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Effectiveness and real-world materials compatibility of a novel hydrogen peroxide disinfectant cleaner

Open AccessPublished:August 17, 2021DOI:https://doi.org/10.1016/j.ajic.2021.08.008

      Highlights

      • Many sporicidal disinfectants have limitations that discourage widespread use.
      • We tested effectiveness of a hydrogen peroxide disinfectant cleaner.
      • The product was effective against Clostridioides difficile spores and Candida auris.
      • The disinfectant did not cause fading or loss of pliability of a mattress.

      Abstract

      A novel 4% hydrogen peroxide disinfectant was effective against methicillin-resistant Staphylococcus aureus (MRSA), Clostridioides difficile spores, carbapenem-resistant Escherichia coli, and 2 strains of Candida auris. In laboratory testing, a sodium hypochlorite disinfectant caused fading and loss of pliability of a hospital mattress, but the hydrogen peroxide disinfectant did not. These findings suggest that the hydrogen peroxide-based disinfectant may be a useful addition to the sporicidal disinfectant products available for use in healthcare settings.

      Key Words

      In U.S. healthcare facilities, sporicidal disinfectants are commonly used in rooms of patients with Clostridioides difficile infection (CDI), whereas non-sporicidal disinfects are typically used in non-CDI rooms.
      • Han Z
      • Pappas E
      • Simmons A
      • Fox J
      • Donskey CJ
      • Deshpande A
      Environmental cleaning and disinfection of hospital rooms: a nationwide survey.
      Given concern that asymptomatic carriers may contribute to transmission of C. difficile, there is a potential rationale for use of sporicidal disinfectants in non-CDI rooms.
      • Donskey CJ
      • Sunkesula VCK
      • Stone ND
      • et al.
      Transmission of Clostridium difficile from asymptomatically colonized or infected long-term care facility residents.
      ,
      • Donskey CJ
      • Kundrapu S
      • Deshpande A
      Colonization versus carriage of Clostridium difficile.
      In recent studies, C. difficile has been cultured from 5% to 24% of non-CDI rooms after cleaning and disinfection.
      • Ng-Wong YK
      • Alhmidi H
      • Mana TSC
      • Cadnum JL
      • Jencson AL
      • Donskey CJ
      Impact of routine use of a spray formulation of bleach on Clostridium difficile spore contamination in non-C difficile infection rooms.
      ,
      • Ray AJ
      • Deshpande A
      • Fertelli D
      • et al.
      A multicenter randomized trial to determine the effect of an environmental disinfection intervention on the incidence of healthcare-associated Clostridium difficile infection.
      However, many sporicidal disinfectants have limitations that discourage widespread use. Sodium hypochlorite (bleach) is corrosive and may be irritating to personnel and patients. Peracetic acid-based disinfectants have better materials compatibility but are relatively unstable with a short shelf-life.
      • Cadnum JL
      • Jencson AL
      • O'Donnell MC
      • Flannery ER
      • Nerandzic MM
      • Donskey CJ
      An increase in healthcare-associated Clostridium difficile infection associated with use of a defective peracetic acid-based surface disinfectant.
      Thus, there is a need for alternative disinfectants with activity against C. difficile spores.
      Sani-HyPerCide disinfectant (Professional Disposables International, Woodcliff Lake, NJ) is a hydrogen peroxide-based spray or wipe disinfectant that has sporicidal activity in part due to generation of low concentrations of peracetic acid during use. The product has an Environmental Protection Agency (EPA) registration for many vegetative pathogens with a 1 minute claim and for C. difficile spores with a 5 minute claim. In the current study, we evaluated the effectiveness and materials compatibility of the hydrogen peroxide disinfectant in comparison to 3 other disinfectants.

      Methods

      The disinfectants tested included Sani-HyPerCide disinfectant, Clorox Germicidal Bleach (Clorox Healthcare, Oakland, CA), OxyCide (EcoLab, Saint Paul, MN), and Oxivir 1 (Diversey, Fort Mill, South Carolina). The American Society for Testing and Materials standard quantitative carrier disk test method (ASTM E-2197-02) was used to test the efficacy of the disinfectants.

      ASTM International, Designation E2197: standard quantitative disk carrier test method for determining bactericidal, virucidal, fungicidal, mycobactericidal, and sporicidal activities of chemicals, 2011.

