Enhanced Environmental Cleaning: A “no-hands” approach. Are superoxides really “super”? Effect on environmental contamination

Background: CIMR™ Infection Control Technology is an ozone-free process that continuously disinfects viruses, bacteria, and fungi by producing 0.02 ppm of hydrogen peroxide (H2O2) gas from oxygen and water vapor in the air. As the disinfectant is a gas it diffuses into places that other processes cannot reach and disinfects air ducts, air, and exposed surfaces. This methodology was found to have 99% kill of H5N8 Virus on surfaces within 2 hours (Kansas State University and Sandia Labs). Within 24 hours, a 96.4% to 99.9% microbial reduction was noted in studies of surfaces contaminated with Staphylococcus aureus (both MSSA and MRSA), E.Coli, Listeria monocytogenes, Candida albicans, Stachybotrys chartarum, Streptococcus, Pseudomonas, and spore forming Bacillus subtilus and thereafter new microbe reduction was virtually instantaneous. Similar findings were also reported by the University of Cincinnati using MS2 Bacteriophage Virus and B. subtilus.
Objective: It was hypothesized that there would be less surface contamination if H2O2 disinfectant was employed. To test this technology in a healthcare setting, units were installed in test (T) rooms. Environmental culturing was performed in T and control (C) rooms (Rs) and results compared.

Methods: 3 T and 3 CRs were selected on a high risk unit where on average 59% of patients are colonized with at least1 significant pathogen. All Rs were occupied and routine activities and care was provided. Units were installed, activated, and inspected to verify placement and function. H2O2 sampling was done using OSHA ID 126SG (impinger, with titanium oxysulfate solution) methodology and environmental culturing was performed on 4 horizontal surfaces (floor, bedside table, call button and door) in T and CRs for 3 consecutive days prior to daily cleaning. Sites were swabbed with a moistened culturette using a 1 inch² template and sent to an external lab (U.S. Micro-Solutions, Inc., Greensburg, PA). Bacteria and fungi were identified and quantitated (reported in CFU/in²⁾. Colony counts in T and CRs were compared.   

Results:

Test Room #			SAMPLE VOLUME  (L)			Hydrogen Peroxide (PPM)
A			220			< O.059
B			259			< 0.050
C			312			<0.042
Blank			---			-------
OSHA Permissible Exposure limit:  1.0 ppm.
	Test Rooms (CFUs/in2)				Control Rooms (CFUs/in2)
	A	B		C	E		F	G
Table	4	0		9	1		0	1
Door	0	0		0	0		0	0
Floor	2	1		2	0		180	228
Call button	1	0		0	215		142	22
Average	1.6				65.8
Table	1	1		-	0		30	7
Door	0	0		-	2		9	0
Floor	0	0		-	2		7	23
Call button	3	5		-	8		12	6
Average	1.25				8.8
Table	0	6		31	0		0	1
Door	1	2		42	3		0	0
Floor	0	2		0	5		4	3
Call button	1	2		1	4		0	2
Average	7.25				1.8
Overall	3.7				25.5

Conclusions:

• Overall, the test rooms demonstrated less surface contamination than control rooms.
• All sites in the test rooms had counts ≤ 42 CFUs/in²
• Of tested sites, call buttons had the highest contamination in control rooms but other sites tested in control rooms were not significantly different to tesdtroom sites. 
• Further investigation of this technology is merited.