Impact of 222-nm ultraviolet disinfection combined with psychological care on the emotional and hospital infection of critical patients

Abstract

BACKGROUND

Empathetic psychological care improves mood and enhances the quality of life in critically ill patients.

AIM

To study the impact of combining 222-nm ultraviolet (UV) disinfection with empathetic psychological care on emotional states, nosocomial infection rates, and quality of life in critically ill patients.

METHODS

A total of 202 critically ill patients admitted to Beijing Ditan Hospital (December 2023 to May 2024) were randomly assigned to control (Ctrl, n = 101) or observation groups (Obs, n = 101). The Ctrl group received 222-nm UV disinfection and routine care, while the Obs group received 222-nm UV disinfection with empathetic psychological care. Emotional states [Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS)], hospital infection rates, quality of life (36-Item Short Form Health Survey), and patient satisfaction were evaluated.

RESULTS

At baseline, there were no significant differences in SAS and SDS scores between the groups (P > 0.05). Following care, both groups demonstrated reductions in SAS and SDS scores, with the Obs group exhibiting a significantly greater reduction (P < 0.05). The Obs group also experienced a significantly lower overall hospital infection rate (P < 0.05). Similarly, while baseline 36-Item Short Form Health Survey scores did not differ significantly between the groups (P > 0.05), post-care scores improved in both groups, with a greater improvement observed in the Obs group (P < 0.05). Additionally, the Obs group reported higher patient satisfaction ratings (P < 0.05).

CONCLUSION

The combination of 222-nm UV disinfection and empathetic psychological care improves emotional states, reduces hospital infection rates, enhances the quality of life, and increases patient satisfaction among critically ill patients.

Key Words: Critically ill patients; 222-nm ultraviolet disinfection system; Empathetic psychological care; Emotional state; Nosocomial infection

Core Tip: In the intensive care unit, effective disinfection and psychological care are crucial for critically ill patients. Enhancing disinfection efficacy not only reduces the risk of hospital-acquired infections, safeguarding patients from infectious diseases, but also boosts their trust in the healthcare environment. By providing timely psychological support and intervention, it helps patients better cope with the stress and anxiety brought on by their illnesses, strengthening their psychological resilience. This comprehensive approach to care not only elevates the quality of life for patients but also facilitates their recovery process, ultimately achieving better therapeutic outcomes and patient satisfaction.

INTRODUCTION

Critical illnesses are characterized by urgency, danger, and severity. Advances in modern medical technology have enabled the effective treatment of various severe conditions. However, during treatment, factors such as the complexity of the environment and nursing care, as well as the widespread use of surgery and mechanical ventilation, inevitably increase the risk of hospital-acquired infections, thereby threatening patient safety[1]. The incidence of hospital infections among critically ill patients has been reported at 17.41%[2]. Although commonly used disinfectants are effective, they are cumbersome, time-consuming, labor-intensive, and can irritate human tissues. The 222-nm ultraviolet (UV) disinfection system, equipped with a quasi-molecular lamp with a peak wavelength of 222 nm and a special optical filter, blocks harmful wavelengths to achieve safe and reliable antiviral and antibacterial effects[3]. This system not only reduces the incidence of hospital infections but also allows for simultaneous operation with humans, making it particularly suitable for emergency departments and observation rooms that require critical care year-round. This system avoids the constraints of conventional UV disinfection, which necessitates the absence of medical staff and patients from the room. However, due to the severity of the disease and the unfamiliar hospital environment, many patients still experience adverse emotions such as anxiety and depression, which can hinder the smooth progression of subsequent treatments. Therefore, enhancing psychological care is essential. Routine psychological care can alleviate the psychological stress caused by the disease, enabling patients to cooperate more effectively with clinical interventions. However, routine care often lacks a systematic and targeted approach, resulting in suboptimal outcomes. The core concept of empathetic psychological care is a patient-centered approach in which nurses comprehensively assess patients’ needs and expectations, accurately perceive their emotions, and provide effective care services[4]. Few clinical reports examine the impact of a 222-nm UV disinfection system combined with empathetic psychological care on critically ill patients’ emotional state and hospital infection rates. We analyzed 202 critically ill patients admitted to the emergency department of our hospital for rescue and observation between December 2023 and May 2024.

