Main Article Content
Central venous catheters (CVCs) are indispensable medical devices that are utilized in clinical settings globally. Though CVCs provide life-saving functions, they are highly susceptible to bacterial colonization that eventually leads to catheter-related bloodstream infection (CRBSI). Existing strategies in hospitals such as standard sterilization protocols have not been effective in significantly lowering the rate of CRBSIs in the past decade. The use of ultraviolet (UV) light as a source of microbial disinfectant is historically known. In particular, UV-C light has been shown to effectively eradicate bacteria, including strains that are difficult to kill with antibiotics. Many studies show that multiple logs-reduction in bacterial colonization after UV-C exposure can be achieved. With the emergence of light emitting diodes (LEDs) that deliver UV-C, the idea of applying UV-C energy to sterilize catheters has become more practical to implement due to their small size and low power consumption implement. In addition to its efficacy against bacteria, UV-C has also been shown to have little to no negative health effect on human tissues and minimal photochemical effect on infusates commonly delivered through CVCs. Central venous catheters (CVCs) are indispensable medical devices that are utilized in clinical settings globally. Though CVCs provide life-saving functions, they are highly susceptible to bacterial colonization that eventually leads to catheter-related bloodstream infection (CRBSI). Existing strategies in hospitals such as standard sterilization protocols have not been effective in significantly lowering the rate of CRBSIs in the past decade. The use of ultraviolet (UV) light as a source of microbial disinfectant is historically known. In particular, UV-C light has been shown to effectively eradicate bacteria, including strains that are difficult to kill with antibiotics. Many studies show that multiple logs-reduction in bacterial colonization after UV-C exposure can be achieved. With the emergence of light emitting diodes (LEDs) that deliver UV-C, the idea of applying UV-C energy to sterilize catheters has become more practical to implement due to their small size and low power consumption implement. In addition to its efficacy against bacteria, UV-C has also been shown to have little to no negative health effect on human tissues and minimal photochemical effect on infusates commonly delivered through CVCs. Altogether, UV-C light has a promising application in the prevention of CRBSIs that is not only effective but safe., UV-C light has a promising application in the prevention of CRBSIs that is not only effective but safe.
This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
2. Raad I, et al. Nosocomial infections related to use of intravascular devices inserted for long-term vascular access. In: Mayhall C, ed. Hospital Epidemiology and Infection Control. Philadelphia, Pa: Lippincott Williams & Wilkins; 1999:165-172.
3. Shah H, Bosch W, Thompson KM, et al. Intravascular Catheter-Related Bloodstream Infection. Neurohospitalist 2013;3(3):144-151.
4. Drewett SR. Central venous catheter removal: procedures and rationale. Br J Nurs 2000 (22):2304-15
5. Sasadeusz KJ, Trerotola SO, Shah H, et al. Tunneled Jugular Small-Bore Central Catheters as an Alternative to Peripherally Inserted Central Catheters for Intermediate-term Venous Access in Patients with Hemodialysis and Chronic Renal Insufficiency. Radiology 1999; 213(1): 303-6.
6. Frasca, D, Dahyot-Fizelier, C, Mimoz, O. Prevention of central venous catheter-related infection in the intensive care unit. Critical Care 2010;14:212.
7. Yevslin AS, Arif A, Loay S. Interventional Nephrology:Principles and Practice. 2014.
8. Mermel LA. What Is The Predominant Source of Intravascular Catheter Infections? Clin Infect Dis 2011;52(2):211–2.
9. Mathur P. Hand hygiene: Back to the basics of infection control. Indian J Med Res 2011;134(5):611-20.
10. Dancer S. Controlling Hospital-Acquired Infection: Focus on the Role of the Environment and New Technologies for Decontamination. Clin Microbiol Rev 2014;27(4):665-90.
11. Chopra V, Olmsted R, Safdar N, et al. Prevention of Central Line-Associated Bloodstream Infections: Brief Update Review. In: Krein S, editor. Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices. Rockville; 2013.
12. Shapey I, Foster M, Whitehouse T, et al. Central venous catheter-related bloodstream infections: improving postinsertion catheter care. J Hosp Infect 2009;71(2):117-22.
13. Pronovost D, Needham D, Berenholtz S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU.N Engl J Med 2006; 355(26): 2725-32.
