title: An evaluation of environmental decontamination with hydrogen peroxide vapor for reducing the risk of patient acquisition of multidrug-resistant organisms.
abstract: BACKGROUND
  Admission to a room previously occupied by a patient with certain multidrug-resistant organisms (MDROs) increases the risk of acquisition. Traditional cleaning strategies do not remove all environmental MDROs. We evaluated the environmental and clinical impact of hydrogen peroxide vapor (HPV) room disinfection.
  
  
  METHODS
  We performed a 30-month prospective cohort intervention study on 6 high-risk units in a 994-bed tertiary care hospital. Following a 12-month preintervention phase, HPV was implemented on 3 units to decontaminate the rooms of patients known to be infected or colonized with epidemiologically important MDROs, following their discharge. Monthly environmental samples for MDROs were collected on all study units for 3 preintervention and 6 intervention months. The risk of MDRO acquisition in patients admitted to rooms decontaminated using HPV was compared with rooms disinfected using standard methods.
  
  
  RESULTS
  The prior room occupant was known to be infected or colonized with an MDRO in 22% of 6350 admissions. Patients admitted to rooms decontaminated using HPV were 64% less likely to acquire any MDRO (incidence rate ratio [IRR], 0.36; 95% confidence interval [CI], .19-.70; P < .001) and 80% less likely to acquire VRE (IRR, 0.20; 95% CI, .08-.52; P < .001) after adjusting for other factors. The risk of acquiring Clostridium difficile, methicillin-resistant Staphylococcus aureus, and multidrug-resistant gram-negative rods individually was reduced, but not significantly. The proportion of rooms environmentally contaminated with MDROs was reduced significantly on the HPV units (relative risk, 0.65, P = .03), but not on non-HPV units.
  
  
  CONCLUSIONS
  HPV decontamination reduced environmental contamination and the risk of acquiring MDROs compared with standard cleaning protocols.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Catherine L
authors.initials: CL
authors.lastname: Passaretti
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Otter
authors.forename: Nicholas G
authors.initials: NG
authors.lastname: Reich
authors.forename: Jessica
authors.initials: J
authors.lastname: Myers
authors.forename: John
authors.initials: J
authors.lastname: Shepard
authors.forename: Tracy
authors.initials: T
authors.lastname: Ross
authors.forename: Karen C
authors.initials: KC
authors.lastname: Carroll
authors.forename: Pam
authors.initials: P
authors.lastname: Lipsett
authors.forename: Trish M
authors.initials: TM
authors.lastname: Perl
mesh_terms: D001419:Bacteria / Q000187:drug effects / Q000302:isolation & purification; D001424:Bacterial Infections / Q000382:microbiology / Q000517:prevention & control*; D015331:Cohort Studies; D003428:Cross Infection / Q000382:microbiology / Q000517:prevention & control*; D004203:Disinfection / Q000379:methods*; D024901:Drug Resistance, Multiple, Bacterial; D004784:Environmental Monitoring; D005260:Female; D005740:Gases; D006801:Humans; D006861:Hydrogen Peroxide; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D062606:Tertiary Care Centers
chemical_list: D005740:Gases; D006861:Hydrogen Peroxide