APIC Greater NY Chapter 13 Journal Club Session January 20, 2016 by Yuri Castillo RN BSN CIC Infection Prevention and Control Department /

Improved Hydrogen Peroxide (from Environmental Services, APIC Text, 4th ed. 2015) Improved hydrogen peroxide –contains very low levels of anionic and/or nonionic surfactants in an acidic product that act with hydrogen peroxide to produce microbiocidal activity  speeds antimicrobial activity and cleaning efficiency Improved hydrogen peroxide has the lowest EPA toxicity category (i.e., category IV) based on its oral, inhalation, and dermal toxicity which means it is practically nontoxic and is not an irritant. Prepared and marketed by several companies in various concentrations (e.g., 0.5 to 7 percent) (from Environmental Services, APIC Text, 4th ed. 2015) May be termed "accelerated" or "activated."

Improved Hydrogen Peroxide (from Environmental Services, APIC Text, 4th ed. 2015) Lower concentrations (i.e., 0.5 percent, 1.4 percent)  low-level disinfection of noncritical environmental surfaces and patient care objects Higher concentrations (e.g., 2 percent)  high-level disinfectants for semi-critical medical devices (e.g., endoscopes) Improved hydrogen peroxide products were superior or similar to the quaternary ammonium compound tested EPA-registered contact time that is substantially less (e.g., 30 seconds, 1 minute for bacteria) than most EPA-registered low-level disinfectants Rutala WA, Gergen MF, Weber DJ. Efficacy of improved hydrogen peroxide against important healthcare- associated pathogens. Infect Control Hosp Epidemiol2012;33:1159–1161 Rutala, Gergen, Weber, 2012, unpublished data: 1.4 percent activated hydrogen peroxide is very effective in reducing microbial contamination of hospital privacy curtains.

Effectiveness of a Hydrogen Peroxide Spray for Decontamination of Soft Surfaces in Hospitals AJIC - July 16, 2015 Article Goals –To evaluate the effectiveness of the IHP (1.4%) solution for decontamination of a wide range of soft surfaces in inpatient and outpatient settings in 2 Cleveland area hospitals Laboratory based and hospital trial –2 Cleveland area hospitals – a Veterans Affairs hospital and a community hospital

Effectiveness of a Hydrogen Peroxide Spray for Decontamination of Soft Surfaces in Hospitals AJIC - July 16, 2015 Laboratory Based (repeated 3x) 3 strains of MRSA & VRE 10uL aliquots with 6 log 10 CFUs Suspended in deionized water Dried then spread on 1 cm 2 section from hospital curtain, Allowed to dry 1:10 Bleach IHP Sterile Saline

Effectiveness of a Hydrogen Peroxide Spray for Decontamination of Soft Surfaces in Hospitals AJIC - July 16, 2015 Healthcare Facility Based Veterans Affairs hospital and community Hospital: 10 hospital rooms from multiple wards, 25 outpatient clinic rooms, the physical therapy department, and patient waiting rooms. Total 433 surfaces Surfaces swabbed and cultured IHP- 1 min contact time Surfaces swabbed and cultured

Effectiveness of a Hydrogen Peroxide Spray for Decontamination of Soft Surfaces in Hospitals AJIC - July 16, 2015

Spray application of IHP significantly reduced recovery of total heterotrophic bacteria, facultative and aerobic gram-negative bacilli, MRSA, and VRE from soft surfaces. On carriers made from privacy curtain fabric, both IHP and the 1:10 dilution of household bleach resulted in a 6 log10 CFU reduction in VRE and MRSA with a 1-minute contact time in the presence or absence of organic load.

Effectiveness of a Hydrogen Peroxide Spray for Decontamination of Soft Surfaces in Hospitals AJIC - July 16, 2015 Conclusion : Results suggest that spraying soft surfaces with IHP could provide a simple and effective means to reduce contamination with health care associated pathogens. Limitations: In laboratory testing, a small number of organisms and strains were tested, and only 1 disinfectant was tested as a competitor to IHP. Did not assess the efficacy of IHP in the presence or absence of mechanical removal. Although we observed no adverse effects on the surfaces tested, it should be noted that the manufacturer does not recommend that the IHP product be used on aluminum, copper, galvanized steel, or silver. Concerns with fragrance