      The exposure time was 1 minute and 5% fetal calf serum was used as a soil load. The test organisms included a clinical USA400 pulsed-field gel electrophoresis type methicillin-resistant Staphylococcus aureus (MRSA) strain, a clinical North American pulsed-field gel electrophoresis type 1 (NAP1) strain of C. difficile, a clinical carbapenem-resistant Escherichia coli strain, and 2 strains of Candida auris, including C. auris Antibiotic Resistance Bank (AR)-0385 (Clade IV; South America origin) and AR-0381 (Clade II; East Asia origin). C. auris isolates from the 2 clades were studied because a recent report suggested that a clade IV isolate of C. auris (AR 0385) was less susceptible to low concentrations of sodium hypochlorite than a clade II isolate (AR 0381).
      • Sexton DJ
      • Welsh RM
      • Bentz ML
      • et al.
      Evaluation of nine surface disinfectants against Candida auris using a quantitative disk carrier method: EPA SOP-MB-35.
      Testing was completed in triplicate. Log10 colony-forming unit (CFU) reductions were calculated by comparing recovery from treated versus untreated control carriers. A 3-log10 reduction with a 1 minute exposure time was considered adequate for clinical effectiveness.
      • Rutala WA
      • Kanamori H
      • Gergen MF
      • Sickbert Bennett EE
      • Weber DJ
      Susceptibility of Candida auris and Candida albicans to 21 germicides used in healthcare facilities.
      The 1 minute exposure time was chosen because longer exposure times may be unrealistic in clinical settings.
      • Rutala WA
      • Kanamori H
      • Gergen MF
      • Sickbert Bennett EE
      • Weber DJ
      Susceptibility of Candida auris and Candida albicans to 21 germicides used in healthcare facilities.
      Materials compatibility testing was conducted using a bedside tabletop and a fluid resistant mattress (Drive DeVilbiss Healthcare mattress) that is used in patient rooms in the study hospital. The items were divided into five 20 cm wide sections, including 4 sections for the 4 disinfectants and 1 section for a water wipe (negative control). The disinfectants were wiped 130 times onto the surfaces using a saturated cotton cloth with air drying for at least 5 minutes between each application. The impact of the treatments was assessed visually with pictures taken to document visible changes and the mattress was manually palpated to assess for changes in texture and pliability.

      Results

      Table 1 shows the ingredients of the disinfectants tested and the mean log10 reductions in the test organisms with 1 minute exposure time. Sani-HyPerCide disinfectant, Clorox Germicidal Bleach, and OxyCide reduced each of the test organisms by greater than 3 log10. Oxivir 1 reduced the MRSA, C. auris, and E. coli test strains by greater than 3 log10 and reduced C. difficile spores by 2.6 log10.
      Table 1Mean (Standard error) log10 reductions in healthcare-associated pathogens using a quantitative carrier test with a 1 minute exposure time
      DisinfectantIngredientsC. difficileMRSACarbapenem-resistant- Escherichia coliCandida auris AR 0381Candida auris AR 0385
      Sani-HyPerCide4.04 % hydrogen peroxide, <10% acetic acid4.7 (0.08)≥6.4 (0)≥5.6 (0)>6.0 (0)≥5.1 (0)
      Clorox Healthcare bleach

      germicidal cleaner
      Sodium hypochlorite 0.65%≥6.7 (0)≥6.4 (0)≥5.6 (0)≥6.1 (0)≥6.6 (0)
      OxyCidePeracetic acid 0.13%, hydrogen peroxide 0.63%≥5.0 (0)≥5.48 (0)≥5.6 (0)≥5.1 (0)≥5.1 (0)
      Oxivir 1Hydrogen peroxide >0.1% - <1%, benzyl alcohol 1%-5%2.6 (0.3)≥6.5 (0)6.2 (0.3)≥5.4 (0)≥5.1 (0)
      MRSA, methicillin-resistant Staphylococcus aureus; C. difficile, Clostridioides difficile; AR, Antibiotic Resistance Bank.
      After 130 disinfectant applications, Clorox Healthcare Bleach Germicidal Cleaner caused mild fading and loss of pliability of the mattress, but no adverse effects were observed on the tabletop. None of the other disinfectants caused visible adverse effects on the mattress or tabletop.

      Discussion

      We found that Sani-HyPerCide disinfectant, the new hydrogen-peroxide-based disinfectant, was effective against all the test pathogens. Clorox Germicidal Bleach and OxyCide had similar effectiveness. Oxivir 1 was effective against MRSA, C. auris, and E. coli, but not C. difficile spores, consistent with the fact that this product does not have a sporicidal claim. Clorox Germicidal Bleach caused fading and loss of pliability of a hospital mattress, but the other disinfectants did not. These findings suggest that the hydrogen peroxide-based disinfectant may be a useful addition to the sporicidal disinfectant products available for use in healthcare settings.
      The hydrogen-peroxide-based disinfectant has potential advantages over some other sporicidal disinfectants. Our results suggest that the hydrogen-peroxide-based disinfectant has relatively good materials compatibility, including on soft surfaces such as mattresses. The disinfectant is stable with a long shelf-life and is ready-to-use with no requirement for dilution of a concentrate that might require special handling procedures. It has an EPA registered 1-minute claim against many vegetative pathogens. Although the disinfectant has a 5-minute EPA claim for C. difficile spores, we found that it was effective in reducing spores by > 3 log10 within 1 minute.
      All the disinfectants tested were effective against the emerging fungal pathogen C. auris, including a Clade IV South America origin isolate (AR-0385) that exhibited reduced susceptibility to low concentrations of sodium hypochlorite and ultraviolet-C light in comparison to a Clade II East Asia origin isolate (AR-0381).
      • Sexton DJ
      • Welsh RM
      • Bentz ML
      • et al.
      Evaluation of nine surface disinfectants against Candida auris using a quantitative disk carrier method: EPA SOP-MB-35.
      ,
      • Pearlmutter BS
      • Haq MF
      • Cadnum JL
      • Jencson AL
      • Donskey Carlisle M
      Efficacy of relatively low-cost ultraviolet-C light devices against Candida auris.
      The EPA has recently released a specific test method for evaluating the efficacy of liquid antimicrobials against C. auris (EPA MLB SOP MB-35-00).

