Division of Infectious Diseases, Wayne State University, School of Medicine, Detroit, Michigan, USA.
Department of Internal Medicine, John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan, USA.
Clin Infect Dis. 2024 Oct 15;79(4):1024-1030. doi: 10.1093/cid/ciae240.
Environmental disinfection is essential for reducing spread of healthcare-associated infections (HAIs). Previous studies report conflicting results regarding the effects of ultraviolet (UV) light in reducing infections. This trial evaluated the impact of adding pulsed-xenon UV (PX-UV) to standard terminal cleaning in reducing environmentally implicated HAIs (eiHAIs).
The Lowering the Acquisition of MDROs with Pulsed-xenon (LAMP) trial was conducted in 2 hospitals (15 inpatient wards) utilizing a cluster-randomized, controlled, double-blinded, interventional crossover trial comparing standard terminal cleaning followed by either PX-UV (intervention arm) or sham (control arm) disinfection. The primary outcome was incidence of eiHAIs from clinical microbiology tests on the fourth day of stay or later or within 3 days after discharge from the study unit. EiHAIs included clinical cultures positive for vancomycin-resistant enterococci, extended-spectrum beta-lactamase-producing Escherichia coli or Klebsiella pneumonia, methicillin-resistant Staphylococcus aureus, and Acinetobacter baumannii, and stool polymerase chain reaction (PCR) positive for Clostridiodes difficile.
Between 18 May 2017 and 7 January 2020, 25 732 patients were included, with an incidence of 601 eiHAIs and 180 954 patient-days. There was no difference in the rate of eiHAIs in the intervention and sham arms (3.49 vs 3.17 infections/1000 patient-days, respectively; RR, 1.10; 95% CI, .94-1.29; P = .23). Study results were similar when stratified by eiHAI type, hospital, and unit type.
The LAMP study failed to demonstrate an effect of the addition of UV light disinfection following terminal cleaning on reductions in rates of eiHAIs. Further investigations targeting hospital environmental surfaces and the role of no-touch technology to reduce HAIs are needed. Clinical Trials Registration. ClinicalTrials.gov identifier: NCT03349268; R01HS024709.
环境消毒对于减少医源性感染（HAI）的传播至关重要。先前的研究报告称，紫外线（UV）光在减少感染方面的效果存在矛盾。本试验评估了在标准终末清洁中添加脉冲氙气 UV（PX-UV）以减少与环境相关的 HAI（eiHAI）的效果。
Lowering the Acquisition of MDROs with Pulsed-xenon（LAMP）试验在 2 家医院（15 个住院病房）进行，采用集群随机、对照、双盲、干预性交叉试验，比较标准终末清洁后进行 PX-UV（干预组）或假（对照组）消毒。主要结局是入住第 4 天或以后或出院后 3 天内从临床微生物学检查中检出的 eiHAI 的发生率。eiHAI 包括万古霉素耐药肠球菌、产超广谱β-内酰胺酶的大肠埃希菌或肺炎克雷伯菌、耐甲氧西林金黄色葡萄球菌和鲍曼不动杆菌的临床培养阳性，以及艰难梭菌粪便聚合酶链反应（PCR）阳性。
2017 年 5 月 18 日至 2020 年 1 月 7 日期间，共纳入 25732 例患者，发生 601 例 eiHAI 和 180954 例患者日。干预组和对照组的 eiHAI 发生率无差异（分别为 3.49 例/1000 患者日和 3.17 例/1000 患者日，RR，1.10；95%CI，0.94-1.29；P =.23）。按 eiHAI 类型、医院和病房类型分层后，研究结果相似。
LAMP 研究未能证明在终末清洁后添加紫外线消毒对降低 eiHAI 发生率有效果。需要进一步研究针对医院环境表面的措施和无接触技术在减少 HAI 方面的作用。临床试验注册。ClinicalTrials.gov 标识符：NCT03349268；R01HS024709。
