Analysis of Range and Use of a Hybrid Hydrogen Peroxide System for Biosafety Level 3 and Animal Biosafety Level 3 Agriculture Laboratory Decontamination.

Introduction: The applications of fumigation and the challenges that high-containment facilities face in achieving effective large volume decontamination are well understood. The Biosecurity Research Institute at Kansas State University sought to evaluate a novel system within their biosafety level 3 (BSL-3) and animal biosafety level 3 agriculture (ABSL-3Ag) facility. Methods: The system chosen for this study is the CURIS® Hybrid Hydrogen PeroxideTM (HHPTM) system, comprising a mobile 36-pound (16 kg) device delivering a proprietary 7% hydrogen peroxide (H2O2) solution. To examine the system's efficacy in multiple laboratory settings, two BSL-3 laboratories (2,281 [65 m3] and 4,668 ft3 [132 m3]) with dropped ceiling interstitial spaces and an ABSL-3Ag necropsy suite (44,212 ft3 [1,252 m3]) with 21-foot (6.4 m) ceilings were selected. Biological indicators (BIs) of Geobacillus stearothermophilus (1.7 × 106 organisms) on steel spore carriers and H2O2 chemical indicators (CIs) were used to provide validation. Results: After cycle optimization, the smaller laboratory had a total of 60 BIs over two treatments that demonstrated a greater than 6-log reduction of bacterial spores. The larger laboratory (192 BIs) and the necropsy suite (206 BIs) had no BIs positive for spore growth when incubated at 60°C for 24 h per manufacturer's specifications. Conclusion: Overall successful results through multiple components of this study demonstrate that the HHP device, paired with the pulsed 7% H2O2 solution, achieved efficacy regardless of variables in laboratory size and layout. Perceived challenges such as 21-ft (6.4 m) ceiling heights, active equipment, and difficult to access ceiling interstitial spaces proved unfounded. Given the successful sterilization of all challenged BIs, the HHP system presents a useful alternative for high level decontamination within BSL-3 and ABSL-3Ag facilities.

Room Temperature Detection of Hydrogen Peroxide Vapor by Fe2O3:ZnO Nanograins.

In this report, a Fe2O3:ZnO sputtering target and a nanograins-based sensor were developed for the room temperature (RT) detection of hydrogen peroxide vapor (HPV) using the solid-state reaction method and the radio frequency (RF) magnetron sputtering technique, respectively. The characterization of the synthesized sputtering target and the obtained nanostructured film was carried out by scanning electron microscopy (SEM), transmission electron microscopy (TEM), and energy-dispersive X-ray (EDX) analyses. The SEM and TEM images of the film revealed its homogeneous granular structure, with a grain size of 10-30 nm and an interplanar spacing of Fe2O3 and ZnO, respectively. EDX spectroscopy presented the real concentrations of Zn in the target material and in the film (21.2 wt.% and 19.4 wt.%, respectively), with a uniform distribution of O, Al, Zn, and Fe elements in the e-mapped images of the Fe2O3:ZnO film. The gas sensing behavior was investigated in the temperature range of 25-250 °C with regards to the 1.5-56 ppm HPV concentrations, with and without ultraviolet (UV) irradiation. The presence of UV light on the Fe2O3:ZnO surface at RT reduced a low detection limit from 3 ppm to 1.5 ppm, which corresponded to a response value of 12, with the sensor's response and recovery times of 91 s and 482 s, respectively. The obtained promising results are attributed to the improved characteristics of the Fe2O3:ZnO composite material, which will enable its use in multifunctional sensor systems and medical diagnostic devices.

Measurement of hydrogen peroxide vapor in powders with potassium titanium oxide oxalate loaded cellulose pellets as probes.

An image-based method for determining H2O2 vapor pressures in powder systems was developed based on cellulose pellets loaded with potassium titanium oxide oxalate (PTO Pellets) as probe particles. Solid titanyl salts change color after exposure to hydrogen peroxide vapor and the quantitative response of PTO pellets to H2O2 has been established by comparing reactions with H2O2 in liquid and solid states. Analysis of pictures of the color changes of PTO Pellets mixed into powders can be used to monitor the presence of ppm levels of H2O2 vapor inside powder systems such as bleach containing dry detergent powders.•H2O2 vapor quantification in dry systems with titanyl loaded cellulose particles.•Simple fabrication of H2O2 probe particles.•High sensitivity with LOD 0.190 ppm H2O2 .

