Utility of hydrogen peroxide disinfection in decreasing pathogens in a critical care environment

ABSTRACT

INTRODUCTION: Environmental surfaces impact pathogen transmission and thus hospital acquired infections. This underscores the need for high-level disinfection, especially considering the vulnerability of critical care patients and the risks posed by multi-drug resistant organisms (MDRO). Enhanced cleaning practices employed by hospitals for environmental disinfection are not all equal. For this investigation, a hydrogen peroxide disinfection system was chosen due to its EPA approval against SARS-CoV-2 and its sporicidal efficacy. This study sought to evaluate the efficacy/ feasibility of a hybrid form of hydrogen peroxide (HHP fogging) compared to current disinfection practices (standard cleaning and enhanced UV-light cleaning) in a critical care setting. METHODS: From Dec '20-Jun '21 data were collected in 17 critical care patient rooms post-discharge. Samples were collected to evaluate HHP fogging versus standard and enhanced cleaning. Sampling followed each intervention post-EVS standard cleaning, post-enhanced cleaning with UV-light, and post HHP fogging following standard/enhanced practices. Five preset high touch patient room locations were swabbed for aerobic colony counts (ACC) and enumerated for MDRO presence toilet, phone, bed rail, touchscreen, sink countertop. Measurements included quantitative and qualitative counts (ACC, adenosine triphosphate (ATP) swabs -measured in relative light units,RLU), hydrogen peroxide chemical indicators, and bacterial spore biological indicators(BIs, Geobacillus stearothermophilus). RESULTS: No difference was seen between standard cleaning and enhanced cleaning with UV light (mean ACC 7.16 and 6.35, respectively;p=0.186). HHP fogging reduced present ACC levels by 98% beyond current EVS post-discharge cleaning practices (mean ACC 0.137, p< 0.0001). MRSA instances were observed after standard and enhanced cleaning with UV light (mean ACC 0.178), no MRSA was detected after HHP fogging. ATP results showed an average 88% reduction post HHP fogging (mean RLU post cleaning=9012, post HHP fogging=1109;p=0.014) and BIs confirmed a 6-log bacterial spore efficacy. CONCLUSION: HHP fogging resulted in successful elimination of MDROs and reduction in aerobic colony counts versus standard and UV-light cleaning. Deployment of HHP fogging is feasible and safe in a critical care setting.