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Ayub A, Cheong YK, Castro JC, Cumberlege O, Chrysanthou A. Use of Hydrogen Peroxide Vapour for Microbiological Disinfection in Hospital Environments: A Review. Bioengineering (Basel) 2024; 11:205. [PMID: 38534479 DOI: 10.3390/bioengineering11030205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/14/2024] [Accepted: 02/19/2024] [Indexed: 03/28/2024] Open
Abstract
Disinfection of nosocomial pathogens in hospitals is crucial to combat healthcare-acquired infections, which can be acquired by patients, visitors and healthcare workers. However, the presence of a wide range of pathogens and biofilms, combined with the indiscriminate use of antibiotics, presents infection control teams in healthcare facilities with ongoing challenges in the selection of biocides and application methods. This necessitates the development of biocides and innovative disinfection methods that overcome the shortcomings of conventional methods. This comprehensive review finds the use of hydrogen peroxide vapour to be a superior alternative to conventional methods. Motivated by observations in previous studies, herein, we provide a comprehensive overview on the utilisation of hydrogen peroxide vapour as a superior high-level disinfection alternative in hospital settings. This review finds hydrogen peroxide vapour to be very close to an ideal disinfectant due to its proven efficacy against a wide range of microorganisms, safety to use, lack of toxicity concerns and good material compatibility. The superiority of hydrogen peroxide vapour was recently demonstrated in the case of decontamination of N95/FFP2 masks for reuse to address the critical shortage caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the COVID-19 pandemic. Despite the significant number of studies demonstrating antimicrobial activity, there remains a need to critically understand the mechanism of action by performing studies that simultaneously measure damage to all bacterial cell components and assess the correlation of this damage with a reduction in viable cell count. This can lead to improvement in antimicrobial efficacy and foster the development of superior approaches.
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Affiliation(s)
- Aaqib Ayub
- School of Physics, Engineering and Computer Science, University of Hertfordshire, Hatfield AL10 9AB, UK
| | - Yuen Ki Cheong
- School of Physics, Engineering and Computer Science, University of Hertfordshire, Hatfield AL10 9AB, UK
| | - Jesus Calvo Castro
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK
| | | | - Andreas Chrysanthou
- School of Physics, Engineering and Computer Science, University of Hertfordshire, Hatfield AL10 9AB, UK
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Lundquist NA, Kifelew LG, Elmas S, Jia Z, Speck PG, Chalker JM. Inactivation of human coronaviruses using an automated room disinfection device. Sci Rep 2023; 13:20048. [PMID: 37973822 PMCID: PMC10654563 DOI: 10.1038/s41598-023-47082-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023] Open
Abstract
The emergence of more virulent and epidemic strains of viruses, especially in the context of COVID-19, makes it more important than ever to improve methods of decontamination. The objective of this study was to evaluate the potential of on-demand production of chlorine species to inactivate human coronaviruses. The commercial prototype disinfection unit was provided by Unipolar Water Technologies. The Unipolar device generates active chlorine species using an electrochemical reaction and dispenses the disinfectant vapour onto surfaces with an aspirator. The minimum effective concentration and exposure time of disinfectant were evaluated on human hepatoma (Huh7) cells using 50% tissue culture infectious dose (TCID50) assay and human coronavirus 229E (HCoV-229E), a surrogate for pathogenic human coronaviruses. We showed that chlorine species generated in the Unipolar device inactivate HCoV-229E on glass surfaces at ≥ 400 parts per million active chlorine concentration with a 5 min exposure time. Here, inactivation refers to the inability of the virus to infect the Huh7 cells. Importantly, no toxic effect was observed on Huh7 cells for any of the active chlorine concentrations and contact times tested.
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Affiliation(s)
- Nicholas A Lundquist
- Institute for Nanoscale Science and Technology, College of Science and Engineering, Flinders University, Bedford Park, SA, 5042, Australia
| | - Legesse G Kifelew
- Molecular Biosciences, College of Science and Engineering, Flinders University, Bedford Park, SA, 5042, Australia
| | - Sait Elmas
- Institute for Nanoscale Science and Technology, College of Science and Engineering, Flinders University, Bedford Park, SA, 5042, Australia
| | - Zhongfan Jia
- Institute for Nanoscale Science and Technology, College of Science and Engineering, Flinders University, Bedford Park, SA, 5042, Australia
| | - Peter G Speck
- Molecular Biosciences, College of Science and Engineering, Flinders University, Bedford Park, SA, 5042, Australia.
| | - Justin M Chalker
- Institute for Nanoscale Science and Technology, College of Science and Engineering, Flinders University, Bedford Park, SA, 5042, Australia.
