The evaluation of electrolyzed water, sodium dichloroisocyanurate, and peracetic acid with hydrogen peroxide for the disinfection of patient room surfaces


      • Sporicidal disinfectants are necessary to control Clostridioides difficiel and emerging pathogens such as Candida auris.
      • Newer sporicidal disinfectants with favorable safety profiles are needed in healthcare Electrolized water, sodium dichloroisocyanurate and peracetic acid with hydrogen peroxide are evaluated in our study.
      • In our study, sodium dichloroisocyanurate resulted in the lowest bacterial colony counts on patient room surfaces.


      Sporicidal disinfectants are necessary to control Clostridioides difficile and Candida auris. Novel application methods such as electrostatic sprayers may increase disinfection effectiveness. We employed a standardized protocol to assess 3 sporicidal disinfectants: electrolyzed water (EW), sodium dichloroisocyanurate (NaDCC) and peracetic acid/hydrogen peroxide (PAA/H2O2).


      The study was conducted at 2 New York City hospitals (1,082 total beds) over an 18-month period. The 3 chemicals were applied by housekeeping personnel following the hospital protocol; the use of electrostatic sprayers was incorporated into EW and NaDCC. In randomly selected rooms, 5 surfaces were sampled for microbial colony counts after cleaning. Data analyses were performed using negative binomial logistic regression.


      We collected 774 samples. NaDCC-disinfected surfaces had a lower mean colony count (14 colony forming units [CFU]) compared to PAA/H2O2 (18 CFU, P = .36) and EW (37 CFU, P < .001). PAA/H2O2 and EW had more samples with any growth (both P < .05) compared to NaDCC. NaDCC applied with wipes and an electrostatic sprayer had the lowest number of samples with no growth and <2.5 CFU/cm2 (difference not significant).


      The use of NaDCC for surface disinfection resulted in the lowest bacterial colony counts on patient room high touch surfaces in our study.

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        • Dancer SJ.
        The role of environmental cleaning in the control of hospital-acquired infection.
        J Hosp Infect. 2009; 73: 378-385
        • Han JH
        • Sullivan N
        • Leas BF
        • Pegues DA
        • Kaczmarek JL
        • Umscheid CA.
        Cleaning hospital room surfaces to prevent health care-associated infections: a technical brief.
        Ann Intern Med. 2015; 163: 598
        • Huang SS.
        Risk of acquiring antibiotic-resistant bacteria from prior room occupants.
        Arch Intern Med. 2006; 166: 1945
        • Adams E
        • Quinn M
        • Tsay S
        • et al.
        Candida auris in healthcare facilities, New York, USA, 2013–2017.
        Emerg Infect Dis. 2018; 24: 1816-1824
      1. Guh A, Carling P, CDC Environmental Workgroup. Options for evaluating environmental cleaning; 2010. Available at: Accessed April 19, 2021.

        • Carling PC
        • Parry MM
        • Rupp ME
        • et al.
        Improving cleaning of the environment surrounding patients in 36 acute care hospitals.
        Infect Control Hosp Epidemiol. 2008; 29: 1035-1041
        • Nante N
        • Ceriale E
        • Messina G
        • Lenzi D
        • Manzi P.
        Effectiveness of ATP bioluminescence to assess hospital cleaning: a review.
        J Prev Med Hyg. 2017; 58: E177-E183
        • Galvin S
        • Dolan A
        • Cahill O
        • Daniels S
        • Humphreys H.
        Microbial monitoring of the hospital environment: why and how?.
        J Hosp Infect. 2012; 82: 143-151
        • Lemmen SW
        • Häfner H
        • Zolldann D
        • Amedick G
        • Lutticken R.
        Comparison of two sampling methods for the detection of Gram-positive and Gram-negative bacteria in the environment: moistened swabs versus Rodac plates.
        Int J Hyg Environ Health. 2001; 203: 245-248
        • Dancer SJ.
        How do we assess hospital cleaning? A proposal for microbiological standards for surface hygiene in hospitals.
        J Hosp Infect. 2004; 56: 10-15
        • Malik R.
        Use of audit tools to evaluate the efficacy of cleaning systems in hospitals.
        Am J Infect Control. 2003; 31: 181-187
        • White LF
        • Dancer SJ
        • Robertson C
        • McDonald J.
        Are hygiene standards useful in assessing infection risk?.
        Am J Infect Control. 2008; 36: 381-384
        • Cloutman-Green E
        • D'Arcy N
        • Spratt DA
        • Hartley JC
        • Klein N
        How clean is clean—is a new microbiology standard required?.
        Am J Infect Control. 2014; 42: 1002-1003
        • Griffith CJ
        • Malik R
        • Cooper RA
        • Looker N
        • Michaels B.
        Environmental surface cleanliness and the potential for contamination during handwashing.
        Am J Infect Control. 2003; 31: 93-96
      2. Safety Data Sheet - PURTABS (Dilution 0.5 - 5550 ppm), Version 3. 2021. Available at: Accessed June 8, 2022.

