Strategies for deployment of ultraviolet disinfection in an acute care facility: A quality improvement initiative.

BACKGROUND: Mobile ultraviolet (UV) disinfection uses UV-C light to render microorganisms nonviable and reduce environmental transmission of pathogens in hospital settings. Optimal strategies for deployment must consider the cost, physical layout, and staffing resources. The aim of this quality improvement study was to increase UV disinfection utilization by developing novel deployment strategies without adding resources. METHODS: A novel deployment strategy and tools were developed by a multidisciplinary group that included infection prevention, environmental services, and nursing unit staff. Utilization was tracked via a manufacturer-supported database. The infection prevention team analyzed the weekly UV disinfection minutes, cycles, and proportions of cycles completed in defined areas across 4 periods: baseline, pilot, baseline 2, and intervention. RESULTS: The median (range) disinfection cycle times per week during a geographically confined pilot (4,985 minutes [3,476-6,551] minutes) and the intervention period (1,454 [512-3,085] minutes) were lower than either baseline period (5,394 [3,953-6,987] and 6,641 [2,830-7,276] minutes, respectively). Cycles per week were lower in the intervention period than in the preceding 3 periods. CONCLUSIONS: Use of UV disinfection in acute care settings should be guided by multidisciplinary groups balancing resources against efficacy and using tailored tools to promote efficiency.

Diagnostic stewardship for Clostridioides difficile testing in an acute care hospital: A quality improvement intervention.

Objective: To evaluate the impact of a diagnostic stewardship intervention on Clostridioides difficile healthcare-associated infections (HAI). Design: Quality improvement study. Setting: Two urban acute care hospitals. Interventions: All inpatient stool testing for C. difficile required review and approval prior to specimen processing in the laboratory. An infection preventionist reviewed all orders daily through chart review and conversations with nursing; orders meeting clinical criteria for testing were approved, orders not meeting clinical criteria were discussed with the ordering provider. The proportion of completed tests meeting clinical criteria for testing and the primary outcome of C. difficile HAI were compared before and after the intervention. Results: The frequency of completed C. difficile orders not meeting criteria was lower [146 (7.5%) of 1,958] in the intervention period (January 10, 2022-October 14, 2022) than in the sampled 3-month preintervention period [26 (21.0%) of 124; P < .001]. C. difficile HAI rates were 8.80 per 10,000 patient days prior to the intervention (March 1, 2021-January 9, 2022) and 7.69 per 10,000 patient days during the intervention period (incidence rate ratio, 0.87; 95% confidence interval, 0.73-1.05; P = .13). Conclusions: A stringent order-approval process reduced clinically nonindicated testing for C. difficile but did not significantly decrease HAIs.