New Robot is on the Job at Foster Hospital
The new Tru-D (Total Room Ultraviolet Disinfection) robot is taking infection prevention to the highest levels at Henry and Lois Foster Hospital for Small Animals (FHSA) at Cummings School of Veterinary Medicine at Tufts University. FHSA is one of the first veterinary hospitals in the country to acquire the sterilization robot, augmenting the hospital's high standards of cleaning and disinfection protocols to prevent the spread of infection. The purchase of the Tru-D was made possible by a generous gift.
The robot, nicknamed R-Tru-D-2 by FHSA staff, is coming at a time when multidrug-resistant bacteria are on the rise—and spreading between pets and owners. Leaders in antimicrobial stewardship efforts are Dr. Claire Fellman (she/her), internal medicine specialist and pharmacologist at FHSA and associate professor in the Department of Clinical Sciences at Cummings School, and Dr. Ian DeStefano (he/him), emergency and critical care specialist at FHSA and assistant clinical professor in the Department of Clinical Sciences.
Raising awareness of the risks of antimicrobial resistance (AMR), Fellman and DeStefano advocate for careful consideration of drug choice and treatment duration to help prevent the spread of multidrug-resistant bacteria. Overuse of antibiotics can cause bacteria to develop resistance, making the medication ineffective.
"Multidrug-resistant infections can affect not only animals, but their owners," says Fellman. "Our global efforts support judicious use of antibiotics so that we reduce the development of these bacteria."
Fellman and DeStefano helped found the Companion Animal Antimicrobial Stewards (CAAMS) group, hosting workshops for veterinary professionals on AMR. Here at FHSA, Fellman and DeStefano head up the Infection Control and Antimicrobial Stewardship Team and led the charge to bring in the Tru-D robot.
"The importance of proper cleaning and disinfection really can't be emphasized enough," says DeStefano. "That and hand washing are the biggest things that prevent infections. That's really the whole name of the game here, infection prevention, not just infection control, but trying to reduce healthcare-associated infections."
In stepping up these efforts at FHSA, Sabrina Richards (she/her) joined the team as the hospital's first infection control technician. She holds a master's degree in public health, specializing in epidemiology and infectious disease management. An infection control assistant supports her and works closely with DeStefano and Fellman.
"Especially with COVID, there's increased awareness of the shared number of diseases that can go between humans and animals—they're very much integrated, human and animal health," says Richards.
Robots like Tru-D are utilized in human hospitals, but are relatively new for veterinary hospitals. In selecting Tru-D, DeStefano and Fellman consulted with colleagues at the University of Pennsylvania and Texas A&M University, who recently began using ultraviolet C (UVC) technology to enhance cleaning protocols in their veterinary hospitals.
After following standard cleaning and disinfection protocols, the Tru-D robot provides an extra layer of sanitation. The stationary robot's 360-degree sensors scan the room to determine the size of the space and the length of the disinfection cycle. Giving off a blue glow, the robot emits UVC light that kills bacteria on every surface exposed to the light. Tru-D works quickly, sanitizing a large space, such as an operating room, in 20-25 minutes, and five to seven minutes for a smaller space, like an exam room. It's controlled via tablet.
Certain bacteria are resistant to typical cleaning and disinfecting methods, and some areas can be challenging to sterilize.
"If you think of an operating room, there are machines, devices, and tabletops—it's a very complex area to try to clean and disinfect as compared to one surface, like a table," says DeStefano. "The robot causes a tremendous decrease in bacterial load on the surface of everything that the light touches—tens and thousands of times less bacterial load, reducing exposure to patients."
Since R-Tru-D-2 arrived in August, Richards has gradually integrated the robot into workflows, starting with high traffic areas, such as in-patient and procedure rooms. For example, in a dog run where larger dogs are housed, after the standard cleaning, R-Tru-D-2 is rolled in for additional sanitization that takes less than five minutes.
"If we have a dog that has a multidrug-resistant infection, then we can treat the run following our cleaning and disinfection to ensure that the space is safe and ready for the next patient," says Fellman.
Eventually, R-Tru-D-2 will be used all over the hospital, from surgical rooms to X-ray suites. Richards is currently training supervisors on the robot. Since she joined the team last winter, Richards has implemented a number of new infection prevention protocols at FHSA. She created a hand hygiene observation program and is working to implement a surveillance program for healthcare-associated infections. She overhauled FHSA's personal protective equipment (PPE), moving from a pathogen-based to syndrome-based approach, taking PPE precautions based on clinical signs before waiting for a diagnosis. She recently organized FHSA's Infection Prevention and Control Awareness Week, with educational activities for staff, including R-Tru-D-2 dressed up to demonstrate required PPE based on precaution levels.
The enhanced protocols instituted by Richards and the addition of the Tru-D robot are raising the bar in patient safety at FHSA.
"We're really grateful that we can increase the level of cleaning and protection because infection prevention is a growing issue and concern as we recognize more resistant organisms transmitting between people and animals," says Fellman. "This is the standard of care in human hospitals, and it needs to come more into veterinary spaces. I'm excited that we can start to use this tool to both support research efforts to show when it is most effective and to help keep our patients safe."