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van der Starre CM, Cremers-Pijpers SAJ, van Rossum C, Bowles EC, Tostmann A. The in situ efficacy of whole room disinfection devices: a literature review with practical recommendations for implementation. Antimicrob Resist Infect Control 2022; 11:149. [PMID: 36471395 PMCID: PMC9724435 DOI: 10.1186/s13756-022-01183-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/10/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Terminal cleaning and disinfection of hospital patient rooms must be performed after discharge of a patient with a multidrug resistant micro-organism to eliminate pathogens from the environment. Terminal disinfection is often performed manually, which is prone to human errors and therefore poses an increased infection risk for the next patients. Automated whole room disinfection (WRD) replaces or adds on to the manual process of disinfection and can contribute to the quality of terminal disinfection. While the in vitro efficacy of WRD devices has been extensively investigated and reviewed, little is known about the in situ efficacy in a real-life hospital setting. In this review, we summarize available literature on the in situ efficacy of WRD devices in a hospital setting and compare findings to the in vitro efficacy of WRD devices. Moreover, we offer practical recommendations for the implementation of WRD devices. METHODS The in situ efficacy was summarized for four commonly used types of WRD devices: aerosolized hydrogen peroxide, H2O2 vapour, ultraviolet C and pulsed xenon ultraviolet. The in situ efficacy was based on environmental and clinical outcome measures. A systematic literature search was performed in PubMed in September 2021 to identify available literature. For each disinfection system, we summarized the available devices, practical information, in vitro efficacy and in situ efficacy. RESULTS In total, 54 articles were included. Articles reporting environmental outcomes of WRD devices had large variation in methodology, reported outcome measures, preparation of the patient room prior to environmental sampling, the location of sampling within the room and the moment of sampling. For the clinical outcome measures, all included articles reported the infection rate. Overall, these studies consistently showed that automated disinfection using any of the four types of WRD is effective in reducing environmental and clinical outcomes. CONCLUSION Despite the large variation in the included studies, the four automated WRD systems are effective in reducing the amount of pathogens present in a hospital environment, which was also in line with conclusions from in vitro studies. Therefore, the assessment of what WRD device would be most suitable in a specific healthcare setting mostly depends on practical considerations.
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Affiliation(s)
- Caroline M. van der Starre
- grid.10417.330000 0004 0444 9382Unit of Hygiene and Infection Prevention, Department of Medical Microbiology, Radboud Center for Infectious Diseases (RCI), Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Suzan A. J. Cremers-Pijpers
- grid.10417.330000 0004 0444 9382Unit of Hygiene and Infection Prevention, Department of Medical Microbiology, Radboud Center for Infectious Diseases (RCI), Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Carsten van Rossum
- grid.10417.330000 0004 0444 9382Unit of Hygiene and Infection Prevention, Department of Medical Microbiology, Radboud Center for Infectious Diseases (RCI), Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Edmée C. Bowles
- grid.10417.330000 0004 0444 9382Unit of Hygiene and Infection Prevention, Department of Medical Microbiology, Radboud Center for Infectious Diseases (RCI), Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Alma Tostmann
- grid.10417.330000 0004 0444 9382Unit of Hygiene and Infection Prevention, Department of Medical Microbiology, Radboud Center for Infectious Diseases (RCI), Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
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Dancer SJ, King MF. Systematic review on use, cost and clinical efficacy of automated decontamination devices. Antimicrob Resist Infect Control 2021; 10:34. [PMID: 33579386 PMCID: PMC7881692 DOI: 10.1186/s13756-021-00894-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 01/21/2021] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND More evidence is emerging on the role of surface decontamination for reducing hospital-acquired infection (HAI). Timely and adequate removal of environmental pathogens leads to measurable clinical benefit in both routine and outbreak situations. OBJECTIVES This systematic review aimed to evaluate published studies describing the effect of automated technologies delivering hydrogen peroxide (H202) or ultra-violet (UV) light on HAI rates. METHODS A systematic review was performed using relevant search terms. Databases were scanned from January 2005 to March 2020 for studies reporting clinical outcome after use of automated devices on healthcare surfaces. Information collected included device type, overall findings; hospital and ward data; study location, length and size; antimicrobial consumption; domestic monitoring; and infection control interventions. Study sponsorship and duplicate publications were also noted. RESULTS While there are clear benefits from non-touch devices in vitro, we found insufficient objective assessment of patient outcome due to the before-and-after nature of 36 of 43 (84%) studies. Of 43 studies, 20 (47%) used hydrogen peroxide (14 for outbreaks) and 23 (53%) used UV technology (none for outbreaks). The most popular pathogen targeted, either alone or in combination with others, was Clostridium difficile (27 of 43 studies: 63%), followed by methicillin-resistant Staphylococcus aureus (MRSA) (16 of 43: 37%). Many owed funding and/or personnel to industry sponsorship (28 of 43: 65%) and most were confounded by concurrent infection control, antimicrobial stewardship and/or cleaning audit initiatives. Few contained data on device costs and rarely on comparable costs (1 of 43: 2%). There were expected relationships between the country hosting the study and location of device companies. None mentioned the potential for environmental damage, including effects on microbial survivors. CONCLUSION There were mixed results for patient benefit from this review of automated devices using H202 or UV for surface decontamination. Most non-outbreak studies lacked an appropriate control group and were potentially compromised by industry sponsorship. Concern over HAI encourages delivery of powerful disinfectants for eliminating pathogens without appreciating toxicity or cost benefit. Routine use of these devices requires justification from standardized and controlled studies to understand how best to manage contaminated healthcare environments.
