Hostname: page-component-8448b6f56d-c4f8m Total loading time: 0 Render date: 2024-04-18T16:30:59.978Z Has data issue: false hasContentIssue false
  • English
  • Français

Impact of Hydrogen Peroxide Vapor Room Decontamination on Clostridium difficile Environmental Contamination and Transmission in a Healthcare Setting

Published online by Cambridge University Press:  02 January 2015

John M. Boyce ,
Nancy L. Havill ,
Jonathan A. Otter ,
L. Clifford McDonald ,
Nicholas M. T. Adams ,
Timothea Cooper ,
Angela Thompson ,
Lois Wiggs ,
George Killgore  and
Allison Tauman
...Show all authors
John M. Boyce*
Affiliation:
Hospital of St. Raphael, New Haven, Connecticut Yale University School of Medicine, New Haven, Connecticut
Nancy L. Havill
Affiliation:
Hospital of St. Raphael, New Haven, Connecticut
Jonathan A. Otter
Affiliation:
Bioquell, Andover, United Kingdom
L. Clifford McDonald
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia
Nicholas M. T. Adams
Affiliation:
Bioquell, Andover, United Kingdom
Timothea Cooper
Affiliation:
Hospital of St. Raphael, New Haven, Connecticut
Angela Thompson
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia
Lois Wiggs
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia
George Killgore
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia
Allison Tauman
Affiliation:
Hospital of St. Raphael, New Haven, Connecticut
Judith Noble-Wang
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia
*
Infectious Diseases Section, Hospital of Saint Raphael, 1450 Chapel Street, New Haven, CT 06511 (JBoyce@srhs.org)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To determine whether hydrogen peroxide vapor (HPV) decontamination can reduce environmental contamination with and nosocomial transmission of Clostridium difficile.

Design.

A prospective before-after intervention study.

Setting.

A hospital affected by an epidemic strain of C. difficile.

Intervention.

Intensive HPV decontamination of 5 high-incidence wards followed by hospital-wide decontamination of rooms vacated by patients with C. difficile-associated disease (CDAD). The preintervention period was June 2004 through March 2005, and the intervention period was June 2005 through March 2006.

Results.

Eleven (25.6%) of 43 cultures of samples collected by sponge from surfaces before HPV decontamination yielded C. difficile, compared with 0 of 37 cultures of samples obtained after HPV decontamination (P < .001). On 5 high-incidence wards, the incidence of nosocomial CDAD was significantly lower during the intervention period than during the preintervention period (1.28 vs 2.28 cases per 1,000 patient-days; P = .047). The hospital-wide CDAD incidence was lower during the intervention period than during the preintervention period (0.84 vs 1.36 cases per 1,000 patient-days; P = .26). In an analysis limited to months in which the epidemic strain was present during both the preintervention and the intervention periods, CDAD incidence was significandy lower during the intervention period than during the preintervention period (0.88 vs 1.89 cases per 1,000 patient-days; P = .047).

Conclusions.

