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Comparison of the Efficacy of a Hydrogen Peroxide Dry-Mist Disinfection System and Sodium Hypochlorite Solution for Eradication of Clostridium difficile Spores

  • F. Barbut (a1), D. Menuet (a1), M. Verachten (a2) and E. Girou (a2)



To compare a hydrogen peroxide dry-mist system and a 0.5% hypochlorite solution with respect to their ability to disinfect Clostridium difficile-contaminated surfaces in vitro and in situ.


Prospective, randomized, before-after trial.


Two French hospitals affected by C. difficile.


In situ efficacy of disinfectants was assessed in rooms that had housed patients with C. difficile infection. A prospective study was performed at 2 hospitals that involved randomization of disinfection processes. When a patient with C. difficile infection was discharged, environmental contamination in the patient's room was evaluated before and after disinfection. Environmental surfaces were sampled for C. difficile by use of moistened swabs; swab samples were cultured on selective plates and in broth. Both disinfectants were tested in vitro with a spore-carrier test; in this test, 2 types of material, vinyl polychloride (representative of the room's floor) and laminate (representative of the room's furniture), were experimentally contaminated with spores from 3 C. difficile strains, including the epidemic clone ribotype 027-North American pulsed-field gel electrophoresis type 1.


There were 748 surface samples collected (360 from rooms treated with hydrogen peroxide and 388 from rooms treated with hypochlorite). Before disinfection, 46 (24%) of 194 samples obtained in the rooms randomized to hypochlorite treatment and 34 (19%) of 180 samples obtained in the rooms randomized to hydrogen peroxide treatment showed environmental contamination. After disinfection, 23 (12%) of 194 samples from hypochlorite-treated rooms and 4 (2%) of 180 samples from hydrogen peroxide treated rooms showed environmental contamination, a decrease in contamination of 50% after hypochlorite decontamination and 91% after hydrogen peroxide decontamination (P < .005). The in vitro activity of 0.5% hypochlorite was time dependent. The mean (±SD) reduction in initial log10 bacterial count was 4.32 ± 0.35 log10 colony-forming units after 10 minutes of exposure to hypochlorite and 4.18 ± 0.8 logl0 colony-forming units after 1 cycle of hydrogen peroxide decontamination.


In situ experiments indicate that the hydrogen peroxide dry-mist disinfection system is significantly more effective than 0.5% sodium hypochlorite solution at eradicating С difficile spores and might represent a new alternative for disinfecting the rooms of patients with C. difficile infection.


Corresponding author

Hôpital Saint-Antoine, UHLIN, 184 rue du Faubourg Saint-Antoine, 75571 Paris Cedex 12 (