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Affiliation(s)
- Stephanie J Dancer
- Department of Microbiology, Hairmyres Hospital, NHS, Lanarkshire, G75 8RG, Scotland, UK.
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, Scotland, UK.
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Role of Hydrogen Peroxide Vapor (HPV) for the Disinfection of Hospital Surfaces Contaminated by Multiresistant Bacteria. Pathogens 2020; 9:pathogens9050408. [PMID: 32456303 PMCID: PMC7281489 DOI: 10.3390/pathogens9050408] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/21/2020] [Accepted: 05/22/2020] [Indexed: 12/14/2022] Open
Abstract
The emergence of multiresistant bacterial strains as agents of healthcare-related infection in hospitals has prompted a review of the control techniques, with an added emphasis on preventive measures, namely good clinical practices, antimicrobial stewardship, and appropriate environmental cleaning. The latter item is about the choice of an appropriate disinfectant as a critical role due to the difficulties often encountered in obtaining a complete eradication of environmental contaminations and reservoirs of pathogens. The present review is focused on the effectiveness of hydrogen peroxide vapor, among the new environmental disinfectants that have been adopted. The method is based on a critical review of the available literature on this topic.
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Otter J, Yezli S, Barbut F, Perl T. An overview of automated room disinfection systems: When to use them and how to choose them. DECONTAMINATION IN HOSPITALS AND HEALTHCARE 2020. [PMCID: PMC7153347 DOI: 10.1016/b978-0-08-102565-9.00015-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Conventional disinfection methods are limited by reliance on the operator to ensure appropriate selection, formulation, distribution, and contact time of the agent. Automated room disinfection (ARD) systems remove or reduce reliance on operators and so they have the potential to improve the efficacy of terminal disinfection. The most commonly used systems are hydrogen peroxide vapor (H2O2 vapor), aerosolized hydrogen peroxide (aHP), and ultraviolet (UV) light. These systems have important differences in their active agent, delivery mechanism, efficacy, process time, and ease of use. The choice of ARD system should be influenced by the intended application, the evidence base for effectiveness, practicalities of implementation, and cost considerations.
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Affiliation(s)
- J.A. Otter
- NIHR Health Protection Research Unit (HPRU) in HCAIs and AMR at Imperial College London, and Imperial College Healthcare NHS Trust, Infection Prevention and Control, London, United Kingdom
| | - S. Yezli
- Global Centre for Mass Gatherings Medicine, WHO Collaborating Centre for Mass Gatherings Medicine, Ministry of Health-Public Health Directorate, Riyadh, Kingdom of Saudi Arabia
| | - F. Barbut
- National Reference Laboratory for C. difficile, Infection Control Unit, Hôpital Saint Antoine, Paris, France,INSERM S-1139, Faculté de Pharmacie de Paris, Université de Paris, Paris, France
| | - T.M. Perl
- Infectious Diseases and Geographic Medicine, UT Southwestern Medical Center, Dallas, TX, United States
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7
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Cobrado L, Silva-Dias A, Azevedo MM, Rodrigues AG. High-touch surfaces: microbial neighbours at hand. Eur J Clin Microbiol Infect Dis 2017. [PMID: 28647859 PMCID: PMC7087772 DOI: 10.1007/s10096-017-3042-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Despite considerable efforts, healthcare-associated infections (HAIs) continue to be globally responsible for serious morbidity, increased costs and prolonged length of stay. Among potentially preventable sources of microbial pathogens causing HAIs, patient care items and environmental surfaces frequently touched play an important role in the chain of transmission. Microorganisms contaminating such high-touch surfaces include Gram-positive and Gram-negative bacteria, viruses, yeasts and parasites, with improved cleaning and disinfection effectively decreasing the rate of HAIs. Manual and automated surface cleaning strategies used in the control of infectious outbreaks are discussed and current trends concerning the prevention of contamination by the use of antimicrobial surfaces are taken into consideration in this manuscript.
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Affiliation(s)
- L Cobrado
- Division of Microbiology, Department of Pathology, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200, Porto, Portugal. .,Burn Unit, Department of Plastic and Reconstructive Surgery, Centro Hospitalar São João, Porto, Portugal. .,CINTESIS, Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal.
