from being treated. Some devices utilize metal grills which still provide kill, but not to where the items are sitting on the actual grill wires.

PURCHASE FROM AN EPA REGISTERED FACILITY
Ultraviolet lights that are sold or distributed with claims that the product can be used for preventing, destroying, repelling or mitigating any pest (plant, animal, virus, bacteria or other microorganism) are federally regulated by the Environmental Protection Agency (EPA) under the Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA). Generally, without such claims, a UV-C light would not be subject to FIFRA. While UV-C devices do not need to be registered by the EPA and, in turn, are not subject to a premarket review by the EPA, if a manufacturer is making claims of preventing or disinfecting viruses, bacteria or other microorganisms, they could be unfounded. In 2015, the Federal Trade Commission went after two companies marketing UV-C disinfectant devices because of false claims about eliminating foot fungus, methicillin-resistant Staphylococcus aureus, E. coli and Salmonella.  The most trusted UV-C products will be manufactured in a US EPA registered facility.

CONTINUOUS vs. PULSED UV-C 
Some companies claim that pulsed xenon is a more effective way to kill harmful pathogens.  Claiming similarities to a punch of a fist on a wall, more punches will weaken it better than one punch. However, light is not a fist.  Light is a form of energy, and continual energy is more effective than rapidly turning it on and off. The US Veterans Administration commissioned an infection prevention research team led by Curtis Donskey, M.D., to conduct an independent study of continuous ultraviolet disinfection versus xenon pulse UV-C disinfection. The results showed surprisingly low pathogen kill rates for the pulsed xenon device, about .5 log for both C.diff and VRE, even as close as 4 feet.  The continuous UV-C device demonstrated a much higher CFU reduction for the pathogens C. difficile, MRSA and VRE.  The study states, “PX-UV was less effective than continuous UV-C in reducing pathogen recovery on glass slides with a 10-minute exposure time in similar hospital rooms” and “the UV-C device achieved significantly greater log10 CFU reductions than the PX-UV device”.

SUMMARY
With a technology that’s been around for over a century, the efficacy of ultraviolet light against bacteria, viruses, fungi and spores is undeniable. However, in an unregulated market with new products and companies emerging often, consumer education is key. Intensity, bulb length, equipment quality, and price are the key factors to consider. Beware of subjective, attention-grabbing marketing techniques, and compare specific, quantifiable data. Read the product specifications, contact the seller with any questions you have, and if it is incredibly inexpensive, then it is probably too good to be true.


REFERENCES
United States Environmental Protection Agency. (2020, October). EPA Regulations About UV Lights that Claim to Kill or Be Effective Against Viruses and Bacteria. https://www.epa.gov/sites/production/files/2020-10/documents/uvlight-complianceadvisory.pdf

United States Food and Drug Administration. (2020, August). UV Lights and Lamps: Ultraviolet-C Radiation, Disinfection, and Coronavirus. https://www.fda.gov/medical-devices/coronavirus-covid-19-and-medicaldevices/uv-lights-and-lamps-ultraviolet-c-radiation-disinfection-and-coronavirus

Erdmann, J. (2020, August). UV Light Wands Are Supposed to Kill Viruses. But Do They Really Work? https://www.discovermagazine.com/health/uv-light-wands-are-supposed-to-kill-viruses-but-dothey-really-work

Infection Prevention Technologies, LLC. (2015, March). VA Funded Study Validates Continuous UV-C Technology For Pathogen Reduction. https://www.prnewswire.com/news-releases/va-funded-studyvalidates-continuous-uv-c-technology-for-pathogen-reduction-300057832.html

Tuesday, November 24, 2020

A Spotlight on Stethoscopes as a Transmitter of COVID-19 and Other Pathogens

 All eyes are on healthcare providers in light of the COVID-19 pandemic and an increase in reported cases. More specifically, this added attention has highlighted the shortcomings of facilities’ infection control programs and the lack of education and enforcement for personnel. Some dangerous, but common employee habits include poor handwashing compliance, wearing scrubs out of the hospital, and not cleaning shared equipment. One of the dirtiest pieces of equipment is one that comes into contact with patients regularly, and that instrument is the stethoscope. 

Despite being  used for nearly every patient examination, the stethoscope is rarely, if ever, cleaned before being placed on a patient’s body (yes, yours included). A recent article published in Infection Control Today featured an interview with W. Frank Peacock, MD, FACEP, FACC, FESC that discussed the lack of stethoscope disinfection.  Dr. Peacock explained, “Only about 4% of healthcare providers clean stethoscopes according to guidelines set down by the US Centers for Disease Control and Prevention, and the CDC’s guidelines don’t go nearly far enough, saying that stethoscopes should be cleaned once a week.” While four percent compliance is unacceptable, the CDC’s guideline of only disinfecting stethoscopes once a week is also unacceptable.  In one week’s time, hundreds of patients can come into contact with the device, easily cross-contaminating pathogens between the sick and the healthy.  As Dr. Peacock details, “To do it [disinfect a stethoscope] right, you are supposed to take an alcohol swab and rub it for a minute. And even when you do that, 20% to 30% of the stethoscope will still be dirty.” That low rate of success is not only true for stethoscopes, but other devices and common touchpoints as well.  One example being MIT’s study of smartphone disinfection methods which showed sprays or wipes are ineffective in comparison to ultraviolet light, which was capable of eliminating all organisms on the tested devices without the use of chemicals. 

