H2O2 Vapor Technology Improves Hospital Infection Control

Lara C. Pullen, PhD

January 16, 2013

Hydrogen peroxide vapor room disinfection, in addition to standard cleaning, can reduce environmental contamination and reduce the risk of infection by multidrug-resistant organisms (MDROs) when compared with a standard cleaning protocol.

Catherine L. Passaretti, MD, from Johns Hopkins University School of Medicine in Baltimore, Maryland, and colleagues published the results of their prospective cohort intervention study in the January 1, 2013, issue of Clinical Infectious Diseases. The 30-month study included 6 high-risk units in a 994-bed tertiary care hospital.

The study was begun after a 12-month preintervention phase. The investigators collected monthly environmental samples for MRDOs for 3 preintervention and 6 intervention months in all 6 study units.

When hydrogen peroxide vapor was used to decontaminate the room, patients were 64% less likely to acquire any MRDO (incidence rate ratio [IRR], 0.36; 95% confidence interval [CI], 0.19 - 0.70; P < .001) and 80% less likely to acquire vancomycin-resistant enterococci (IRR, 0.20; 95% CI, 0.08 - 0.52; P < .001).

Although the single-institution results are impressive, the authors note that the results may not be generalizable to other institutions.

The investigators demonstrated a reduced risk of acquiring MDROs, but they were not able to identify independently reduced risks of acquiring methicillin-resistant Staphylococcus aureus, multidrug-resistant gram-negative rods, or Clostridium difficile.

"A surprising finding of our study was that [hydrogen peroxide vapor] may protect patients even when the prior room occupant was not known to be colonized with an MDRO.... Whether this was the result of unidentified MDRO carriers, residual contamination from previous room occupants, or contamination of healthcare workers' hands is not known," the authors write.

Recent studies have demonstrated that a patient admitted to a room that had just been inhabited by a patient with an MDRO is at increased risk of acquiring an MDRO.

Luke F. Chen, MBBS, MPH, from Duke Medicine in Durham, North Carolina, discussed the research with Medscape Medical News. He was very enthusiastic about the study and explained, "Patients can get infections from contaminated environments...this is one of the bigger studies to illustrate that."

Although many experts recognize that environmental contamination plays an important role in the transmission of healthcare-acquired pathogens, transmission prevention is controversial. Partially, this is a result of practical challenges. The authors identify several challenges in their article: the need to vacate areas for duration of decontamination, the need to seal air vents and doors, and the urgent need to admit the next patient.

Hydrogen peroxide vapor decontamination services were provided by Bioquell without charge for the duration of the study. One of the coauthors is employed by Bioquell. The other authors have disclosed no relevant financial relationships. Dr. Chen is a participant in the Duke-CDC Prevention Epicenter Program.

Clin Infect Dis. 2013;56:27-35. Abstract