| | - A Silva-Dias
- Division of Microbiology, Department of Pathology, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200, Porto, Portugal.,CINTESIS, Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal
| | - M M Azevedo
- Division of Microbiology, Department of Pathology, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200, Porto, Portugal.,CINTESIS, Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal
| | - A G Rodrigues
- Division of Microbiology, Department of Pathology, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200, Porto, Portugal.,Burn Unit, Department of Plastic and Reconstructive Surgery, Centro Hospitalar São João, Porto, Portugal.,CINTESIS, Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal
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Weber DJ, Rutala WA, Anderson DJ, Chen LF, Sickbert-Bennett EE, Boyce JM. Effectiveness of ultraviolet devices and hydrogen peroxide systems for terminal room decontamination: Focus on clinical trials. Am J Infect Control 2016; 44:e77-84. [PMID: 27131140 PMCID: PMC7132689 DOI: 10.1016/j.ajic.2015.11.015] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 11/10/2015] [Indexed: 02/08/2023]
Abstract
Over the last decade, substantial scientific evidence has accumulated that indicates contamination of environmental surfaces in hospital rooms plays an important role in the transmission of key health care-associated pathogens (eg, methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, Clostridium difficile, Acinetobacter spp). For example, a patient admitted to a room previously occupied by a patient colonized or infected with one of these pathogens has a higher risk for acquiring one of these pathogens than a patient admitted to a room whose previous occupant was not colonized or infected. This risk is not surprising because multiple studies have demonstrated that surfaces in hospital rooms are poorly cleaned during terminal cleaning. To reduce surface contamination after terminal cleaning, no touch methods of room disinfection have been developed. This article will review the no touch methods, ultraviolet light devices, and hydrogen peroxide systems, with a focus on clinical trials which have used patient colonization or infection as an outcome. Multiple studies have demonstrated that ultraviolet light devices and hydrogen peroxide systems have been shown to inactivate microbes experimentally plated on carrier materials and placed in hospital rooms and to decontaminate surfaces in hospital rooms naturally contaminated with multidrug-resistant pathogens. A growing number of clinical studies have demonstrated that ultraviolet devices and hydrogen peroxide systems when used for terminal disinfection can reduce colonization or health care-associated infections in patients admitted to these hospital rooms.
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Affiliation(s)
- David J Weber
- Department of Hospital Epidemiology, University of North Carolina Health Care, Chapel Hill, NC; Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC.
| | - William A Rutala
- Department of Hospital Epidemiology, University of North Carolina Health Care, Chapel Hill, NC; Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC
| | | | - Luke F Chen
- Division of Infectious Diseases, Duke University Medical School, Durham, NC
| | - Emily E Sickbert-Bennett
- Department of Hospital Epidemiology, University of North Carolina Health Care, Chapel Hill, NC; Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC
| | - John M Boyce
- Division of Infectious Diseases, Yale School of Medicine, New Haven, CT
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Boyce JM. Modern technologies for improving cleaning and disinfection of environmental surfaces in hospitals. Antimicrob Resist Infect Control 2016; 5:10. [PMID: 27069623 PMCID: PMC4827199 DOI: 10.1186/s13756-016-0111-x] [Citation(s) in RCA: 196] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 03/23/2016] [Indexed: 12/21/2022] Open
Abstract
Experts agree that careful cleaning and disinfection of environmental surfaces are essential elements of effective infection prevention programs. However, traditional manual cleaning and disinfection practices in hospitals are often suboptimal. This is often due in part to a variety of personnel issues that many Environmental Services departments encounter. Failure to follow manufacturer’s recommendations for disinfectant use and lack of antimicrobial activity of some disinfectants against healthcare-associated pathogens may also affect the efficacy of disinfection practices. Improved hydrogen peroxide-based liquid surface disinfectants and a combination product containing peracetic acid and hydrogen peroxide are effective alternatives to disinfectants currently in widespread use, and electrolyzed water (hypochlorous acid) and cold atmospheric pressure plasma show potential for use in hospitals. Creating “self-disinfecting” surfaces by coating medical equipment with metals such as copper or silver, or applying liquid compounds that have persistent antimicrobial activity surfaces are additional strategies that require further investigation. Newer “no-touch” (automated) decontamination technologies include aerosol and vaporized hydrogen peroxide, mobile devices that emit continuous ultraviolet (UV-C) light, a pulsed-xenon UV light system, and use of high-intensity narrow-spectrum (405 nm) light. These “no-touch” technologies have been shown to reduce bacterial contamination of surfaces. A micro-condensation hydrogen peroxide system has been associated in multiple studies with reductions in healthcare-associated colonization or infection, while there is more limited evidence of infection reduction by the pulsed-xenon system. A recently completed prospective, randomized controlled trial of continuous UV-C light should help determine the extent to which this technology can reduce healthcare-associated colonization and infections. In conclusion, continued efforts to improve traditional manual disinfection of surfaces are needed. In addition, Environmental Services departments should consider the use of newer disinfectants and no-touch decontamination technologies to improve disinfection of surfaces in healthcare.
