Ultraviolet technology a resource to save lives in aged care – south australian study finds encouraging results in fighting respiratory infections

Scientific models predict that novel respiratory pathogens are set to emerge more frequently than ever. In response, researchers in South Australia wanted to honour the need to identify further effective ways to mitigate pathogen transmission within aged care settings. The challenge to contain outbreaks of infections in aged care settings during the pandemic was a key reason these researchers, Andrew Shoubridge and Geraint Rogers, created a controlled study with ultraviolet light examining this possible game-changer in the arsenal to combat the significant impact of infection. The findings have been encouraging in bringing answers, options and actionables to the aged care sector.

Urgent need

For Australia’s seniors, common respiratory viral infections are anything but common. With increased vulnerability from age, both seniors, loved ones and front-line staff remember well the inexplicable time of COVID and navigating its impacts within facilities. For those who call RAC facilities home and the thousands of staff who work daily to keep their residents safe, the fact is that common respiratory viral infections are serious, as well as being a key source of hospitalisation and death. Researchers from Flinders University in South Australia understood this and the urgency to step directly into this area of study.

Spread and impact

Researchers approached the study with context. Due to the rising vulnerability with age, with the ease of pathogen spread within shared aged care environments, the impact of influenza according to government data has been prevalent in the over 65s. Shoubridge and Rogers noted the frequently reported mortality rates about 30%. With such serious outbreaks continuing, even past the COVID years, despite focused infection control measures, they highlighted the vital need of scientists and researchers to re-investigate strategies used to safeguard vulnerable seniors from respiratory infections.

Airborne transmission

Common and well used control strategies of facemasks and physical distancing were designed to mitigate the transmission of pathogens in cough droplets, generally larger and tending to settle onto surfaces quickly, they explain. What was as yet unexamined, was airborne transmission, which are much smaller amounts of liquids called aerosols. These aerosols can be sustained in the air for far longer. Shoubridge and Rogers argued that having this area investigated was critical, due to the mounting evidence that this type of transmission, particularly within the structure of age care facilities was behind prolific spread.

Germicidal ultraviolet light technology

Sounding almost as if it is more at home in a sci-fi movie, the germicidal ultraviolet (GUV) light technology is an approach the team wanted to put through its paces in finding and neutralising the pathogens in their miniscule suspended aerosols.

Shoubridge and Rogers wanted to definitively see if the technology could seek out the infectious virus aerosols in the air columns and damage their nucleic acids, nullifying their infectious capacity. This process had been shown to work within a laboratory space for a host of common respiratory viruses but proof that it could work to safeguard seniors in RAC had not been tried.

Two-year study

To prove that the technology could do what they hoped it could, the team ran a two-year randomised cluster-controlled clinical trial using GUV in RAC facilities across South Australia. To be actionable the results had to clearly show an effectiveness in lowering the rates of symptomatic respiratory infections.

GUV appliances were placed in communal spaces, dining rooms, corridors, lift lobbies and lounges. Active appliances, those working to neutralise the nucleic acids in the air, and those switched off, were established to set about intervention and control data points. Active and non-active machines switched spots and use after six weeks, allowing for comparisons of infection rates between intervention and control sites. Over two years, this approach was completed seven times, through many viral outbreaks, as the team identified cases of acute respiratory infection through symptoms displayed and sample testing.

Understanding the results

When looking only at a six-week period, the levels of infection did not highlight that GUV had a statistically reducing effect compared to the control sites, yet the researchers believe this is due to the relatively low infection cases presenting in the age care centres they studied.

Where the results started to highlight an encouraging possibility is when the researchers looked at the cumulative data set of infection over the course of the entire study.

They saw that the amount of infection over the active intervention periods could be pin-pointed at 12.2% lower compared to the control areas. Shoubridge and Rogers indicate that this percentage translates to lives saved. A lowering of this degree, they attest, can be linked to over 90 less cases per 1000 seniors in RAC per year.

Avoiding fatalism

Shoubridge and Rogers are methodical scientists acknowledging the need to shape study to safeguard some of Australia’s most vulnerable.

They describe the findings as “heartening”, assessing their results clearly demonstrate an uplifting potential due to being secured within real-world aged care functioning.

Far from what they see as a limiting common perception, that seasonable respiratory infections are inevitable due to the close proximity of vulnerable seniors, Shoubridge and Rogers advocate for a growing understanding, that such outbreaks are not unavoidable.

Using government data to extrapolate their findings, for the 250,000 seniors currently residing in RAC settings, the rates of GUV infection reduction has the potential to mean 23,000 less cases and 2,300 less hospitalisations. Placed within the context of needing to mitigate strain on Australia’s healthcare system, the impacts start to become substantial, strategically, ethically and financially.

Taking it further

Both Shoubridge and Rogers call for further research to entrench the benefits of their GUV results, to confirm benefits and to increase the efficacy of the approach. They see their work as one important part of a larger effort to safeguard care through informed study and proven methods, leading to real-world multi-sector results.

Safeguarding vulnerable Australians, and reducing the strain on hospitals managing respiratory outbreaks, will take a coalition of researchers, industry leaders and government involved to meet the only ever growing need as Australia ages. Key studies are here and have yielded results, the momentum must continue.