Vapourized hydrogen peroxide decontamination in a hospital setting inactivates SARS-CoV-2 and HCoV-229E without compromising filtration efficiency of unexpired N95 respirators.

BACKGROUND: The COVID-19 pandemic highlighted the need for evidence-based approaches to decontamination and reuse of N95 filtering facepiece respirators (FFRs). We sought to determine whether vapourized hydrogen peroxide (VHP) reduced SARS-CoV-2 bioburden on FFRs without compromising filtration efficiency. We also investigated coronavirus HCoV-229E as a surrogate for decontamination validation testing. METHODS: N95 FFRs were laced with SARS-CoV-2 or HCoV-229E and treated with VHP in a hospital reprocessing facility. After sterilization, viral burden was determined using viral outgrowth in a titration assay, and filtration efficiency of FFRs was tested against ATSM F2299 and NIOSH TEB-STP-APR-0059. RESULTS: Viable SARS-CoV-2 virus was not detected after VHP treatment. One replicate of the HCoV-229E laced FFRs yielded virus after processing. Unexpired N95 FFRs retained full filtration efficiency after VHP processing. Expired FFRs failed to meet design-specified filtration efficiency and therefore are unsuitable for reprocessing. DISCUSSION: In-hospital VHP is an effective decontaminant for SARS-CoV-2 on FFRs. Further, filtration efficiency of unexpired respirators is not affected by this decontamination process. CONCLUSIONS: VHP is effective in inactivating SARS-CoV-2 on FFRs without compromising filtration efficiency. HCoV-229E is a suitable surrogate for SARS-CoV-2 for disinfection studies.

Decontamination of respirators amid shortages due to SARS-CoV-2.

The pandemic created by SARS-CoV-2 has caused a shortage in the supplies of N95 filtering facepiece respirators (FFRs), disposable respirators with at least 95% efficiency to remove non-oily airborne particles, due to increasing cases all over the world. The current article reviewed various possible decontamination methods for FFR reuse including ultraviolet germicidal irradiation (UVGI), hydrogen peroxide vapor (HPV), microwave-generated steam (MGS), hydrogen peroxide gas plasma (HPGP), and 70% or higher ethanol solution. HPV decontamination was effective against bacterial spores (6 log10 reduction of Geobacillus stearothermophilus spores) on FFRs and viruses (> 4 log10 reduction of various types of viruses) on inanimate surfaces, and no degradation of respirator materials and fit has been reported. 70% or higher ethanol decontamination showed high efficacy in inactivation of coronaviruses on inanimate surfaces (> 3.9 log10 reduction) but it was lower on FFRs which filtration efficiency was also decreased. UVGI method had good biocidal efficacy on FFRs (> 3 log10 reduction of H1N1 virus) combined with inexpensive, readily available equipment; however, it was more time-consuming to ensure sufficient reduction in SARS-CoV-2. MGS treatment also provided good viral decontamination on FFRs (> 4 log10 reduction of H1N1 virus) along with less time-intensive process and readily available equipment while inconsistent disinfection on the treated surfaces and deterioration of nose cushion of FFRs were observed. HPGP was a good virucidal system (> 6 log10 reduction of Vesicular stomatitis virus) but filtration efficiency after decontamination was inconsistent. Overall, HPV appeared to be one of the most promising methods based on the high biocidal efficacy on FFRs, preservation of respirator performance after multiple cycles, and no residual chemical toxicity. Nonetheless, equipment cost and time of the HPV process and a suitable operating room need to be considered.

COVID-19 global pandemic planning: Decontamination and reuse processes for N95 respirators.

IMPACT STATEMENT: There is a critical shortage of personal protective equipment (PPE) around the globe. This article describes the safe collection, storage, and decontamination of N95 respirators using hydrogen peroxide vapor (HPV). This article is unique because it describes the HPV process in an operating room, and is therefore, a deployable method for many healthcare settings. Results presented here offer creative solutions to the current PPE shortage.

Role of Hydrogen Peroxide Vapor (HPV) for the Disinfection of Hospital Surfaces Contaminated by Multiresistant Bacteria.

The emergence of multiresistant bacterial strains as agents of healthcare-related infection in hospitals has prompted a review of the control techniques, with an added emphasis on preventive measures, namely good clinical practices, antimicrobial stewardship, and appropriate environmental cleaning. The latter item is about the choice of an appropriate disinfectant as a critical role due to the difficulties often encountered in obtaining a complete eradication of environmental contaminations and reservoirs of pathogens. The present review is focused on the effectiveness of hydrogen peroxide vapor, among the new environmental disinfectants that have been adopted. The method is based on a critical review of the available literature on this topic.