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1.Barbut, F, Petit, JC. Epidemiology of Clostridium difficile-associated infections. Clin Microbiol Infect 2001;7:405410.
2.Bartlett, JG. Narrative review: the new epidemic of Clostridium difficile-associated enteric disease. Ann Intern Med 2006;145:758764.
3.McFarland, LV, Mulligan, ME, Kwok, RY, Stamm, WE. Nosocomial acquisition of Clostridium difficile infection. N Engl J Med 1989;320:204210.
4.Loo, VG, Poirier, L, Miller, MA, Oughton, M, et al.A predominantly clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality. N Engl J Med 2005;353:24422449.
5.McDonald, LC, Killgore, GE, Thompson, A, et al. An epidemic, toxin gene-variant strain of Clostridium difficile. N Engl J Med 2005;353:24332441.
6.Coignard, B, Barbut, F, Blanckaert, K, et al.Emergence of Clostridium difficile toxinotype III, PCR-ribotype 027-associated disease, France, 2006. Euro Surveill 2006;1LE0609141.
7.Réseau d'Alerte d'Investigation et de Surveillance des Infections Nosocomiales. Conduite à tenir: diagnostic, surveillance, investigation, prévention et contrôle des infections à Clostridium difficile. Saint-Maurice, France: Institut de Veille Sanitaire, 2006
8.Kuijper, E, Barbut, F, Brazier, J, et al.Update of Clostridium difficile infection due to PCR ribotype 027 in Europe. Euro Surveill 2008;13:31.
9.Kim, KH, Fekety, R, Batts, DH, et al.Isolation of Clostridium difficile from the environment and contacts of patients with antibiotic-associated colitis. J Infect Dis 1981;143:4250.
10.Riggs, MM, Sethi, AK, Zabarsky, TF, Eckstein, EC, Jump, RL, Donskey, CJ. Asymptomatic carriers are a potential source for transmission of epidemic and nonepidemic Clostridium difficile strains among long-term care facility residents. Clin Infect Dis 2007;45:992998.
11.Akerlund, T, Persson, I, Unemo, M, et al.Increased sporulation rate of epidemic Clostridium difficile type 027/NAP1. J Clin Microbiol 2008;46:15301533.
12.Fawley, WN, Underwood, S, Freeman, J, et al.Efficacy of hospital cleaning agents and germicides against epidemic Clostridium difficile strains. Infect Control Hosp Epidemiol 2007;28:920925.
13.Wilcox, MH, Fawley, WN, Wigglesworth, N, Parnell, P, Verity, P, Freeman, J. Comparison of the effect of detergent versus hypochlorite cleaning on environmental contamination and incidence of Clostridium difficile infection. J Hosp Infect 2003;54:109114.
14.Dubberke, E, Gerding, DN, Classen, D, et al.Strategies to prevent Clostridium difficile infection in acute care hospitals. Infect Control Hosp Epidemiol 2008;29 (supp 1):S81S92.
15.Andersen, BM, Rasch, M, Hochlin, K, Jensen, FH, Wismar, P, Fredriksen, JE. Decontamination of rooms, medical equipment and ambulances using an aerosol of hydrogen peroxide disinfectant. J Hosp Infect 2006;62:149155.
16.Shapey, S, Machin, K, Levi, K, Boswell, TC. Activity of a dry mist hydrogen peroxide system against environmental Clostridium difficile contamination in elderly care wards. J Hosp Infect 2008;70:136141.
17.Otter, JA, French, GL. Survival of nosocomial bacteria and spores on surfaces and inactivation by hydrogen peroxide vapor. J Clin Microbiol 2009;47:205207.
18.Johnston, MD, Lawson, S, Otter, JA. Evaluation of hydrogen peroxide vapour as a method for the decontamination of surfaces contaminated with Clostridium botulinum spores. J Microbiol Methods 2005;60:403411.
19.Mayfield, JL, Leet, T, Miller, J, Mundy, LM. Environmental control to reduce transmission of Clostridium difficile. Clin Infect Dis 2000;31:9951000.
20.Vonberg, RP, Kuijper, EJ, Wilcox, MH, et al.Infection control measures to limit the spread of Clostridium difficile. Clin Microbiol Infect 2008;14(suppl 5):220.
21.Majcher, MR, Bernard, KA, Sattar, SA. Identification by quantitative carrier test of surrogate spore-forming bacteria to assess sporicidal chemicals for use against Bacillus anthracis. Appl Environ Microbiol 2008;74:676681.
22.Wullt, M, Odenholt, I, Walder, M. Activity of three disinfectants and acidified nitrite against Clostridium difficile spores. Infect Control Hosp Epidemiol 2003;24:765768.
23.Verity, P, Wilcox, MH, Fawley, W, Parnell, P. Prospective evaluation of environmental contamination by Clostridium difficile in isolation side rooms. J Hosp Infect 2001;49:204209.
24.Samore, MH, Venkataraman, L, DeGirolami, PC, Arbeit, RD, Karchmer, AW. Clinical and molecular epidemiology of sporadic and clustered cases of nosocomial Clostridium difficile diarrhea. Am J Med 1996;100:3240.
25.Eckstein, BC, Adams, DA, Eckstein, EC, et al.Reduction of Clostridium difficile and vancomycin-resistant Enterococcus contamination of environmental surfaces after an intervention to improve cleaning methods. BMC Infect Dis 2007;7:61.
26.Kaatz, GW, Gitlin, SD, Schaberg, DR, et al.Acquisition of Clostridium difficile from the hospital environment. Am J Epidemiol 1988;127:12891294.
27.McMullen, KM, Zack, J, Coopersmith, CM, Kollef, M, Dubberke, E, Warren, DK. Use of hypochlorite solution to decrease rates of Clostridium difficile-associated diarrhea. Infect Control Hosp Epidemiol 2007;28:205207.
28.Dubberke, ER, Reske, KA, Olsen, MA, et al.Evaluation of Clostridium difficile-associated disease pressure as a risk factor for C difficile-associated disease. Arch Intern Med 2007;167:10921097.
29.Wilcox, MH, Fawley, WN. Hospital disinfectants and spore formation by Clostridium difficile. Lancet 2000;356:1324.
30.Boyce, JM. Environmental contamination makes an important contribution to hospital infection. J Hosp Infect 2007;65(suppl 2):5054.
31.Boyce, JM, Havill, NL, Otter, JA, et al.Impact of hydrogen peroxide vapor room decontamination on Clostridium difficile environmental contamination and transmission in a healthcare Setting. Infect Control Hosp Epidemiol 2008;29:723729.
32.Otter, JA, French, GL, Adams, NM, Watling, D, Parks, MJ. Hydrogen peroxide vapour decontamination in an overcrowded tertiary care referral centre: some practical answers. J Hosp Infect 2006;62:384385.
33.Omidbakhsh, N, Sattar, SA. Broad-spectrum microbicidal activity, toxicologic assessment, and materials compatibility of a new generation of accelerated hydrogen peroxide-based environmental surface disinfectant. Am J Infect Control 2006;34:251257.
34.Perez, J, Springthorpe, VS, Sattar, SA. Activity of selected oxidizing microbicides against the spores of Clostridium difficile, relevance to environmental control. Am J Infect Control 2005;33:320325.
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Infection Control & Hospital Epidemiology
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