Evaluation of a New Hydrogen Peroxide Wipe DisinfectantAuthor(s): John M. Boyce, MD; Nancy L. Havill, MT, CICSource: Infection Control and Hospital Epidemiology, Vol. 34, No. 5, Special Topic Issue: TheRole of the Environment in Infection Prevention (May 2013), pp. 521-523Published by: The University of Chicago Press on behalf of The Society for Healthcare Epidemiologyof AmericaStable URL: http://www.jstor.org/stable/10.1086/670212 .

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infection control and hospital epidemiology may 2013, vol. 34, no. 5

c o n c i s e c o m m u n i c a t i o n

figure 1. Percentage of sites yielding no growth after cleaning. BP,blood pressure.

Evaluation of a New Hydrogen PeroxideWipe Disinfectant

John M. Boyce, MD;1,2 Nancy L. Havill, MT, CIC1

A new activated hydrogen peroxide wipe disinfectant was used todisinfect 10 high-touch surfaces in 72 patient rooms. After cleaning,99% of surfaces yielded less than 2.5 colony-forming units/cm2, 75%yielded no growth, and 70% yielded adenosine triphosphate countsof less than 250 relative light units. The new disinfectant was highlyeffective.

Infect Control Hosp Epidemiol 2013;34(5):521-523

Current guidelines recommend cleaning of noncritical items,including environmental surfaces, on a regular basis.1 Dis-infectants used in hospitals include quaternary ammoniumcompounds, dilute sodium hypochlorite (bleach), phenolicdisinfectants, and activated hydrogen peroxide. We conducteda prospective study to evaluate the efficacy of a new activatedhydrogen peroxide disinfectant wipe using aerobic colonycounts and an adenosine triphosphate bioluminescence assay.

methods

A convenience sample of 72 patient rooms in a 500-bed uni-versity-affiliated hospital was included in this study. Ten high-touch surfaces were sampled before and after cleaning witha hydrogen peroxide wipe (Activated Hydrogen Peroxide;Clorox Healthcare). The 10 sites sampled included bedsiderails, over-bed table, television remote control, telephone,bedside panel, chair arm, blood pressure cuff, toilet seat, grabbar, and faucet handles. Sampling of the sites was conductedusing 2 methods. Dey/Engley (D/E) neutralizing contact agarplates (Becton-Dickinson or Remel) were used to determineaerobic colony counts (ACCs) before and after cleaning. Sur-faces yielding less than 2.5 colony-forming units (cfu)/cm2

or 65 colonies per plate were considered clean.2,3 Because thisseemed rather high, we also decided arbitrarily to calculatethe proportion of surfaces that yielded less than 0.4 cfu/cm2,which is equivalent to 10 colonies per contact plate. Surfacesthat yielded no growth before cleaning were omitted fromfurther analysis of ACC results, because such surfaces thatwere already considered clean prior to the use of the newhydrogen peroxide wipe would not yield useful informationregarding its effectiveness.

An adenosine triphosphate (ATP) bioluminescence assaysystem (CleanTrace; 3M) was also used to sample each sitebefore and after cleaning.4 An area of approximately 25.6 cm2

(equivalent to the surface area of a contact plate) on eachsite was sampled with the specialized swabs used with thebioluminescence assay. Results were recorded as relative light

units (RLUs). Surfaces yielding less than 250 RLUs were con-sidered to be clean.2,4 Surfaces that yielded less than 250 RLUsbefore cleaning were omitted from further analysis of ATPresults.

results

A total of 16 surfaces that yielded no growth before cleaningwere excluded from the analysis of ACCs. Ninety-nine percentof the cultures (698 of 704) yielded ACCs less than 2.5 cfu/cm2, whereas 96% (679 of 704) yielded ACCs less than 0.4cfu/cm2 after cleaning. Seventy-five percent (528 of 704)yielded no growth after cleaning. The proportion of sitesyielding no growth after cleaning ranged from 53% to 89%for the 10 sites ( ; Figure 1). The median ACC beforeP ! .001cleaning was 63.1 cfu, whereas the median ACC after cleaningwas 0 cfu.