MATERIALS AND METHODS

General data

Inclusion criteria: Patients who were observed for more than 48 hours in the emergency department’s observation room at Beijing Ditan Hospital, affiliated with Capital Medical University, with stable vital signs and clear consciousness. Patients or their families were informed and voluntarily participated in the study. Patients with unstable vital signs, severe consciousness disorders, cerebrovascular disease or history, those taking antipsychotic drugs, and those with communication barriers were excluded.

A total of 202 critically ill patients admitted to the emergency department’s observation room at Beijing Ditan Hospital, affiliated with Capital Medical University, between December 2023 and May 2024, were selected for this study. Using the random number table method, they were randomly divided into a control group (Ctrl, n = 101) and an observation group (Obs, n = 101). The Ctrl group consisted of 55 males and 46 females, aged 39-76 years, with an average age of 57.50 ± 6.12 years. Disease types included heart failure (16 cases), severe pneumonia (21 cases), diabetic ketoacidosis (13 cases), liver cirrhosis with abdominal infection (21 cases), and acute gastrointestinal bleeding (30 cases). The Obs group included 59 males and 42 females, aged 41-76 years, with an average age of 58.50 ± 6.10 years. Disease types included heart failure (18 cases), severe pneumonia (22 cases), diabetic ketoacidosis (16 cases), liver cirrhosis with abdominal infection (18 cases), and acute gastrointestinal bleeding (27 cases). The clinical data of the patients in both groups were comparable (P > 0.05).

Control group methodology

The 222-nm UV disinfection system (Manufacturer: Zhejiang Yiyuan Medical Technology Co., Ltd., Model: EY-100) was employed to disinfect high-risk contamination areas, including emergency rescue rooms, emergency isolation rooms, and emergency observation rooms, with continuous operation for 24 hours a day. Routine care: Patients were provided with brief information regarding the operation and benefits of the 222-nm UV disinfection system. Vital signs were closely monitored for any changes, and pharmaceutical nursing interventions were administered as needed. Any abnormalities were promptly reported to the attending physician. While the patients were conscious, their condition and treatment plan were explained using simple language, and psychological counseling was offered to encourage active cooperation with both treatment and nursing care. The procedure continued until the patient was discharged.

Observational group methodology

The 222-nm UV disinfection system was used in the same manner as the control, with the addition of empathetic psychological care.

Establishment of an empathetic psychological care team

The psychological care team consisted of two attending physicians specializing in critically ill patients, one head nurse, two psychological nurses, three nursing staff members, and one nursing assistant. The head nurse served as the team leader, overseeing and guiding the nursing work, while the remaining members contributed to the team’s activities. An expert in nursing was invited to provide training on “empathetic psychological care” to the team members. After the training, an assessment was conducted, with a score above 95% required for both theoretical knowledge and practical skills.

Development of an empathetic psychological care plan

Team members collaborated in their roles to search for domestic and international literature using keywords such as “critically ill patients”, “psychological nursing”, “empathetic care”, and “222-nm UV disinfection system”, summarizing and analyzing the findings. Two team members also summarized their past clinical experiences. A team meeting was held to discuss the psychological issues currently faced by critically ill patients, previous handling approaches, and to formulate an empathetic psychological care plan.

Implementation of the empathetic psychological care plan

Assessing the patient’s emotional state: Professional tools, namely the “Self-Rating Anxiety Scale” and the “Self-Rating Depression Scale”, were used to evaluate the patient’s emotions. Face-to-face communication facilitated the expression of the patient's inner thoughts, analysis of the causes of negative emotions, and the tailoring of psychological nursing methods accordingly.

Active listening and understanding: A specific time was scheduled for communication in a serene and comfortable patient environment. Patients were encouraged to articulate their thoughts actively, and the team listened attentively to their needs, feelings, and opinions, expressing empathy through acceptance and understanding. Thinking from the patient’s perspective, they showed respect for their views, empathizing with their pain and confusion, frequently using phrases such as “I understand you” and “I can feel that”.

