Clinical and cost effectiveness of eight disinfection methods for terminal disinfection of hospital isolation rooms contaminated with Clostridium difficile 027.
BACKGROUND
Clostridium difficile spores can survive in the environment for months or years, and contaminated environmental surfaces are important sources of nosocomial C. difficile transmission.


OBJECTIVE
To compare the clinical and cost effectiveness of eight C. difficile environmental disinfection methods for the terminal cleaning of hospital rooms contaminated with C. difficile spores.


METHODS
This was a novel randomized prospective study undertaken in three phases. Each empty hospital room was disinfected, then contaminated with C. difficile spores and disinfected with one of eight disinfection products: hydrogen peroxide vapour (HPV; Bioquell Q10) 350-700 parts per million (ppm); dry ozone at 25 ppm (Meditrox); 1000 ppm chlorine-releasing agent (Actichlor Plus); microfibre cloths (Vermop) used in combination with and without a chlorine-releasing agent; high temperature over heated dry atomized steam cleaning (Polti steam) in combination with a sanitizing solution (HPMed); steam cleaning (Osprey steam); and peracetic acid wipes (Clinell). Swabs were inoculated on to C. difficile-selective agar and colony counts were performed pre and post disinfection for each method. A cost-effectiveness analysis was also undertaken comparing all methods to the current method of 1000 ppm chlorine-releasing agent (Actichlor Plus).


RESULTS
Products were ranked according to the log(10) reduction in colony count from contamination phase to disinfection. The three statistically significant most effective products were hydrogen peroxide (2.303); 1000 ppm chlorine-releasing agent (2.223) and peracetic acid wipes (2.134).


CONCLUSIONS
The cheaper traditional method of using a chlorine-releasing agent for disinfection was as effective as modern methods.
Department of Infection Prevention and Control, Derby Hospitals Foundation Trust, Derby, UK.
L
L
Doan
H
H
Forrest
A
A
Fakis
J
J
Craig
L
L
Claxton
M
M
Khare
D016360:Clostridioides difficile / Q000187:drug effects / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D004202:Disinfectants / Q000008:administration & dosage; D004203:Disinfection / Q000191:economics* / Q000379:methods*; D004783:Environmental Microbiology; D006761:Hospitals; D006801:Humans; D011446:Prospective Studies; D011897:Random Allocation
D004202:Disinfectants