Effect of SARs-CoV-2 pandemic on infection prevention behaviors and bacterial burden of high touch surfaces in a medical/surgical setting

Abstract

This study aimed to determine the longitudinal efficacy of ultraviolet germicidal disinfection (UV-C) in a non-terminal disinfection context. Moreover, factors influencing enhanced infection prevention behaviors during the SARS-CoV-2 pandemic were evaluated. Sixty nursing staff from three medical/surgical wards in a large military hospital were recruited for a survey and microbiological sampling of high-touch surfaces (stethoscope, personal electronic device, common access card, and hospital ID badge) and portable medical equipment (wheelchairs and mobile commodes). Surveys included hand hygiene estimates, frequency/method of cleaning items of interest, perception of UV-C, and factors influencing the use of enhanced disinfection tools. Surveys and microbiological samples were performed prior to and after the installation of a rapid, automated ultraviolet disinfection enclosure for staff use. Both time points preceded the SARS-CoV-2 pandemic in the United States. A final survey/sampling time point was carried out eight months after the declaration of the COVID-19 pandemic. Participants' hand hygiene frequency did not increase throughout the study, with > 80% reporting a minimum of 4 hand hygiene events per patient hour. The cleaning frequency of high-touch surfaces (non-clinical) but not portable medical equipment increased after installation of a UV-C disinfection tool and was sustained eight months into the COVID-19 pandemic. While a modest decrease in bacterial burden was observed after UV-C intervention, a more significant reduction was observed across all surfaces during pandemic time sampling, though no detectable decrease in pathogenic contamination was observed at either time point. Motivators of UV-C use included fear of SARS-CoV-2 contamination and transmission, ease of device use, and access to rapid, automated disinfection tools while deterrents reported included technical concerns, lack of time, and preference for other disinfection methods. Automated, rapid-cycle UV-C disinfection can be efficacious for high-touch surfaces not currently governed by infection prevention and control guidelines. The introduction of enhanced disinfection tools like UV-C can enhance the overall cleaning frequency and is correlated with mild decreases in bacterial burden of high-touch surfaces, this is enhanced during periods of heightened infection threat. Evidence from this study offers insights into the factors which prompt healthcare workers to internalize/dismiss enhanced infection prevention procedures.

Figure 1

Percentage of nursing staff who performed disinfection of high-touch surfaces at least once daily. Baseline sampling: n=11 for CAC, n=14 for IDs, n=29 for PEDs, and n= 46 for stethoscopes. Post-UV sampling: n=34 for CAC, n=34 for IDs, n=34 for hands, n=42 for PEDs, and n=45 for stethoscopes. All post-SARS-CoV-2 sampling n=16 except for CAC (n=14) and commodes (n=12). CleanSlate UV was limited to include only cards, phones, and stethoscopes. Error bars denote Standard Error, **p≤0.001; *p≤0.05.

Figure 2

Bioburden of high-touch surfaces before and during a global outbreak of a novel coronavirus (SARS-CoV-2). Baseline sampling: n=59 for CAC, n=59 for IDs, n=31 for hands, n=60 for phones, and n= 43 for stethoscopes. Post-intervention sampling: n=57 for CAC, n=57 for IDs, n=34 for hands, n=56 for phones, and n=30 for stethoscopes. All post-outbreak sampling n=23 except for stethoscopes (n=20). Error bars denote Standard Error, *p≤0.001; #p≤0.05.

Figure 3

Staff perception of ultraviolet disinfection impact of work-related safety.