HAIs not only threaten patients' health and life but bring additional economic burdens to patients and the healthcare system, including direct financial loss and prolonged hospitalization. Total hospital length of stay (LOS) is known to be extended by the occurrence of HAI. [source]
At any one time in the United States, 1 out of every 25 hospitalized patients is affected by an HAI [source], and according to the Centers for Disease Control and Prevention, an estimated 99,000 die from their infection.
This article will discuss the different types of HAIs and how light can support the prevention efforts for these types of infections.
Healthcare-Associated Infection (HAI)
Common types of HAIs include . . .
1. Catheter-associated urinary tract infections (CAUTI)
A urinary tract infection (UTI) is a common type of HAI. According to the National Healthcare Safety Network (NHSN), 75% of UTIs acquired in the hospital are associated with a urinary catheter.
2. Bloodstream infections (CLABSI)
CLABSI occurs when bacteria enter the bloodstream through the central line—a tube inserted in the vein.
There are steps to avert infection from the clinicians to the healthcare organizations. The CDC provides a checklist for preventing central line-associated bloodstream infections.
3. Surgical site infections (SSI)
Another area of focus is preventing infection in the patient post-operation. This is referred to as a Surgical Site Infection or SSD.
Surgical site infections are the second most common healthcare-associated infection. The infection occurs after surgery and can involve only the incision site or other organs. Most SSIs can be treated.
4. Ventilator-associated pneumonia (VAP)
VAP is a lung infection that can occur in a patient who is on a ventilator.
Similar to the other infections, the CDC has preventable measures and guidelines for healthcare-associated pneumonia.
HAIs occur in all types of care settings, from acute care hospitals to long-term care facilities:
- Acute care hospitals
- Ambulatory surgical centers
- Dialysis facilities
- Outpatient care (e.g., physicians' offices and health care clinics)
- Long-term care facilities (e.g., nursing homes and rehabilitation facilities)
source: Healthy People, Healthcare-Associated Infections
Although HAIs can be transmitted in different healthcare facilities, prevention practices can reduce specific HAIs.
Current Methods for Preventing HAIs
Best practices by healthcare providers can include:
- Proper pre-op preparations
- Suitable patient pre/post-op procedures
- Equipment readiness
- Exam/OR room precautions
These precautions help reduce the chances of infection. Healthcare personnel has an important role in maintaining a patient's safety.
However, failure to properly disinfect or sterilize medical equipment also plays a crucial role. Sterilization technologies used in healthcare are essential to ensure the instruments do not transmit infectious pathogens to the patients.
In the next section, we cover guidelines for disinfection and sterilization in healthcare facilities . . .
Using Light Technology for Sterilization and Disinfection of Hospital Equipment
Ultraviolet (UV) light, primarily UVC bandwidth of 280 nm-200 nm, has been used for sterilization and disinfection as early as the mid-20th century. It is convenient to use as there are no chemicals needed, and it is capable of killing all types of microorganisms—bacteria, viruses, and fungi.
UV disinfection is a photochemical process. Microorganisms that pollute a surface or indoor environment are DNA or RNA-based. The cell membranes and DNA break down when exposed to high-intensity UV light at or around 253.7nm. The efficacy of UVC light disinfection can be directly related to the time of exposure and intensity of the light. Other factors like humidity, other airborne particles, and distance between pathogen and UV light source can also affect the efficacy of the UV sterilization process.
Once a pathogen is exposed to UV light, how does it help eradicate it?
First, the microorganisms must be exposed for a sufficient period of time in order for the UV rays to penetrate the cellular membrane. Once exposed, the light then breaks down the molecular bonds. Once these bonds are broken, the cellular membrane becomes damaged, which causes the cells to die. Alternatively, this can also cause DNA/RNA damage, rendering the germs harmless because they can no longer reproduce and cause diseases.
UV sterilization is invaluable for preventing the spread of HAIs. Hospitals use UV exposure to sterilize their surgical equipment to help reduce infections. UV exposure can be harmful to the human skin thus it is utilized only on equipment and when people are not present. Some very specific wavelengths, 220-222 and 405, have been proven to be safe for human exposure. UV sterilization has proven economical because there is very little maintenance or continual upkeep, as is common with other systems such as steam or chemical sterilization.
Infrared radiation (IR), or infrared light, is a type of radiant energy invisible to human eyes but can feel as heat.
According to John Hageman, MS, CHP, Radiation Safety Officer at Southwest Research Institute,
"Sterilization, the killing of bacteria (or any types of cells), on medical instruments is primarily achieved by the radiation causing severe damage to the cell's components and the cell's chromosomes, specifically the DNA." [source]
Next to IR on the electromagnetic spectrum is Microwave. Microwave—UV light sterilization is highly effective in sterilizing microorganisms.
The use of UV lighting is also used as a disinfection aid.
Watch as Acuity Brands shows UV light having the ability to inactive pathogens in the air and on non-porous surfaces . . .
Source: Acuity Brands, Inc., "What is UV Light Disinfection Technology?" via YouTube
New technologies have introduced other methods to kill microorganisms into the medical world.
The other is—dry heat sterilizers. Dry heat sterilizers use very high heat to destroy bacteria. This sterilizer is particularly useful when sanitizing metal instruments because it does not rust the equipment or dull metal edges.
How do HAIs Impact Healthcare Facilities?
The CDC estimates U.S. hospitals have direct medical costs of at least $28.4 billion each year due to HAIs. They also account for an additional $12.4 billion in costs to society from early deaths and lost productivity. With such a large amount of premature deaths and the rising cost of healthcare expenses due to HAIs, there is a need to reduce the amount of HAIs using the most cost-effective and efficient methods available.
The recent Covid-19 pandemic has made it difficult for hospitals to sterilize facilities and equipment as quickly and effectively as was once done at pre-pandemic levels. The cleaning and disinfecting protocols added to most hospital protocols have increased the time between surgeries, thus reducing the overall number of surgeries completed in a single day. UV sterilization has shown to be effective in killing +99% of harmful pathogens quickly. In some cases, the efficacy of UV light in eradicating pathogens has shown to be effective in as little as 10-12 minutes.
UV sterilization systems generally have a higher initial cost than conventional ones such as Steam or Autoclaving. However, the required continual maintenance and architecture to install conventional sterilization systems surpass most UV sterilization methods.