Airborne hydrogen peroxide for disinfection of the hospital environment and infection control: a systematic review

Summary

We reviewed the effectiveness of airborne hydrogen peroxide as an environmental disinfectant and infection control measure in clinical settings. Systematic review identified ten studies as eligible for inclusion. Hydrogen peroxide was delivered in the form of vapour and dry mist in seven and three studies, respectively. Pathogens evaluated included meticillin-resistant Staphylococcus aureus (MRSA), Clostridium difficile and multiple bacterial types, in five, three, and two studies, respectively. Before the application of any cleaning intervention, 187/480 (39.0%; range: 18.9–81.0%) of all sampled environmental sites were found to be contaminated by the studied pathogens in nine studies that reported specific relevant data. After application of terminal cleaning and airborne hydrogen peroxide, 178/630 (28.3%; range: 11.9–66.1%) of the sampled sites in six studies and 15/682 (2.2%; range: 0–4.0%) of the sampled sites in ten studies, respectively, remained contaminated. Four studies evaluated the use of hydrogen peroxide vapour for infection control. This was associated with control of a nosocomial outbreak in two studies, eradication of persistent environmental contamination with MRSA and decrease in C. difficile infection in each of the remaining two studies.

Introduction

The inanimate hospital environment can be a source of transmission of various pathogens, including meticillin-resistant Staphylococcus aureus (MRSA), Acinetobacter baumannii, Serratia marcescens, Clostridium difficile and norovirus.1, 2, 3 Multidrug-resistant organisms can survive for prolonged periods of time on a variety of surfaces, including medical equipment and sites of the immediate patient environment.⁴ They can spread from patient to patient through contact with inanimate surfaces or via the hands of healthcare personnel.5, 6, 7

Despite emphasis for hand hygiene, implementation of transmission precautions, and use of environmental cleaning measures, nosocomial cross-transmission is an important cause of nosocomial infections and even outbreaks of multidrug-resistant organisms in many healthcare institutions.8, 9 Nosocomial infections and, particularly, nosocomial outbreaks are associated with substantial morbidity and mortality, with subsequent increase in the duration of hospital stay and in healthcare expenditures.¹⁰ Although the role of cleaning of the hospital environment in the transmission of nosocomial pathogens has not been subjected to high quality research, the effectiveness of the conventional cleaning methods for the eradication of environmental contamination by nosocomial pathogens appears to be suboptimal.8, 11 Further evaluation and use of novel disinfection methods are also necessary.¹²

One potentially novel method which has not yet received clearance by the US Food and Drug Administration, but which is increasingly used at healthcare institutions in Europe and elsewhere, is the use of airborne hydrogen peroxide delivered by specific devices.¹³ We sought to assess the effectiveness of this method of disinfection against bacterial contamination of the hospital environment and also as an infection control measure, by performing a systematic review of the literature.