14. Gahlot R, Nigam C, Kumar V, et al. Catheter-related bloodstream infections. Int J Crit Illn Inj Sci 2014; 4(2):162-7.
15. Mah TF, O’Toole GA. Mechanisms of biofilm resistance to antimicrobial agents. Trends Microbiol 2001;9(1):34-9.
16. Wilkins KM, Hanlon GW, Martin GP, et al. The migration of bacteria through gels in the presence of IUCD monofilament tails. Contraception1989;39(2):205-16.
17. Wolfe AJ, Berg HC. Migration of bacteria in semisolid agar. Proc Natl Acad Sci U S A 1989;86(18):6973-7.
18. Harkes G, Dankert J, Feijen J. Bacterial migration along solid surfaces. Appl Environ Microbiol1992;58(5):1500-5
19. Garrett, TR, et al. Bacterial adhesion and biofilms on surfaces. Progress in Natural Science 2008;18(9):1049-56.
20. Sudarsan, R, Ghosh S, Stockie JM, et al. Simulating biofilm deformation and detachment with the immersed boundary method. Communications in Computational Physics 2016;19(3):682-732.
21. Shunmugaperumal, T. Biofilm Eradication and Prevention: A Pharmaceutical Approach to Medical Device Infections; 2010:78.
22. Mascari L, Ymele-Leki P, Eggleton C, et al. Fluid Shear Contribution to Bacteria Cell Detachment Initiated by a Monoclonal Antibody. Wiley Periodicals. 2003.
23. Lecuyer S, Rusconi R, Shen Y, et al. Shear stress increases the residence time of adhesion of Pseudomonas eruginosa.Biophys J 2011;100(2):341-50.
24. Stewart PS. Biophysics of biofilm infection. Pathog Dis 2014;70(3):212-8
25. Doran AK, Ivy DD, Barst RJ, et al. Guidelines for the prevention of central venous catheter-related blood stream infections with prostanoid therapy for pulmonary arterial hypertension. Int J Clin Pract Suppl 2008;62:5-9.
26. Drewett SR. Central venous catheter removal: procedures and rationale. Br J Nurs 2000;9(22):2304-15.
27. Kim DK, Gottesman MH, Forero A, et al. The CVC removal distress syndrome: an unappreciated complication of central venous catheter removal. Am Surg 1998;64(4):344-7.
28. Chaftari A-M, Zakhem AE, Jamal MA, et al. The use of minocycline-rifampin coated central venous catheters for exchange of catheters in the setting of staphylococcus aureus central line associated bloodstream infections. BMC Infect Dis 2014;14:518.
29. Doran AK, Ivy DD, Barst RJ, et al. Guidelines for the prevention of central venous catheter-related blood stream infections with prostanoid therapy for pulmonary arterial hypertension. Int J Clin Pract Suppl 2008;62:5-9.
30. Jacob J. Pathophysiology of Sepsis. Am J Heal Pharm 2002;136:1-51.
31. Klingenberg C, Aarag E, Rønnestad A, et al. Coagulasenegative staphylococci sepsis in neonates. Association between antibiotic resistance, biofilm formation, and the host inflammatory response. Pediatr Infect Dis J 2005; 24(9):817-822.
32. Furuya YE, Dick A, Perencevich EN, et al. Central line bundle implementation in US intensive care units and impact on bloodstream infections. PLoS One 2011;6(1):e15452.
33. Pradeep Kumar SS, Easwer HV, Maya Nandkumar A.Multiple drug resistant bacterial biofilms on implanted catheters - a reservoir of infection. J Assoc Physicians India 2013;61(10):702-7.
34. Menyhay S, Maki D. Disinfection of needleless catheter connectors and access ports with alcohol may not prevent microbial entry: the promise of a novel antiseptic-barrier cap. Infect Control Hosp Epidemiol 2006;27(1):23-7.
35. Rabindranath KS, Bansal T, Adams J, et al. Systematic review of antimicrobials for the prevention of haemodialysis catheterrelated infections. Nephrol Dial Transplant 2009;24(12):3763-74.
36. Theaker, C, Juste R, Lucas N, et al. Comparison of bacterial colonization rates of antiseptic impregnated and pure polymer central venous catheters in the critically ill. J Hosp Infect 2002;52(4);310-2.
