Validation of Hydrogen Peroxide Vapor Technology for Terminal Cleaning of Isolation Rooms

Background:  During an outbreak of Multi-Drug Resistant Acinetobacter (MDRA), we repeatedly isolated MDRA from environmental surfaces. After re-evaluating our cleaning protocol, we were eventually able to control this outbreak by performing two terminal cleans on MDRA rooms after patient discharge.  As this is a time consuming process, we researched alternative cleaning methods.

Objective:  We sought to evaluate the use of hydrogen peroxide vapor technology as a means for cleaning isolation rooms.

Methods: Environmental Services (EVS) notified Infection Control when an isolation patient was discharged.  After EVS performed a 45 minute terminal clean of the room with bleach, environmental culturing was done.  Ten to twelve cultures were taken per room with BBL Culture Swabs (IVD) and included monitor buttons, sinks, bedrails, mattresses, supply cabinets, IV poles, call buttons, telephones, and door handles.  The same room was then treated with hydrogen peroxide vapor (Bioquell system) and the exact same sites were cultured again.  Swabs were incubated in tubes of enrichment media for 48 hours at 35° C in a shaking incubator.  Swabs were then plated to blood agar plates and incubated for another 48 hours at 35° C.  Plates with bacterial growth were subcultured and identified using routine microbiological processes.

Results:  A total of 6 rooms and 68 different surfaces were cultured.  Of the 68 cultures taken after EVS cleaned the rooms, 48 (72%) were positive for growth.  Of the 68 cultures taken after the rooms were cleaned with hydrogen peroxide vapor, 14 (22%) were positive for growth.  Ninety-two percent of growth after EVS cleaning was SSNA/Bacillus, 6% was multi-drug resistant gram-negatives, and 2% was Micrococcus.  All growth after hydrogen peroxide vapor cleaning was SSNA/Bacillus.

Conclusions: The use of hydrogen peroxide vapor technology is recommended for terminal cleans of isolation rooms as it effectively reduces the amount of bacterial growth on environmental surfaces.