Paying attention to details: In daily care, the patient’s personal preferences and needs were closely observed. Personalized nursing services were provided when feasible, such as offering the patient’s favorite food or playing their preferred music or videos to improve their mood.

Consideration and care: Nursing staff expressed concern for patients through language and gestures. With warm language and a kind demeanor, necessary care procedures were communicated. Comfort and encouragement were offered to patients with negative emotions, while praise and support were given to patients with positive emotions.

Conveying positive messages: During communication with the patient, disease information was explained in the simplest terms. Patients were actively guided, with positive information conveyed, and sensitive words or phrases avoided. Guidance on a healthy diet and rest was provided to encourage active recovery.

Empathetic experience: During interactions, the patient’s feedback, movements, expressions, and language were carefully observed. Patients were gently asked to ensure that they felt cared for, enhancing their desire to express themselves positively. Nursing staff assumed the role of “patient” and guided the patient in psychological counseling methods, including: (1) Mindfulness therapy: Depending on the patient’s condition, they could choose a sitting or lying position, close their eyes, and attentively experience their current thoughts, emotional state, and bodily sensations. They were guided to focus slowly on their breath, noting abdominal movements with each inhale and exhale, and perceiving their body as a whole entity; (2) Diaphragmatic breathing: When the patient’s condition was stable, they were guided to relax their hands, inhale through the nose (expanding the abdomen), and exhale through the mouth (causing the abdomen to fall back while the chest remained still). Deep inhalation and shallow exhalation were practiced to enhance diaphragmatic contraction strength; and (3) Music therapy: At appropriate times, the patient’s preferred music type and song titles were inquired about. Targeted music tracks were played with the volume adjusted for comfort, with sessions lasting 20 minutes twice daily until the patient’s discharge.

Observational indicators

Comparison of emotional states before and after nursing care between the groups: The levels of anxiety and depression in the patients were assessed using the Self-Rating Anxiety Scale (SAS) and the Self-Rating Depression Scale (SDS) before and after nursing care. Both scales consist of 20 items rated on a 5-score rating system. The raw scores were calculated by simple addition, and the standard scores were obtained by multiplying the raw scores by 1.25 and rounding to the nearest whole number. For SAS: A standard score < 50 indicates no anxiety symptoms, while a standard score ≥ 50 indicates the presence of anxiety symptoms; for SDS: A standard score < 53 indicates no depression, while a standard score ≥ 53 suggests depressive symptoms. Higher scores indicate more severe anxiety and depressive symptoms[5].

Comparison of hospital-acquired infection rates among groups: Diagnosing hospital-acquired infections in patients was based on the “Diagnostic Criteria for Hospital Infections”[6], mainly including infections of the respiratory system, urinary system, skin, mucous membranes, and digestive systems.

Comparison of quality of life before and after nursing care between the two groups: The 36-Item Short Form Health Survey assessed patients’ quality of life before and after nursing care. This study focused on three dimensions: Vitality, physical, and emotional. Each item is scored on a scale of 0 to 100, with the total score being the sum of the transformed scores of each dimension, ranging from 0 to 100. The higher the score, the higher the patient’s quality of life of the patient[7].

Comparison of patient satisfaction between groups: Patient satisfaction was assessed using a patient satisfaction questionnaire, which mainly included trust in medical staff, sense of respect, sense of being understood, and sense of empathy. Each item is scored from 0 to 25, with the total score ranging from 0 to 100. Scores < 60 indicated dissatisfaction, 60-80 indicated general satisfaction, 81-100 indicate high satisfaction; the overall satisfaction rate was calculated as: 1 - the proportion of dissatisfaction. The questionnaire has good reliability and validity.

Statistical analysis

Data were processed using SPSS 26.0. Categorical data were presented as n (%), and the χ² test was applied for analysis. Continuous data were expressed as mean ± SD, and the t-test was utilized to determine the significance of differences. P < 0.05 indicates a statistically significant difference.

