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Randomized Controlled Trial
. 2025 Sep 1;185(9):1128-1135.
doi: 10.1001/jamainternmed.2025.3388.

Germicidal UV Light and Incidence of Acute Respiratory Infection in Long-Term Care for Older Adults: A Randomized Clinical Trial

Andrew P Shoubridge  1   2 , Amanda Brass  1   2 , Maria Crotty  1   2   3 , Lidia Morawska  4 , Scott C Bell  5   6 , Erin Flynn  1   7 , Caroline Miller  1   8 , Yiming Wang  1   2 , Carol A Holden  1 , Megan Corlis  9 , Nicolas Larby  10 , Paul Worley  3   11 , Levi Elms  1   2 , Sarah K Manning  1   2 , Ming Qiao  7 , Maria C Inacio  1   12   13 , Steve L Wesselingh  2 , Lito E Papanicolas  1   2   7 , Richard J Woodman  2 , Steven L Taylor  1   2 , Geraint B Rogers  1   2
Affiliations
Randomized Controlled Trial

Germicidal UV Light and Incidence of Acute Respiratory Infection in Long-Term Care for Older Adults: A Randomized Clinical Trial

Andrew P Shoubridge et al. JAMA Intern Med. .

Abstract

Importance: Infectious outbreaks of respiratory viruses within long-term care facilities (LTCFs) for older adults are associated with high rates of hospitalization and death. Despite evidence that airborne transmission contributes substantially to the spread of respiratory viruses within residential care for older adults, this mode of transmission has been largely unaddressed by existing infection control practices.

Objective: To determine whether germicidal UV (GUV) appliances reduce acute respiratory infection (ARI) incidence in LTCFs.

Design, setting, and participants: This multicenter, 2-arm, double-crossover, cluster randomized clinical trial assessed the effectiveness of GUV appliances in common spaces on the incidence of ARIs in 4 LTCFs in metropolitan and regional South Australia. LTCFs were divided into 2 equally sized zones (mean [SD] size, 44 [9] beds per zone). Within each LTCF, zones were randomized to active GUV appliances (intervention) or inactive (control) for 6 weeks, which was followed by a 2-week washout, crossover, and a further 2-week washout. Seven consecutive cycles were performed during the 110-week study period from August 31, 2021, to November 13, 2023. Data were analyzed from January 18, 2024, to December 4, 2024.

Intervention: Continuous GUV appliance activity within common (non-resident room) areas for 6 weeks.

Main outcome and measures: The primary outcome was the incidence rate of ARIs (per zone per cycle). A secondary analysis of long-term trends was performed based on infections per week.

Results: Eight assessed zones across 4 LTCFs represented a total of 211 952 bed-days. Of 596 ARIs recorded across all zones, 475 (79.7%) occurred during intervention or control periods. The incidence rate in the control arm was 4.17 infections per zone per cycle (95% CI, 2.43-5.91), compared with 3.81 infections per zone per cycle (95% CI, 2.21-5.41) in the intervention arm (incidence rate ratio, 0.91; 95% CI, 0.77-1.09; P = .33). A posteriori secondary analysis with time-series autoregressive modeling showed that the control group recorded 2.61 ARIs per week (95% CI, 2.51-2.70) compared with 2.29 ARIs per week (95% CI, 2.06-2.51) in the intervention group (mean difference, 0.32; 95% CI, 0.10-0.54; P = .004).

Conclusions and relevance: This randomized clinical trial found that GUV light appliances in common areas of LTCFs did not reduce the incidence rate of ARIs per zone per cycle but did modestly reduce the total numbers of ARIs by the study conclusion. GUV appliances might be considered to support existing infection prevention and control practices in these settings.

Trial registration: Australian and New Zealand Clinical Trial Registration: ACTRN12621000567820.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Shoubridge reported grants from the Australian Department of Health and Aged Care during the conduct of the study. Dr Bell reported personal fees from Vertex Pharmaceuticals outside the submitted work. Dr Worley reported being an employee of Riverland Mallee Coorong Local Health Network during the conduct of the study. Dr Inacio reported grants from the Australian Government, (Medical Research Future Fund GNT 2005904) during the conduct of the study as well as grants from the Australian Government, Medical Research Future Fund, National Health and Medical Research Council, and Hospital Research Foundation and personal fees from the Australian Government, Star Rating Expert Advisory Committee, Quality Indicator Program Technical Advisory Group, and Independent Health and Aged Care Pricing Authority outside the submitted work. Dr Papanicolas reported being an employee of SA Pathology outside the submitted work. Dr Taylor reported grants from the Medical Research Future Fund during the conduct of the study. Dr Morawska discloses support for the research of this work from the ARC Training Centre for Advanced Building Systems Against Airborne Infection Transmission (THRIVE) (IC220100012). Dr Rogers reported grants from the Australian Government/Medical Research Future Fund and research support from a Matthew Flinders Professorial Fellowship during the conduct of the study. Drs Inacio, Taylor, and Miller received research support from National Health and Medical Research Council Investigator grants (GNT119378, GNT2008625, and GNT1195421, respectively). No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Study Flow Diagram
Flow of long-term care facilities for older adults in South Australia targeted for the PETRA (Prevention of SARS-CoV-2 Transmission in Residential Aged Care Using UV Light) study, including the intervention, facilities enrolled, and facilities analyzed.
Figure 2.
Figure 2.. Incidence of Acute Respiratory Infections in PETRA (Prevention of SARS-CoV-2 Transmission in Residential Aged Care Using UV Light)
A, The number and distribution of acute respiratory infection events across all long-term care facilities for older adults in PETRA from August 31, 2021, to November 13, 2023, among residents during periods of no intervention (control), or germicidal UV light (GUV) activity (intervention). B, The incidence rate of respiratory infections per resident per month in PETRA for control or intervention.
Figure 3.
Figure 3.. Cumulative Incidence of Acute Respiratory Infections in Control vs Intervention Conditions
The observed (solid) and predicted (dashed) cumulative incidence of respiratory infections of the control and intervention conditions over 110 consecutive weeks, including (A) and excluding (B) events in memory support units (MSUs). Predicted series and trends were calculated with autoregressive modeling after removing level 2 autocorrelation.
See this image and copyright information in PMC

Comment on

References

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