title: Impact of hydrogen peroxide vapor room decontamination on Clostridium difficile environmental contamination and transmission in a healthcare setting.
abstract: OBJECTIVE
  To determine whether hydrogen peroxide vapor (HPV) decontamination can reduce environmental contamination with and nosocomial transmission of Clostridium difficile.
  
  
  METHODS
  A prospective before-after intervention study.
  
  
  METHODS
  A hospital affected by an epidemic strain of C. difficile.
  
  
  METHODS
  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.
authors.affiliation: Hospital of St. Raphael, Yale University School of Medicine, New Haven, Connecticut 06511, USA. JBoyce@srhs.org
authors.forename: John M
authors.initials: JM
authors.lastname: Boyce
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Havill
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Otter
authors.forename: L Clifford
authors.initials: LC
authors.lastname: McDonald
authors.forename: Nicholas M T
authors.initials: NM
authors.lastname: Adams
authors.forename: Timothea
authors.initials: T
authors.lastname: Cooper
authors.forename: Angela
authors.initials: A
authors.lastname: Thompson
authors.forename: Lois
authors.initials: L
authors.lastname: Wiggs
authors.forename: George
authors.initials: G
authors.lastname: Killgore
authors.forename: Allison
authors.initials: A
authors.lastname: Tauman
authors.forename: Judith
authors.initials: J
authors.lastname: Noble-Wang
mesh_terms: D016360:Clostridioides difficile / Q000187:drug effects* / Q000302:isolation & purification; D003237:Connecticut; D003428:Cross Infection / Q000517:prevention & control*; D003470:Culture Media; D003666:Decontamination / Q000379:methods*; D004761:Enterocolitis, Pseudomembranous / Q000517:prevention & control*; D006746:Hospital Bed Capacity, 500 and over; D006785:Hospitals, University; D006801:Humans; D006861:Hydrogen Peroxide / Q000008:administration & dosage / Q000494:pharmacology; D017053:Infection Control / Q000379:methods; D010362:Patients' Rooms; D014835:Volatilization
chemical_list: D003470:Culture Media; D006861:Hydrogen Peroxide