37. Sánchez-Prado L, Llompart M, Lores M, et al. Further research on the photo-SPME of triclosan. Anal Bioanal Chem 2006;384(7-8):1548-57.
38. Hoiby N, Bjarnsholt, T, Givskov M, et al. Antibiotic resistance of bacterial biofilms. Int J Antimicrob Agents 2010;35:322-32.
39. Crnich CL, Maki DG. Are Antimicrobial-impregnated catheters effective? Don’t throw out the baby with the bathwater. Clin Infect Dis 2004;38(9):1287-92.
40. Skovgaard S, Nielsen L, Larsen M, et al. Staphylococcus epidermidis isolated in 1965 are more susceptible to triclosan than current isolates. PLoS One 2013;8(4):e62197.
41. Brunelli SM, Njord L, Hunt AE, et al. Use of the Tego needlefree connector is associated with reduced incidence of catheter-related bloodstream infections in hemodialysis patients. Int J Nephrol Renovasc Dis 2014;7:131-9.
42. Cookson ST, Ihrig M, O’Mara EM. Increased bloodstream infection rates in surgical patients associated with recommended use and care following implementation of a needleless device. Infect Control Hosp Epidemiol 1998;19:23-7.
43. Soi V, Moore CL, Kumbar L, et al. Prevention of catheterrelated bloodstream infections in patients on hemodialysis: challenges and management strategies. Int J Nephrol Renovasc Dis 2016; 9:95-103.
44. Luther MK, Bilida S, Mermel LA, et al. Ethanol and Isopropyl Alcohol Exposure Increases Biofilm Production in Staphylococcus aureus and Staphylococcus epidermidis. Infect Dis Ther 2015;4(2):219-26.
45. WrightMC, Tropp J, Schora DM, et al. Continuous passive disinfection of catheter hubs prevents contamination and bloodstream infection. Am J Infect Control 2013;41(1):33-8.
46. Landry DL, Braden GL, Gobeille SL, et al. Emergence of gentamicin-resistant bacteremia in hemodialysis patients receiving gentamicin lock catheter prophylaxis. Clin J Am Soc Nephrol 2010;5(10):1799-804.
47. Solomon LR, Cheesbrough JS, Bhargava R, et al. Observational study of need for thrombolytic therapy and incidence of acteremia using taurolidine-citrate-heparin, taurolidinecitrate and heparin catheter locks in patients treated with hemodialysis. Semin Dial 25(2):233-8.
48. Justo JA, Bookstaver PB. Antibiotic lock therapy: review of technique and logistical challenges. Infect Drug Resist 2014;7:343-63.
49. Downes A, Blunt TP. On the Influence of Light upon Protoplasm. Proceedings of the Royal Society of London. 1878;28(190-195):199-212.
50. Moller K, Kongshoj B, Philipsen P, et al. How Finsen’s light cured lupus vulgaris. Photodermatology, Photoimmunology and Photomedicine 2005;21(3):118-124.
51. Wallner-Pendelton E, Sumner S, Froning G, et al. The use of ultraviolet radiation to reduce salmonella and psychrotrophic bacterial contamination on poultry carcasses. Poult Sci 1994;73(8):1327-53.
52. Rowan NJ, MacGregor SJ, Anderson JG, et al. Pulsed-light inactivation of food-related microorganisms. Appl Environ Microbiol 1999;65(3):1312-5.
53. Steven C, William B. Ultraviolet Light Disinfection in the Use of Individual Water Purification Devices. 2006 (Accessed November 1, 2016 at file:///C:/Users/Pasuta/Documents/V%2013/final%20AW/ADA453967.pdf).
54. Song K, Mohseni M, Taghipour F. Application of ultraviolet light-emitting diodes (UV-LEDs) for water disinfection: A review. Water Res 2016;94:341-9.
55. Reed NG. The history of ultraviolet germicidal irradiation for air disinfection. Public Health Rep 2010;125(1):15-27.
56. Turnbull P, Reyes A, Chute M, et al. Effectiveness of UV Exposure of Items Contaminated with Anthrax Spores in a Class 2 Biosafety Cabinet and a Biosafety Level 3 Laboratory Pass-Box. Applied Biosafety 2008;13(3):164-8.
57. Kramer A, Schwebke I, Kampf G. How long do nosocomial pathogens persist on inanimate surfaces? A Systematic Review. BMC Infect Dis. 2006;6:130.
