Table 10Summary of Findings of Included Primary Studies

Main Study FindingsAuthor’s Conclusions
Brite et al., 201817
Post-intervention (PX-UV) versus pre-intervention in a bone marrow transplant unit
  • Length of hospital stay (median, SD): 29.48 (16.41) versus 24.33 (12.59) days
  • Monthly incidence rate of infection
    –

    C. difficile: 9.3 per 1,000 patient days versus 7.1 per 1,000 patient days; P = 0.503

    –

    VRE: 12.2 per 1,000 patient days versus 9.7 per 1,000 patient days; P = 0.4389

  • Interrupted time series analysis
    Level change after UV cleaning
    –

    C. difficile: IRR (95% CI) = 0.51 (0.13 to 2.11); P = 0.356

    –

    VRE: IRR (95% CI) = 1.34 (0.37 to 4.80); P = 0.652

    Trend change after UV cleaning
    –

    C. difficile: IRR (95% CI) = 1.08 (0.89 to 1.31); P = 0.413

    –

    VRE: IRR (95% CI) = 0.96 (0.81 to 1.14); P = 0.625

  • Hospital-acquired incidence rate of infectiony
    –

    C. difficile: 1.411 per 1,000 days versus 1.114 per 1,000 days; P = 0.70

    –

    VRE: 3.0236 per 1,000 days versus 3.6588 per 1,000 days; P = 0.60

  • Manual cleaning, hand hygiene compliance, antibiotic utilization: no difference between two periods
“Utilization of UV disinfection to supplement routine terminal cleaning of rooms was not effective in reducing hospital acquired VRE and C. difficile among stem cell transplant recipients”17 p.1301
Pavia et al., 201818
Post-intervention (UV-C) versus pre-intervention in a pediatric long-term care facility
  • Hospital acquired viral infections
    • Unadjusted IRR (95% CI) = 0.56 (0.37 to 0.84); P = 0.003
“The results suggest that UV-C technology is a potentially important component of eliminating the environment as a source of viral infections”18 p.720
Raggi et al., 201819
Post-intervention (UV-C) versus pre-intervention at a community hospital
  • Overall HAI incidence rates (per 1,000 patient days): 3.94 versus 4.87; P = 0.006
  • HAI incidence rates with MDRO (per 1,000 patient days)
    –

    Acinetobacter baumannii: 0.16 versus 0.34; P = 0.03

    –

    Klebsiella pneumonia: 1.22 versus 1.16; P = 0.36

    –

    MRSA: 0.98 versus 1.42; P = 0.02

    –

    Pseudomonas aeruginosa: 1.16 versus 1.29; P = 0.22

    –

    VRE: 0.45 versus 0.68; P = 0.05

  • Emergency department admissions: 297.9 minutes versus 296.2 minutes; P = 0.18
  • Direct cost saving: $1,219,878 over a 12-month period calculated from the reduction of hospital length of stay
“The UV-C disinfection was associated with a statistically significant facility-wide reduction of multidrug-resistant HAIs and generated substantial direct cost savings without adversely impacting hospital operations”19 p.1224
Sampathkumar et al., 201820
PX-UV disinfection in 3 units (2 hematology and bone marrow transplant units and a medical-surgery unit) versus 3 control units (same type of patients)
  • C. difficile infection rates (per 10,000 patient days):
    –

    Before intervention (21 months): 21.3 versus 26.1; P = 0.17

    –

    Intervention (6 months): 11.2 versus 28.7; P = 0.03

  • VRE infection rates in hematology and bone marrow transplant units only (per 10,000 patient days):
    –

    Before intervention (21 months): 25.6 versus 46.0; P = 0.002

    –

    Intervention (6 months): 12.3 versus 32.5; P = 0.02

“The addition of UV disinfection to terminal cleaning has resulted in a reduction in C. difficile infection in our hospital that has sustained over several months. During the pilot phase on units with a VRE surveillance program, we also saw a reduction in VRE acquisition.”20 p.3
Ethington et al., 201821
Post-intervention (UV-C air sterilizer) versus pre-intervention in ICU
  • Overall HAI rates (case per month): 3.5 versus 8.8; P < 0.001
  • HAI rates with specific organism (case per year)
    –

    C. difficile: 1 versus 8; P = 0.01

    –

    MRSA: 6 versus 13; P = 0.107

    –

    VRE: 6 versus 7; P = 0.764

    –

    CAUTI: 9 versus 20; P = 0.012

    –

    CLABSI: 9 versus 16; P = 0.226

“Continuous shielded UV-C reduced airborne bacteria and may lower the number of HAI, including those caused by contact pathogens.”21 p.482
Heredia-Rodriguez et al., 201822
UV-C air sterilizer rooms versus control rooms in ICU of cardiac surgery
  • Patient colonization rates (%)
    –

