Should UV light be a weapon in our infection-control arsenal inside hospitals?

As an engineer who spends a significant amount of time designing healthcare building systems, I am concerned about healthcare acquired infections (HAI). An individual who picks up an infection while receiving care in the hospital will likely require a longer stay, which is very expensive for the healthcare system. In the worst case, they become seriously ill and die. 

The Center for Disease Control reports that healthcare acquired infections kill around 100,000 people every year in the US. As I’ve mentioned previously, revamping the way we handle air exhaust during renovations can help prevent some of these infections. But I’m just as concerned about the day-to-day operations of healthcare institutions. Are there any new technologies worth exploring?

We need some fresh ideas to deal with HAIs, but which infections specifically? This broad spectrum of infections can include complications from surgery or a non-sterile instrument, or from a lack of hand washing, or an encounter with dirty surfaces. Let’s look at one narrow subset of these infections, Clostridium difficile, which most commonly affects older adults in hospitals or in long-term care facilities. These infections can come from diarrhea. It aerosolizes, the bacteria lands on a surface, they colonize, someone makes contact with that surface, that gets in their body, and they’re sick. This especially happens in hospitals with shared patient rooms and shared patient washrooms. Many hospitals, usually older ones, have wards where you have six beds and one shared bathroom. According to the CDC, C. diff attacks 500,000 US patients every year and kills 15,000 of them within 30 days of being diagnosed. 

Here’s where the lights come in: Ultraviolet Germicidal Irradiation using Ultraviolet C (shortwave ultraviolet light) lighting, or UVc, for short has great potential. I’m excited and curious about UVc in healthcare because it has the potential to make a difference in the battle against hospital acquired infections. Use of UVc is well established in the water treatment industry, but its implementation in healthcare is not yet widespread. I’ve seen UVc lights used frequently to kill germs in the hospital water supplies, air handling equipment, and sterile device processing. But the application of a UVc lighting system in shared bathrooms to irradiate C. diff germs after the bathroom has been used still appears to be the exception, instead of the rule. 

A second area in healthcare where UVc may be beneficial is controlling biofilm. Biofilm, which is like that slime that accumulates on children’s bathtub toys, isn’t necessarily bad bacteria, but when we see it in healthcare settings—where we have sick and vulnerable patients—it becomes undesirable. With a UVc light on it, that bacteria will find itself in a losing genetic battle, with the UVc invisible rays damaging the bacteria’s DNA faster than the DNA can repair itself. Goodbye bathtub slime. There are several products available on the marketplace that offer a fixed UVc lighting system for keeping HVAC equipment, like cooling coils, clean. However, I don’t see an established marketplace for all of these other key spots that need cleaning, like the hospital sinks. 

A third area to consider is mobile electronic devices. In today’s “smart hospitals,” doctors and healthcare team members are regularly using cell phones, tablets, or COWS (computers on wheels) as they make their rounds. Studies show that these devices, especially cell phones, are likely to be contaminated. Can UVc light treatment help us deal with contamination of these smart devices and reduce the transport of infection from one space to another?

I’m enthusiastic about UVc lighting in healthcare, but I’m also curious. In addition to the questions above, I’m thinking about the following:

Effectiveness? 

How do I know what kind of a “dose” of UVc is required to be effective? One limitation of using light to fight bugs is that you need a line of sight to shine on them. Is it practical to expect that the systems won’t cast any shadows? Even if they do, is that OK and still enough to make a difference? I’m interested in seeing more impartial and in situ research that can help me sort through the white noise on UVc.

Standards?

I don’t see any real established codes or standards for UVc use in healthcare. What kind of lights are safe to use? What kind of UV lights aren’t? Too much UV is harmful to humans as we know, and many of these systems require interlocks to protect against human skin and eye exposure. Is there a standard that defines what level of protection is appropriate to provide? And what will it do to our materials? Are our backsplashes and flooring going to break down more quickly? What’s the life cycle of a light? What happens when a light breaks? Is it dangerous? 

On the sustainability front, do UVc lights require more power, will UVc lights make it harder to meet sustainability goals? How about embodied fossil fuel and GHG emissions associated with these lights?

Replacement or an addition?

My understanding thus far is that UVc light is used in addition to regular cleaning in maintaining a facility. If privatized healthcare sees UVc lighting as an additional burden, that’s going to raise costs. But if the benefit is strong enough, it’s a marginal cost all should be willing to accept, eventually resulting in a net decrease in total healthcare costs. 

LEDs?

We’re seeing a major shift in lighting from incandescent to LED lighting and huge energy savings as a result. What about LED lighting for UVc? Is LED the future of UVc? While I have seen some marketing of LED UVc, we have yet to see widespread adaptation.

What’s holding it back?

If UVc lighting in healthcare is so effective, what’s holding it back? What are the hurdles to get over to make it a reality? And if it’s so good, why isn’t it mandated by code regulations? Or when will it be?

From my perspective, learning more about the application of a potentially beneficial technology such as UVc lighting in healthcare requires us to start asking and answering some of these questions.