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Implementation Lessons Learned From the Benefits of Enhanced Terminal Room (BETR) Disinfection Study: Process and Perceptions of Enhanced Disinfection with Ultraviolet Disinfection Devices

Published online by Cambridge University Press:  14 January 2018

Deverick J. Anderson ,
Lauren P. Knelson ,
Rebekah W. Moehring ,
Sarah S. Lewis ,
David J. Weber ,
Luke F. Chen ,
Patricia F. Triplett ,
Michael Blocker ,
R. Marty Cooney  and
J. Conrad Schwab
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Deverick J. Anderson*
Affiliation:
Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University Medical Center, Durham, North Carolina
Lauren P. Knelson
Affiliation:
Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University Medical Center, Durham, North Carolina
Rebekah W. Moehring
Affiliation:
Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University Medical Center, Durham, North Carolina Durham Veterans Affairs Medical Center, Durham, North Carolina
Sarah S. Lewis
Affiliation:
Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University Medical Center, Durham, North Carolina
David J. Weber
Affiliation:
Department of Hospital Epidemiology, University of North Carolina Health Care, Chapel Hill, North Carolina
Luke F. Chen
Affiliation:
Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University Medical Center, Durham, North Carolina
Patricia F. Triplett
Affiliation:
Department of Hospital Epidemiology, University of North Carolina Health Care, Chapel Hill, North Carolina High Point Regional Hospital, High Point, North Carolina
Michael Blocker
Affiliation:
Alamance Regional Medical Center, Burlington, North Carolina Carolinas Medical Center, Charlotte, North Carolina
R. Marty Cooney
Affiliation:
Rex Healthcare, Raleigh, North Carolina
J. Conrad Schwab
Affiliation:
Chesapeake Regional Medical Center, Chesapeake, Virginia
Yuliya Lokhnygina
Affiliation:
Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
William A. Rutala
Affiliation:
Department of Hospital Epidemiology, University of North Carolina Health Care, Chapel Hill, North Carolina
Daniel J. Sexton
Affiliation:
Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University Medical Center, Durham, North Carolina
*
Address correspondence to Deverick J Anderson, MD, MPH, Associate Professor of Medicine, DUMC Box 102359, Durham, NC 27710 (Deverick.anderson@duke.edu).
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Abstract

OBJECTIVE

To summarize and discuss logistic and administrative challenges we encountered during the Benefits of Enhanced Terminal Room (BETR) Disinfection Study and lessons learned that are pertinent to future utilization of ultraviolet (UV) disinfection devices in other hospitals

DESIGN

Multicenter cluster randomized trial

SETTING AND PARTICIPANTS

Nine hospitals in the southeastern United States

METHODS

All participating hospitals developed systems to implement 4 different strategies for terminal room disinfection. We measured compliance with disinfection strategy, barriers to implementation, and perceptions from nurse managers and environmental services (EVS) supervisors throughout the 28-month trial.

RESULTS

Implementation of enhanced terminal disinfection with UV disinfection devices provides unique challenges, including time pressures from bed control personnel, efficient room identification, negative perceptions from nurse managers, and discharge volume. In the course of the BETR Disinfection Study, we utilized several strategies to overcome these barriers: (1) establishing safety as the priority; (2) improving communication between EVS, bed control, and hospital administration; (3) ensuring availability of necessary resources; and (4) tracking and providing feedback on compliance. Using these strategies, we deployed ultraviolet (UV) disinfection devices in 16,220 (88%) of 18,411 eligible rooms during our trial (median per hospital, 89%; IQR, 86%–92%).

CONCLUSIONS

Implementation of enhanced terminal room disinfection strategies using UV devices requires recognition and mitigation of 2 key barriers: (1) timely and accurate identification of rooms that would benefit from enhanced terminal disinfection and (2) overcoming time constraints to allow EVS cleaning staff sufficient time to properly employ enhanced terminal disinfection methods.

TRIAL REGISTRATION

Clinical trials identifier: NCT01579370

Infect Control Hosp Epidemiol 2018;39:157–163

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 2 , February 2018 , pp. 157 - 163
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved 

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References

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