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Affiliation(s)
- John M Boyce
- J.M. Boyce Consulting, LLC, 62 Sonoma Lane, Middletown, CT 06457 USA
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Ling ML, Apisarnthanarak A, Thu LTA, Villanueva V, Pandjaitan C, Yusof MY. APSIC Guidelines for environmental cleaning and decontamination. Antimicrob Resist Infect Control 2015; 4:58. [PMID: 26719796 PMCID: PMC4696151 DOI: 10.1186/s13756-015-0099-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 12/18/2015] [Indexed: 11/10/2022] Open
Abstract
This document is an executive summary of APSIC Guidelines for Environmental Cleaning and Decontamination. It describes best practices in routine cleaning and decontamination in healthcare facilities as well as in specific settings e.g. management of patients with isolation precautions, food preparation areas, construction and renovation, and following a flood. It recommends the implementation of environmental hygiene program to keep the environment safe for patients, staff and visitors visiting a healthcare facility. Objective assessment of cleanliness and quality is an essential component of this program as a method for identifying quality improvement opportunities. Recommendations for safe handling of linen and bedding; as well as occupational health and safety issues are included in the guidelines. A training program is vital to ensure consistent adherence to best practices.
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Affiliation(s)
- Moi Lin Ling
- />Singapore General Hospital, Outram Road, 169608 Singapore
| | | | | | | | - Costy Pandjaitan
- />Association of Infection Prevention Control Nurse, Jakarta, Indonesia
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11
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Touchless Technologies for Decontamination in the Hospital: a Review of Hydrogen Peroxide and UV Devices. Curr Infect Dis Rep 2015; 17:498. [DOI: 10.1007/s11908-015-0498-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Parer S, Lotthé A, Chardon P, Poncet R, Jean-Pierre H, Jumas-Bilak E. An Outbreak of Heterogeneous Glycopeptide-IntermediateStaphylococcus aureusRelated to a Device Source in an Intensive Care Unit. Infect Control Hosp Epidemiol 2015; 33:167-74. [DOI: 10.1086/663703] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective.The emergence ofStaphylococcus aureuswith reduced susceptibility to glycopeptides (glycopeptide-intermediateS. aureus[GISA] and heterogeneous GISA [h-GISA]) leads to intensive care unit (ICU) outbreaks that frequently result in ward closure. We investigated the role of hospital hygiene in the transmission and eradication of an h-GISA outbreak.Design.The study is a description of an original environmental investigation around a series of 12 cases.Setting and Patients.The outbreak occurred in a 20-bed polyvalent/trauma ICU in a 2,800-bed tertiary care university hospital in France.Interventions.Specimens were obtained for surveillance and diagnostic cultures from all patients in the unit. Surface sampling was also performed. Geographic cohorting, contact isolation, emphasis on adherence to infection control practices, and environmental cleaning were implemented.Results.Twelve patients with h-GISA infection (n= 5) or colonization (n= 7) were identified. The mean interval between admission and h-GISA detection was 23.6 days (range, 10–89 days), with a median of 16.5 days. Environmental investigation identified an unexpected reservoir, namely, SpO2sensors. The outbreak was controlled by a combination of measures, including eradication of this reservoir, avoiding total ward closure.Conclusions.Targeted surface sampling helps to secure the environment through active investigation of various reservoirs while maintaining normal activity on the ward. In our study, this method led to the detection of an unsuspected reservoir, the eradication of which helped control the h-GISA epidemic. Further applications of this original investigative procedure should allow confirmation of its relevance and efficiency.Infect Control Hosp Epidemiol2012;33(2):167-174
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Siani H, Maillard JY. Best practice in healthcare environment decontamination. Eur J Clin Microbiol Infect Dis 2014; 34:1-11. [PMID: 25060802 DOI: 10.1007/s10096-014-2205-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 07/03/2014] [Indexed: 02/08/2023]
Abstract
There is now strong evidence that surface contamination is linked to healthcare-associated infections (HCAIs). Cleaning and disinfection should be sufficient to decrease the microbial bioburden from surfaces in healthcare settings, and, overall, help in decreasing infections. It is, however, not necessarily the case. Evidence suggests that there is a link between educational interventions and a reduction in infections. To improve the overall efficacy and appropriate usage of disinfectants, manufacturers need to engage with the end users in providing clear claim information and product usage instructions. This review provides a clear analysis of the scientific evidence supporting the role of surfaces in HCAIs and the role of education in decreasing such infections. It also examines the debate opposing the use of cleaning versus disinfection in healthcare settings.
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Affiliation(s)
- H Siani
- College of Biomedical and Life Sciences, Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Redwood Building, King Edward VII Avenue, Cardiff, CF10 3NB, UK
| | - J-Y Maillard
- College of Biomedical and Life Sciences, Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Redwood Building, King Edward VII Avenue, Cardiff, CF10 3NB, UK.