RESULTS

Comparison of emotional states between groups

Before nursing care, there were no statistically significant differences in the SAS and SDS scores between the Obs and Ctrl groups (P > 0.05). After nursing care, both groups showed a reduction in scores, with the Obs group exhibiting significantly lower SAS and SDS scores than the Ctrl group (P < 0.05) in Table 1.

Table 1 Comparison of emotional states between two groups, mean ± SD.

Groups	Numbers	SAS (score)		SDS (score)
		Pre-nursing	Post-nursing	Pre-nursing	Post-nursing
Control	101	56.60 ± 3.20	52.10 ± 2.95a	58.85 ± 3.65	54.12 ± 3.00a
Observation	101	57.10 ± 3.23	47.65 ± 2.88a	57.90 ± 3.68	50.00 ± 2.12a
t		1.105	10.848	1.842	11.271
P value		0.270	< 0.050	0.067	< 0.050

^aP < 0.05 compared with pre-nursing within the same group.

Conversely, the Self-Rating Anxiety Scale was employed to evaluate the subjective experience of anxiety in patients and to monitor its alteration throughout the therapeutic process. The Self-Rating Depression Scale is a self-assessment tool designed to measure the severity of depressive states and track changes during treatment. SAS: Self-Rating Anxiety Scale; SDS: Self-Rating Depression Scale.

Comparison of nosocomial infection rates between groups

The overall incidence of hospital infections in the Obs group was significantly lower than in the Ctrl group (P < 0.05) in Table 2.

Table 2 Comparison of nosocomial infection rates between two groups, n (%).

Groups	Number	Respiratory system	Urinary system	Skin and mucous membranes	Digestive system	Total incidence rate
Control	101	4 (3.96)	3 (2.97)	2 (1.98)	4 (3.96)	13 (12.87)
Observation	101	1 (0.99)	1 (0.99)	0 (0.00)	1 (0.99)	3 (2.97)
χ2						6.787
P value						0.009

Comparison of quality of life between groups

Before nursing care, there were no statistically significant differences in the scores for each dimension or the total 36-Item Short Form Health Survey score between the two groups (P > 0.05). After nursing care, both groups demonstrated an improvement in scores, with the Obs group scoring significantly higher than the Ctrl group (P < 0.05) in Table 3.

Table 3 Comparison of quality of life between two groups (mean ± SD, scores).

Groups	Number	Vitality		Physical functioning		Emotional functioning		Total score
		Pre-nursing	Post-nursing	Pre-nursing	Post-nursing	Pre-nursing	Post-nursing	Pre-nursing	Post-nursing
Control	101	52.85 ± 5.40	63.35 ± 4.95a	55.25 ± 4.65	61.15 ± 4.35a	60.55 ± 6.65	66.80 ± 5.10a	62.35 ± 6.50	73.65 ± 4.60a
Observation	101	54.10 ± 5.65	70.12 ± 5.10a	56.00 ± 4.70	66.90 ± 2.30a	61.00 ± 6.70	72.35 ± 4.65a	63.10 ± 6.55	78.10 ± 5.12a
t		1.607	9.573	1.140	11.744	0.479	8.082	0.817	6.498
P value		0.110	< 0.050	0.256	< 0.050	0.632	< 0.050	0.415	< 0.050

^aP < 0.05 compared with pre-nursing within the same group.

Comparison of satisfaction between groups

The satisfaction scores for the Obs group were significantly higher than those for the Ctrl group, with this difference being statistically significant (P < 0.05) in Table 4.

Table 4 Comparison of satisfaction between two groups.

Groups	Number	Moderately satisfied	Generally satisfied	Dissatisfied	Overall satisfaction
Control, n (%)	101	45 (44.55)	35 (34.65)	21 (20.79)	80 (79.21)
Observation, n (%)	101	50 (49.50)	43 (42.57)	8 (7.92)	93 (92.08)
χ2					6.804
P value					0.009

