Objective
To determine whether hydrogen peroxide vapor (HPV) decontamination can reduce environmental contamination with and nosocomial transmission of Clostridium difficile.
Design
A prospective before-after intervention study. Setting: a hospital affected by an epidemic strain of C. difficile.
Intervention
Intensive HPV decontamination of five high-incidence wards, followed by hospital-wide decontamination of rooms vacated by patients with C. difficile–associated disease (CDAD). The pre-intervention period was June 2004 through March 2005, and the intervention period was June 2005 through March 2006.
Results
11 (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 < 0.001). On the five high-incidence wards, the incidence of nosocomial CDAD was significantly lower during the intervention period than during the pre-intervention period (1.28 vs. 2.28 cases per 1,000 patient-days; P = 0.047).
The hospital-wide CDAD incidence was lower during the intervention period than during the pre-intervention period (0.84 vs. 1.36 cases per 1,000 patient-days; P = 0.26). In an analysis limited to the months in which the epidemic strain was present during both the pre-intervention and the intervention periods, CDAD incidence was significantly lower during the intervention period than during the pre-intervention period (0.88 vs. 1.89 cases per 1,000 patient-days; P = 0.047).
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.
Researchers
John M. Boyce, MD; Nancy L. Havill, MT; Jonathan A. Otter, BSc; L. Clifford McDonald, MD; Nicholas M. T. Adams, BSc; Timothea Cooper, RN; Angela Thompson, MSc; Lois Wiggs; George Killgore, DrPH; Allison Tauman, PharmD; Judith Noble-Wang, PhD.
From the Hospital of St. Raphael (J.M.B., N.L.H., T.C., A. Tauman) and Yale University School of Medicine (J.M.B.), New Haven, Connecticut; the Centers for Disease Control and Prevention, Atlanta, Georgia (L.C.M., A. Thompson, L.W., G.K., J.N.-W.); and Bioquell, Andover, United Kingdom (J.A.O., N.M.T.A.).
