Alternative Room Disinfection Modalities –Pros and Cons - Use of Biocidal Surfaces for Reduction of Healthcare Acquired Infections - page 199

contaminated with dangerous pathogens, fumigation may allow the building to be
safely re-occupied. In other situations where patients are shedding organisms such
as MRSA, this approach must be used with caution. It is unclear how fumigation
can be effective when there is a likelihood of continuous recontamination.
There appears to be an assumption that since UVC is effective for upper air
disinfection, so it must also be effective for surface disinfection. This assumption is
seriously flawed because it is much easier to inactivate organisms in the air than on
surfaces. As of this writing, there is limited research on the effectiveness of UVC
for surface disinfection under actual use conditions. This lack of scientific support
suggests that the use of this modality should limited to such applications as upper
air and ventilation cooling coil disinfection until such time that convincing
evidence of effectiveness on surfaces is demonstrated.
If ineffective cleaning and conventional surface disinfection is the problem, then
strategies that improve housekeeping effectiveness should be considered. Dancer
and his colleagues addressed the problem with MRSA contamination in a hospital
in the United Kingdom by improving patient screening and isolation of patients
infected with MRSA and by implementing an enhanced cleaning protocol [ 1 ].
This enhanced protocol simply involved adding an additional housekeeper, more
frequent cleaning and careful monitoring of cleaning performance. The enhanced
cleaning resulted in a 32.5 % reduction in aerobic colony counts. There was also a
reduction in new nosocomial MRSA cases. However, the authors noted that the
study lacked sufficient power to determine if the reduction in infections was
significant. According to the authors, the increased cost of an additional staff
member and additional supplies was more than offset by the reduction in MRSA
infections and the costs associated with patient care. Goodman et al. did a similar
study in an intensive care unit targeting MRSA and VRE contamination [ 104 ].
Their approach was to study “high-touch” surfaces, train housekeeper to focus on
these surfaces, and then monitor the effectiveness of cleaning using microbial
cultures and a backlight. Their enhanced cleaning procedures also resulted in
significant reductions in MRSA and VRE.
The fact that accidental releases of chemical fumigants in healthcare have not
yet been reported does not mean that they will not happen or have happened and
were not reported. The evidence from non-healthcare applications demonstrates
that accidents are possible, and consequences can be severe. Occupational and
environmental exposures in non-healthcare operations have been published, and
there is little evidence to indicate that similar exposures cannot occur in healthcare.
There appears to be a lack of consensus and guidance on the safe application
protocols for the use of fumigants in healthcare. Validated methods for the recog-
nition and control of hazards must be developed and used to protect workers,
patients, and the general public. Exposure limits for these chemicals for patients
or other non-occupational groups currently do not exist, making it difficult to
determine the safe concentration of chlorine dioxide or HPV for someone who
may be in a weakened state. The current Occupational Safety and Health Admin-
istration (OSHA) Permissible Exposure Limit (PEL) for chlorine dioxide is
0.1 ppm, and OSHA's sampling method (ID-202) has a limit of detection for a