Making the Case for Whole Room Disinfection

High-tech cleaning devices such as UV lights and hydrogen peroxide misting machines aren't new to surgery. Facilities have used these products for years. But the effects of COVID-19 brought these devices to the forefront and moved whole room disinfection closer to the standard of care. Experts say it's important to supplement manual cleaning with high-tech systems, not only because they work, but also because staff and patients feel safer when they're used. Below, a couple environmental services directors dish on whole room cleaning technologies that help keep ORs COVID-free.

This disinfection method uses short-wavelength ultraviolet (ultraviolet C or UV-C) light to kill or inactivate microorganisms by destroying nucleic acids and disrupting their DNA, leaving them unable to perform vital cellular functions. "You have to calculate through dose verification cards or UV light meters to determine the run time for a certain area," says Matthew Patterson, system director of environmental services for St. Elizabeth Healthcare in Edgewood, Ky. "We use this on all isolations and terminal and cycle cleaning."

His team utilizes small UV light wands after the standard cleaning of surfaces. They also use a large UV light kit to sanitize entire rooms, which takes about 15 minutes for a standard OR. Before COVID hit, Mr. Patterson already had 10 UV light systems in his disinfection arsenal. Thanks to the pandemic, however, he's more than doubled that number, which is now up to 25. Mr. Patterson also installed UV lights on keyboards and at nurses' stations, one of the dirtiest areas in the entire hospital. "In my opinion, the most effective disinfection tool is UV light," he says. "However, they do require the OR to be empty when they are in use. They are expensive, too; the cheapest one I have found is around $25,000," he says.

Hydrogen peroxide systems — also referred to by environmental services professionals as "foggers" — are frequently used to perform meticulous disinfection of ORs. They produce airborne hydrogen peroxide in the form of a vapor or mist, and cover every surface of the sealed room in which they are positioned. "The fogger will produce a dry mist of disinfectant that is only microns in size, which allows for full coverage of the room without causing damaging saturation," says Mr. Patterson.

In addition to effectiveness, these systems offer a number benefits for outpatient facilities because, as Mr. Patterson notes, "they're very portable, and training is minimal." The main drawback to this technology is time. Not only does your staff have to be out of the room when the hydrogen peroxide system is in use, you also have to close HVAC vents and monitor the OR being treated to ensure the vapor or mist isn't escaping the room — because it's toxic to humans.

"Depending on the fogger you use, and the size of the space being treated, it may take an hour or more before everything settles before it is safe for someone to enter the space," says Mr. Patterson. This is why his staff uses it during end-of-day cleaning, he says.

However, the disinfection process itself is relatively simple and straightforward. "You just need to calculate the square footage of the room to ensure proper run time," says Mr. Patterson. For instance, the square footage in St. Elizabeth's ORs is approximately 450 sq. ft. To calculate the run time for this size OR, you simply measure the room's dimensions (length x width x height) and refer to a chart that's posted on the system to determine the appropriate run time.

Every surgical area could benefit from hydrogen peroxide misting systems, because they effectively penetrate every part of the room.
— Matthew Patterson

Mr. Patterson says his facility hasn't added foggers since the pandemic began. The systems they currently use have been employed for more than five years, and Mr. Patterson swears by their effectiveness. "Every surgical area could benefit from hydrogen peroxide misting systems, because they effectively penetrate every part of the room, including areas that are hard to access with manual cleaning," he says.

The pandemic is making whole room disinfection systems the standard rather than the exception. Still, they'll never replace traditional surface disinfection. In the end, infectious disease response teams still rely on good old-fashioned elbow grease. "We're still manually cleaning according to CDC Guidelines," says Cokela Nicolette Walker, MBA, LSSGB, environmental services director at Sparrow Health System in Lansing, Mich. "It's all about technique, proper cleaning and following protocols."

Mr. Patterson also says whole room disinfection technology is an advantageous additional step to manual cleaning. "We're still using microfibers to wipe down surfaces," he says. "It's a multifaceted approach. With the help of current technology, we're able to produce a better product that's safe for our providers and patients."

Mr. Patterson believes the pandemic gave his team the recognition and respect they deserve. "I always preach that they're not just mopping floors, that they're helping to save lives," he says. "We're an important part of patient care and keeping people safe." OSM