UV-C as a Critical Second Step in Reducing HAIs: Why Adjunct Disinfection Is a Strategic Investment in High-Risk Health Care Environments

Abstract

Environmental contamination plays a measurable role in the transmission of multidrug-resistant organisms (MDROs) and other health care-associated pathogens. While manual cleaning and chemical disinfection remain foundational, variability in execution introduces residual risk. Ultraviolet-C (UV-C) disinfection, when deployed as an adjunct to manual terminal cleaning, has been shown to reduce environmental bioburden and decrease transmission of target organisms. This article examines the clinical evidence, financial implications, and operational strategies that position UV-C as a critical second-step intervention in high-acuity health care settings.

Manual Disinfection Is Foundational but Variable

Environmental services programs are essential to infection prevention infrastructure. However, even well-trained teams operating within structured protocols face inherent variability, including:

• Missed high-touch surfaces
• Inconsistent adherence to disinfectant dwell times
• Differences in room configuration and furniture positioning
• Human fatigue during high-throughput periods
• Variability in soil load and biofilm presence

Multiple studies demonstrate that patients admitted to rooms previously occupied by individuals colonized or infected with MDROs face increased acquisition risk, even when standard cleaning protocols are followed.¹

Manual cleaning is essential. It is not infallible.

Evidence Supporting UV-C as Adjunct Disinfection

The Benefits of Enhanced Terminal Room (BETR) Disinfection study, a multicenter randomized controlled trial, demonstrated that adjunct UV-C disinfection reduced transmission of target MDROs when added to standard manual cleaning protocols.¹

Additional investigations have demonstrated:
• Reduced environmental contamination following UV-C implementation^2,3
• Laboratory-confirmed efficacy of UV-C devices against key health care pathogens⁴
• Reduced contamination of health care workers’ hands following enhanced environmental disinfection⁵
• Persistent variability in manual cleaning thoroughness across acute care facilities⁶

Review literature consistently supports no-touch disinfection systems, including UV-C, as effective adjunct technologies within comprehensive infection prevention programs.^3,7

UV-C disrupts microbial DNA and RNA, preventing replication. When applied after thorough manual cleaning, it reduces residual contamination on exposed surfaces in a consistent and measurable manner.

Strategic Deployment: Where UV-C Has the Greatest Impact

UV-C should not be deployed indiscriminately across all room types. High-performing programs target their use in:

• Isolation room discharges involving MDROs, Clostridioides difficile, or Candida auris
• Oncology and transplant units
• Intensive care units
• Immunocompromised populations
• Outbreak response areas

In these settings, incremental reductions in environmental contamination can translate into meaningful risk reduction. A layered defense is particularly important when patient vulnerability is high.

Financial Considerations: Investment vs Risk

Health care leaders appropriately evaluate cost relative to measurable benefit. However, a single health care-associated infection may result in:

• Extended length of stay
• Centers for Medicare & Medicaid Services penalties
• Increased readmission risk
• Litigation exposure
• Reputational damage

The financial impact of a single preventable HAI can exceed the cost of months of adjunct UV-C deployment. When evaluated as risk mitigation rather than capital expenditure, UV-C becomes a strategic investment in system resilience.

Maintaining Throughput: Operational Integration Without Delay

A common objection to UV-C deployment is concern regarding room turnaround time. Successful integration requires workflow design rather than device placement alone.

Effective programs:
• Deploy UV-C selectively in high-risk discharges
• Stage rooms efficiently before initiating cycles
• Utilize parallel processing, such as documentation, cart reset, and supply restocking, during UV cycles
• Coordinate closely with bed management
• Track cycle time metrics and compliance

Modern UV-C devices can complete cycles in minutes, depending on room size and protocol. When embedded into discharge workflows, they enhance protection without compromising throughput. The key is integration rather than addition.

What UV-C Does and Does Not Do

UV-C:
• Reduces residual contamination after manual cleaning
• Delivers consistent energy across exposed surfaces
• Provides measurable and repeatable disinfection cycles
• Strengthens interdisciplinary confidence

UV-C does not:
• Replace manual cleaning
• Remove organic soil
• Eliminate shadowed surfaces
• Compensate for weak process design

Manual cleaning remains the first step. UV-C reinforces the process.

Multiple studies now show that UV-C disinfection can damage common health care polymers and surface finishes, with important implications for infection prevention.^8-11,13-15.

Call for Material Compatibility Evaluation

Emerging research on UV-C and material degradation indicates that repeated exposure can cause discoloration, embrittlement, cracking, and surface roughening in plastics such as Acrylonitrile Butadiene Styrene (ABS), nylon, and polycarbonate, which are widely used in health care environments.^8-11 These changes are not just cosmetic: microcracks, roughened textures, and degraded coatings can create microbial reservoirs, protected niches where organisms can find “safe harbor” out of the direct line of sight of UV-C and mechanical cleaning.

Because of this, any facility planning to implement or expand UV-C disinfection should treat material compatibility as a core design and procurement requirement, not an afterthought. This includes the following:

• Conducting a careful evaluation of all surfaces and equipment in areas where UV-C will be used against published data on UV-C induced polymer damage^8-11,13-15
• Selecting products made from materials that tolerate UV-C disinfection, drawing on manufacturer testing, accelerated exposure data, and third-party studies^13-15
• Engaging in proactive discussions with manufacturers before purchase to confirm compatibility with planned UV-C doses and frequencies^13,14

By integrating material compatibility review into both UV-C implementation and product selection, health care organizations can avoid creating new microbial harborage points, protect capital assets, and ensure that UV-C functions as a reliable adjunct to manual cleaning rather than inadvertently undermining surface integrity.

