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

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.

Conflict of interest statement

Potential conflicts of interest: W.A.R. and D.J.W. report receiving consulting fees from Clorox. All other authors report no conflicts of interest relevant to this article.

Figures

Figure 1

Median time* required to complete ultraviolet (UV) disinfection device cycles in 9 study hospitals during the Benefits of Enhanced Terminal Room (BETR) Disinfection Study. NOTE: *Median, IQR, and 95% confidence interval provided for each of the 9 study hospitals using the standard box and whiskers approach.

Figure 2A

Percentage of 598,291 patient discharges per shift during the Benefits of Enhanced Terminal Room (BETR) Disinfection Study. Data are provided for any type of patient discharge (all rooms) and for patient discharges after which a UV device was deployed (UV rooms).

Figure 2B

Percentage of 598,291 patient discharges per hour during the Benefits of Enhanced Terminal Room (BETR) Disinfection Study. Data are provided for any type of patient discharge (all rooms) and for patient discharges after which a UV device was deployed (UV rooms).