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Abstract：
More evidence is emerging on the role of surface decontamination for reducing hospital-acquired infection (HAI). Timely and adequate removal of environmental pathogens leads to measurable clinical benefit in both routine and outbreak situations.
This systematic review aimed to evaluate published studies describing the effect of automated technologies delivering hydrogen peroxide (H202) or ultra-violet (UV) light on HAI rates.
A systematic review was performed using relevant search terms. Databases were scanned from January 2005 to March 2020 for studies reporting clinical outcome after use of automated devices on healthcare surfaces. Information collected included device type, overall findings; hospital and ward data; study location, length and size; antimicrobial consumption; domestic monitoring; and infection control interventions. Study sponsorship and duplicate publications were also noted.
While there are clear benefits from non-touch devices in vitro, we found insufficient objective assessment of patient outcome due to the before-and-after nature of 36 of 43 (84%) studies. Of 43 studies, 20 (47%) used hydrogen peroxide (14 for outbreaks) and 23 (53%) used UV technology (none for outbreaks). The most popular pathogen targeted, either alone or in combination with others, was Clostridium difficile (27 of 43 studies: 63%), followed by methicillin-resistant Staphylococcus aureus (MRSA) (16 of 43: 37%). Many owed funding and/or personnel to industry sponsorship (28 of 43: 65%) and most were confounded by concurrent infection control, antimicrobial stewardship and/or cleaning audit initiatives. Few contained data on device costs and rarely on comparable costs (1 of 43: 2%). There were expected relationships between the country hosting the study and location of device companies. None mentioned the potential for environmental damage, including effects on microbial survivors.
There were mixed results for patient benefit from this review of automated devices using H202 or UV for surface decontamination. Most non-outbreak studies lacked an appropriate control group and were potentially compromised by industry sponsorship. Concern over HAI encourages delivery of powerful disinfectants for eliminating pathogens without appreciating toxicity or cost benefit. Routine use of these devices requires justification from standardized and controlled studies to understand how best to manage contaminated healthcare environments.
This systematic review aimed to evaluate published studies describing the effect of automated technologies delivering hydrogen peroxide (H202) or ultra-violet (UV) light on HAI rates.
A systematic review was performed using relevant search terms. Databases were scanned from January 2005 to March 2020 for studies reporting clinical outcome after use of automated devices on healthcare surfaces. Information collected included device type, overall findings; hospital and ward data; study location, length and size; antimicrobial consumption; domestic monitoring; and infection control interventions. Study sponsorship and duplicate publications were also noted.
While there are clear benefits from non-touch devices in vitro, we found insufficient objective assessment of patient outcome due to the before-and-after nature of 36 of 43 (84%) studies. Of 43 studies, 20 (47%) used hydrogen peroxide (14 for outbreaks) and 23 (53%) used UV technology (none for outbreaks). The most popular pathogen targeted, either alone or in combination with others, was Clostridium difficile (27 of 43 studies: 63%), followed by methicillin-resistant Staphylococcus aureus (MRSA) (16 of 43: 37%). Many owed funding and/or personnel to industry sponsorship (28 of 43: 65%) and most were confounded by concurrent infection control, antimicrobial stewardship and/or cleaning audit initiatives. Few contained data on device costs and rarely on comparable costs (1 of 43: 2%). There were expected relationships between the country hosting the study and location of device companies. None mentioned the potential for environmental damage, including effects on microbial survivors.
There were mixed results for patient benefit from this review of automated devices using H202 or UV for surface decontamination. Most non-outbreak studies lacked an appropriate control group and were potentially compromised by industry sponsorship. Concern over HAI encourages delivery of powerful disinfectants for eliminating pathogens without appreciating toxicity or cost benefit. Routine use of these devices requires justification from standardized and controlled studies to understand how best to manage contaminated healthcare environments.
摘要：
越来越多的证据表明表面去污对减少医院获得性感染（HAI）的作用。及时和充分去除环境病原体在常规和爆发情况下都会带来可衡量的临床益处。
本系统综述旨在评估已发表的研究，这些研究描述了提供过氧化氢（H202）或紫外线（UV）光的自动化技术对HAI率的影响。
使用相关搜索词进行系统评价。从2005年1月到2020年3月，对数据库进行了扫描，以研究报告在医疗保健表面上使用自动化设备后的临床结果。收集的信息包括设备类型，总体结果；医院和病房数据；研究地点，长度和大小；抗菌素消费；国内监测；和感染控制干预措施。还注意到研究赞助和重复出版物。
虽然体外非触摸设备有明显的好处，我们发现,43项研究中有36项(84%)的研究存在前后性质,因此对患者结局的客观评估不足.在43项研究中，20（47％）使用过氧化氢（14用于爆发），23（53％）使用紫外线技术（没有用于爆发）。最流行的目标病原体，无论是单独还是与他人结合，艰难梭菌（43项研究中有27项：63%），其次是耐甲氧西林金黄色葡萄球菌（MRSA）（43中的16：37％）。许多人欠行业赞助的资金和/或人员（43中的28人：65％），大多数人被并发感染控制所困扰。抗菌药物管理和/或清洁审核计划。很少有关于设备成本的数据，很少有关于可比成本的数据(43中的1:2%)。托管研究的国家与设备公司的所在地之间存在预期的关系。没有人提到环境破坏的可能性，包括对微生物幸存者的影响。
从使用H202或UV进行表面净化的自动化设备的这次审查中，患者受益的结果喜忧参半。大多数非爆发研究缺乏适当的对照组，并且可能受到行业赞助的影响。对HAI的关注鼓励提供强大的消毒剂以消除病原体，而不会产生毒性或成本效益。这些设备的常规使用需要标准化和受控研究的理由，以了解如何最好地管理受污染的医疗保健环境。
本系统综述旨在评估已发表的研究，这些研究描述了提供过氧化氢（H202）或紫外线（UV）光的自动化技术对HAI率的影响。
使用相关搜索词进行系统评价。从2005年1月到2020年3月，对数据库进行了扫描，以研究报告在医疗保健表面上使用自动化设备后的临床结果。收集的信息包括设备类型，总体结果；医院和病房数据；研究地点，长度和大小；抗菌素消费；国内监测；和感染控制干预措施。还注意到研究赞助和重复出版物。
虽然体外非触摸设备有明显的好处，我们发现,43项研究中有36项(84%)的研究存在前后性质,因此对患者结局的客观评估不足.在43项研究中，20（47％）使用过氧化氢（14用于爆发），23（53％）使用紫外线技术（没有用于爆发）。最流行的目标病原体，无论是单独还是与他人结合，艰难梭菌（43项研究中有27项：63%），其次是耐甲氧西林金黄色葡萄球菌（MRSA）（43中的16：37％）。许多人欠行业赞助的资金和/或人员（43中的28人：65％），大多数人被并发感染控制所困扰。抗菌药物管理和/或清洁审核计划。很少有关于设备成本的数据，很少有关于可比成本的数据(43中的1:2%)。托管研究的国家与设备公司的所在地之间存在预期的关系。没有人提到环境破坏的可能性，包括对微生物幸存者的影响。
从使用H202或UV进行表面净化的自动化设备的这次审查中，患者受益的结果喜忧参半。大多数非爆发研究缺乏适当的对照组，并且可能受到行业赞助的影响。对HAI的关注鼓励提供强大的消毒剂以消除病原体，而不会产生毒性或成本效益。这些设备的常规使用需要标准化和受控研究的理由，以了解如何最好地管理受污染的医疗保健环境。