DISCUSSION

Life-saving equipment is typically available in intensive care units, where critically ill patients are often admitted. However, constant noise from these machines and invasive therapeutic procedures can cause significant disturbances during treatment. Additionally, hospital-acquired infections can complicate treatment and may result in severe psychological issues for patients. These factors pose a serious threat to the health and well-being of critically ill individuals[8,9]. The 222-nm UV disinfection system disrupts the DNA structure of pathogens such as bacteria and viruses. It can provide real-time, highly effective disinfection in an occupied environment and demonstrates good bactericidal effects on both surfaces and in the air, thereby reducing the incidence of nosocomial infections[10]. However, critically ill patients, affected by factors such as confined environments, uncertainty about their illness, intubation, and concerns about prognosis, are vulnerable to psychological issues such as anxiety, depression, and fear. This increases their mental burden, and in severe cases, it can lead to mental disorders, reduce quality of life, and affect prognosis[11]. Therefore, implementing effective psychological nursing interventions for critically ill patients is essential.

Empathetic nursing, a relatively new approach in the field, enables healthcare providers to demonstrate profound understanding and respect for patients while addressing their physical, psychological, and social needs[12]. Previous research has shown that psychological nursing interventions for critically ill patients can alleviate psychological distress during treatment, improve sleep quality and overall well-being, and support recovery[4]. This study employed a UV disinfection system to sterilize the external environment while also offering psychological care. Results indicated that patients in the psychological care group experienced a significant reduction in both the SAS and SDS scores. These findings suggest that, compared to routine nursing, the combination of a 222-nm UV disinfection system and empathetic psychological nursing had a more profound impact on improving patients’ emotional well-being[4]. Empathetic nursing emphasizes both the physical and mental comfort of patients, with its core principle being humanization, which aims to optimize patient comfort. In this study, a professional medical team was formed to deliver expert, compassionate, and scientifically sound nursing services. Prior to implementing empathetic psychological care, professional assessment tools were used to evaluate patients’ emotional states. Based on these assessments, targeted empathetic psychological interventions were applied, yielding more noticeable outcomes. Active listening and understanding help patients feel focused and validated, alleviating anxiety, stress, and fear. Attention to detail in nursing provides personalized and targeted psychological care, addressing patients’ diverse emotional needs and further promoting emotional relief. Additionally, demonstrating care and consideration fosters a sense of being valued in patients. Conveying positive information boosts patient confidence and mitigates fear, while empathetic experiences empower patients to learn psychological counseling and stress management techniques, which significantly enhance their emotional health[13,14].

We observed that after nursing intervention, the incidence of nosocomial infections in the Obs group was lower than in the Ctrl group. This was due to the application of the 222-nm UV disinfection system, which effectively eliminates viruses, bacteria, and fungal spores. It can also disinfect the air in occupied spaces, thus broadening the potential applications of UV sterilization lamps. The ability of the system to penetrate biological tissues is limited, and it does not harm skin basal cells or eyes, making it a safe and effective disinfection method. The 222-nm UV disinfection system can enhance the environment for critically ill patients and reduce the risk of cross-infection[15]. When combined with empathetic psychological nursing, it can improve patient compliance and cooperation, guide patients in adopting correct self-protection and nursing practices, and help reduce the incidence of nosocomial infections.

Furthermore, this study found that, after nursing intervention, the Obs group exhibited higher quality of life and satisfaction compared to the Ctrl group. The 222-nm UV disinfection system helps maintain a sterile, clean, and safe environment, reducing the incidence of nosocomial infections. This promotes faster recovery and improves patients’ quality of life. A positive emotional state is crucial for recovery, and the implementation of empathetic psychological nursing significantly alleviates patients’ adverse emotional states, contributing to better quality of life. The 222-nm UV disinfection system is non-harmful to the human body, and its effects are evident, fostering greater trust in medical staff and resulting in higher patient satisfaction. Empathetic psychological nursing helps patients feel understood, cared for, and respected, leading to enhanced psychological and emotional satisfaction, increased compliance, and more active cooperation with clinical work, ultimately improving satisfaction with the efforts of the medical staff.

CONCLUSION

The combination of the 222-nm UV disinfection system and empathetic psychological nursing significantly alleviates the emotional state of critically ill patients, can reduce the incidence of nosocomial infection, improve the quality of life and patient satisfaction, and has value for promotion.