58. Dai T et al. Ultraviolet C irradiation: an alternative antimicrobial approach to localized infections? Expert Rev Anti Infect Ther 2012;10(2):185-95.
59. Russell AD. Ultraviolet radiation. In: Russell AD, Hugo WB,Ayliffe GAJ, eds. Principles and practices of disinfection, preservation and sterilization. Oxford: Blackwell Science,1999:688-702.
60. Unluturk S, Atilgan MR, Baysal AH, et al. Use of UV-C radiation as a non-thermal process for liquid egg products (LEP). J Food Eng 2008;85:561-8
61. U.S. Food and Drug Administration. Kinetics of Microbial Inactivation for Alternative Food Processing Technologies -- Ultraviolet Light. (Accessed November 1, 2016 at http:// www.fda.gov/Food/FoodScienceResearch/SafePracticesforFoodProcesses/ucm103137.htm).
62. Anderson DJ, Gergen MF, Smathers E, et al. Decontamination of Targeted Pathogens from Patient Rooms Using an Automated Ultraviolet-C-Emitting Device. Infect Control Hosp Epidemiol 2013;34(5):466-71.
63. Owens MU, Deal DR, Michael O, et al. High-Dose Ultraviolet C Light Inactivates Spores of Bacillus Atrophaeus and Bacillus Anthracis Sterne on Nonreflective Surface. Applied Biosafety 2005;10(4):240-7.
64. Boyce JM. Modern technologies for improving cleaning and disinfection of environmental surfaces in hospitals. Antimicrob Resist Infect Control 2016;5:10.
65. Lin R, Prologo J. Inactivation of Bacteria on Explanted Dialysis Catheter Lumens with Fiber Optically Delivered Ultraviolet Light. J Vasc Interv Radiol 2015;26(12):1895-9.
66. Nerandzic MM, Cadnum JL, Eckart KE, et al. Evaluation of a hand-held far-ultraviolet radiation device for decontamination of Clostridium difficile and other healthcare-associated pathogens. BMC Infect Dis 2012;12:120.
67. Nerandzic M, Cadnum J, Pultz M, et al. Evaluation of an automated ultraviolet radiation device for decontamination of Clostridium difficile and other healthcare-associated pathogens in hospital rooms. BMC Infect Dis 2010;10(1):197.
68. Haas J, Menz J, Dusza S, et al. Implementation and impact of ultraviolet environmental disinfection in an acute care setting. Am J Infect Control 2014;42(6):586-90.
69. Rao BK, Kumar P, Rao S, et al. Bactericidal effect of ultraviolet C (UVC), direct and filtered through transparent plastic, on gram-positive cocci: an in vitro study. Ostomy Wound Manage 2011;57(7):46-52.
70. Taylor G, Bannister G, Leeming J. Wound disinfection with ultraviolet radiation. J Hosp Infect 1995;30(2):85-93.
71. Dai T, Murray C, Vrahas M, et al. Ultraviolet C light for Acinetobacter baumannii wound infections in mice. J Trauma Acute Care Surg 2012;73(3):661-7.
72. Nerandzic MM, Fisher CW, et al. Sorting through the wealth of options: comparative evaluation of two ultraviolet disinfection systems. PLoS One 2014Sep23;9(9).
73. Umezawa K, Asai S, Inokuchi S, et al. A Comparative study of the bactericidal activity and daily disinfection housekeeping surfaces by a new portable pulsed UV radiation device. Curr Microbiol 2012;64(6):581-7.
74. Menyhay SZ, Maki DG. Disinfection of needleless catheter connectors and access ports with alcohol may not prevent microbial entry: the promise of a novel antiseptic barrier cap. Infect Control Hosp Epidemiol 2006;27(1):23-7.
75. Tran T, Racz L, Grimaila M, et al. Comparison of continuous versus pulsed ultraviolet light emitting diode use for the inactivation of Bacillus globigii spores. Water Sci Technol 2014;70(9):1473-80.
76. Würtele M, Kolbe T, Lipsz M, et al. Application of GaN-based ultraviolet-C light emitting diodes – UV LEDs – for water disinfection. Water Res 2011;45(3):1481-9.
