Each hospital should have an infection control team aiming to evaluate the risk factors involved in healthcare infection occurrences with a multidisciplinary and dynamic approach. Epidemiological infection control in hospital may detect all of the critical points of the healthcare procedures performed by nurses, healthcare workers, physicians, students, and external staff. This evaluation may also include the sanitization process and its management. An appropriate evaluation of the whole sanitization process, including the reprocessing of cleaning materials, would be the best practice.
The UV-C disinfection robot (Mediland Enterprise Corporation, Taoyuan City, Taiwan) uses amalgam lamps (UV lamp NNI / XL Niederdruck VUV Strahler) and protective reflector technology to generate high-energy, broad-spectrum ultraviolet light (UV-C nm). The manufacturer of the lamps declares in the technical data sheet that the lamps have a filter that blocks radiation between nm, eliminating the possibility of producing ozone as a by-product of UV-C radiation. The UV-C device uses min disinfection cycles and multiple positions with minimal distances from high-touch surfaces. Due to the use of high-intensity UV-C radiation, the device must operate in unoccupied rooms. There are multi-motion sensors that shut off the device if any movement is detected inside the room being disinfected or if the door is accidentally opened. When the robot operates in accordance with these procedures, the manufacturer declares that the amalgam lamps produce no ozone gas and leave no toxic residues.
Our study has some limitations. Firstly, the non-homogeneous sampling for all of the settings, where a greater number of analyses were dedicated to the OTs rather than the ICUs or patient rooms: it was not always possible to proceed with the UV-C treatment at the patient discharge because trained personnel were limited and not always available. This problem underlines the importance of having dedicated personnel identifiable as that of the outsourced cleaning company. The use of new technologies could in fact be included in outsourcing contracts as an improvement action in the event of non-compliance in the cleaning service. These personnel could be adequately trained not only on the cleaning protocols to be adopted but also on infection control issues.
Among the appliable strategies for the improvement of cleaning and disinfection practices are the use of new materials and/or disinfectants, the training and audit of operators, and the use of new automated technologies, which are becoming increasingly important. In particular, no-touch disinfection technologies have the great advantage of not being dependent on the operator, ensuring process repeatability. Furthermore, their effectiveness has been demonstrated even on sites that are difficult to reach with manual intervention. Their use complements but does not replace ordinary cleaning and disinfection protocols. In the past few years, ultraviolet disinfection systems have been widely investigated and used as a way to improve standard cleaning protocols. Currently, ultraviolet devices are automated in order to guarantee process repeatability and reduce human errors. The application of UV devices as an addition to traditional environmental cleaning has become increasingly common due to their effectiveness in reducing the environmental microbial burden in a shorter time compared to other technologies using chemical products [
The role of the environment, particularly of high-touch surfaces in the patients room (e.g., bedrails, over-bed tables, and call-buttons) and reusable care equipment that is moved between rooms, has been demonstrated to be fundamental in the transmission of healthcare-related infections. Together with standard precautions and the application of good practices in invasive procedures, environmental cleaning and disinfection represents one of the three pillars of infection risk prevention in healthcare settings.