Hydrogen peroxide vapour (HPV) decontamination to tackle Clostridium difficile at the Kent and Sussex Hospital

Maidstone Hospital, Maidstone and Tunbridge Wells NHS Trust

Case study contributors:

Gail Locock (Lead Nurse, Infection Control, Maidstone and Tunbridge Wells NHS Trust),  Jonathan A. Otter (BIOQUELL (UK) Ltd.)

We experienced an outbreak of C. difficile-associated disease in late 2005 at Maidstone hospital. The number of cases increased from 17 to 49 between September and December 2005 and the number of cases from September - December 2005 was 45% higher than the comparable period in 2004. Most of the isolates sent off for typing during the outbreak period were ribotype 027. Many of the cases occurred on two wards; an orthopaedic and general medicine ward. The outbreak response included prompt cohort isolation of C. difficile positive patients and the implementation of a cohort ward. The number of C. difficile cases returned towards baseline levels within 6 months. Once we judged that the outbreak was under control, the cohort ward returned to normal service. We believed that potential environmental contamination with C. difficile could have been a risk following the high volume of C. difficile patients treated on the ward during the prior 6-months. Therefore, we used hydrogen peroxide vapour (HPV) decontamination to ensure that the ward was safe to re-open. We were not able to close and empty the entire ward due to bed pressures. The ward consists of four 6-bed bays, which were decontaminated sequentially in November 2006, each cycle taking two hours to complete and the cohort ward was returned to
normal service. The number of C. difficile cases in the hospital has remained at or below the baseline level for six months, and we believe that HPV decontamination was useful for the terminal decontamination of our cohort ward.

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.

Boyce JM. Environmental contamination makes an important contribution to hospital infection. J Hosp Infect 2007;65 Suppl 2:50-54

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.