HPV decontamination was efficacious in eradicating C. difficile from contaminated surfaces. Further studies of the impact of HPV decontamination on nosocomial transmission of C. difficile are warranted.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 8 , August 2008 , pp. 723 - 729
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.McFarland, LV. Diarrhea acquired in the hospital. Gastroenterol Clin N Am 1993;22:563–577.Google Scholar
2.Morris, AM, Jobe, BA, Stoney, M, Sheppard, BC, Deveney, CW, Deveney, KE. Clostridium difficile colitis: an increasingly aggressive iatrogenic disease? Arch Surg 2002;137:1096–1100.CrossRefGoogle ScholarPubMed
3.Archibald, LK, Banerjee, SN, Jarvis, WR. Secular trends in hospital-acquired Clostridium difficile disease in the United States, 1987-2001. J Infect Dis 2004;189:1585–1589.Google Scholar
4.Dallal, RM, Harbrecht, BG, Goujoukas, AJ, et al.Fulminant Clostridium difficile: an underappreciated and increasing cause of death and complications. Ann Surg 2002;235:363–372.Google Scholar
5.McDonald, LC, Owings, M, Jernigan, DB. Clostridium difficile infection in patients discharged from US short-stay hospitals, 1996-2003. Emerg Infect Diseases 2006;12:409–415.CrossRefGoogle ScholarPubMed
6.Loo, VG, Poirier, L, Miller, MA, et al.A predominantly clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality. N Engl J Med 2005;353:2442–2449.Google Scholar
7.McDonald, LC, Killgore, GE, Thompson, A, et al.An epidemic, toxin gene-variant strain of Clostridium difficile. N Engl J Med 2005;353:2433–2441.Google Scholar
8.Boyce, JM, Havill, NL, McDonald, LC, et al.An outbreak of severe Clostridium difficile-associated disease involving an epidemic strain with increased virulence. In: Program and abstracts of the 15th Annual Scientific Meeting of the Society for Healthcare Epidemiology of America; April 9-12, 2005; Los Angeles, CA. Abstract 59.Google Scholar
9.Mulligan, ME, George, WL, Rolfe, RD, Finegold, SM. Epidemiological aspects of Clostridium difficile-induced diarrhea and colitis. Am J Clin Nutr 1980;33:2533–2538.CrossRefGoogle ScholarPubMed
10.Fekety, R, Kim, K-H, Brown, D, Batts, DH, Cudmore, M, Silva, J Jr. Epidemiology of antibiotic-associated colitis: isolation of Clostridium difficile from the hospital environment. Am J Med 1981;70:906–908.Google Scholar
11.Samore, MH, Venkataraman, L, Degirolami, PC, Levin, E, Karchmer, AW. Clinical and molecular epidemiology of sporadic and clustered cases of nosocomial Clostridium difficile diarrhea. Am J Med 1996;100:32–40.Google Scholar
12.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;60:403–411.CrossRefGoogle ScholarPubMed
13.French, GL, Otter, JA, Shannon, KP, Adams, NMT, Watling, D, Parks, MJ. Tackling contamination of the hospital environment by methicillin-resistant Staphylococcus aureus (MRSA): a comparison between conventional terminal cleaning and hydrogen peroxide vapour decontamination. J Hosp Infect 2004;57:31–37.Google Scholar
14.Dubberke, ER, Reske, KA, Noble-Wang, J, et al.Prevalence of Clostridium difficile environmental contamination and strain variability in multiple health care facilities. Am J Infect Cont 2007;35:315–318.CrossRefGoogle ScholarPubMed
15.NNIS System. National Nosocomial Infections Surveillance (NNIS) System report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004;32:470–485.Google Scholar
16.World Health Organization (WHO). Anatomical therapeutic chemical (ATC) classification index with defined daily doses (DDD). Oslo, Norway: WHO Collaborating Centre for Drug Statistics Methodology; 2004.Google Scholar
17.Gerding, DN, Johnson, S, Peterson, LR, Mulligan, ME, Silva, J Jr. Clostridium difficile-associated diarrhea and colitis. Infect Control Hosp Epidemiol 1995;16:459–477.Google Scholar
18.Simor, AE, Bradley, SF, Strausbaugh, LJ, Crossley, K, Nicolle, LE, SHEA Long-Term-Care Committee. Clostridium difficile in long-term-care facilities for the elderly. Infect Control Hosp Epidemiol 2002;23:696–703.Google Scholar
