Advertisement

Evaluation of an aerosolized hydrogen peroxide disinfection system for the reduction of Clostridioides difficile hospital infection rates over a 10 year period

Published:March 16, 2022DOI:https://doi.org/10.1016/j.ajic.2021.11.021

      Highlights

      • Whole room terminal disinfection system.
      • Aerosolized hydrogen peroxide decreases infection rates at an acute care hospital.
      • Hospital infection rate decreases in Clostridioides difficile with a novel hydrogen peroxide system.

      Abstract

      Background

      Clostridioides difficile infections (CDI) cause significant morbidity and mortality in healthcare facilities worldwide. We examined the use of an aerosolized hydrogen peroxide (aHP) disinfection system for reduction of CDI rates.

      Methods

      We conducted a retrospective analysis of CDI rates at an acute care facility over a 10-year period. The first 5-year period investigated the before and after implementation of an aHP system followed by another 5-year period of continued use on CDI rates.

      Results

      The before and after period showed a reduction in CDI rates from 4.6 per 10,000 patient days down to 2.7 per 10,000 patient days after implementation (P < .001). The second study period for the continued aHP use exhibited a consistent decrease in CDI rates to 1.4 per 10,000 patient days at the end of the study.

      Conclusions

      The addition of a touchless aHP whole room disinfection system as part of terminal cleaning resulted in a significant reduction in CDI rates that have been sustained year after year.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Infection Control
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. Centers for Disease Control and Prevention. Clostridioides difficile Infection. https://www.cdc.gov/HAI/organisms/cdiff/Cdiff_infect.html. Published 2019. Accessed November 19, 2020.

        • Martin JS
        • Monaghan TM
        • Wilcox MH
        Clostridium difficile infection: epidemiology, diagnosis and understanding transmission.
        Nat Rev Gastroenterol Hepatol. 2016; 13: 206-216
        • The Joint Commission Center for Transforming Healthcare
        Reducing Clostridium Difficile Infections Project.
        Oakbrook Terrace: The Joint Commission, 2016
        • Zhu D
        • Sorg JA
        • Sun X
        Clostridioides difficile biology: sporulation, germination, and corresponding therapies for C. difficile infection.
        Front Cell Infect Microbiol. 2018; 8: 29
        • Shaughnessy MK
        • Bobr A
        • Kuskowski MA
        • et al.
        Environmental contamination in households of patients with recurrent Clostridium difficile infection.
        Appl Environ Microbiol. 2016; 82: 2686-2692
        • Weber DJ
        • Anderson DJ
        • Sexton DJ
        • Rutala WA
        Role of the environment in the transmission of Clostridium difficile in health care facilities.
        Am J Infect Control. 2013; 41: S105-S110
        • Gerding DN
        • Muto CA
        • Owens Jr., RC
        Measures to control and prevent Clostridium difficile infection.
        Clin Infect Dis. 2008; 46: S43-S49
        • Shaughnessy MK
        • Micielli RL
        • DePestel DD
        • et al.
        Evaluation of hospital room assignment and acquisition of Clostridium difficile infection.
        Infect Control Hosp Epidemiol. 2011; 32: 201-206
        • Boyce JM
        • Havill NL
        • Otter JA
        • McDonald LC
        • Adams NM
        • Cooper T
        Impact of hydrogen peroxide vapor room decontamination on Clostridium difficile environmental contamination and transmission in a healthcare setting.
        Infect Control Hosp Epidemiol. 2008; 29: 723-729
        • Manian FA
        • Griesnauer S
        • Bryant A
        Implementation of hospital-wide enhanced terminal cleaning of targeted patient rooms and its impact on endemic Clostridium difficile infection rates.
        Am J Infect Control. 2013; 41: 537-541
        • Horn K
        • Otter JA
        Hydrogen peroxide vapor room disinfection and hand hygiene improvements reduce Clostridium difficile infection, methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and extended-spectrum β-lactamase.
        Am J Infect Control. 2015; 43: 1354-1356
        • Otter JA
        • Havill NL
        • Boyce JM
        Hydrogen peroxide vapor is not the same as aerosolized hydrogen peroxide.
        Infect Control Hosp Epidemiol. 2010; 31: 1201-1202
      2. US Environmental Protection Agency. List A: Antimicrobial Products Registered with the EPA as Sterilizers. https://www.epa.gov/pesticide-registration/list-antimicrobial-products-registered-epa-sterilizers. Published 2016. Accessed January 6, 2021.