A total of 163 of the 720 surfaces yielded ATP readings ofless than 250 RLUs before cleaning and were excluded fromthe ATP analyses. Overall, 69.7% of the sites (388 of 557)yielded ATP readings of less than 250 RLUs after cleaning.The proportion of the 10 sites that yielded less than 250 RLUsranged from 43.3% to 96.8% ( ; Figure 2). The twoP ! .001individuals who applied the product to the high-touch sur-faces did not experience any adverse effects while using theproduct.

discussion

To the best of our knowledge, our study is the first to evaluatethe efficacy of a new activated hydrogen peroxide wipe dis-infectant on surfaces in patient care settings. Seventy-five per-cent of 704 high-touch surfaces yielded no growth after useof the new hydrogen peroxide wipe product, and 99% ofsurfaces met currently proposed ACC standards for cleanli-ness after use of the wipe. The percentage of sites that yielded

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522 infection control and hospital epidemiology may 2013, vol. 34, no. 5

figure 2. Percentage of sites yielding less than 250 relative lightunits after cleaning. BP, blood pressure.

no growth after use of the product varied by site, which isnot surprising. Earlier studies that used a different disinfec-tant also yielded variable ACCs and ATP values after cleaningof similar high-touch surfaces,4 perhaps because of variabilityin the amount of contact with surfaces and the type of ma-terial from which objects are made. Our study confirms arecent laboratory-based study that demonstrated the effec-tiveness of the new activated hydrogen peroxide wipe dis-infectant.5 Earlier laboratory and field studies with a different“accelerated” hydrogen peroxide disinfectant that was intro-duced several years ago revealed that it has activity against avariety of pathogens.6-8

Activated hydrogen peroxide wipes provide a new alter-native to disinfectants currently used for cleaning and dis-infection of surfaces in healthcare facilities. Although qua-ternary ammonium compounds are widely used for cleaningand disinfection in healthcare in the United States,1 they dohave some disadvantages, including susceptibility to bacterialcontamination, poor activity against norovirus (or its sur-rogate viruses), and rare instances of disinfectant-relatedasthma.1,9,10

The fact that the proposed standard (less than 2.5 cfu/cm2)for defining environmental surfaces in hospitals as clean isequivalent to 65 colonies on a 25.6-cm2 contact plate raisesthe question of whether this cutoff may be rather liberal. Thefact that 96% of surfaces sampled in our study yielded lessthan 0.4 cfu/cm2 after cleaning with the activated hydrogenperoxide wipe suggests that lower degrees of surface contam-ination are achievable and that the current ACC cutoff mayneed to be reevaluated.

Our study has several limitations, including the fact thatit was conducted in a single hospital and involved a limitednumber of patient rooms. Surfaces were wiped by 2 trainedpersonnel, and this may have yielded different results thanwould be achieved by routine hospital housekeepers. How-ever, we used trained personnel so that our results wouldaccurately reflect the activity of the product being evaluatedand not be adversely influenced by poor housekeeping prac-

tices.4 Our study did not compare this product with otherdisinfectants or nondisinfectant impregnated wipes, becausethese methods have been previously shown to be effective inremoving pathogens from surfaces. It should be noted thatthis proposed standard definition of clean has never beenclinically validated and is a somewhat arbitrary definition todefine surfaces as clean.

The activated hydrogen peroxide wipe product evaluatedin our study proved to be an effective surface disinfectant,as reflected by ACC and ATP bioluminescence assays. ATPbioluminescence assays can be used as a tool to monitor theeffectiveness of cleaning practices while using an activatedhydrogen peroxide disinfectant. Additional studies are war-ranted to determine whether ATP and ACC cutoff points usedto classify surfaces as clean should vary depending on thesurface sampled.

acknowledgments

Financial support. The study was supported in part by a grant from CloroxHealthcare.

Potential conflicts of interest. J.M.B. is a consultant to Clorox Healthcare.All other authors report no conflicts of interest relevant to this article. Allauthors submitted the ICMJE Form for Disclosure of Potential Conflicts ofInterest, and the conflicts that the editors consider relevant to this articleare disclosed here.

Affiliations: 1. Yale-New Haven Hospital, New Haven, Connecticut;2. Yale University School of Medicine, New Haven, Connecticut.

Address correspondence to John M. Boyce, MD, Yale-New Haven Hospital,Saint Raphael Campus, 1450 Chapel Street, New Haven, CT 06511(john.boyce@ynhh.org).

Received September 28, 2012; accepted December 2, 2012; electronicallypublished April 9, 2013.� 2013 by The Society for Healthcare Epidemiology of America. All rightsreserved. 0899-823X/2013/3405-0013$15.00. DOI: 10.1086/670212

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