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Infection Control & Hospital Epidemiology Article, Published July 2008

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

John M. Boyce, MD; Nancy L. Havill, MT; Jonathan A. Otter, BSc; L. Clifford McDonald, MD; Nicholas M. T. Adams, BSc; Timothea Cooper, RN; Angela Thompson, MSc; Lois Wiggs; George Killgore, DrPH; Allison Tauman, PharmD; Judith Noble-Wang, PhD

From the Hospital of St. Raphael (J.M.B., N.L.H., T.C., A. Tauman) and Yale University School of Medicine (J.M.B.), New Haven, Connecticut; the Centers for Disease Control and Prevention, Atlanta, Georgia (L.C.M., A. Thompson, L.W., G.K., J.N.-W.); and Bioquell, Andover, United Kingdom (J.A.O., N.M.T.A.).

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 significantly 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.

Received August 15, 2007; accepted April 23, 2008; electronically published July 17th, 2008.

To view the ICHE abstract and download the full article, Click here...

  • Address reprint requests to John M. Boyce, MD, Infectious Diseases Section, Hospital of Saint Raphael, 1450 Chapel Street, New Haven, CT 06511 ().

  • The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

  • Presented in part: 16th Annual Scientific Meeting of the Society for Healthcare Epidemiology of America; Chicago, IL; March 2006.
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