    Any type of bacteria: 40.4 versus 43.1

    –

    Gram-positive: 21.6 versus 24.3

    –

    Gram-negative: 18.8 in both groups

  • HAI rates (%)
    –

    Total: 14.0 versus 15.5; P = 0.45 VAP: 4.6 versus 5.0; P = 0.77

    –

    Urinary tract: 2.9 versus 2.6; P = 0.78

    –

    Catheter: 1.4 versus 1.6; P = 0.71

    –

    Blood: 2.4 versus 2.8; P = 0.78

    –

    Surgical site: 2.8 versus 3.5; P = 0.56

  • Stay in the ICU (mean days, SD): 4.6 ± 8.2 versus 4.6 ± 7.3; P = 0.98
  • Total hospital stay (mean days, SD): 18.3 ± 5.5 versus 19.2 ± 18.6; P = 0.38
  • 30-day mortality rate (%): 3.83 versus 6.4; P = 0.053
“Novel UV-C technology had not been shown to significantly reduce nosocomial infections or mortality rates in cardiac surgery patients”22 p.299
Kane et al., 201823
UV disinfecting (UV-C air sterilizer) wing versus control wing in long-term care ventilator unit
  • Overall infection rate based on antibiotic ordered: 12.5 ± 2.12 per 1,000 patient days versus 17.5 ± 2.81 per 1,000 patient days; P = 0.022
  • Types of infection-causing organisms: Acinetobacter, MRSA, VRE and C. difficile
  • Infection rates caused by those organisms: No statistically significant difference between groups (P > 0.05). The authors suggested that the non-significant difference was due to relatively small sample size (n = 81), which is underpowered.
“Findings suggest that continuous exposure to UV-C treated air reduces HAI. Shielded UV-C units in patient rooms may be an effective non-staff intervention dependent method for reducing HAI.”23 p.44
Ryan et al., 201124
Post-intervention (UV-C air sterilizer) versus pre-intervention in neonatal ICU
  • Tracheal colonization decreased 45% (P = 0.004)
  • Number of high-risk babies (<30 weeks gestation and ventilated for ≥ 14 days)
    –

    Pre (6 months): 31 (57%)

    –

    Post (first next 6 months): 25 (44%)

    –

    Post (second next 6 months): 24 (33%)

    –

    Post (third next 6 months): 18 (35%)*

  • High risk babies with at least one VAP
    –

    Pre (6 months): 74%

    –

    Post (first next 6 months): 56%

    –

    Post (second next 6 months): 54%

    –

    Post (third next 6 months): 39%

  • Number of VAP per high risk patient with any VAP
    –

    Pre (6 months): 1.7

    –

    Post (first next 6 months): 1.3

    –

    Post (second next 6 months): 1.5

    –

    Post (third next 6 months): 1.1*

  • Number of antibiotics per high-risk patient
    –

    Pre (6 months): 2.6

    –

    Post (first next 6 months): 1.7

    –

    Post (second next 6 months): 1.9

    –

    Post (third next 6 months): 1.0*

*P < 0.011 compared to pre-intervention		“Enhanced ultraviolet germicidal irradiation (eUVGI) decreased heating ventilation and air conditioning system microbial colonization and was associated with reduced newborn intensive care unit environment and tracheal microbial colonization. Significant reduction in VAP and antibiotic use were also associated with eUVGI in this single-center study.”24 p.607

CAUTI = Catheter-associated urinary tract infection; CI = confidence interval; C. difficile = Clostridium difficile; CLABSI = Central line-associated bloodstream infection; HAI = hospital-acquired infection; IRR = incidence rate ratio; MDRO = multidrug-resistant organisms; MRSA = methicillin resistant Staphylococcus Aureus; OR = odds ratio; PX-UV = pulsed xenon ultraviolet radiation; SD = standard deviation; UV = ultraviolet; UV-C = continuous ultraviolet radiation; VAP = ventilator-associated pneumonia; VRE = vancomycin-resistant enterococcus

From: Non-Manual Ultraviolet Light Disinfection for Hospital Acquired Infections: A Review of Clinical Effectiveness and Guidelines

Cover of Non-Manual Ultraviolet Light Disinfection for Hospital Acquired Infections: A Review of Clinical Effectiveness and Guidelines
Non-Manual Ultraviolet Light Disinfection for Hospital Acquired Infections: A Review of Clinical Effectiveness and Guidelines [Internet].
Tran K, McCormack S.
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