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.
In our study, we evaluated the efficacy of the UV-C treatment only on the reduction in mesophilic growth that mainly represents human contamination, but not on specific pathogens of interest; however, the reduction was very significant, suggesting that this system can easily eliminate pathogens as well. We have previously demonstrated that the adoption of an automated UV-C-disinfection robot in the enhancement of SOP in high-risk settings was successful in reducing pathogens on high-touch surfaces, improving the patients safety [
Moreover, it would be important to evaluate the advantages of implemented cleaning and disinfection protocols with the use of UV-C devices in areas hosting fragile and vulnerable patients, e.g., in intensive care units. The principal limitation is the continuous presence of people in this type of setting. For this reason, it would be worth evaluating strategies aimed at protecting the patients safety using protective devices, which may be evaluated for human security during UV-C emission at specific dosages and times.
Monitoring data feedback to cleaning staff through periodic audits can be a valid aid for improving cleaning and disinfection procedures and adherence to protocols. This strategy was adopted in our study and, thanks to the collaboration between the infection control team and the outsourced cleaning company, it was possible to identify the critical issues and take corrective actions. To this end, environmental monitoring is essential for process verification.
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