The High-Reliability Imperative

High-reliability industries rely on layered defense systems. Aviation does not depend on a single instrument. Nuclear facilities do not rely on a single containment layer. Historically, health care relied primarily on manual environmental disinfection.

UV-C represents a shift toward redundancy, not because frontline teams are insufficient, but because health care environments are complex and pathogen transmission is multifactorial. Systems must account for human variability. Layered protection strengthens reliability.

Conclusion

Manual disinfection remains the cornerstone of environmental infection prevention. Yet in high-acuity health care environments, where pathogen burden is high, patients are vulnerable, and operational pressures are constant, reliance on a single layer of defense is no longer sufficient.

The evidence is clear: When layered onto standardized cleaning protocols, adjunct UV-C disinfection reduces environmental contamination and lowers transmission of targeted multidrug-resistant organisms. More importantly, it reduces variability, an often overlooked but critical driver of preventable harm.

Health care leaders are not deciding whether to replace manual cleaning. They are deciding whether to reinforce it.

Strategically deployed UV-C is not an optional enhancement or a symbolic technology purchase. It is a measurable risk-reduction strategy. It protects patients at their most vulnerable moments. It supports environmental services teams by strengthening the reliability of their work. It signals to clinicians, regulators, and patients that infection prevention is engineered—not assumed.

In an era defined by antimicrobial resistance, public reporting, reimbursement pressures, and rising expectations for safety, resilience is built through layered safeguards. High-reliability health care systems do not accept preventable variability when proven mitigation exists.

Reducing variability is leadership.
Investing in layered protection is stewardship.
Deploying UV-C strategically is not excessive; it is evidence-aligned risk management.

Moreover, a broader understanding of surface ecology reinforces the urgency of adjunct technologies such as UV-C. Pathogenic organisms can persist on and within diverse health care surfaces for extended periods—even after cleaning—due to material properties, biofilms, and design complexities that impede effective disinfection.^8,12 By acknowledging that some surface materials inherently support microbial survival or resist thorough cleaning, UV-C becomes even more critical as a second-step intervention to address these persistent reservoirs, complementing manual efforts and surface selection strategies in the fight against healthcare-associated infections.

References

1. Anderson DJ, Chen LF, Weber DJ, et al. Enhanced terminal room disinfection and acquisition of multidrug-resistant organisms and Clostridioides difficile (BETR Disinfection Study). Lancet. 2017;389(10071):805-814.
2. Rutala WA, Kanamori H, Gergen MF, Sickbert-Bennett EE, Weber DJ. Enhanced disinfection leads to reduction of microbial contamination and hospital-acquired infection rates. Infect Control Hosp Epidemiol. 2013;34(5):466-471.
3. Weber DJ, Kanamori H, Rutala WA. No-touch technologies for environmental decontamination: focus on ultraviolet devices and hydrogen peroxide systems. Curr Opin Infect Dis. 2016;29(4):424-431.
4. Sickbert-Bennett EE, Gergen MF, Weber DJ, Rutala WA. Comparative efficacy of multiple ultraviolet-C light devices against healthcare-associated pathogens. Infect Control Hosp Epidemiol. 2016;37(4):461-463.
5. Kundrapu S, Sunkesula VCK, Jury LA, et al. Daily disinfection of high-touch surfaces in isolation rooms to reduce contamination of healthcare workers’ hands. Infect Control Hosp Epidemiol. 2012;33(10):1039-1042.
6. Carling PC, Parry MF, Von Beheren SM. Identifying opportunities to enhance environmental cleaning in 23 acute care hospitals. Infect Control Hosp Epidemiol. 2008;29(1):1-7.
7. Otter JA, Yezli S, Perl TM, Barbut F, French GL. The role of no-touch automated room disinfection systems in infection prevention and control. J Hosp Infect. 2013;83(1):1-13.
8. Suh D, Hockett S, Dukes KC, Perencevich EN, Marra AR. Impact of UV-C on material degradation: a scoping review. Antimicrob Steward Healthc Epidemiol. 2025;5(1):e199.
9. McGreer M. Testing the effects of UV-C radiation on materials. Int Surf Technol. 2021;14(2):46-47.
10. de Brouwer H, Anbuchezhian N. The effects of UVC irradiation on the properties of thermoplastics. Polym Degrad Stab. 2024;222:110703.
11. Malpartida-Carrillo V, Tinedo-López PL, Salas-Quispe JE, Fry-Oropeza MA, Amaya-Pajares S, Özcan M. Effect of ultraviolet-C light disinfection on the dimensional stability of dental impression materials: a scoping review. J Clin Exp Dent. 2024;16(11):e1428-e1436.
12. Lybert L, Rohde RE. Why surface materials matter in health care settings. American Society for Microbiology. January 2024. Accessed February 28, 2026. https://asm.org/articles/2024/january/why-surface-materials-matter-in-health-care-settin
13. Teska P. Damage to common health care polymer surfaces from UV-C. National Institute of Standards and Technology. Accessed March 19, 2026. https://www.nist.gov/document/panel-abstract-teska
14. UltraViolet Devices Inc. UV-C and surface compatibility: UVDI-360 room sanitizer. 2022. Accessed March 19, 2026. https://www.uvdi.com/wp-content/uploads/2022/02/UV-Materials-Compat_UVDI-360_MKTFM-341-REV-D.pdf
15. Essentra Components. UV and its effect on plastics: an overview. 2018. Accessed March 19, 2026. https://www.essentracomponents.com/en-us/news/manufacturing/injection-molding/uv-and-its-effect-on-plastics-an-overview