      3. Safety Data Sheet - Oxcyide Daily Disinfectant Cleaner. 2021. Available at: Accessed June 8, 2022.

        • Vohra P
        • Poxton IR.
        Efficacy of decontaminants and disinfectants against Clostridium difficile.
        J Med Microbiol. 2011; 60: 1218-1224
      4. Scott D, Hansraj F. Literature review and practice recommendations: existing and emerging technologies used for decontamiation of the healthcare environment - electrolyzed water. National Health Services Scotland, Antimicrobial Resistance and Healthcare Associated Infections. Version 1.1. published December 2016.

        • Bolton SL
        • Kotwal G
        • Harrison MA
        • Law SE
        • Harrison JA
        • Cannon JL.
        Sanitizer efficacy against murine norovirus, a surrogate for human norovirus, on stainless steel surfaces when using three application methods.
        Appl Environ Microbiol. 2013; 79: 1368-1377
        • Zhang C
        • Li B
        • Jadeja R
        • Hung YC.
        Effects of electrolyzed oxidizing water on inactivation of Bacillus subtilis and Bacillus cereus spores in suspension and on carriers: Bacillus spores inactivation by EO water….
        J Food Sci. 2016; 81: M144-M149
        • Deshpande A
        • Mana TSC
        • Cadnum JL
        • et al.
        Evaluation of a sporicidal peracetic acid/hydrogen peroxide–based daily disinfectant cleaner.
        Infect Control Hosp Epidemiol. 2014; 35: 1414-1416
      5. BD Diagnostics. BD trypticase soy agar II with 5% sheep blood. Instructions for use. 2013. Available at: Accessed June 9, 2022.

      6. FDA Center for Food Safety and Applied Nutrition. Control of listeria monocytogenes in ready-to-eat foods: guidance for industry. 2017.

      7. Minnesota Hospital Association. Environmental services cleaning guidebook. Available at: Accessed April 15, 2021.

      8. CDC. 4. Environmental cleaning procedures. 2020. Available at: Accessed April 15, 2021.

        • Mulvey D
        • Redding P
        • Robertson C
        • et al.
        Finding a benchmark for monitoring hospital cleanliness.
        J Hosp Infect. 2011; 77: 25-30
        • Boyce JM
        • Guercia KA
        • Sullivan L
        • et al.
        Prospective cluster controlled crossover trial to compare the impact of an improved hydrogen peroxide disinfectant and a quaternary ammonium-based disinfectant on surface contamination and health care outcomes.
        Am J Infect Control. 2017; 45: 1006-1010
        • Al-Hamad A
        • Maxwell S.
        How clean is clean? Proposed methods for hospital cleaning assessment.
        J Hosp Infect. 2008; 70: 328-334
      9. Centers for Disease Control and Prevention. Infection prevention and control for Candida auris. 2021. Available at: Accessed June 8, 2022.

        • Jinadatha C
        • Villamaria FC
        • Coppin JD
        • et al.
        Interaction of healthcare worker hands and portable medical equipment: a sequence analysis to show potential transmission opportunities.
        BMC Infect Dis. 2017; 17: 800