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Borkow G, Assadian O. Survival of Microorganisms on Inanimate Surfaces. USE OF BIOCIDAL SURFACES FOR REDUCTION OF HEALTHCARE ACQUIRED INFECTIONS 2014. [PMCID: PMC7123372 DOI: 10.1007/978-3-319-08057-4_2] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In healthcare settings microbial contaminated surfaces play an important role in indirect transmission of infection. Especially surfaces close to the patients’ environment may be touched at high frequencies, allowing transmission from animated sources to others via contaminated inanimate surfaces. Therefore, the knowledge on the survival of bacteria, fungi, viruses and protozoa on surfaces, and hence, in a broader sense, in the human environment, is important for implementing tactics for prevention of Healthcare-acquired Infections (HAI). This chapter will elaborate the role of surfaces in the transmission of pathogens. Particular emphasis is laid on the current knowledge of the survival time and conditions favouring survival of the pathogens. Finally, mechanisms of transmission from inanimate surfaces to patients are highlighted. Within the multi-barrier strategy of the prevention of HAI, environmental disinfection policies should be based on risk assessments for surfaces with different risks for cross contamination such as high- and low-touched surfaces with appropriate standards for adequate disinfection measures under consideration of the persistence and infectious dose of the pathogens. As a result, surface disinfection is indicated in the following situations:Frequently touched surfaces adjacent to patients Surfaces with assumed or visible contamination Terminal disinfection in rooms or areas where infected or colonized patients with easily transferable nosocomial pathogens are cared for, and in outbreak situations.
Furthermore, the knowledge of the persistence of pathogens will also support ensuring the biosafety in microbiological and biomedical laboratories, food-handling settings, and for hygienic behaviour in the everyday life to prevent transmission of infectious diseases.
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Quoi de neuf dans les techniques de désinfection des chambres de réanimation ? MEDECINE INTENSIVE REANIMATION 2014. [DOI: 10.1007/s13546-014-0884-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Wiuff C, Murdoch H, Coia JE. Control of Clostridium difficile infection in the hospital setting. Expert Rev Anti Infect Ther 2014; 12:457-69. [PMID: 24579852 DOI: 10.1586/14787210.2014.894459] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Clostridium difficile infection (CDI) has emerged as a leading challenge in the control of healthcare-associated infection (HCAI). The epidemiology of CDI has changed dramatically, this is associated with emergence of 'hypervirulent' strains, particularly PCR ribotype 027. Despite the epidemic spread of these strains, there are recent reports of decreasing incidence from healthcare facilities where multi-facetted targeted control programs have been implemented. We consider these changes in epidemiology and reflect on the tools available to control CDI in the hospital setting. The precise repertoire of measures adopted and emphasis on different interventions will vary, not only between healthcare systems, but also within different institutions within the same healthcare system. Finally, we consider both the sustainability of reductions already achieved, and the potential to reduce CDI further. This takes account of newly emerging data on more recent changes in the epidemiology of CDI, and the potential of novel interventions to decrease the burden of disease.
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Affiliation(s)
- Camilla Wiuff
- Health Protection Scotland, 5 Cadogan Street, Glasgow, G2 6QE, UK
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Abstract
Conventional disinfection methods are limited by reliance on the operator to ensure appropriate selection, formulation, distribution and contact time of the agent. ‘No-touch’ automated room disinfection (NTD) systems remove or reduce reliance on operators and so they have the potential to improve the efficacy of terminal disinfection. The most commonly used systems are hydrogen peroxide vapour (H2O2 vapour), aerosolised hydrogen peroxide (aHP) and ultraviolet (UV) radiation. These systems have important differences in their active agent, delivery mechanism, efficacy, process time and ease of use. The choice of NTD system should be influenced by the intended application, the evidence base for effectiveness, practicalities of implementation and cost constraints.
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Otter JA, Nowakowski E, Salkeld JAG, Duclos M, Passaretti CL, Yezli S, Ross T, Carroll KC, Perl TM. Saving costs through the decontamination of the packaging of unused medical supplies using hydrogen peroxide vapor. Infect Control Hosp Epidemiol 2013; 34:472-8. [PMID: 23571363 DOI: 10.1086/670210] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE. Individually packaged sterile supply items may become contaminated and act as vectors for nosocomial transmission of multidrug-resistant organisms (MDROs). Thus, many hospitals have a policy to dispose of these unused, packaged supply items at patient discharge from the hospital, which has considerable cost implications. We evaluated the frequency of contamination of these items, the efficacy of hydrogen peroxide vapor (HPV) in disinfecting them, and costs associated with discarded supplies. DESIGN. Before-after study. METHODS. A pilot study was performed in the rooms of 20 patients known to be colonized or infected with vancomycin-resistant enterococci (VRE), and a follow-up study was performed in an additional 20 rooms of patients under precautions for various MDROs in 6 high-risk units. Five pairs of supply items were selected. One item of each pair was sampled without exposure to HPV, and the other was sampled after HPV exposure. The cost of discarded supplies was calculated by examining stock lists of supplies stored on the study units. RESULTS. Seven (7%) of 100 items were contaminated with VRE in the pilot study, and 9 (9%) of 100 items were contaminated with MDROs in the follow-up study. None of the items were contaminated after exposure to HPV (P < .02 in both the pilot and the follow-up study). The annual cost of supplies discarded at patient hospital discharge was $387,055. This figure does not include the cost of waste disposal and is therefore likely to be an underestimation of the financial burden. CONCLUSIONS. HPV effectively disinfected the packaging of supply items, which could generate considerable financial and environmental benefits.
