Eradication of persistent methicillin-resistant Staphylococcus aureus (MRSA) using hydrogen peroxide vapour (HPV) decontamination

Lewisham Hospital NHS Trust

(Published in Jeanes et al. J Hosp Infect 2005;61:85-86.)

Case study contributors:

Annette Jeanes (previously Lead Nurse, Infection Control, Lewisham Hospital NHS Trust), Gopal Rao (Consultant Microbiologist Lewisham Hospital NHS Trust), Jonathan A. Otter (BIOQUELL (UK) Ltd).

Ten patients were infected or colonised with MRSA on a 20-bed Nightingale design surgical ward and it appeared that cross transmission had occurred. During our outbreak investigation, we conducted environmental screening and found that 35.7% of 28 surfaces and 27.7% of 18 air samples were contaminated with MRSA. Based on these results and following consultation with the HPA, the ward was emptied and deep cleaned (a three-day process involving detergent cleaning followed by 1000ppm sodium hypochlorite and steam cleaning). However, the deep cleaning failed to eradicate MRSA; 16% of 65 surfaces remained contaminated including hand-touch sites such as telephones and Patient Line hand-held controls. The MRSA remaining on surfaces was considered to be a risk to patients so the ward with decontaminated using HPV. The process took 12 hours, was managed by BIOQUELL personnel and the ward was available for re-occupation immediately after the process. No patients acquired MRSA in the months following re-occupation of the ward. This project required close collaboration between the infection control team, ward staff, hospital managers, engineering and BIOQUELL. Decontamination using HPV provides a rapid and cost-effective method for the eradication of environmental MRSA, which provides a viable option for outbreak control in the future. Furthermore, HPV decontamination has been across our Trust since this outbreak as part of a ward renovation project.

Other information or references:

Bates CJ, Pearse R. Use of hydrogen peroxide vapour for environmental control during a Serratia outbreak in a neonatal intensive care unit. J Hosp Infect 2005;61:364-366.

French GL, Otter JA, Shannon KP, Adams NM, Watling D, Parks MJ. Tackling contamination of the hospital environment by methicillin-resistant Staphylococcus aureus (MRSA): a comparison between conventional terminal cleaning and hydrogen peroxide vapour decontamination. J Hosp Infect 2004;57:31-37.

Jeanes A, Rao G, Osman M, Merrick P. Eradication of persistent environmental MRSA. J Hosp Infect 2005;61:85-86.

Johnston MD, Lawson S, Otter JA. Evaluation of hydrogen peroxide vapour as a method for the decontamination of surfaces contaminated with Clostridium botulinum spores. J Microbiol Methods 2005;60:403-411.

Otter J. Bio-deactivation of hospital pathogens. Health Estate 2005;59:41-44.

Otter JA, French GL, Adams NM, Watling D, Parks MJ. Hydrogen peroxide vapour decontamination in an overcrowded tertiary care referral centre: some practical answers. J Hosp Infect 2006;62:384-385.

Rogers JV, Sabourin CL, Choi YW, Richter WR, Rudnicki DC, Riggs KB, Taylor ML, Chang J. Decontamination assessment of Bacillus anthracis, Bacillus subtilis, and Geobacillus stearothermophilus spores on indoor surfaces using a hydrogen peroxide gas generator. J Appl Microbiol 2005;99:739-748.