Two societies join forces to fight infections in healthcare settings
By Alex Baker
Many regard the U.S. healthcare system as the best in the world, owing to superior technology and a medical talent pool drawn from around the globe. Yet despite the quality of our facilities and the tireless dedication of our medical personnel and support staff, we humans are often no match against a multitude of invisible pathogens. Long before the SARS-CoV-2 virus first landed at a U.S. international airport, inflicting COVID-19 (or not) on some poor unsuspecting soul who later passed it to others, another menacing threat has existed in all of our healthcare settings. Indeed, it is a serious problem for all countries.
In 2011, there were an estimated 720,000 cases of healthcare-associated infections (HAIs) in the U.S. HAIs are estimated to kill 99,000 people per year in the U.S. alone. Put another way, this is more than 11 people dying from HAIs every hour. The human toll of HAIs is accompanied by significant economic costs. HAIs are estimated to result in $10 billion in direct medical costs annually, and up to $147 billion in total societal costs.
In healthcare settings, infections can be spread in a multitude of ways. Airborne transmission can occur within a shared space, such as a waiting room. HVAC systems are in turn capable of circulating pathogens from room to room, and from floor to floor. Viruses, bacteria and microorganisms can be spread from one patient to another via commonly touched surfaces, such as hospital beds, overbed tables, bathroom fixtures and nurse call buttons. Air filtration and mechanical cleaning of surfaces eliminates many of these pathogens, but when humans fight an invisible enemy there are always a few that will survive. We know that they are there, but how do we eradicate those stragglers? One way is with germicidal ultraviolet (GUV) devices utilizing C-band ultraviolet radiation.
Months before the stupid coronavirus came along (an accurate term of art coined by my 10-year-old son), the IES was approached by the International Ultraviolet Association (IUVA) to discuss the state of the germicidal ultraviolet device market, and to identify ways our organizations could work together to improve the use of GUV to reduce the incidence of HAIs in healthcare settings. The membership of the International Ultraviolet Association is “advancing the sciences, engineering & applications of ultraviolet technologies to enhance the quality of human life & to protect the environment” (iuva.org). It was clear from the start that despite their focus on an adjacent portion of the electromagnetic spectrum, IUVA’s mission closely aligns with that of the IES.
There are a variety of GUV devices in use today, beginning with upper-room air systems mounted to the wall in various spaces including waiting rooms, emergency rooms and homeless shelters, to name a few. Upper-room systems irradiate only the room air over 7 ft above the floor. With forced and natural convection, airborne bacteria, microorganisms and viruses passing through a GUV beam are inactivated. GUV is also commonly employed within HVAC duct work to reduce the circulation of pathogens between the interior spaces of a building. More peculiar looking but also promising is surface disinfection with GUV irradiance devices that often take on the appearance of robots. Picture, for instance, a dozen low-pressure mercury lamps (similar to fluorescent T8s, with specialized glass and no phosphor) mounted vertically on a rolling cart with onboard ballasts, a cord and plug, and an on/off timer. Such devices are used to “flash” vacant patient rooms with enough ultraviolet C-band radiation to further reduce the count of “live” pathogens on room surfaces. There are also bona fide robot versions of these devices, programmed to autonomously move from room to room, disinfecting as they go.
Despite the rapidly growing number of GUV devices in the market, however, today there are no standards in place for measuring and characterizing the performance of such devices to enable procuring hospitals and healthcare facilities to make apples-to-apples comparisons. In May, the IES and IUVA entered into a Memorandum of Understanding “to cooperatively promote awareness of and improve the application of ultraviolet ‘disinfection’ technology in the healthcare system, initially through the development of standardized methods of measurement of…products including UV lamps, luminaires and lighting/radiating systems, utilizing both discharge (e.g. low-pressure mercury and xenon) and solid-state (e.g. light-emitting diode) technologies.”
Joined by experts from IUVA, Dr. Cameron Miller from the National Institute of Standards and Technology (NIST) is leading the task group within the IES Testing Procedures Committee developing a series of methods of measurement (working titles): Approved Method for Electrical and Ultraviolet Measurement of Discharge Sources; … of Solid-State Sources; Approved Method for Electrical and Spectral Radiant Intensity Measurements of Ultraviolet Luminaire Disinfection Systems; … for Electrical and Spectral Irradiance Measurements of Ultraviolet Luminaire Disinfection Systems. These ANSI/IES/IUVA standards will represent a significant advancement in the market for germicidal ultraviolet devices, with the first two envisioned to be published by year’s end. The hope is for accredited laboratories to begin measuring and reporting performance results in early 2021.
“IUVA is pleased to work with IES on developing disciplined UV measurement standards for the healthcare industry,” says Troy Cowan, IUVA’s healthcare working group coordinator. “This effort is driven by recognition that, in this time of epic healthcare challenges, healthcare administrators need credible, comparable UV product performance data in making their infection control investment decisions. We believe these UV measurement standards will help provide a key basis for those decisions.”
Since our initial introduction, I’ve attended the IUVA Healthcare/UV Workshop at the Yale School of Medicine, the NIST Workshop on Ultraviolet Disinfection Technologies & Healthcare Associated Infections (with heavy IUVA attendance) and the 2020 IUVA Americas conference. At each event I’ve learned quite a bit, not least of which is how dedicated IUVA members are to seeing that
germicidal ultraviolet technology is put to good use for the benefit of humanity. I’m excited to continue working with them and encourage IES Members to watch for new developments in the coming months and years.