Eyeworld

OPHTHALMOLOGY BUSINESS 126 October 2017 by Liz Hillman EyeWorld Staff Writer Bringing it into practice Francis Price Jr., MD, Price Vision Group, Indianapolis, said he had a UV disinfection system installed in his clinic and ASC a few years ago. "We run a lot of patients through the exam room and through the waiting room. Especial- ly in the winter time, it seems like everyone is passing along infectious agents … we thought we'd give it a try," he said, adding later, "I think anything we can do to make the environment safer for the employees and patients is helpful. Viruses get transmitted easily, that's the biggest problem, and I think this makes sense." Doug Mastel, Mastel Precision, Rapid City, South Dakota, is an exclusive distributor for Sanuvox Technologies (Montreal, Canada), a company that produces ultravi- olet air treatment systems, for the ophthalmic community. There are a number of other companies that produce ultraviolet systems for disinfection purposes in the medical community at large as well. "We can install anywhere at any scale worldwide," Mr. Mastel said, adding that he's establishing an LLC that will be MastelAire (www. MastelAire.com). Mr. Mastel said the systems pro- duced by Sanuvox emit both the 254 nm wavelength to disrupt genetic material of bacteria, viruses, and fungi, as well as the hydroxyl-pro- ducing wavelength. The system, Mr. Mastel said, is built with titanium dioxide, and does not emit ozone, existing ocular infections without the use of antibiotics. 2,3 According to the U.S. Center for Disease Control and Prevention's (CDC) Guideline for Disinfection and Sterilization in Healthcare Facil- ities, UV radiation is most effective against bacteria at 240–280 nm. 4 "Inactivation of microorganisms results from destruction of nucleic acid through induction of thymine dimers," the guidelines stated. As Dr. Hernandez put it, when an infectious microbe gets inside you, it's able to produce ill effects through a strength in numbers situa- tion based on its replication, which results in an immune response. Inhibiting replication by damaging these components with UV light, however, can prevent this. UV light has another mode of disinfection as well. Other wave- lengths of UV light—far or vacuum UV—in the presence of water in the air (humidity) or hydrogen peroxide can create powerful disinfecting ox- ygen radicals. Ozone, for example, is a powerful oxidizing agent that can disinfect the air and is produced at 184.45 nm. Hydroxyls, produced at 187 nm, are another example. "The light activates certain oxygen carrying species—water, peroxide—on a surface or in the air, and that generates something that's a strong oxidant, very much like chlorine," Dr. Hernandez said. "That action on microbes, or our skin, or anything else biological destroys tissue, fat, carbohydrate, and protein in the cell wall of microbes." found UVGI gives patients extra reassurance and gives his practice an edge over others in the area. UVGI is based on the princi- ple that ultraviolet light of specific wavelengths damages microbes in a way to prevent their replication, a process called inactivation, said Mark Hernandez, PhD, professor and registered professional engineer, Department of Civil, Environmen- tal, and Architectural Engineering, University of Colorado Boulder. "UV doesn't kill," Dr. Hernan- dez said, making an important distinction. "What it does is, like sunburn, it damages certain parts of tissues, mainly protein and genetic material, and if you get enough sun or if it hits a microbe, UV damages its proteins or its genetic material or both. [The microbe] doesn't stop breathing, it doesn't stop doing its normal business, but when it tries to replicate it's unable to do so." The science behind how it works The idea of UV disinfection is not new. A study published in 2010 detailed the history of UVGI, stating that interest in the disinfectant properties of sunlight began in the 19th century with William F. Wells. 1 Since then, research has pro- gressed, and UV light has been used to disinfect water in developing countries and at wastewater treat- ment plants, for example. In oph- thalmology, UV-A light in crosslink- ing has been discussed as a way to inactivate microorganisms causing Preventing spread of potentially infectious agents with UV light systems M itchell Jackson, MD, Jacksoneye, has a refractive surgical suite in his Lake Villa, Illinois office. In one room he performs minor procedures like corneal inlays and implantable collamer lenses. In another room, he performs LASIK and PRK. Dr. Jackson said he does every- thing an ambulatory surgery center (ASC) would do to reduce the risk of infections in his procedure rooms. "We have washable ceilings and floors. … We autoclave our instru- ments, we gown and glove as in cataract surgery," he said. But for the past year and a half he has taken his infection preven- tion efforts to the next level, using ultraviolet germicidal irradiation (UVGI), which inactivates infectious agents in the air and on surfaces. "I always say sterility is relative —there's no absolute sterility—so if you can make it closer to absolute by doing things like this, it's better for the patient," Dr. Jackson said. While infection rates in his practice—and in ophthalmology in general—are low, Dr. Jackson said he wanted to reduce rates further and found UVGI disinfection a cost-ef- fective, low-maintenance way to do so. In addition to being an added prevention tactic, Dr. Jackson has Disinfecting air and surfaces using UV light

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