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Rutala WA, Weber DJ. Disinfectants used for environmental disinfection and new room decontamination technology. Am J Infect Control 2013; 41:S36-41. [PMID: 23622746 DOI: 10.1016/j.ajic.2012.11.006] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Revised: 11/15/2012] [Accepted: 11/16/2012] [Indexed: 01/24/2023]
Abstract
Environmental contamination plays an important role in the transmission of several key health care-associated pathogens. Effective and thorough cleaning/disinfecting of the patient environment is essential. Room decontamination units (such as ultraviolet-C and hydrogen peroxide systems) aid in reducing environmental contamination after terminal room cleaning and disinfection.
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Affiliation(s)
- William A Rutala
- Hospital Epidemiology, University of North Carolina Health Care System, Chapel Hill, NC 27599-7030, USA.
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Gandra S, Ellison RT. Modern trends in infection control practices in intensive care units. J Intensive Care Med 2013; 29:311-26. [PMID: 23753240 DOI: 10.1177/0885066613485215] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Hospital-acquired infections (HAIs) are common in intensive care unit (ICU) patients and are associated with increased morbidity and mortality. There has been an increasing effort to prevent HAIs, and infection control practices are paramount in avoiding these complications. In the last several years, numerous developments have been seen in the infection prevention strategies in various health care settings. This article reviews the modern trends in infection control practices to prevent HAIs in ICUs with a focus on methods for monitoring hand hygiene, updates in isolation precautions, new methods for environmental cleaning, antimicrobial bathing, prevention of ventilator-associated pneumonia, central line-associated bloodstream infections, catheter-associated urinary tract infections, and Clostridium difficile infection.
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Affiliation(s)
- Sumanth Gandra
- Division of Infectious Diseases and Immunology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Richard T Ellison
- Division of Infectious Diseases and Immunology, University of Massachusetts Medical School, Worcester, MA, USA
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Otter JA, Yezli S, Perl TM, Barbut F, French GL. The role of 'no-touch' automated room disinfection systems in infection prevention and control. J Hosp Infect 2012. [PMID: 23195691 DOI: 10.1016/j.jhin.2012.10.002] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Surface contamination in hospitals is involved in the transmission of pathogens in a proportion of healthcare-associated infections. Admission to a room previously occupied by a patient colonized or infected with certain nosocomial pathogens increases the risk of acquisition by subsequent occupants; thus, there is a need to improve terminal disinfection of these patient rooms. Conventional disinfection methods may be limited by reliance on the operator to ensure appropriate selection, formulation, distribution and contact time of the agent. These problems can be reduced by the use of 'no-touch' automated room disinfection (NTD) systems. AIM To summarize published data related to NTD systems. METHODS Pubmed searches for relevant articles. FINDINGS A number of NTD systems have emerged, which remove or reduce reliance on the operator to ensure distribution, contact time and process repeatability, and aim to improve the level of disinfection and thus mitigate the increased risk from the prior room occupant. Available NTD systems include hydrogen peroxide (H(2)O(2)) vapour systems, aerosolized hydrogen peroxide (aHP) and ultraviolet radiation. These systems have important differences in their active agent, delivery mechanism, efficacy, process time and ease of use. Typically, there is a trade-off between time and effectiveness among NTD systems. The choice of NTD system should be influenced by the intended application, the evidence base for effectiveness, practicalities of implementation and cost constraints. CONCLUSION NTD systems are gaining acceptance as a useful tool for infection prevention and control.
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Affiliation(s)
- J A Otter
- Centre for Clinical Infection and Diagnostics Research, CIDR, Department of Infectious Diseases, King's College London, School of Medicine and Guy's and St Thomas' NHS Foundation Trust, UK.
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Passaretti CL, Otter JA, Reich NG, Myers J, Shepard J, Ross T, Carroll KC, Lipsett P, Perl TM. An Evaluation of Environmental Decontamination With Hydrogen Peroxide Vapor for Reducing the Risk of Patient Acquisition of Multidrug-Resistant Organisms. Clin Infect Dis 2012; 56:27-35. [DOI: 10.1093/cid/cis839] [Citation(s) in RCA: 156] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
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Barbut F, Yezli S, Mimoun M, Pham J, Chaouat M, Otter JA. Reducing the spread of Acinetobacter baumannii and methicillin-resistant Staphylococcus aureus on a burns unit through the intervention of an infection control bundle. Burns 2012; 39:395-403. [PMID: 22884127 DOI: 10.1016/j.burns.2012.07.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 06/22/2012] [Accepted: 07/12/2012] [Indexed: 02/06/2023]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) and Acinetobacter baumannii are major nosocomial pathogens in burns units. We investigated the impact of an infection control bundle on the incidence of nosocomial MRSA and A. baumannii in our burns unit, comparing a pre-intervention period (December 2006-August 2008) with an intervention period (September 2008-December 2009). The bundle comprised regular hydrogen peroxide vapour (HPV) disinfection of the rooms following discharge of patients colonized or infected by multidrug-resistant bacteria, pre-emptive cohort isolation of newly admitted patients before being proven culture negative, cohorting of colonized or infected patients, installation of two air disinfection systems in the corridors of the unit and improvement of material storage. We also investigated the microbiological efficacy of HPV disinfection by sampling the environment before and after HPV treatments. HPV disinfection eliminated pathogens from the environment and significantly reduced total bacterial surface counts, and total fungal air and surface counts, on both a unit and room scale. The incidence of nosocomial MRSA infection or colonization fell by 89.3% from 7.22 to 0.77 cases/1000 patient days (p<0.0001) and A. baumannii fell by 88.8% from 6.92 to 0.77 cases/1000 patient days (p=0.002) in the intervention period with no further outbreaks of these organisms occurring in this period. The infection control bundle resulted in a significant reduction in the incidence of nosocomial MRSA and A. baumannii in our burns unit and prevented further outbreaks of these organisms.