Comparison of Aerosolized Hydrogen Peroxide Fogging with a Conventional Disinfection Product for a Dental Surgery.

AIM AND OBJECTIVE: The study aimed to determine the efficacy of adding a 12% hydrogen peroxide dry hydrogen peroxide vapor fogger system as an additional layer of infection control in a dental surgery. MATERIALS AND METHODS: A total number of agar plates from the five locations were used during the treatment of the 22 patients (n = 440). During the treatment of each patient, four agar plates (n = 4) were used per location [location 1: X-ray, location 2: the dental arm, location 3: left side desk, location 4: under the foot of the dental chair, location 5: ri ght side desk and (n = 20 for the five locations per patient)]. The control agar plates were incubated after the treatment of the patient was completed period. The test agar plate groups were sprayed with a 70% isopropanol surface disinfectant, or received exposure to an automated 12% hydrogen peroxide fog, or a 70% isopropanol surface disinfectant spray immediately followed by exposure to the automated 12% hydrogen peroxide. RESULTS: One-way ANOVA and Scheffé's method identified significant differences (p < 0.01). Between the control agar plates and the three disinfection methods used a significantly lower colony count was established for colonies recorded in the surgery assessed as a whole, the X-ray unit, and the ri ght side desk. CONCLUSION: The disinfection of dental surgery r equires sufficient time as it not only includes the working surfaces but also various inanimate objects. Surface disinfectant spray followed by hydrogen peroxide decontamination has potential for dental surgery, as the colony-forming units have been r educed further compared to spray alone and even just fog alone for all the various areas of the dental surgery that was assessed. CLINICAL SIGNIFICANCE: The infection control protocols with hydrogen peroxide vapor would ensure the maximum efficacy of the disinfection protocols.

Assessment of surface cleaning and disinfection in neonatal intensive care unit.

BACKGROUND: Surveillance for healthcare-associated infections (HAI) is a priority in the neonatal intensive care unit (NICU), given the critical immune status of patients. The aim of this study was to assess surface bacterial contamination before and after improving cleaning and disinfection practices. MATERIALS AND METHODS: This was a cross-sectional study conducted in March 2018. Surface samples were taken from the same areas in three steps: after cleaning, after "improved" cleaning, and after terminal disinfection using hydrogen peroxide vapor (VHP). Sampling and culture was carried out according to standard ISO14698-1: 2004. Results interpretation was based on the thresholds defined by good hospital pharmacy practice. Statistical analysis was performed by SPSS 21.0 and a P-value < 0.05 was considered to be significant. RESULTS: In total, 290 samples were taken from different zones: fixed equipment (69%), aseptic washbasins (12%), pneumatic system (9%), computer equipment (6%) and mobile equipment (4%). Prevalence of non-compliances after cleaning and disinfection was 75%, 10% after "improved" cleaning, and 0% after automated VHP (P < 0.0001). Median of CFU was 24[EI (0-625)] after standard cleaning, 2[EI (0-35)] after "improved" cleaning and 0 [EI (0-3)] after VHP (P < 0.0001). Isolated germs werecoagulase-negative Staphylococcus (31.2%), Acinetobacter baumannii (26%), Staphylococcus aureus (19.5%), Pseudomonas aeruginosa (9%), Klebsiella pneumoniae (9%), E. coli (4%) and Enterobacter sp (1.3%). CONCLUSION: Improved cleaning and disinfection practices associated to VHP give microbiological satisfactory results. It is important to educate cleaning staff for effective surface cleaning and disinfection operations to control HAI.

Decontamination devices in health care facilities: Practical issues and emerging applications.

"No-touch" decontamination devices are increasingly used as an adjunct to standard cleaning and disinfection in health care facilities. Although there is evidence that these devices are effective in reducing contamination, there are several areas of controversy regarding their use. This review addresses some of the questions frequently posed by infection prevention and environmental services personnel about decontamination devices.

Modern technologies for improving cleaning and disinfection of environmental surfaces in hospitals.

