Lowering the Acquisition of Multi-drug Resistant Organism (MDROs) with Pulsed-xenon (LAMP) Study: a cluster randomized controlled, double-blinded, interventional crossover trial

Sorabh Dhar; Chetan Jinadatha; Paul E Kilgore; Oryan Henig; George W Divine; Erika N Todter; John D Coppin; Marissa J Carter; Teena Chopra; Steve Egbert; Philip C Carling; Keith S Kaye

doi:10.1093/cid/ciae240

Lowering the Acquisition of Multi-drug Resistant Organism (MDROs) with Pulsed-xenon (LAMP) Study: a cluster randomized controlled, double-blinded, interventional crossover trial

Clin Infect Dis. 2024 May 14:ciae240. doi: 10.1093/cid/ciae240. Online ahead of print.

Authors

Affiliations

¹ Professor of Medicine, Division of Infectious Diseases, Wayne State University, John D. Dingell Veterans Affairs Medical Center, Harper University Hospital - 5 Hudson, 3990 John R St, Detroit, MI 48201.
² Central Texas Veterans Health Care System, School of Medicine, Texas A&M University, 8447 Riverside Pkwy, Bryan, TX 77807.
³ Professor, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Department of Family Medicine and Public Health Sciences, School of Medicine, Wayne State University, Detroit, Michigan, 259 Mack Ave., Room 2156, Detroit, Michigan 48201.
⁴ Tel Aviv Sourasky Medical Center, Weizmann 7, Tel Aviv, Israel.
⁵ Michigan State University, Department of Epidemiology and Biostatistics, Henry Ford Health, 1 Ford Place, 3C16, Detroit, MI 48202.
⁶ Henry Ford Health, Department of Public Health Sciences, 1 Ford Place, Detroit, MI 48202.
⁷ Central Texas Veterans Health Care System, 1901 South 1st Street, Temple, TX 76504.
⁸ Strategic Solutions, Inc., 37 Voyager Lane, Bozeman, MT 59718, USA.
⁹ Professor of Medicine, Division of Infectious Diseases, Wayne State University, Harper University Hospital - 5 Hudson, 3990 John R St, Detroit, MI 48201.
¹⁰ XENDELLA Facilities Management, 6 Shearwater Ct, Hawthorn Woods, IL 60047.
¹¹ Clinical Professor of Medicine, Department of Infectious Diseases, Boston University School of Medicine, 72 E Concord Street, Boston, MA 02118.
¹² Professor of Medicine, Division of Allergy, Immunology and Infectious Diseases, Robert Wood Johnson Medical School, 125 Paterson Street, CAB 7136, New Brunswick, NJ 08901.

PMID: 38743564
DOI: 10.1093/cid/ciae240

Abstract

Background: Environmental disinfection is essential for reducing spread of healthcare associated infections (HAIs). Previous studies report conflicting results regarding the effects of ultraviolet light (UV) 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).

Methods: The 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 pulsed xenon ultraviolet (PX-UV) disinfection (intervention arm) or sham disinfection (control arm). The primary outcome was incidence of eiHAIs from clinical microbiology tests on the 4th day of stay or later or within 3 days after discharge from the study unit. EiHAIs included clinical cultures positive for vancomycin-resistant enterococci (VRE), extended spectrum beta-lactamase-producing Escherichia coli or Klebsiella pneumonia, methicillin-resistant Staphylococcus aureus (MRSA), and Acinetobacter baumannii, and stool PCR positive for Clostridiodes difficile.

Findings: Between May 18, 2017 to Jan 7, 2020, 25,732 patients were included, with an incidence of 601 eiHAI 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 CI (0.94, 1.29, p= 0.23)). Study results were similar when stratified by eiHAI type, hospital, and unit type.

Conclusion: 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.

Keywords: Environmental Disinfection; Multi-Drug Resistant Organisms; hospital acquired infection; infection control.

© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.