      3. US Environmental Protection Agency. List K: EPA's Registered Antimicrobial Products Effective against Clostridium difficile Spores. https://www.epa.gov/pesticide-registration/list-k-epas-registered-antimicrobial-products-effective-against-clostridium. Published 2020. Accessed January 6, 2021.

      4. Centers for Disease Control and Prevention. Paving the Path Forward: 2015 Rebaseline. https://www.cdc.gov/nhsn/2015rebaseline/index.html. Published 2017. Accessed February 18, 2021.

        • Piskin N
        • Celebi G
        • Kulah C
        • Mengeloglu Z
        • Yumusak M
        Activity of a dry mist-generated hydrogen peroxide disinfection system against methicillin-resistant Staphylococcus aureus and Acinetobacter baumannii.
        Am J Infect Control. 2011; 39: 757-762
        • Steindl G
        • Fiedler A
        • Huhulescu S
        • Wewalka G
        • Allerberger F
        Effect of airborne hydrogen peroxide on spores of Clostridium difficile.
        Wien Klin Wochenschr. 2015; 127: 421-426
        • Mitchell BG
        • Digney W
        • Locket P
        • Dancer SJ
        Controlling methicillin-resistant Staphylococcus aureus (MRSA) in a hospital and the role of hydrogen peroxide decontamination: an interrupted time series analysis.
        BMJ Open. 2014; 4e004522
        • McCord J
        • Prewitt M
        • Dyakova E
        • Mookerjee S
        • Otter JA
        Reduction in Clostridium difficile infection associated with the introduction of hydrogen peroxide vapour automated room disinfection.
        J Hosp Infect. 2016; 94: 185-187
        • Pegues DA
        • Han J
        • Gilmar C
        • McDonnell B
        • Gaynes S
        Impact of ultraviolet germicidal irradiation for no-touch terminal room disinfection on Clostridium difficile infection incidence among hematology-oncology patients.
        Infect Control Hosp Epidemiol. 2017; 38: 39-44
        • Napolitano NA
        • Mahapatra T
        • Tang W
        The effectiveness of UV-C radiation for facility-wide environmental disinfection to reduce health care-acquired infections.
        Am J Infect Control. 2015; 43: 1342-1346
        • Vianna PG
        • Dale Jr, CR
        • Simmons S
        • Stibich M
        • Licitra CM
        Impact of pulsed xenon ultraviolet light on hospital-acquired infection rates in a community hospital.
        Am J Infect Control. 2016; 44: 299-303
        • Miller R
        • Simmons S
        • Dale C
        • Stachowiak J
        • Stibich M
        Utilization and impact of a pulsed-xenon ultraviolet room disinfection system and multidisciplinary care team on Clostridium difficile in a long-term acute care facility.
        Am J Infect Control. 2015; 43: 1350-1353
        • Levin J
        • Riley LS
        • Parrish C
        • English D
        • Ahn S
        The effect of portable pulsed xenon ultraviolet light after terminal cleaning on hospital-associated Clostridium difficile infection in a community hospital.
        Am J Infect Control. 2013; 41: 746-748
        • Otter JA
        • Yezli S
        • Barbut F
        • Perl TM
        An overview of automated room disinfection systems: When to use them and how to choose them.
        Decontamination in Hospitals and Healthcare. 2020: 353
        • Zhang S
        • Palazuelos-Munoz S
        • Balsells EM
        • Nair H
        • Chit A
        • Kyaw MH
        Cost of hospital management of Clostridium difficile infection in United States-a meta-analysis and modelling study.
        BMC Infect Dis. 2016; 16: 447
        • Zhang D
        • Prabhu VS
        • Marcella SW
        Attributable healthcare resource utilization and costs for patients with primary and recurrent Clostridium difficile infection in the United States.
        Clin Infect Dis. 2018; 66: 1326-1332
        • Gilboa M
        • Houri-Levi E
        • Cohen C
        • et al.
        Environmental shedding of toxigenic Clostridioides difficile by asymptomatic carriers: A prospective observational study.
        Clin Microbiology Infect. 2020; 26: 1052-1057
        • Anderson DJ
        • Chen LF
        • Weber DJ
        • et al.
        CDC prevention epicenters program. Enhanced terminal room disinfection and acquisition and infection caused by multidrug-resistant organisms and Clostridium difficile (the Benefits of Enhanced Terminal Room Disinfection study): a cluster-randomised, multicentre, crossover study.
        Lancet. 2017; 389: 805-814