Experts agree that careful cleaning and disinfection of environmental surfaces are essential elements of effective infection prevention programs. However, traditional manual cleaning and disinfection practices in hospitals are often suboptimal. This is often due in part to a variety of personnel issues that many Environmental Services departments encounter. Failure to follow manufacturer's recommendations for disinfectant use and lack of antimicrobial activity of some disinfectants against healthcare-associated pathogens may also affect the efficacy of disinfection practices. Improved hydrogen peroxide-based liquid surface disinfectants and a combination product containing peracetic acid and hydrogen peroxide are effective alternatives to disinfectants currently in widespread use, and electrolyzed water (hypochlorous acid) and cold atmospheric pressure plasma show potential for use in hospitals. Creating "self-disinfecting" surfaces by coating medical equipment with metals such as copper or silver, or applying liquid compounds that have persistent antimicrobial activity surfaces are additional strategies that require further investigation. Newer "no-touch" (automated) decontamination technologies include aerosol and vaporized hydrogen peroxide, mobile devices that emit continuous ultraviolet (UV-C) light, a pulsed-xenon UV light system, and use of high-intensity narrow-spectrum (405 nm) light. These "no-touch" technologies have been shown to reduce bacterial contamination of surfaces. A micro-condensation hydrogen peroxide system has been associated in multiple studies with reductions in healthcare-associated colonization or infection, while there is more limited evidence of infection reduction by the pulsed-xenon system. A recently completed prospective, randomized controlled trial of continuous UV-C light should help determine the extent to which this technology can reduce healthcare-associated colonization and infections. In conclusion, continued efforts to improve traditional manual disinfection of surfaces are needed. In addition, Environmental Services departments should consider the use of newer disinfectants and no-touch decontamination technologies to improve disinfection of surfaces in healthcare.

A multi-pronged approach to the search for an alternative to formaldehyde as an egg disinfectant without affecting worker health, hatching, or broiler production parameters.

Research was carried out to determine the effectiveness of 4 hatching eggs disinfection processes (i.e., disinfecting products and administration method) using a multi-pronged approach assessing the reduction of microbial eggshell contamination, the effects on worker exposure, hatching results and broiler performance, and, finally, suitability for use in commercial hatcheries. The 4 disinfection processes were: sodium dichlorocyanurate (DC) by thermonebulization, hydrogen peroxide 6% by nebulization (HP6), electrolyzed oxidizing water (EOW) by fogging, and hydrogen peroxide 30% vapor (HP30). In order to meet commercial hatchery conditions, the tested products were applied in an experimental hatchery by aerial disinfection in a dedicated room, not sprayed directly onto the eggs. Compared to the untreated control group, eggshell microbial load was significantly decreased by over 1 log10 cfu per egg in groups DC and HP30. These results were confirmed during a second experiment. In addition, these 2 products comply with legal requirements on worker exposure. Fertility and hatching results were significantly higher in group HP30 than in group DC, with no impact on chick quality and subsequent broiler performance. Under these study conditions, the disinfection process (i.e., administration of the product, contact with the eggs and aeration) lasted 65 min in group DC vs. 135 min in group HP30. When considering commercial hatchery conditions, this difference in application time confers a clear advantage on the DC process. Moreover, the investment required for HP30 is much higher than for DC. Overall, HP30 presented a clear advantage for hatching results whereas DC is a relatively more practical and less expensive disinfection process. To our knowledge, this is the first report on the use of hydrogen peroxide vapor as an egg disinfection process. Further research is needed to confirm the results of this study under commercial hatchery conditions.

Terminal decontamination of the Royal Free London's high-level isolation unit after a case of Ebola virus disease using hydrogen peroxide vapor.

We report the decontamination of the high-level isolation unit at the Royal Free London after the discharge of a patient with Ebola virus disease, who was repatriated from West Africa. Hydrogen peroxide vapor (HPV) was used to decontaminate the patient care isolators and the rooms housing them. HPV decontamination was completed without incident and allowed the unit to be returned to service more quickly than the previous protocol of using formaldehyde.

Multidisciplinary performance improvement team for reducing health care-associated Clostridium difficile infection.

Clostridium difficile is the most frequent cause of health care-associated diarrhea and is a significant cause of morbidity and mortality. It is also associated with a considerable financial burden. A concerted multidisciplinary approach is required for prevention.

Hydrogen peroxide vapor room disinfection and hand hygiene improvements reduce Clostridium difficile infection, methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and extended-spectrum ß-lactamase.

