title: Efficiency of hydrogen peroxide in improving disinfection of ICU rooms.
abstract: BACKGROUND
  The primary objective of this study was to determine the efficiency of hydrogen peroxide (H₂O₂) techniques in disinfection of ICU rooms contaminated with multidrug-resistant organisms (MDRO) after patient discharge. Secondary objectives included comparison of the efficiency of a vaporizator (HPV, Bioquell) and an aerosolizer using H₂O₂, and peracetic acid (aHPP, Anios) in MDRO environmental disinfection, and assessment of toxicity of these techniques.
  
  
  METHODS
  This prospective cross-over study was conducted in five medical and surgical ICUs located in one University hospital, during a 12-week period. Routine terminal cleaning was followed by H₂O₂ disinfection. A total of 24 environmental bacteriological samplings were collected per room, from eight frequently touched surfaces, at three time-points: after patient discharge (T0), after terminal cleaning (T1) and after H₂O₂ disinfection (T2).
  
  
  RESULTS
  In total 182 rooms were studied, including 89 (49%) disinfected with aHPP and 93 (51%) with HPV. At T0, 15/182 (8%) rooms were contaminated with at least 1 MDRO (extended spectrum β-lactamase-producing Gram-negative bacilli 50%, imipenem resistant Acinetobacter baumannii 29%, methicillin-resistant Staphylococcus aureus 17%, and Pseudomonas aeruginosa resistant to ceftazidime or imipenem 4%). Routine terminal cleaning reduced environmental bacterial load (P <0.001) without efficiency on MDRO (15/182 (8%) rooms at T0 versus 11/182 (6%) at T1; P = 0.371). H₂O₂ technologies were efficient for environmental MDRO decontamination (6% of rooms contaminated with MDRO at T1 versus 0.5% at T2, P = 0.004). Patient characteristics were similar in aHPP and HPV groups. No significant difference was found between aHPP and HPV regarding the rate of rooms contaminated with MDRO at T2 (P = 0.313). 42% of room occupants were MDRO carriers. The highest rate of rooms contaminated with MDRO was found in rooms where patients stayed for a longer period of time, and where a patient with MDRO was hospitalized. The residual concentration of H₂O₂ appears to be higher using aHPP, compared with HPV.
  
  
  CONCLUSIONS
  H₂O₂ treatment is efficient in reducing MDRO contaminated rooms in the ICU. No significant difference was found between aHPP and HPV regarding their disinfection efficiency.
authors: Critical Care Center, University Hospital of Lille, Rue E. Laine, 59037, Lille Cedex, France. caroline.blazejewski@gmail.com.
authors: Caroline
authors: C
authors: Blazejewski
authors: Microbiology Department, University Hospital of Lille, boulevard du Pr. Leclercq, 59000, Lille Cedex, France. frederic.wallet@chru-lille.fr.
authors: Frédéric
authors: F
authors: Wallet
authors: Critical Care Center, University Hospital of Lille, Rue E. Laine, 59037, Lille Cedex, France. anahita.rouze@chru-lille.fr.
authors: Anahita
authors: A
authors: Rouzé
authors: Microbiology Department, University Hospital of Lille, boulevard du Pr. Leclercq, 59000, Lille Cedex, France. remy.leguern@chru-lille.fr.
authors: Rémi
authors: R
authors: Le Guern
authors: Critical Care Center, University Hospital of Lille, Rue E. Laine, 59037, Lille Cedex, France. sylvie.ponthieux@chru-lille.fr.
authors: Sylvie
authors: S
authors: Ponthieux
authors: Statistics Department, University Hospital of Lille, 1 place de Verdun, 59037, Lille Cedex, France. jsalleron@gmail.com.
authors: Julia
authors: J
authors: Salleron
authors: Critical Care Center, University Hospital of Lille, Rue E. Laine, 59037, Lille Cedex, France. s-nseir@chru-lille.fr.|Medicine School, Univeristy of Lille, 1 place de Verdun, 59037, Lille Cedex, France. s-nseir@chru-lille.fr.
authors: Saad
authors: S
authors: Nseir
mesh_terms: D003428:Cross Infection / Q000517:prevention & control*; D018592:Cross-Over Studies; D004202:Disinfectants / Q000494:pharmacology* / Q000627:therapeutic use; D004203:Disinfection / Q000295:instrumentation* / Q000379:methods; D024901:Drug Resistance, Multiple, Bacterial / Q000187:drug effects; D004526:Efficiency; D006861:Hydrogen Peroxide / Q000494:pharmacology* / Q000627:therapeutic use; D007362:Intensive Care Units / Q000592:standards*; D010362:Patients' Rooms / Q000592:standards; D010463:Peracetic Acid / Q000494:pharmacology / Q000627:therapeutic use; D011446:Prospective Studies; D014835:Volatilization
chemical_list: D004202:Disinfectants; D006861:Hydrogen Peroxide; D010463:Peracetic Acid
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