title: Effectiveness of deep cleaning followed by hydrogen peroxide decontamination during high Clostridium difficile infection incidence.
abstract: BACKGROUND
  Clostridium difficile infection (CDI) remains an infection control challenge, especially when environmental spore contamination and suboptimal cleaning may increase transmission risk.
  
  
  OBJECTIVE
  To substantiate the long-term effectiveness throughout a stroke rehabilitation unit (SRU) of deep cleaning and hydrogen peroxide decontamination (HPD), following a high incidence of CDI.
  
  
  METHODS
  Extensive environmental sampling (342 sites on each occasion) for C. difficile using sponge wipes was performed: before and after deep cleaning with detergent/chlorine agent; immediately following HPD; and on two further occasions, 19 days and 20 weeks following HPD. C. difficile isolates underwent polymerase chain reaction ribotyping and multi-locus variable repeat analysis (MLVA).
  
  
  RESULTS
  C. difficile was recovered from 10.8%, 6.1%, 0.9%, 0% and 3.5% of sites at baseline, following deep cleaning, immediately after HPD, and 19 days and 20 weeks after HPD, respectively. C. difficile ribotypes recovered after deep cleaning matched those from CDI cases in the SRU during the previous 10 months. Similarly, 10/12 of the positive sites identified at 20 weeks post-HPD harboured the same C. difficile ribotype (002) and MLVA pattern as the isolate from the first post-HPD CDI case. CDI incidence [number of cases on SRU per 10 months (January-October 2011)] declined from 20 before to seven after the intervention.
  
  
  CONCLUSIONS
  HPD, after deep cleaning with a detergent/chlorine agent, was highly effective for removing environmental C. difficile contamination. Long-term follow-up demonstrated that a CDI symptomatic patient can rapidly recontaminate the immediate environment. Determining a role for HPD should include long-term cost-effectiveness evaluations.
authors.affiliation: Microbiology Department, Old Medical School, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
authors.forename: E L
authors.initials: EL
authors.lastname: Best
authors.affiliation: Microbiology Department, Old Medical School, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
authors.forename: P
authors.initials: P
authors.lastname: Parnell
authors.affiliation: Microbiology Department, Old Medical School, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
authors.forename: G
authors.initials: G
authors.lastname: Thirkell
authors.affiliation: Microbiology Department, Old Medical School, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
authors.forename: P
authors.initials: P
authors.lastname: Verity
authors.affiliation: Microbiology Department, Old Medical School, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
authors.forename: M
authors.initials: M
authors.lastname: Copland
authors.affiliation: Microbiology Department, Old Medical School, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
authors.forename: P
authors.initials: P
authors.lastname: Else
authors.affiliation: Microbiology Department, Old Medical School, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
authors.forename: M
authors.initials: M
authors.lastname: Denton
authors.affiliation: Microbiology Department, Old Medical School, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
authors.forename: R P
authors.initials: RP
authors.lastname: Hobson
authors.affiliation: Microbiology Department, Old Medical School, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK; University of Leeds, Leeds, UK. Electronic address: mark.wilcox@leedsth.nhs.uk.
authors.forename: M H
authors.initials: MH
authors.lastname: Wilcox
mesh_terms: D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000453:epidemiology* / Q000517:prevention & control*; D004202:Disinfectants / Q000008:administration & dosage*; D004203:Disinfection / Q000379:methods*; D004783:Environmental Microbiology; D006801:Humans; D006861:Hydrogen Peroxide / Q000008:administration & dosage*; D015994:Incidence
chemical_list: D004202:Disinfectants; D006861:Hydrogen Peroxide
keywords: Clostridium difficile infection; Environmental cleaning; Hospital infection; Hydrogen peroxide decontamination