Skip to main content Accessibility help

Effectiveness of ultraviolet disinfection in reducing hospital-acquired Clostridium difficile and vancomycin-resistant Enterococcus on a bone marrow transplant unit

  • Jennifer Brite (a1), Tracy McMillen (a1), Elizabeth Robilotti (a1) (a2) (a3), Janet Sun (a1), Hoi Yan Chow (a1), Frederic Stell (a4), Susan K. Seo (a2) (a3), Donna McKenna (a5), Janet Eagan (a1), Marisa Montecalvo (a6), Donald Chen (a6) (a5), Kent Sepkowitz (a2) (a7) and Mini Kamboj (a1) (a2) (a3)...



To determine the effectiveness of ultraviolet (UV) environmental disinfection system on rates of hospital-acquired vancomycin-resistant enterococcus (VRE) and Clostridium difficile.


Using active surveillance and an interrupted time-series design, hospital-acquired acquisition of VRE and C. difficile on a bone marrow transplant (BMT) unit were examined before and after implementation of terminal disinfection with UV on all rooms regardless of isolation status of patients. The main outcomes were hospital-based acquisition measured through (1) active surveillance: admission, weekly, and discharge screening for VRE and toxigenic C. difficile (TCD) and (2) clinical surveillance: incidence of VRE and CDI on the unit.


Bone marrow transplant unit at a tertiary-care cancer center.


Stem cell transplant (SCT) recipients.


Terminal disinfection of all rooms with UV regardless of isolation status of patients.


During the 20-month study period, 579 patients had 704 admissions to the BMT unit, and 2,160 surveillance tests were performed. No change in level or trend in the incidence of VRE (trend incidence rate ratio [IRR], 0.96; 95% confidence interval [CI], 0.81–1.14; level IRR, 1.34; 95% CI, 0.37–1.18) or C. difficile (trend IRR, 1.08; 95% CI, 0.89–1.31; level IRR, 0.51; 95% CI, 0.13–2.11) was observed after the intervention.


Utilization of UV disinfection to supplement routine terminal cleaning of rooms was not effective in reducing hospital-acquired VRE and C. difficile among SCT recipients.


Corresponding author

Author for correspondence: Mini Kamboj MD, 1275 York Avenue, New York, NY 10065. E-mail:


