UV-C decontamination
Expanding the scope of UV-C
Jørn Terkelsen discusses the hidden reservoirs of contamination in clinical environments and argues that episodic decontamination is no longer enough.
Ultraviolet-C (UV-C) technology is well established within healthcare as an adjunct tool for terminal room decontamination and surface disinfection. Over the past decade, its use has expanded across operating theatres, isolation rooms and other high-risk clinical environments, as part of a broader strategy to reduce healthcare-associated infections (HCAIs). However, while episodic decontamination
strategies have demonstrated value in reducing surface bioburden, they are inherently limited when faced with persistent and continuously active sources of contamination. Increasingly, infection prevention and control (IPC) teams are recognising that some of the most challenging contamination risks do not originate from visible surfaces, but from hidden environmental reservoirs that sit outside the traditional focus of cleaning and reprocessing protocols. This article explores how the scope of
UV-C based decontamination can be expanded beyond visible surfaces to address concealed environmental reservoirs, with particular emphasis on biofilm formation within clinical water systems. Using a real-world case study from Gentofte Hospital, Denmark, the article examines how recurrent contamination events associated with bronchoscopy prompted a reassessment of environmental risk factors and the implementation of a targeted UV-C based intervention within a sink drain. Clinical perspectives are included to illustrate how addressing these hidden reservoirs can complement established endoscope reprocessing and infection prevention strategies without increasing operational burden.
Biofilms and the endoscopy challenge Endoscopy-associated infections remain a significant concern despite continual improvements in scope design, washer- disinfector performance and reprocessing standards. Biofilm formation within endoscopes has been widely documented as a key challenge, driven by complex internal channels, repeated exposure to organic material and mechanical
wear over time. As a result, much of the focus within sterile services departments (SSDs) has centred on optimising reprocessing workflows, monitoring washer-disinfector performance and ensuring strict adherence to national and international guidance. While these measures are essential, they may not fully address the risk of recontamination arising from the surrounding clinical environment. Endoscopy units are complex ecosystems
in which scopes, staff, water, surfaces and air interact continuously. Manual cleaning steps, sink design, drainage systems and water flow patterns all influence the microbial landscape within these environments. Where environmental reservoirs harbour established biofilms, they may act as a persistent source of recontamination, undermining otherwise robust reprocessing protocols.
Hidden reservoirs: water systems as an overlooked risk Water systems represent a particularly challenging component of infection prevention. Drains and water traps may provide ideal conditions for biofilm formation, combining moisture, nutrients and limited mechanical disturbance. Once established, biofilms within drainage systems are difficult to eradicate and may intermittently release microorganisms into the surrounding environment. In clinical settings, backflow from contaminated
drains can result in contamination of sink surfaces and adjacent work areas, particularly during manual cleaning activities. These risks are often underestimated, in part because responsibility for water systems typically sits at the intersection of IPC, estates and clinical services, rather than within a single department. As awareness of environmental reservoirs
grows, IPC teams are increasingly recognising the need to incorporate water system management into broader decontamination strategies, particularly in high-risk areas such as endoscopy units.
UV-C light within the drain targets microbial biofilm formation inside the water trap, addressing a hidden environmental reservoir.
Expanding the scope of UV-C Traditionally, UV-C has been applied as an event- based intervention, deployed at specific points in time to supplement manual cleaning. While effective in reducing surface contamination, this approach does not address continuous contamination risks arising from hidden infrastructure.
Expanding the scope of UV-C involves
rethinking its role within infection prevention strategies – shifting from episodic disinfection towards continuous risk mitigation. This includes applications targeting air-handling systems, water systems and other concealed environments where biofilms may persist. Importantly, such approaches are not
intended to replace established reprocessing or cleaning protocols. Rather, they aim to complement existing measures by addressing sources of contamination that lie beyond the reach of routine cleaning.
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