We report a statistically significant reduction in Clostridium difficile infection (from 1.38 to 0.90 cases per 1,000 patient days), vancomycin-resistant enterococci (from 0.21 to 0.01 cases per 1,000 patient days), and extended-spectrum ß-lactamase-producing gram-negative bacteria (from 0.16 to 0.01 cases per 1,000 patient days) associated with the introduction of hydrogen peroxide vapor for terminal decontamination of patient rooms and improvements in hand hygiene compliance.

Effectiveness and reaction networks of H2O2 vapor with NH3 gas for decontamination of the toxic warfare nerve agent, VX on a solid surface.

The nerve agent, O-ethyl S-[2-(diisopropylamino)ethyl] methylphosphonothioate (VX) must be promptly eliminated following its release into the environment because it is extremely toxic, can cause death within a few minutes after exposure, acts through direct skin contact as well as inhalation, and persists in the environment for several weeks after release. A mixture of hydrogen peroxide vapor and ammonia gas was examined as a decontaminant for the removal of VX on solid surfaces at ambient temperature, and the reaction products were analyzed by gas chromatography-mass spectrometry (GC-MS) and nuclear magnetic resonance spectrometry (NMR). All the VX on glass wool filter disks was found to be eliminated after 2 h of exposure to the decontaminant mixtures, and the primary decomposition product was determined to be non-toxic ethyl methylphosphonic acid (EMPA); no toxic S-[2-(diisopropylamino)ethyl] methylphosphonothioic acid (EA-2192), which is usually produced in traditional basic hydrolysis systems, was found to be formed. However, other by-products, such as toxic O-ethyl S-vinyl methylphosphonothioate and (2-diisopropylaminoethyl) vinyl disulfide, were detected up to 150 min of exposure to the decontaminant mixture; these by-products disappeared after 3 h. The two detected vinyl byproducts were identified first in this study with the decontamination system of liquid VX on solid surfaces using a mixture of hydrogen peroxide vapor and ammonia gas. The detailed decontamination reaction networks of VX on solid surfaces produced by the mixture of hydrogen peroxide vapor and ammonia gas were suggested based on the reaction products. These findings suggest that the mixture of hydrogen peroxide vapor and ammonia gas investigated in this study is an efficient decontaminant mixture for the removal of VX on solid surfaces at ambient temperature despite the formation of a toxic by-product in the reaction process.

Evaluation of hydrogen peroxide vapor for the inactivation of nosocomial pathogens on porous and nonporous surfaces.

BACKGROUND: Clostridium difficile spores and multidrug-resistant (MDR) organisms, such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), and MDR Acinetobacter baumannii, are important nosocomial pathogens that are difficult to eliminate from the hospital environment. We evaluated the efficacy of hydrogen peroxide vapor (HPV), a no-touch automated room decontamination system, for the inactivation of a range of pathogens dried onto hard nonporous and porous surfaces in an operating room (OR). METHODS: Stainless steel and cotton carriers containing >4 log10 viable MRSA, VRE, or MDR A baumannii were placed at 4 locations in the OR along with 7 pouched 6 log10Geobacillus stearothermophilus spore biologic indicators (BIs). HPV was then used to decontaminate the OR. The experiment was repeated 3 times. RESULTS: HPV inactivated all spore BIs (>6 log10 reduction), and no MRSA, VRE, or MDR A baumannii were recovered from the stainless steel and cotton carriers (>4-5 log10 reduction, depending on the starting inoculum). HPV was equally effective at all carrier locations. We did not identify any difference in efficacy for microbes dried onto stainless steel or cotton surfaces, indicating that HPV may have a role in the decontamination of both porous and nonporous surfaces. CONCLUSION: HPV is an effective way to decontaminate clinical areas where contamination with bacterial spores and MDR organisms is suspected.

Clostridium difficile: improving the prevention paradigm in healthcare settings.

Clostridium difficile infection (CDI) is a major public health problem worldwide with significant morbidity and mortality that is spread by spores and fecal oral transmission. A variety of risk factors have been identified. Some risk factors such as age, are not amenable to change, while others such as antimicrobial utilization have resulted in broadly implemented antimicrobial stewardship programs. New risk factors are emerging such as proton pump inhibitor (PPI) use, irritable bowel disease (IBD) and obesity, with others yet to be determined. Prevention of spread of CDI is imperative, since therapy remains imperfect. We review established and emerging risks for CDI and offer potential preventative strategies with the use of a multidisciplinary CDI prevention bundle checklist.