Hide All
1. Drees, M, Snydman, DR, Schmid, CH, et al. Prior environmental contamination increases the risk of acquisition of vancomycin-resistant Enterococci. Clin Infect Dis 2008;46:678685.
2. Shaughnessy, MK, Micielli, RL, DePestel, DD, et al. Evaluation of hospital room assignment and acquisition of Clostridium difficile infection. Infect Control Hosp Epidemiol 2011;32:201206.
3. Kramer, A, Schwebke, I, Kampf, G. How long do nosocomial pathogens persist on inanimate surfaces? A systematic review. BMC Infect Dis 2006;6:130.
4. Freedberg, DE, Salmasian, H, Cohen, B, Abrams, JA, Larson, EL. Receipt of antibiotics in hospitalized patients and risk for Clostridium difficile infection in subsequent patients who occupy the same bed. JAMA Intern Med 2016;176:18011808.
5. Jinadatha, C, Quezada, R, Huber, TW, Williams, JB, Zeber, JE, Copeland, LA. Evaluation of a pulsed-xenon ultraviolet room disinfection device for impact on contamination levels of methicillin-resistant Staphylococcus aureus . BMC Infect Dis 2014;14:187.
6. Nerandzic, MM, Cadnum, JL, Pultz, MJ, Donskey, CJ. Evaluation of an automated ultraviolet radiation device for decontamination of Clostridium difficile and other healthcare-associated pathogens in hospital rooms. BMC Infect Dis 2010;10:197.
7. Anderson, DJ, Chen, LF, Weber, DJ, et al. Enhanced terminal room disinfection and acquisition and infection caused by multidrug-resistant organisms and Clostridium difficile (the Benefits of Enhanced Terminal Room Disinfection study): a cluster-randomised, multicentre, crossover study. Lancet 2017;389:805814.
8. Green, C, Pamplin, JC, Chafin, KN, Murray, CK, Yun, HC. Pulsed-xenon ultraviolet light disinfection in a burn unit: impact on environmental bioburden, multidrug-resistant organism acquisition and healthcare associated infections. Burns 2017;43:388396.
9. Haas, JP, Menz, J, Dusza, S, Montecalvo, MA. Implementation and impact of ultraviolet environmental disinfection in an acute care setting. Am J Infect Control 2014;42:586590.
10. Levin, J, Riley, LS, Parrish, C, English, D, Ahn, S. The effect of portable pulsed xenon ultraviolet light after terminal cleaning on hospital-associated Clostridium difficile infection in a community hospital. Am J Infect Control 2013;41:746748.
11. Miller, R, Simmons, S, Dale, C, Stachowiak, J, Stibich, M. Utilization and impact of a pulsed-xenon ultraviolet room disinfection system and multidisciplinary care team on Clostridium difficile in a long-term acute care facility. Am J Infect Control 2015;43:13501353.
12. Nagaraja, A, Visintainer, P, Haas, JP, Menz, J, Wormser, GP, Montecalvo, MA. Clostridium difficile infections before and during use of ultraviolet disinfection. Am J Infect Control 2015;43:940945.
13. Simmons, S, Morgan, M, Hopkins, T, Helsabeck, K, Stachowiak, J, Stibich, M. Impact of a multi-hospital intervention utilising screening, hand hygiene education and pulsed xenon ultraviolet (PX-UV) on the rate of hospital associated meticillin resistant Staphylococcus aureus infection. J Infect Prevent 2013;14:172174.
14. Vianna, PG, Dale, CR, Simmons, S, Stibich, M, Licitra, CM. Impact of pulsed xenon ultraviolet light on hospital-acquired infection rates in a community hospital. Am J Infect Control 2016;44(3):299303.
15. Kamboj, M, Sheahan, A, Sun, J, et al. Transmission of Clostridium difficile during hospitalization for allogeneic stem cell transplant. Infect Control Hosp Epidemiol 2016;37:815.
16. Huang, Y-S, Chen, Y-C, Chen, M-L, et al. Comparing visual inspection, aerobic colony counts, and adenosine triphosphate bioluminescence assay for evaluating surface cleanliness at a medical center. Am J Infect Control 2015;43:882886.
17. Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L. 2007 guideline for isolation precautions: preventing transmission of infectious agents in health care settings. Am J Infect Control 2007;35:S65S164.
18. Nerandzic, MM, Thota, P, Jencson, A, et al. Evaluation of a pulsed xenon ultraviolet disinfection system for reduction of healthcare-associated pathogens in hospital rooms. Infect Control Hosp Epidemiol 2015;36:192197.
19. Yang, J-H, Wu, U-I, Tai, H-M, Sheng, W-H. Effectiveness of an ultraviolet-C disinfection system for reduction of healthcare-associated pathogens. J Microbiol Immunol Infect 2017;S1684S1182.
20. Ghantoji, SS, Stibich, M, Stachowiak, J, et al. Non-inferiority of pulsed xenon UV light versus bleach for reducing environmental Clostridium difficile contamination on high-touch surfaces in Clostridium difficile infection isolation rooms. J Med Microbiol 2015;64:191194.
21. Pegues, DA, Han, J, Gilmar, C, McDonnell, B, Gaynes, S. Impact of ultraviolet germicidal irradiation for no-touch terminal room disinfection on Clostridium difficile infection incidence among hematology-oncology patients. Infect Control Hosp Epidemiol 2017;38:3944.
22. Sampathkumar, P, Nation, L, Folkert, C, Wentink, JE, Zavaleta, KW. A trial of pulsed xenon ultraviolet disinfection to reduce C. difficile infection. Am J Infect Control 2016;44(6):S32S33.
23. Lessa, FC, Mu, Y, Bamberg, WM, et al. Burden of Clostridium difficile infection in the United States. New Engl J Med 2015;372:825834.
24. Ziakas, PD, Thapa, R, Rice, LB, Mylonakis, E. Trends and significance of VRE colonization in the ICU: a meta-analysis of published studies. PLoS One 2013;8:e75658.
Type Description Title
Supplementary materials

Brite et al. supplementary material
Figure 1A and B

 Unknown (3.0 MB)
3.0 MB
Supplementary materials

Brite et al. supplementary material
Table 2A and B

 Word (14 KB)
14 KB
Supplementary materials

Brite et al. supplementary material
Figure 3A-D

 Unknown (5.4 MB)
5.4 MB


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed