Journal of Occupational and Environmental Hygiene

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Ultraviolet (UV)-reflective paint with ultraviolet

germicidal irradiation (UVGI) improves
decontamination of nosocomial bacteria on
hospital room surfaces

Katelyn C. Jelden, Shawn G. Gibbs, Philip W. Smith, Angela L. Hewlett, Peter

C. Iwen, Kendra K. Schmid & John J. Lowe

To cite this article: Katelyn C. Jelden, Shawn G. Gibbs, Philip W. Smith, Angela L. Hewlett,
Peter C. Iwen, Kendra K. Schmid & John J. Lowe (2017) Ultraviolet (UV)-reflective paint with
ultraviolet germicidal irradiation (UVGI) improves decontamination of nosocomial bacteria on
hospital room surfaces, Journal of Occupational and Environmental Hygiene, 14:6, 456-460, DOI:
10.1080/15459624.2017.1296231

To link to this article: http://dx.doi.org/10.1080/15459624.2017.1296231

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JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE
, VOL. , NO. , –
http://dx.doi.org/./..

Ultraviolet (UV)-reflective paint with ultraviolet germicidal irradiation (UVGI)

improves decontamination of nosocomial bacteria on hospital room surfaces
Katelyn C. Jeldena , Shawn G. Gibbsb , Philip W. Smithc , Angela L. Hewlettc , Peter C. Iwend,e , Kendra K. Schmidf ,
and John J. Lowe a
a
Department of Environmental, Agricultural & Occupational Health, University of Nebraska Medical Center, Omaha, Nebraska; b Department of
Environmental Health, Indiana University School of Public Health, Bloomington, Indiana; c Department of Internal Medicine, Division of
Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska; d Department of Pathology and Microbiology, College of Medicine,
University of Nebraska Medical Center, Omaha, Nebraska; e Nebraska Public Health Laboratory, Omaha, Nebraska; f Department of Biostatistics;
University of Nebraska Medical Center, Omaha, Nebraska

ABSTRACT KEYWORDS
An ultraviolet germicidal irradiation (UVGI) generator (the TORCH, ClorDiSys Solutions, Inc.) was used Environmental
decontamination; hospital
to compare the disinfection of surface coupons (plastic from a bedrail, stainless steel, and chrome- room; surfaces; ultraviolet
plated light switch cover) in a hospital room with walls coated with ultraviolet (UV)-reflective paint germicidal irradiation;
(Lumacept) or standard paint. Each surface coupon was inoculated with methicillin-resistant Staphy- UV-reflective paint
lococcus aureus (MRSA) or vancomycin-resistant Enterococcus faecalis (VRE), placed at 6 different sites
within a hospital room coated with UV-reflective paint or standard paint, and treated by 10 min UVC
exposure (UVC dose of 0–688 mJ/cm2 between sites with standard paint and 0–553 mJ/cm2 with UV-
reflective paint) in 8 total trials. Aggregated MRSA concentrations on plastic bedrail surface coupons
were reduced on average by 3.0 log10 (1.8 log10 Geometric Standard Deviation [GSD]) with standard
paint and 4.3 log10 (1.3 log10 GSD) with UV-reflective paint (p = 0.0005) with no significant reduction
differences between paints on stainless steel and chrome. Average VRE concentrations were reduced
by ࣙ4.9 log10 (<1.2 log10 GSD) on all surface types with UV-reflective paint and ࣘ4.1 log10 (<1.7 log10
GSD) with standard paint (p < 0.05). At 5 aggregated sites directly exposed to UVC light, MRSA con-
centrations on average were reduced by 5.2 log10 (1.4 log10 GSD) with standard paint and 5.1 log10 (1.2
log10 GSD) with UV-reflective paint (p = 0.017) and VRE by 4.4 log10 (1.4 log10 GSD) with standard paint
and 5.3 log10 (1.1 log10 GSD) with UV-reflective paint (p < 0.0001). At one indirectly exposed site on the
opposite side of the hospital bed from the UVGI generator, MRSA concentrations on average were
reduced by 1.3 log10 (1.7 log10 GSD) with standard paint and 4.7 log10 (1.3 log10 GSD) with UV-reflective
paint (p < 0.0001) and VRE by 1.2 log10 (1.5 log10 GSD) with standard paint and 4.6 log10 (1.1 log10 GSD)
with UV-reflective paint (p < 0.0001). Coating hospital room walls with UV-reflective paint enhanced
UVGI disinfection of nosocomial bacteria on various surfaces compared to standard paint, particularly
at a surface placement site indirectly exposed to UVC light.

Introduction
The financial and human health costs associated with
nosocomial infection transmission have necessitated the
development and utilization of a broad range of methods
for hospital disinfection, such as treatment with ultravio-
let germicidal irradiation (UVGI) by ultraviolet-C (UVC)
light.[1] Yet, pathogen disinfection by UVGI is limited
in areas not directly exposed to UV light in the hospi-
tal environment,[1–4] and the required 10–50 min treat-
ment times restrict application in clinical settings requir-
ing rapid room turnaround.[5]
Coating walls with UV-reflective paint (Lumacept,
Grand Forks, ND) in conjunction with UVGI treatment
has been shown to increase UV irradiance in a hospital
room while reducing UVC treatment times and maintain-
ing environmental pathogen inactivation, as compared to
standard paint.[4–6] For instance, in a hospital room at
sites indirectly exposed to UVC, UV irradiance increased
from 3.7 × 10−6 W/cm2 with standard paint to 4.5 × 10−5
W/cm2 with UV-reflective paint using a V-360+ UVC-
generating device (UltraViolet Devices).[4] Another study
evaluating UV-reflective wall coating using a Tru-DTM

CONTACT John J. Lowe jjlowe@unmc.edu Department of Environmental, Agricultural & Occupational Health; University of Nebraska Medical Center;
 Nebraska Medical Center, Omaha, NE -.
©  JOEH, LLC

UVC-generating device (Lumalier) found UV-reflective
paint decreased UV treatment times by ∼80% compared
to standard paint while maintaining >4 log10 reductions
of methicillin-resistant Staphylococcus aureus (MRSA).[6]
Also using a Tru-DTM device for UVC treatment, Clostrid-
ium difficile spores were reduced by an average of 2.78
log10 in ∼43 min in a room coated with standard white
paint and by an average of 2.91 log10 in ∼9 min in a room
coated with UV-reflective paint.[5] Last, a study examined
UV decontamination by coating walls, ceilings, and floors
as compared to only walls with UV-reflective paint.(6)
Each coating scenario (i.e., only walls; walls and ceiling;
walls and floor; and walls, floor, and ceiling) reduced
MRSA concentrations on average by ࣙ3.80 log10 in a
mean time range of 3.55–4.53 min.[6] Coating surfaces
such as ceilings and floors with UV-reflective paint did
not decrease decontamination times when compared to
coating only walls.[6] Overall, few studies have examined
the parameters of this technology in the hospital room
and none on the disinfection nuances between varied sur-
faces. This study evaluated the decontamination of sur-
faces inoculated with HAI-related bacterial strains using
a portable UVGI generator (the TORCH, ClorDiSys Solu-
tions, Inc., Lebanon, NJ) in a hospital room coated with
standard paint or UV-reflective paint (Lumacept, Grand
Forks, ND).
Methods
As described in a previous study, trials were completed
within a single 20 m2 hospital room in the Nebraska Bio-
containment Unit at the University of Nebraska Medical
Center.[2] The hospital room contained medical equip-
ment, a patient bed and mannequin, and computers on
wheels positioned to simulate the patient care environ-
ment. Five control trials were completed with walls coated
in standard paint, which is approximately 3–7% reflective
to UV light.[5] For three experimental trials, walls of this
hospital room were coated with a white shade of UVC
Max, a UV-reflective paint (Lumacept, Grand Forks, ND)
formulated with nanoparticles to increase reflectivity of
254 nm UVC light to 65%[4,5] and identical procedures
performed. The UV-reflective paint was applied to the
room walls by roller or brush, can be matched to existing
paint colors (a white shade was evaluated in this study),
and has been estimated to cost less than $300 to cover a
∼12.1 m2 room.[5]
Six sites throughout the hospital room were selected
for surface coupon placement.[2] Prior to trials, a UVC
sensor (ClorDiSys Solutions, Inc., Lebanon, NJ) was
placed at each site and treated by UVGI (the TORCHTM ,
ClorDiSys Solutions, Inc., Lebanon, NJ) for 10 min to
JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 457
record the mean UVC dose at each site (Table 1). The UV
sensor is cosine corrected with a spectral response of
249–261 nm (greatest response at 254 nm) and range of
0.01µW/cm2 to 2000 µW/cm2 . As Table 1 displays, five
sites were defined as direct UVC exposures (dose range
of 9–688 mJ/cm2 with standard paint and 2–553 mJ/cm2
with UV-reflective paint), and one site was defined as an
indirect exposure on the opposite side of the hospital bed
from the UVGI generator facing the wall with a UVC
dose of 0 mJ/cm2 for both standard and UV-reflective
paint.(2) Distances between surface placement sites and
the UVGI generator ranged from 1.0–3.5 m, with the sole
placement site indirectly exposed to UVC light at 2.8 m
(Table 1).
Solutions containing microorganisms were cultured
and diluted to ࣙ6 log10 CFU/mL as described previ-
ously.[7] Surface coupons (∼35 cm2 ) composed of stain-
less steel, chrome, and plastic bedrail (polyvinyl chlo-
ride [PVC]) were inoculated with 100 µL solutions of
either MRSA ATCC 43300 or vancomycin-resistant Ente-
rococcus faecalis (VRE) ATCC 51299 in 4 even drops
and dried.[2,7] Triplicates of each type of surface were
placed on vertical panels (∼60°) and placed at each site
within the hospital room.[2] Surface coupons were pre-
pared identically and positioned within the Nebraska Bio-
containment Unit during treatment but were not moved
out of the transport container or exposed to the UVC
light to control for desiccation during treatment. The
TORCHTM bulbs, which are low pressure T5 bulbs 5 ft
in length that emit a total of 264 W UVC, were seasoned
∼100 hr prior to this study and warmed for 10 min imme-
diately before each trial. For trials, hospital room windows
were covered, lights were turned off, the door closed, and a
remote was used to activate the TORCHTM from outside
the room. The hospital room and surfaces were treated
with a 10-min UVC exposure (per UV disinfection treat-
ment time utilized by the Nebraska Medicine hospital)
using a single TORCHTM generator placed in the center of
the room, while a UVC sensor measured dosage from the
corner of the room (average UVC dose of 206 mJ/cm2 for
standard paint and 218 mJ/cm2 for UV-reflective paint).
Following treatment, log10 reductions were quantified
as described elsewhere.[8] Log10 reductions due to vegeta-
tive bacteria desiccation were controlled for by subtract-
ing the log10 reductions in untreated control surfaces from
the treated surfaces. Geometric mean log10 reductions,
geometric standard deviations of log10 reductions, f-tests,
and one-tailed t-tests between standard paint and UV-
reflective paint groups were calculated using Microsoft
Excel (Microsoft Corporation, Redmond, WA). F-tests
were calculated to determine whether t-test samples were
of equal or unequal variance. P < 0.05 indicated a
458 K. C. JELDEN ET AL.

