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Dear Margaret,
I tried to send you some documents as an attachment but they got sent back to you. If you’d like any of the attachments referred to below, let me know.
Back in 2004, Bioquell began a research project into the eradication of nosocomial pathogens from the hospital environment with a team from St. Thomas’ Hospital (London) and King’s College London led by Professor Gary French. This has led to a paper demonstrating the in vitro efficacy of HPV against a range of nosocomial pathogens, including C. difficile spores, MRSA, VRE, Acinetobacter and Klebsiella (Otter 2009, attached) and a paper showing that HPV is considerably more effective than conventional terminal cleaning for the inactivation of MRSA on hospital surfaces (French 2004, attached).
Bioquell has been deployed to help to control outbreaks of various pathogens in hospitals in the UK, Europe, the Far East and the USA. Outbreaks have includes MRSA on surgical wards (Dryden 2008 and Jeanes 2005, attached), Gram-negatives on critical care units (Bates 2005 and Otter 2010, attached) and C. difficile outbreaks.
Three studies to date have been published suggesting that the routine use of HPV to decontaminate rooms and clinical areas vacated by patients with MDROs can reduce the incidence of acquisition.
Boyce 2008 (attached). In 2005 Bioquell began a non-randomised prospective intervention trial controlled using historical infection rate data to investigate the impact of a hospital-wide routine use of HPV in a 500-bed university affiliated hospital, in collaboration with the US CDC. Eleven of 43 (25.6%) sponge cultures of surfaces obtained before HPV decontamination yielded C. difficile, compared with none of 37 cultures obtained after HPV decontamination (P 0.0006). On 5 wards with the highest incidence of CDI before the study, the incidence of nosocomial CDI was significantly lower during the intervention period than during the pre-intervention period (1.28 vs 2.28 cases per 1000 patient-days, respectively) (P 0.047). Hospital-wide CDI incidence was lower during the intervention period than during the pre-intervention period (0.84 vs 1.36 cases per 1000 patient-days, respectively, P 0.26). If analysis was limited to months when the epidemic strain was present both during the pre-intervention and intervention periods, CDI incidence was significantly lower during the intervention period than during the pre-intervention period (0.88 vs 1.89 cases per 1000 patient-days, respectively) (P 0.047). HPV decontamination was efficacious in eradicating C. difficile from contaminated surfaces and the reduction in the rate of nosocomial CDI was associated with the hospital-wide use of HPV. As we discuss, this paper
Passaretti 2008 (abstract attached). A prospective study conducted in collaboration with John Hopkins Hospital investigated the impact of the routine use of HPV on six ICUs. Three ICUs were used as controls and three as intervention units. Whilst the incidence of VRE acquisition reduced on both the control and intervention units, when the data were analysed on a patient level, when the prior room occupant had VRE, patients admitted to rooms that had been decontaminated using HPV were 78% less likely to acquire VRE (IRR 95%CI 0.06, 0.80; p0.02) than patients admitted to rooms that had been cleaned using standard methods. These data are currently being written up for publication.
Manian 2010 (abstract attached). A prospective study from Dr Manian and his team at St. John’s Mercy Medical Center in St. Louis investigated the impact of the routine hospital-wide use of hydrogen peroxide vapour (HPV) decontamination. The HPV decontamination was implemented to prioritize rooms vacated by patients with multidrug-resistant Acinetobacter baumannii-calcoaceticus (MDRABC), followed by Clostridium difficile then vancomycin-resistant enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA). Following one year’s intervention, and using historical data as a control, significant reductions in nosocomial infection rates occurred for VRE (incidence rate ratio, IRR 0.50, p<0.001) and C. difficile (IRR 0.60, p<0.001), a near significant reduction occurred for MRSA (IRR 0.76, p 0.059) and a large reduction occurred for MDRAB (IRR 0.47, p 0.23) that did not reach statistical significance due to the small number of cases. These data show that routine use of HPV can reduce nosocomial infection acquisition in an endemic setting. I understand that Dr Manian is almost ready to submit this.
Other work has investigated the feasibility of routine use of the technology in busy hospitals, for example a recent paper in ICHE (Otter, 2009b) and a report from the UK Department of Health (also attached).
The UK government has conducted an independent assessment of the Bioquell system by a group of UK experts called the Rapid Review Panel, who awarded recommendation 1 status, meaning that 'Basic research and development, validation and recent in use evaluations have shown benefits that should be available to NHS bodies to include as appropriate in their cleaning, hygiene or infection control protocols.' (See attached report, Bioquell – Hydrogen Peroxide Vapour).
There is another hydrogen peroxide system on the market – the ASP Glosair system (which has been derived from the Sterinis system). They use a different system – producing an aerosol from a mixture of hydrogen peroxide and silver. There are important differences in these two systems that are addressed in an editorial by Boyce et al. (2009, attached). It is worth noting that the Sterinis system has been awarded a recommendation 3 from the Rapid Review Panel, meaning that it is 'A potentially useful new concept but insufficiently validated; more research and development is required before it is ready for evaluation in practice.'
Let me know if I can be of any further assistance.