Ultraviolet light, specifically UV-C, is able to kill bacteria, viruses, and spores quickly.  UV-C’s drawback is that it essentially needs direct contact with all surfaces in order to guarantee high-level disinfection on all sides of an item.  If the light is blocked or shadowed, disinfection of those surfaces is reduced or non-existent.   To overcome those challenges, ClorDiSys Solutions, Inc utilizes quartz glass shelving in the Flashbox and Flashbox-mini UV-C disinfection chambers for items to sit upon. Quartz glass is one of the few materials capable of allowing UV-C light to penetrate through completely, allowing for the full disinfection of the surfaces resting on the shelving.  High level disinfection of a stethoscope or similar item can be as short as 30 seconds depending on the UV-C system being used.  Since no chemicals are used with UV-C light, this allows for a wide variety of items to be disinfected including clipboards, cellphones, keyboards, remotes, badges, blood pressure cuffs, even N95 masks.  

Disinfecting shared devices and supplies like a stethoscope is simple, quick, and truly a necessity when reducing possible transmission of pathogens. As quoted in ACP Hospitalist, Michael B. Edmond, MD, FACP, MPH, MPA states, “Like anything that we're asking health care workers to do, you have to make it easy for them to actually do it, or your compliance rates will be low.” Just as washing hands was once seen as new and optional but now an obvious requirement, hopefully healthcare providers will disinfect stethoscopes just as regularly and thoroughly.

Monday, November 16, 2020

Case Studies: Biotech Facility's Beta-Lactam Inactivation

Recently, the ClorDiSys Decontamination Services team assisted a biotech company repurpose equipment which was previously used to manufacture a beta-lactam based product.  Repurposing equipment exposed to beta-lactams requires high-level inactivation due to the potentially life-threatening nature of beta-lactam allergies and their prevalence within society.  Having studied the inactivation of various beta-lactams using chlorine dioxide gas, our Decontamination Services team is well-equipped to handle such a task.  To read the article detailing our initial study, click here.

The laboratory in which the equipment was located had a drop ceiling.  As chlorine dioxide gas can penetrate cracks and crevices extremely well, it is able to go around and above the ceiling tiles and travel to other parts of the facility.  To mitigate the risk of leakage, the drop ceiling was covered in plastic to fully seal it off.  Inactivating the initial eight beta-lactams tested against required a dosage ten times what is required to provide a 6-log sporicidal reduction.  This meant that the use of biological indicators, our usual go-to verification method, was mostly irrelevant.  However, some biological indicators were still placed around the room in order to provide an additional data point.  In order to check for efficacy, plates were placed throughout the room with a measured inoculation of the target beta-lactam.  These plates were recovered upon completion of the chlorine dioxide gas treatment and sent to a third party laboratory for recovery testing.

The treatment itself went according to plan, with a dosage of over 7240 ppm-hrs being delivered to all surfaces within the space.  Testing came back with no recovered amounts of the target beta-lactam, showing a successful inactivation cycle had been performed.  This allowed the facility to safely repurpose the production equipment for its new use.

Thursday, November 12, 2020

Published Study Reveals Places with Highest Risk of Spreading COVID-19

 A new study by Stanford University and Northwestern University suggests most COVID-19 cases in large cities across the United States stem from visits to just a few types of places. The researchers analyzed hourly cellphone data from 98 million Americans in 10 major cities, tracking their movements to certain non-residential locations or "points-of-interest" while looking at the coronavirus counts in their areas. Based on this information, the published article determined full-service restaurants, gyms, hotels and houses of worship are among the 10 percent of locations that would appear to account for 80 percent of the infections. This determination is not all too surprising as these locations tend to be smaller in size, more crowded, and people dwell there longer. Study co-author and Stanford University Professor Jure Leskovec says “Our work highlights that it doesn’t have to be all or nothing,” suggesting the reduction of these establishments’ capacity to 20 percent, as opposed to shutting them down entirely, could curb transmissions by 80 percent. Also, by capturing who is infected at which locations, the study’s model supports detailed analyses that can inform more effective and equitable policy decisions on how to reopen society safely. More research is needed to determine whether similar findings would emerge among other populations and places.

Jacqueline Howard’s CNN article was referenced for this post. The complete published study can be found in the journal, Nature. Contact ClorDiSys for highly-effective disinfection solutions to combat COVID-19 and other harmful pathogens.

What to Consider When Purchasing an Ultraviolet Light Disinfection Device

Ultraviolet light disinfection, or ultraviolet germicidal irradiation (UVGI), is a fast-growing and invaluable option for preventing the spr...