Table . Hospital room surface coupon placement and mean ultraviolet-C (UVC) dose.
c
Mean UVC Dose (range, mJ/cm ) Distance in Meters
a
Description Exposure Standard Paint UV-Reflective Paint UVGI Generator Floor

Wall mounted counter Direct  (–)  (–) . .
Floor near UVC generator Direct  (–)  (–) . .
Top of bed mattress Direct  (–)  (–) . .
Top of corner chair Direct  (–)  (–) . .
Floor near window Direct  (–)  (–) . .
Floor on opposite side of bed from generator Indirect   . .
b d d
UVC sensor placed in corner of room Direct  (–)  (–) . .
a Surface coupons representing each surface type were placed at six sites. Every site was tested with methicillin-resistant Staphylococcus aureus (MRSA) and
vancomycin-resistant Enterococcus faecalis (VRE).
b The UVC Sensor was placed in the corner of the room during trials.
c Prior to trials, the UVC Sensor was placed at each site for three -min exposures to record mean UVC Doses.
d Indicates Mean UVC Dose and dose range recorded during -min exposure trials.

statistically significant difference between standard paint
and UV-reflective paint groups. Percent reduction was
calculated per the equation [P = (1–10−L ) x100] where
P is percent reduction and L is log10 reduction.
Results
Average MRSA concentrations were significantly low-
ered on the plastic surface coupon from a bedrail in the
room coated with UV-reflective paint compared to stan-
dard paint (p = 0.0005), while concentration reductions
were not significantly different between paint groups on
stainless steel and chrome surfaces (Table 2). Average
VRE concentrations were significantly reduced on plas-
tic bedrail surface coupons (p < 0.0001), stainless steel
(p < 0.0001), and chrome (p = 0.0005) when treated by
UVC light with UV-reflective paint compared to standard
paint.
At 5 aggregated sites directly exposed to UVC light,
average MRSA concentrations were significantly reduced
with standard paint (5.2 log10 reduction, 1.4 log10 GSD)
compared to UV-reflective paint (5.1 log10 reduction, 1.2
log10 GSD, p = 0.017), while average VRE concentrations
were significantly reduced with UV-reflective paint com-
pared to standard paint (p < 0.0001) (Table 3). At one site
on the opposite side of the hospital bed from the UVGI
generator indirectly exposed to UVC, average MRSA
concentrations were significantly reduced with UV-
reflective paint (4.7 log10 reduction, 1.3 log10 GSD)
compared to standard paint (1.3 log10 reduction, 1.7 log10
GSD, p < 0.0001) with similar results for VRE concen-
trations with UV-reflective paint (4.6 log10 reduction, 1.1
log10 GSD) and standard paint (1.2 log10 reduction, 1.5
log10 GSD, p < 0.0001).
Overall, 93% (50/54) of VRE plates and 92% (129/140)
of MRSA plates were 100% inactivated with UV-reflective
painted walls.
Discussion
This study was the first to systematically evaluate the use
of UVGI with UV-reflective paint on disinfecting various
surface types in a hospital room. The plastic surface from
a bedrail was the only type to show significantly lowered
MRSA concentrations with UV-reflective paint (p =
0.0005) compared to standard paint. This finding was not
surprising given the concentration reductions on chrome
(5.5 log10 ) and stainless steel (5.0 log10 ) compared to
the plastic bedrail (3.0 log10 ), limiting the capacity for
reduction differences for chrome and stainless steel. All

Table . Comparison of mean Log reduction (Geometric Standard Deviation [GSD], percent reduction [%]) for methicillin-resistant
Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus faecalis (VRE) between each surface type.
MRSA VRE
log (GSD, %) log (GSD, %)
b
Surface Standard Paint UV-Reflective Paint p-value Standard Paint UV-Reflective Paint p-value
a a
Plastic from a bedrail . (., .%) . (., .%) . . (., .%) . (., .%) <.
a
Stainless steel . (., .%) . (., .%) . . (., .%) . (., .%) <.
a
Chrome . (., .%) . (., .%) . . (., .%) . (., .%) .
c
Mean UVC Dose (mJ/cm , range)  (–)  (–) (–) 
a Indicates a statistically significant (α = .) difference between Standard Paint and UV-reflective paint.
b Surface type data is aggregated from six sites.
c Indicates the Mean UVC Dose and range measured by the UVC sensor in the directly exposed hospital room corner during trials.