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Falagas M, Thomaidis P, Kotsantis I, Sgouros K, Samonis G, Karageorgopoulos D. Airborne hydrogen peroxide for disinfection of the hospital environment and infection control: a systematic review. J Hosp Infect 2011; 78:171-7. [DOI: 10.1016/j.jhin.2010.12.006] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Accepted: 12/10/2010] [Indexed: 10/18/2022]
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Fey G, Klassen S, Theriault S, Krishnan J. Decontamination of a Worst-case Scenario Class II Biosafety Cabinet using Vaporous Hydrogen Peroxide. APPLIED BIOSAFETY 2010. [DOI: 10.1177/153567601001500307] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Greg Fey
- Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Stan Klassen
- Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | | | - Jay Krishnan
- Public Health Agency of Canada, Winnipeg, Manitoba, Canada
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Rogers JV, Richter WR, Wendling MQS, Shesky AM. Inactivation of Brucella Suis, Burkholderia pseudomallei, Francisella tularensis, and Yersinia pestis using Vaporous Hydrogen Peroxide. APPLIED BIOSAFETY 2010. [DOI: 10.1177/153567601001500105] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Richter WR, Wendling MQS, Rogers JV. A Novel Approach for Conducting Room-scale Vaporous Hydrogen Peroxide Decontamination of VirulentBacillus AnthracisSpores. APPLIED BIOSAFETY 2009. [DOI: 10.1177/153567600901400403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Rogers JV, Richter WR, Shaw MQ, Shesky AM. Large-Scale Inactivation ofBacillus AnthracisAmes, Vollum, and Sterne Spores Using Vaporous Hydrogen Peroxide. APPLIED BIOSAFETY 2009. [DOI: 10.1177/153567600901400304] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Shapey S, Machin K, Levi K, Boswell TC. Activity of a dry mist hydrogen peroxide system against environmental Clostridium difficile contamination in elderly care wards. J Hosp Infect 2008; 70:136-41. [PMID: 18694613 DOI: 10.1016/j.jhin.2008.06.008] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2008] [Accepted: 06/06/2008] [Indexed: 10/21/2022]
Abstract
Clostridium difficile causes serious healthcare-associated infections. Infection control is difficult, due in part to environmental contamination with C. difficile spores. These spores are relatively resistant to cleaning and disinfection. The activity of a dry mist hydrogen peroxide decontamination system (Sterinis) against environmental C. difficile contamination was assessed in three elderly care wards. Initial sampling for C. difficile was performed in 16 rooms across a variety of wards and specialties, using Brazier's CCEY (cycloserine-cefoxitin-egg yolk) agar. Ten rooms for elderly patients (eight isolation and two sluice rooms) were then resampled following dry mist hydrogen peroxide decontamination. Representative isolates of C. difficile were typed by polymerase chain reaction ribotyping. C. difficile was recovered from 3%, 11% and 26% of samples from low, medium and high risk rooms, respectively. In 10 high risk elderly care rooms, 24% (48/203) of samples were positive for C. difficile, with a mean of 6.8 colony-forming units (cfu) per 10 samples prior to hydrogen peroxide decontamination. Ribotyping identified the presence of the three main UK epidemic strains (ribotypes 001, 027 and 106) and four rooms contained mixed strains. After a single cycle of hydrogen peroxide decontamination, only 3% (7/203) of samples were positive (P<0.001), with a mean of 0.4 cfu per 10 samples ( approximately 94% reduction). The Sterinis hydrogen peroxide system significantly reduced the extent of environmental contamination with C. difficile in these elderly care rooms. This relatively quick and user-friendly technology might be a more reliable method of terminally disinfecting isolation rooms, following detergent cleaning, compared to the manual application of other disinfectants.
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Affiliation(s)
- S Shapey
- Department of Clinical Microbiology, Nottingham University Hospital NHS Trust, Queen's Medical Centre, Nottingham, UK
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