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Implementation Lessons Learned From the Benefits of Enhanced Terminal Room (BETR) Disinfection Study: Process and Perceptions of Enhanced Disinfection with Ultraviolet Disinfection Devices

  • Deverick J. Anderson (a1), Lauren P. Knelson (a1), Rebekah W. Moehring (a1) (a2), Sarah S. Lewis (a1), David J. Weber (a3), Luke F. Chen (a1), Patricia F. Triplett (a3) (a4), Michael Blocker (a5) (a6), R. Marty Cooney (a7), J. Conrad Schwab (a8), Yuliya Lokhnygina (a9), William A. Rutala (a3), Daniel J. Sexton (a1) and for the CDC Prevention Epicenters Program...



To summarize and discuss logistic and administrative challenges we encountered during the Benefits of Enhanced Terminal Room (BETR) Disinfection Study and lessons learned that are pertinent to future utilization of ultraviolet (UV) disinfection devices in other hospitals


Multicenter cluster randomized trial


Nine hospitals in the southeastern United States


All participating hospitals developed systems to implement 4 different strategies for terminal room disinfection. We measured compliance with disinfection strategy, barriers to implementation, and perceptions from nurse managers and environmental services (EVS) supervisors throughout the 28-month trial.


Implementation of enhanced terminal disinfection with UV disinfection devices provides unique challenges, including time pressures from bed control personnel, efficient room identification, negative perceptions from nurse managers, and discharge volume. In the course of the BETR Disinfection Study, we utilized several strategies to overcome these barriers: (1) establishing safety as the priority; (2) improving communication between EVS, bed control, and hospital administration; (3) ensuring availability of necessary resources; and (4) tracking and providing feedback on compliance. Using these strategies, we deployed ultraviolet (UV) disinfection devices in 16,220 (88%) of 18,411 eligible rooms during our trial (median per hospital, 89%; IQR, 86%–92%).


Implementation of enhanced terminal room disinfection strategies using UV devices requires recognition and mitigation of 2 key barriers: (1) timely and accurate identification of rooms that would benefit from enhanced terminal disinfection and (2) overcoming time constraints to allow EVS cleaning staff sufficient time to properly employ enhanced terminal disinfection methods.


Clinical trials identifier: NCT01579370

Infect Control Hosp Epidemiol 2018;39:157–163


Corresponding author

Address correspondence to Deverick J Anderson, MD, MPH, Associate Professor of Medicine, DUMC Box 102359, Durham, NC 27710 (


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Supplementary materials

Anderson et al. supplementary material
Table S1 and Figure S1

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