Table . Comparison of Mean Log Reductions (Geometric Standard Deviation [GSD], Percent Reduction [%]) for Methicillin-resistant
Staphylococcus aureus (MRSA) and Vancomycin-resistant Enterococcus faecalis (VRE) Between Standard Paint and UV-Reflective Painted
Hospital Rooms.
MRSA
log (GSD, %)
a
Exposure Standard Paint UV-Reflective Paint
Direct . (., .%) . (., .%)
Indirect . (., %) . (., .%)
c
UV Dose (mJ/cm , range)  (–)  (–)
a Indicates a statistically significant (α = .) difference between standard paint and UV-reflective paint.
b Exposure data is aggregated from five sites for direct exposure.
c Indicates the mean UVC Dose and range measured by the UVC sensor in the directly exposed hospital room corner during trials.
surfaces inoculated with VRE showed significantly low-
ered concentrations with UV-reflective paint compared
to standard paint (p < 0.05). Given the high likelihood of
plastic bedrail contamination within the clinical environ-
ment, the demonstrated organism reductions have the
potential to be impactful at reducing contamination and
nosocomial infections.
This study supported previous research on combina-
tional UVGI treatment with UV-reflective paint at sites
directly and indirectly exposed to UVC in a hospital
room. Rutala et al.[4] found that on surfaces indirectly
exposed to UVC, MRSA concentrations were reduced on
average by 2.74 log10 with standard paint and 4.21 log10
with UV-reflective paint (5 minute exposure, 13.5mJ/cm2
dose with UV-reflective paint) and C. difficile concentra-
tions by 1.80 log10 with standard paint and 2.61 log10
with UV-reflective paint (10 minute exposure, 27 mJ/cm2
dose with UV-reflective paint). This study similarly found
UV-reflective paint lead to significantly lowered concen-
trations of MRSA (p < 0.0001) and VRE (p < 0.0001)
on surfaces facing the wall and out of direct line of UVC
exposure as compared to standard paint, a major limita-
tion of UVC disinfection when evaluated against decon-
tamination methods such as vaporized hydrogen peroxide
or chlorine dioxide exposures.[10]
This study was limited. First, only one site was eval-
uated with indirect UVC exposure. Second, VRE and
MRSA are vegetative bacteria requiring a lower UVC dose
for inactivation compared to bacterial spores associated
with organisms such as C. difficile. Finally, 93% of VRE
and 92% of MRSA plates achieved ࣙ6 log10 reduction,
limiting the quantification of log10 reductions beyond
the concentration inoculated. Study methods could have
been improved by increasing inoculation concentrations
or decreasing UVC treatment lengths to better quantify
reduction differences between surfaces and paint groups.
Future studies should assess the applicability and effi-
cacy of UV-reflective paint in various clinical settings
(especially those requiring rapid room turnaround), on
surfaces not directly in line with the UVC generator
JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 459
VRE
log (GSD, %)
p-value Standard Paint UV-Reflective Paint p-value
a a
. . (., .%) . (., .%) <.
a a
<. . (., %) . (., .%) <.
(–) 
or coated walls and placed at varying distances, with
increased inoculation concentrations or reduced UVC
treatment lengths, and with other pathogenic organ-
isms, including those known to persist for long periods
of time in the environment. Additionally, the benefits
of UV-reflective paint in combination with UVC treat-
ment should be assessed against the costs of applying
UV-reflective paint in various clinical settings, which has
been estimated at less than $300 per ∼12.1m2 room.[5]
UVGI room decontamination with standard paint inac-
tivated >4 log10 of vegetative bacteria on surfaces directly
exposed to UVC light, yet UV-reflective paint effectively
enhances disinfection by UVC exposure, particularly in
room areas not directly exposed to UVC light. The use
of UVC treatment with standard or UV-reflective paint
should be evaluated in terms of potentially lowering inci-
dence of nosocomial infections.
Conclusions
UVGI treatment in combination with walls coated with
UV-reflective paint (Lumacept), as compared to standard
paint, enhanced inactivation of nosocomial bacteria inoc-
ulated onto surface coupons placed at various sites within
a hospital room. MRSA concentrations on coupons com-
posed of plastic from a bedrail were reduced on average
by 3.0 log10 with standard paint and 4.3 log10 with UV-
reflective paint (p = 0.0005) with no significant reduction
differences between paints on stainless steel and chrome.
Average VRE concentrations were reduced by ࣙ4.9 log10
on all surface types with UV-reflective paint and ࣘ4.1
log10 with standard paint (p < 0.05). At the site indirectly
exposed to UVC light on the opposite site of the hospi-
tal bed from the UVGI generator, concentrations of VRE
and MRSA were reduced by >4 log10 with UV-reflective
paint and <2 log10 with standard paint (p < 0.0001). UV-
reflective paint enhances pathogen decontamination by
UVGI in a hospital room. Future study should continue
examination of the parameters and clinical applicability of
UV-reflective paint use with UVGI as well as evaluate this
460 K. C. JELDEN ET AL.
technology’s potential in decreasing incidence of nosoco-
mial infection.
Acknowledgments
The authors thank Nathan Harms for his laboratory support
Kathleen Boulter, and Angela Vasa, and Michelle Schwed-
helm for coordinating access to the Nebraska Biocontainment
Unit.
Funding
This work was financially supported by the University of
Nebraska Medical Center and Nebraska Biocontainment Unit.
The TORCH is on loan to the research group from ClorDiSys
Solutions, Inc. and the UVC Max paint was donated from Luma-
cept. However, neither ClorDiSys nor Lumacept were part of
the research team, party to experimental design, or aware of
the results of the study ahead of print. ClorDiSys has put no
conditions on use of the TORCH except that the instrument
be returned when the study is completed. Lumacept has put no
conditions on use of UVC Max. No authors have any financial
disclosures.
ORCID
John J. Lowe http://orcid.org/0000-0002-2893-1312
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