This article appears in the September/October issue of Surgical Products.

Lehigh Valley Health Network includes three hospital facilities - two in Allentown and one in Bethlehem, Pa.; nine health centers caring for communities in four counties; and numerous primary and specialty care physician practices throughout the region. Terry Burger, RN, the Director of Infection Control and Prevention for Lehigh Valley Health Network and an employee at the institution for the past 35 years, recently spoke about the network’s investment, implementation, and use of portable ultraviolet disinfection systems. Since 2008, LVHN has purchased seven TRU-D SmartUVC devices from Memphis-based Lumalier.

SP: Please offer a little background on your facility and its infection control needs prior to the purchase and implementation of the first portable UV disinfection system, as well as the thought process behind the investment. 

Burger: Our hospital epidemiologist is an infectious disease specialist. He and I often attend national conferences and take the time to investigate new technology. During one of those conferences, we saw this particular piece of equipment on display.

We are always looking to see how we can maintain a safe environment for our patients with the ultimate goal to prevent healthcare associated infections. We were intrigued with the UV-C disinfection technology but were hesitant to be an  an early adopter. We wanted to do our homework and find out the costs and benefits of this new technology.

We have a template for evaluating new equipment. It is a set of guidelines. We look at factors such as effectiveness, published evidence about (equipment), ease of use, costs, environmental impact, as well as patient and staff preferences. Also, one factor we are always considering is patient and employee safety. In addition to exploring the ultraviolet-C-emitting device, we also looked at some fogging technology with hydrogen peroxide vapor.  After looking at all of those factors and performing some testing, we selected the UVC disinfection machine, TRU-D.  The decision to utilize this technology was made with the understanding that it did not replace our day-to-day manual disinfection of the hospital rooms. This was to be used in addition to our routine environmental sanitation. 

Our expectations were realistic. We knew it was not going to eradicate every infection. We developed criteria to use TRU-D. We decided to use it for terminal disinfection on discharge for rooms of patients that had been identified with Clostridium difficile.   Eventually we expanded the use of TRU-D to include the Burn Center and our operating rooms on a rotational basis. As we purchased more, we continued to expand the use when we had a cluster outbreak in a certain unit.

The technology is particularly useful when responding to a  a cluster outbreak, whether in an intensive care unit, a burn unit, or on a medical surgical floor. When two or three cases of the same organism are observed, the machine is deployed to supplement  routine disinfection methods. We bring in TRU-D and use it on the entire floor as the patients are discharged.  In every circumstance it has helped to mitigate the outbreak.

SP: Why did you feel this was the right type of technology to act as a complement to your disinfection processes? 

Burger: Number one, it had the most published evidence. That was very important to us. It also offered the most patient and employee safety features. It can measure the amount of UV-C that is delivered and has different time settings to choose based on what type of organism you are trying to eradicate.The device is controlled remotely and has an automatic shut off safety feature in the event someone inadvertently attempts to enter the room while the machine is in operation.

SP: This is something you use in conjunction with other disinfection methods. Has it altered those other methods in any way?

Burger: We did have to develop some modifications in our work processes, because this does add time to clean the room. It can additional time dependent upon the settings and the room size and configuration. Adjustments were made to minimize the turnover time that included enhanced communication, and deployment guidelines. A multi-disciplinary taskforce was convened to develop an implementation process. 

We have come along way since 2008. We did have some hurdles, and it did modify some of our work processes.

SP: What made you decide to invest in more devices?

Burger: We recognized more opportunities to use the technology in other inpatient and ambulatory location.  We needed more of them to achieve our goals. 

Patient through-put is an important quality indicator and a challenge for most organizations. Our goal is to decrease admission wait times for our patients. Identifying ways to decrease the amount of time it takes to terminally disinfect the patient room without compromising patient safety continues to be a major priority.  We are collaborating with a TRU-D manufacturer to identify issues that are important to the end-users.

TRU-D is working on a paint that improves the reflectivity of the room. The TRU-D process works based on the reflectivity of the room. In order to get better turnover times, the reflectivity of the rooms must be improved. Published articles report that the  new paint can decrease exposure time significantly.

SP: Can you discuss the training process? Was that a hurdle at all?

Burger: We have a contracted environmental cleaning service. They have purchased the devices through a contract with our organization. They have designated only certain individuals who are trained to utilize the equipment.

SP: What advice would you give to those individuals tasked with making purchasing decisions at their own hospital facilities who are looking into this kind of technology to address their own infection control needs?

Burger: They have to figure out what they want the technology to do. They have to determine what problems they see in their facility, which will help guide them toward the best equipment for them.

Also, we did site visits and spoke to people who were already using the technology. As I mentioned, we brought a multi-disciplinary team together that represented patient care services, infection control, finance, purchasing, and environmental services. We developed a a cost-benefit analysis, based on our facility, and what our experiences were to determine expected outcomes and whether our expectations were realistic.

It is important to recognize this is an investment. We put a tremendous amount of emphasis on infection control and prevention in our facility. We feel this reflects our commitment to creating a safe patient environment.

Maybe this technology is not right for every facility, based on their size or the infections they are seeing. It was the right decision for us. It was a very methodical, well researched and collaborative decision.