Jon
Dear Margaret,
Your question to the AICA has filtered through to me. I appreciate that I may not exactly answer your question, but I hope that the information will be helpful.
I work for Bioquell, a company that provides hydrogen peroxide vapour (HPV) decontamination services and equipment. I am based in the UK but we have some distributors covering Australia and our Asia-Pacific HQ is in Singapore. I have attached a few papers describing the use of this technology in hospitals in the UK and USA, which may of interest to you.
I have recently been in touch with Prof David McGechie (from Fremantle) who is possibility going to try out a Bioquell system in Australia.
If you'd like any more information, please let me know.
Regards
Jon
Jon Otter
Scientific Director, Healthcare
Bioquell UK LtdT: +44 (0)1264 325 090
M: +44 (0)7970 111 151
F: +44 (0)1264 835 917
E: jon.otter@bioquell.comHi All,
Are any of you using peroxide cleaning solutions or wipes in your hospitals? What is your experience?
Regards,
Margaret Davidson
CNC Infection Control
Bentley Health Service
Bentley
WA 6108Click here to report this email as spam.
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We recently trialled Hydrogen peroxide wipes during an outbreak of Norovirus. I have a report which I can share. They were very successful, and the outbreak was well contained. Although there were many complaints about the vinegary smell, we actually found that it was a good indicator that the correct rooms had been cleaned appropriately. The wipes also allowed shared equipment to be cleaned properly by nursing staff between patients. We intend to continue using this product to clean rooms with suspected/confirmed Norovirus and C.diff.
Nan Horton
Infection Control Nurse
War Memorial Hospital
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Dear Nan, dear Group,
I assume what is meant is peracetic acid, which consists of acetic acid and
hydrogen peroxide. The acetic acid gives it its vinegar smell.This has an interesting history in having been a very popular disinfectant
(like an everyday ‘bread and butter’ substance) for a long time in the
former East Germany (German Democratic Republic) before German
reunification, and was then ‘rediscovered’ in the West.It has also been popular in the food industry, because food bowls and
machinery can be disinfected efficiently with it, because the residual
substances (acetic acid and water) are completely non-toxic and
food-compatible.Best regards, Matthias.
—
Matthias Maiwald, MD, FRCPA
Consultant in Microbiology
Adj. Assoc. Prof., Natl. Univ. Singapore
Department of Pathology and Laboratory Medicine
KK Women’s and Children’s Hospital
100 Bukit Timah Road
Singapore 229899
Tel. +65 6394 8725 (Office)
Tel. +65 6394 1389 (Laboratory)
Fax +65 6394 1387Nan Horton
To
Sent by: AICA AICALIST@AICALIST.ORG.AU
Infexion cc
Connexion
Re: Peroxide cleaning solutions and
wipes30/12/2010 01:17
PMPlease respond to
AICA Infexion
ConnexionWe recently trialled Hydrogen peroxide wipes during an outbreak of
Norovirus. I have a report which I can share. They were very successful,
and the outbreak was well contained. Although there were many complaints
about the vinegary smell, we actually found that it was a good indicator
that the correct rooms had been cleaned appropriately. The wipes also
allowed shared equipment to be cleaned properly by nursing staff between
patients. We intend to continue using this product to clean rooms with
suspected/confirmed Norovirus and C.diff.
Nan Horton
Infection Control Nurse
War Memorial Hospital
WaverleyMessages posted to this list are solely the opinion of the authors, and do
not represent the opinion of AICA.Archive of all messages are available at http://aicalist.org.au/archives –
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Hi Nan, can you advise whether these cloths needed “wetting” prior to
use and if so how was this accepted by users. Were you using them for
C.difficile as well?Thanks Jacqui
Jacqueline Kennon RN; RM; CICS; B.Ed.St; Grad Dip Clin Epi
Program Manager
Infection Prevention and Health Care Epidemiology
ph. 61 03 90762820
m 0438314735
fax 90766093
e J.Kennon@alfred.org.auAlfred Health
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Melbourne VIC 3004
PO Box 315 Prahran
VIC 3181 AustraliaAlfred Health incorporates The Alfred, Caulfield Hospital and
Sandringham Hospital
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—–Original Message—–
Behalf Of Nan HortonWe recently trialled Hydrogen peroxide wipes during an outbreak of
Norovirus. I have a report which I can share. They were very
successful, and the outbreak was well contained. Although there were
many complaints about the vinegary smell, we actually found that it was
a good indicator that the correct rooms had been cleaned appropriately.
The wipes also allowed shared equipment to be cleaned properly by
nursing staff between patients. We intend to continue using this product
to clean rooms with suspected/confirmed Norovirus and C.diff.
Nan Horton
Infection Control Nurse
War Memorial Hospital
WaverleyMessages posted to this list are solely the opinion of the authors, and
do not represent the opinion of AICA.Archive of all messages are available at http://aicalist.org.au/archives
– registration and login required.Replies to this message will be directed back to the list. To create a
new message send an email to aicalist@aicalist.org.auTo send a message to the list administrator send an email to
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(without the quotes) to listserv@aicalist.org.au—
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