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Efficiency of hydrogen peroxide in improving disinfection of ICU rooms
Caroline Blazejewski1, Frédéric Wallet2, Anahita Rouzé3
1Critical Care Center, University Hospital of Lille, Rue E. Laine, 59037, Lille Cedex, France. caroline.blazejewski@gmail.com.
Introduction:
The primary objective of this study was to determine the efficiency of hydrogen peroxide (H₂O₂) techniques in disinfection of ICU rooms contaminated with multidrug-resistant organisms (MDRO) after patient discharge. Secondary objectives included comparison of the efficiency of a vaporizator (HPV, Bioquell) and an aerosolizer using H₂O₂, and peracetic acid (aHPP, Anios) in MDRO environmental disinfection, and assessment of toxicity of these techniques.
Methods:
This prospective cross-over study was conducted in five medical and surgical ICUs located in one University hospital, during a 12-week period. Routine terminal cleaning was followed by H₂O₂ disinfection. A total of 24 environmental bacteriological samplings were collected per room, from eight frequently touched surfaces, at three time-points: after patient discharge (T0), after terminal cleaning (T1) and after H₂O₂ disinfection (T2).
Results:
In total 182 rooms were studied, including 89 (49%) disinfected with aHPP and 93 (51%) with HPV. At T0, 15/182 (8%) rooms were contaminated with at least 1 MDRO (extended spectrum β-lactamase-producing Gram-negative bacilli 50%, imipenem resistant Acinetobacter baumannii 29%, methicillin-resistant Staphylococcus aureus 17%, and Pseudomonas aeruginosa resistant to ceftazidime or imipenem 4%). Routine terminal cleaning reduced environmental bacterial load (P <0.001) without efficiency on MDRO (15/182 (8%) rooms at T0 versus 11/182 (6%) at T1; P = 0.371). H₂O₂ technologies were efficient for environmental MDRO decontamination (6% of rooms contaminated with MDRO at T1 versus 0.5% at T2, P = 0.004). Patient characteristics were similar in aHPP and HPV groups. No significant difference was found between aHPP and HPV regarding the rate of rooms contaminated with MDRO at T2 (P = 0.313). 42% of room occupants were MDRO carriers. The highest rate of rooms contaminated with MDRO was found in rooms where patients stayed for a longer period of time, and where a patient with MDRO was hospitalized. The residual concentration of H₂O₂ appears to be higher using aHPP, compared with HPV.
Conclusions:
H₂O₂ treatment is efficient in reducing MDRO contaminated rooms in the ICU. No significant difference was found between aHPP and HPV regarding their disinfection efficiency.
Insights
Hydrogen peroxide (H₂O₂) disinfection effectively reduces multidrug-resistant organisms (MDRO) in ICU rooms. Both vaporized H₂O₂ (HPV) and aerosolized H₂O₂ with peracetic acid (aHPP) showed similar disinfection efficiency.
Area of Science:
- Infection Control and Hospital Epidemiology
- Environmental Disinfection
- Microbiology
Background:
- Intensive Care Units (ICUs) are prone to contamination with multidrug-resistant organisms (MDROs) after patient discharge.
- Effective terminal disinfection strategies are crucial to prevent the spread of MDROs in healthcare settings.
- Hydrogen peroxide (H₂O₂) based disinfection technologies are increasingly utilized for environmental decontamination.
Purpose of the Study:
- To evaluate the efficacy of hydrogen peroxide (H₂O₂) disinfection techniques in reducing MDRO contamination in ICU rooms.
- To compare the disinfection efficiency of a vaporizator (HPV) and an aerosolizer (aHPP) using H₂O₂.
- To assess the toxicity associated with these H₂O₂-based disinfection methods.
Main Methods:
- A prospective cross-over study conducted in five ICUs over 12 weeks.
- Environmental sampling of 182 rooms across three time points: post-discharge (T0), post-terminal cleaning (T1), and post-H₂O₂ disinfection (T2).
- Analysis of bacterial load and MDRO presence on frequently touched surfaces using both HPV and aHPP disinfection methods.
Main Results:
- Routine terminal cleaning did not significantly reduce MDRO contamination (6% at T1 vs. 8% at T0).
- H₂O₂ disinfection significantly reduced MDRO contamination, with only 0.5% of rooms remaining contaminated post-disinfection (P = 0.004).
- No significant difference in disinfection efficiency was observed between HPV and aHPP methods (P = 0.313).
Conclusions:
- Hydrogen peroxide (H₂O₂) treatment is an effective method for decontaminating ICU rooms of multidrug-resistant organisms (MDROs).
- Both HPV and aHPP technologies demonstrate comparable efficacy in environmental disinfection.
- Further assessment of H₂O₂ residual concentrations indicated potentially higher levels with aHPP compared to HPV.
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