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Evaluating a New Paradigm for Comparing Surface Disinfection in Clinical Practice

Published online by Cambridge University Press:  10 May 2016

Philip C. Carling*
Carney Hospital and Boston University School of Medicine, Boston, Massachusetts
Jennifer Perkins
Maple Grove Hospital, Maple Grove, Minnesota
JoAnn Ferguson
Maple Grove Hospital, Maple Grove, Minnesota
Anita Thomasser
Ecolab, St. Paul, Minnesota
Carney Hospital, 2100 Dorchester Avenue, Dorchester, MA 02124 (



Despite an increasing understanding of the importance of near-patient surfaces in the transmission of healthcare-associated pathogens, there remains a need to define the relative clinical effectiveness of disinfection interventions


A serial 2-phase evaluation of the clinical effectiveness of 2 surface disinfectants.


A general acute care hospital.


A unique system for quantifying bioburden reduction while monitoring the possible impact of differences in cleaning thoroughness was used to compare the clinical effectiveness of a traditional quaternary ammonium compound (QAC) and a novel peracetic acid/hydrogen peroxide disinfectant (ND) as part of terminal room cleaning.


As a result of QAC cleaning, 93 (40%) of 237 cleaned surfaces confirmed by fluorescent marker (DAZO) removal were found to have complete removal of aerobic bioburden. During the ND phase of the study, bioburden was removed from 211 (77%) of 274 cleaned surfaces. Because there was no difference in the thoroughness of cleaning with either disinfectant (65.3% and 66.4%), the significant (P > .0001) difference in bioburden reduction can be attributed to better cleaning efficacy with the ND.


In the context of the study design, the ND was 1.93 times more effective in removing bacterial burden than the QAC (P > .0001). Furthermore, the study design represents a new research paradigm in which 2 interventions can be compared by concomitantly and objectively analyzing both the product and process variables in a manner that can be used to define the relative effectiveness of all disinfection cleaning interventions.

Infect Control Hosp Epidemiol 2014;35(11):1349–1355

Original Article
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved.

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