by Zaina Hamza, Staff Writer, MedPage Today March 18, 2022
Use of a touchless whole-room aerosolized hydrogen peroxide (aHP) disinfection system led to a reduction in Clostridioides difficile infection (CDI) rates at an acute care facility, a retrospective study found.
Over the first 5 years of the study, CDI rates significantly dropped from 4.6 per 10,000 patient-days to 2.7 per 10,000 patient-days after implementation of the system (P<0.001), reported Christopher Truitt, PhD, of Wayland Baptist University in Lubbock, Texas, and colleagues.
During the next 5 years, CDI rates were consistently reduced with the continued use of the aHP disinfection system, with a rate of 1.4 per 10,000 patient-days at the end of the 10-year study, they noted in the American Journal of Infection Control.
"To our knowledge, this is the first study showing the effectiveness of aHP in reducing CDI rates in a clinical setting," the authors wrote.
"CDI is difficult to prevent because it is so hard to eliminate from the environment," said Linda Dickey, RN, MPH, president of the Association for Professionals in Infection Control and Epidemiology, in a press release. "The study ... provides valuable insight about the benefits of supplementing prevention efforts with aHP to help meaningfully decrease rates of this often-deadly disease."
CDIs are the most common healthcare-associated infections, and can lead to significant morbidity and mortality across healthcare facilities, Truitt's group noted. Patients with CDI present with a wide range of symptoms and with varying severity: some patients are asymptomatic, while others have mild to severe diarrhea, pseudomembranous colitis, or even toxic megacolon.
Asymptomatic patients can shed C. difficile endospores, which often remain resistant to most disinfectants, increasing the risk for environmental spread among patients. "Unlike clinical treatment, there is no specific environmental intervention used in the industry as best practice," Truitt and team noted.
"[These study] results suggest effect; however, a significant set of limitations exist due to the retrospective design," said Paul Auwaerter, MD, of Johns Hopkins University School of Medicine in Baltimore. "Multiple other factors could influence, such as antibiotic prescription changes and other infection control interventions."
"A prospective design would best validate the benefit of hydrogen peroxide," added Auwaerter, who was not involved in this study.
For this study, Truitt and colleagues examined data on CDI rates over 10 years at Pennsylvania Hospital, an acute care facility in Philadelphia from July 2009 to September 2011 (before use of the aHP system) and from April 2012 to December 2014 (after implementation of the system). October 2011 to March 2012 was excluded because the aHP disinfection system was not consistently used. The researchers also examined the effects of continued use of the system from January 2015 through December 2019.
The researchers used the aerosolized Halo Disinfection System, an Environmental Protection Agency-registered whole-room unit that generates a dry-mist fog to cover all exposed surfaces without wetting, comprising 5.0% w/w hydrogen peroxide and 0.01% ionic silver. The cost of the system was significantly less than other no-touch disinfection systems, they noted.
Treated rooms were also cleaned with a 10% bleach (sodium hypochlorite) solution prior to use of the system. A fluorescent gel program to monitor cleaning effectiveness was used from 2009 to 2016, with the team switching to an ATP system in 2017.
The authors noted that antibiotic use was not evaluated, which was a limitation to the study. In addition, colonization pressure and hand hygiene compliance may have affected CDI rates.
Zaina Hamza is a staff writer for MedPage Today, covering Gastroenterology and Infectious disease. She is based in Chicago.
Truitt and co-authors reported no conflicts of interest.
American Journal of Infection Control
Source Reference: Truitt CL, et al "Evaluation of an aerosolized hydrogen peroxide disinfection system for the reduction of Clostridioides difficile hospital infection rates over a 10 year period" Am J Infect Control 2022; DOI: 10.1016/j.ajic.2021.11.021.
The material on this site is for informational purposes only, and is not a substitute for medical advice, diagnosis or treatment provided by a qualified health care provider. © 2022 MedPage Today, LLC. All rights reserved. Medpage Today is among the federally registered trademarks of MedPage Today, LLC and may not be used by third parties without explicit permission.