      EPA MLB SOP MB-35-00: OECD Quantitative Method for Evaluating the Efficacy of Liquid Antimicrobials Against Candida Auris on Hard, Non-porous Surfaces. US Environmental Protection Agency Office of Pesticide Programs. Available at: https://www.epa.gov/pesticide-registration/interim-guidance-efficacy-evaluationproducts-claims-against-candida-auris-0. Accessed July 24, 2021.

      Each of the tested disinfectants met the criteria of EPA MLB SOP MB-35-00 for efficacy based on a 5-log10 reduction in C. auris AR-0381.

      EPA MLB SOP MB-35-00: OECD Quantitative Method for Evaluating the Efficacy of Liquid Antimicrobials Against Candida Auris on Hard, Non-porous Surfaces. US Environmental Protection Agency Office of Pesticide Programs. Available at: https://www.epa.gov/pesticide-registration/interim-guidance-efficacy-evaluationproducts-claims-against-candida-auris-0. Accessed July 24, 2021.

      In addition, these disinfectants are on List P, a listing of antimicrobial products registered with EPA for claims against Candida auris.

      List P: Antimicrobial products registered with EPA for claims against Candida auris. Available at: https://www.epa.gov/pesticide-registration/list-p-antimicrobial-products-registered-epa-claims-against-candida-auris. Accessed July 24, 2021.

      Our results are consistent with previous studies that have demonstrated efficacy of sodium hypochlorite, peracetic acid, and hydrogen peroxide-based disinfectants against C. auris.
      • Sexton DJ
      • Welsh RM
      • Bentz ML
      • et al.
      Evaluation of nine surface disinfectants against Candida auris using a quantitative disk carrier method: EPA SOP-MB-35.
      • Rutala WA
      • Kanamori H
      • Gergen MF
      • Sickbert Bennett EE
      • Weber DJ
      Susceptibility of Candida auris and Candida albicans to 21 germicides used in healthcare facilities.
      In contrast, water-based quaternary ammonium disinfectants have relatively limited activity against C. auris.
      • Sexton DJ
      • Welsh RM
      • Bentz ML
      • et al.
      Evaluation of nine surface disinfectants against Candida auris using a quantitative disk carrier method: EPA SOP-MB-35.
      • Rutala WA
      • Kanamori H
      • Gergen MF
      • Sickbert Bennett EE
      • Weber DJ
      Susceptibility of Candida auris and Candida albicans to 21 germicides used in healthcare facilities.

      Conclusion

      We found that a new hydrogen-peroxide-based disinfectant was effective against vegetative bacteria, C. auris, and C. difficile spores with a 1 minute exposure time. In laboratory testing, the disinfectant did not cause adverse effects on a bedside tabletop or hospital mattress. Further studies are needed to evaluate the effectiveness and materials compatibility of the disinfectant in healthcare settings.

      Acknowledgments

      This work was supported by the Department of Veterans Affairs and by a grant from Professional Disposables International C.J.D.

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        Impact of routine use of a spray formulation of bleach on Clostridium difficile spore contamination in non-C difficile infection rooms.
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      1. ASTM International, Designation E2197: standard quantitative disk carrier test method for determining bactericidal, virucidal, fungicidal, mycobactericidal, and sporicidal activities of chemicals, 2011.

        • Sexton DJ
        • Welsh RM
        • Bentz ML
        • et al.
        Evaluation of nine surface disinfectants against Candida auris using a quantitative disk carrier method: EPA SOP-MB-35.
        Infect Control Hosp Epidemiol. 2020; 41: 1219-1221
        • Rutala WA
        • Kanamori H
        • Gergen MF
        • Sickbert Bennett EE
        • Weber DJ
        Susceptibility of Candida auris and Candida albicans to 21 germicides used in healthcare facilities.
        Infect Control Hosp Epidemiol. 2019; 40: 380-382
        • Pearlmutter BS
        • Haq MF
        • Cadnum JL
        • Jencson AL
        • Donskey Carlisle M
        Efficacy of relatively low-cost ultraviolet-C light devices against Candida auris.
        Infect Control Hosp Epidemiol. 2021; (in press)
      2. EPA MLB SOP MB-35-00: OECD Quantitative Method for Evaluating the Efficacy of Liquid Antimicrobials Against Candida Auris on Hard, Non-porous Surfaces. US Environmental Protection Agency Office of Pesticide Programs. Available at: https://www.epa.gov/pesticide-registration/interim-guidance-efficacy-evaluationproducts-claims-against-candida-auris-0. Accessed July 24, 2021.

      3. List P: Antimicrobial products registered with EPA for claims against Candida auris. Available at: https://www.epa.gov/pesticide-registration/list-p-antimicrobial-products-registered-epa-claims-against-candida-auris. Accessed July 24, 2021.