Ultraviolet-C disinfection in aeromedical evacuation: A pilot evaluation of effectiveness and usability

Background: As the US military shifts toward prolonged field care and delayed evacuation during large-scale combat operations, preventing health care-associated infections in aeromedical evacuation (AE) platforms has become an increasing operational concern. Ultraviolet-C (UV-C) disinfection systems may provide a rapid, nonconsumable method for reducing environmental microbial contamination in austere environments. Materials and methods: This exploratory, mixed-methods pilot study evaluated the effectiveness and feasibility of portable UV-C systems within a C-130 AE training fuselage. Effectiveness testing used pre- and post-intervention colony-forming unit sampling at 20 high-touch sites following a 30-minute UV-C disinfection cycle. Feasibility was assessed using the System Usability Scale, a modified Environmental Cleaning Survey, and qualitative participant feedback from military health care personnel enrolled in an AE training course. Results: UV-C disinfection resulted in a mean 93.5% reduction in colony-forming units, with mean counts decreasing from 19.4 before UV exposure to 1.3 afterward ( P = .006). These findings reflected a reduction in general environmental bacterial burden rather than pathogen-specific eradication. Thirty participants completed feasibility surveys. Participants identified operational benefits, including standardized and rapid disinfection; however, they also described barriers related to bulk, fragility, maneuverability, power requirements, and concerns regarding UV-induced degradation of aircraft materials. Conclusions: UV-C disinfection substantially reduced environmental bacterial burden within an AE training fuselage under simulated operational conditions; however, currently available commercial systems present significant operational and logistical limitations for widespread military implementation.