19.Johnson, S, Gerding, DN, Olson, MM, et al.Prospective, controlled study of vinyl glove use to interrupt Clostridium difficile nosocomial transmission. Am J Med 1990;88:137–140.Google Scholar
20.Rutala, WA. APIC guideline for selection and use of disinfectants. 1994, 1995, and 1996 APIC Guidelines Committee. Association for Professionals in Infection Control and Epidemiology, Inc. Am J Infect Control 1996;24:313–342.Google Scholar
21.Mayfield, JL, Leet, T, Miller, J, Mundy, LM. Environmental control to reduce transmission of Clostridium difficile. Clin Infect Dis 2000;31:995–1000.CrossRefGoogle Scholar
22.Worsley, MA. Infection control and prevention of Clostridium difficile infection. J Antimicrob Chemother 1998;41(Suppl C):59–66.Google Scholar
23.Sehulster, L, Chinn, RY, CDC, HICPAC. Guidelines for environmental infection control in health-care facilities. Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). MMWR Recomm Rep 2003;52(RR-10):1–42.Google Scholar
24.Rutala, WA, Weber D, J. Use of inorganic hypochlorite (bleach) in healthcare facilities. Clin Microbiol Rev 1997;10:597–610.Google Scholar
25.Larson, HE, Barclay, FE, Honour, P, Hill, ID. Epidemiology of Clostridium difficile in infants. J Infect Dis 1982;146:727–733.Google Scholar
26.Wilcox, MH, Settle, C, Parnell, P, Porter, C, Keer, V, Hawkey, P. Isolation of patients with Clostridium difficile infection. J Hosp Infect 1997;37:331–343.CrossRefGoogle ScholarPubMed
27.McFarland, LV, Mulligan, ME, Kwok, RYY, Stamm, WE. Nosocomial acquisition of Clostridium difficile infection. N Engl J Med 1989;320:204–210.Google Scholar
28.Kaatz, GW, Gitlin, SD, Schaberg, DR, et al.Acquisition of Clostridium difficile from the hospital environment. Am J Epidemiol 1988;127:1289–1294.Google Scholar
29.Struelens, MJ, Maas, A, Nonhoff, C, et al.Control of nosocomial transmission of Clostridium difficile based on sporadic case surveillance. Am J Med 1991;91(Suppl 3B):138–144.Google Scholar
30.Fawley, WN, Wilcox, MH. Molecular epidemiology of endemic Clostridium difficile infection. Epidemiol Infect 2001;126:343–350.Google Scholar
31.Savage, AM, Alford, RH. Nosocomial spread of Clostridium difficile. Infect Control 1983;4:31–33.CrossRefGoogle ScholarPubMed
32.McFarland, LV. Epidemiology of infectious and iatrogenic nosocomial diarrhea in a cohort of general medicine patients. Am J Infect Control 1995;23:295–305.Google Scholar
33.Brooks, SE, Veal, RO, Kramer, M, Dore, L, Schupf, N, Adachi, M. Reduction in the incidence of Clostridium difficile associated diarrhea in an acute care hospital and a skilled nursing facility following replacement of electronic thermometers with single-use disposables. Infect Control Hosp Epidemiol 1992;13:98–103.CrossRefGoogle Scholar
34.Jernigan, JA, Siegman-Igra, Y, Guerrant, RC, Farr, BM. A randomized crossover study of disposable thermometers for prevention of Clostridium difficile and other nosocomial infections. Infect Control Hosp Epidemiol 1998;19:494–499.CrossRefGoogle ScholarPubMed
35.Bhalla, A, Pultz, NJ, Gries, DM, et al.Acquisition of nosocomial pathogens on hands after contact with environmental surfaces near hospitalized patients. Infect Control Hosp Epidemiol 2004;25:164–167.CrossRefGoogle ScholarPubMed
36.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;54:109–114.CrossRefGoogle ScholarPubMed
37.Apisarnthanarak, A, Zack, JE, Mayfield, JL, et al.Effectiveness of environmental and infection control programs to reduce transmission of Clostridium difficile. Clin Infect Dis 2004;39:601–602.Google Scholar
38.Otter, JA, Cummins, M, Ahmad, F, van Tonder, C, Drabu, YJ. Assessing the biological efficacy and rate of recontamination following hydrogen peroxide vapour decontamination. J Hosp Infect 2007;67:182–188.CrossRefGoogle ScholarPubMed
39.Bates, CJ, Pearse, R. Use of hydrogen peroxide vapour for environmental control during a Serratia outbreak in a neonatal intensive care unit. J Hosp Infect 2006;61:364–366.Google Scholar
40.Otter, JA, French, GL, Adams, NMT, Watling, D, Parks, MJ. Hydrogen peroxide vapour decontamination in an overcrowded tertiary care referral centre: some practical answers. J Hosp Infect 2006;62:384–392.Google Scholar