77. Dujowich M, Case J, Ellison G, et al. Evaluation of Low-Dose Ultraviolet Light C for Reduction of Select ESKAPE Pathogens in a Canine Skin and Muscle Model. Photomed Laser Surg 2016;34(8):363-70.
78. Dean S, Petty A, Swift S, et al. Efficacy and safety assessment of a novel ultraviolet C device for treating corneal bacterial infections. Clin Exp Ophthalmol 2011;39(2):156-63.
79. Messina G, Fattorini M, Nante N, et al. Time Effectiveness of Ultraviolet C Light (UVC) Emitted by Light Emitting Diodes (LEDs) in Reducing Stethoscope Contamination. IJERPH 2016;13(10):940.
80. Tønnesen H. The photostability of drugs and drug formulations. 2nd ed. Boca Raton: Taylor & Francis; 2004.
81. Boettner E, Wolter J. Transmission in the ocular media. Investigative Ophthalmology & Visual Science 1962;1:776-83.
82. Verhaar R, Dekkers D, De Cuyper I, Ginsberg M, de Korte D, Verhoeven A. UV-C irradiation disrupts platelet surface disulfide bonds and activates the platelet integrin αIIbβ3.Blood 2008;112(13):4935-9.
83. Turker H. Haematological effects of Ultraviolet-C Radiation extract on Swiss Albino Mice. Int J Toxicology Applied Pharm 2014;4(1):17-22.
84. Altinaş A, Bilgili A, Eşsiz D, et al. Effects of artificial ultraviolet C radiation on several blood and urine parameters related to renal and hepatic functions in albino mice. BulletinVeterinary Institute in Pulawy 2007;51:303-8.
85. Bak J, Jørgensen T, Helfmann J, et al. Potential in vivo UVC disinfection of catheter lumens: estimation of the doses received by the blood flow outside the Catheter tip hole. Photochem Photobiol 2011;87(2):350-6.
86. Mohr H, Steil L, Gravemann U, et al. Blood component: A novel approach to pathogen reduction in platelet concentrates using short-wave ultraviolet light. Transfusion 2009;49(12):2612-24.
87. Kogelschatz U. Advanced Ozone Generation. Process Technologies for Water Treatment. 1988;87-118.
88. Eliasson B, Kogelschatz U. Ozone Generation with Narrow–Band UV Radiation. Ozone: Science & Engineering 1991;13(3):365-73.
89. O’Donnell C. Ozone in food processing. Hoboken: John Wiley & Sons; 2012.
90. Summerfelt S. Ozonation and UV irradiation—an introduction and examples of current applications. Aquacultural Engineering 2003;28(1-2):21-36.
91. Zhang A, Elmets C, Elston D. Drug-Induced Photosensitivity [Internet]. : Background, Pathophysiology, Epidemiology. (Accessed November 1, 2016, at http://emedicine.medscape.com/article/1049648-overview).
92. Lugovic L, Situm M, Ozanic-Bulie S, Sjerobabski-Masnee I.Phototoxic and Photoallergic Skin Reaction. Coll Anthropol 2007;31:63-7.
93. Ceppatelli M, Fanetti S, Citroni M, et al. Photoinduced Reactivity of Liquid Ethanol at High Pressure. J Phys Chem B 2010;114(47):15437-44.
94. Ha J, Ha S. Synergistic effects of ethanol and UV radiation to reduce levels of selected foodborne pathogenic bacteria. JFood Prot 2010;73(3):556-61.
95. Revelle L, Doub W, Wilson R, Rutter A. Synthesis of Chlorhexidine Digluconate Impurities . Pharm Res1994;10(12):1777-84.
96. Sheldon JL, Kokjohn TA, Martin EL. The effects of salt concentration and growth phase on MRSA solar and germicidal ultraviolet radiation resistance. Ostomy Wound Manage 2005;51(1):36-8, 42-4, 46.
97. Khan K, Farooq R, Iqbal M. Chemical effects of UV radiation on aqueous solutions of heparin-Ca salt. Polymer Photochemistry 1985;6(6):465-74.
98. Ehrlich J, Stivala S. Chemistry and Pharmacology of Heparin.J Pharm Sci 1973;62(4):517-44.
99. Reddick A, Ronald J, Morrison W. Intravenous fluid resuscitation: was Poiseuille right? Emerg Med J2011;28:201e202.