Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Clin Infect Dis. 2013 Jan;56(1):27-35. doi: 10.1093/cid/cis839. Epub 2012 Oct 5.
Admission to a room previously occupied by a patient with certain multidrug-resistant organisms (MDROs) increases the risk of acquisition. Traditional cleaning strategies do not remove all environmental MDROs. We evaluated the environmental and clinical impact of hydrogen peroxide vapor (HPV) room disinfection.
We performed a 30-month prospective cohort intervention study on 6 high-risk units in a 994-bed tertiary care hospital. Following a 12-month preintervention phase, HPV was implemented on 3 units to decontaminate the rooms of patients known to be infected or colonized with epidemiologically important MDROs, following their discharge. Monthly environmental samples for MDROs were collected on all study units for 3 preintervention and 6 intervention months. The risk of MDRO acquisition in patients admitted to rooms decontaminated using HPV was compared with rooms disinfected using standard methods.
The prior room occupant was known to be infected or colonized with an MDRO in 22% of 6350 admissions. Patients admitted to rooms decontaminated using HPV were 64% less likely to acquire any MDRO (incidence rate ratio [IRR], 0.36; 95% confidence interval [CI], .19-.70; P < .001) and 80% less likely to acquire VRE (IRR, 0.20; 95% CI, .08-.52; P < .001) after adjusting for other factors. The risk of acquiring Clostridium difficile, methicillin-resistant Staphylococcus aureus, and multidrug-resistant gram-negative rods individually was reduced, but not significantly. The proportion of rooms environmentally contaminated with MDROs was reduced significantly on the HPV units (relative risk, 0.65, P = .03), but not on non-HPV units.
HPV decontamination reduced environmental contamination and the risk of acquiring MDROs compared with standard cleaning protocols.
入住曾有特定多重耐药菌（MDRO）患者居住的病房会增加获得 MDRO 的风险。传统的清洁策略无法清除所有环境 MDRO。我们评估了过氧化氢蒸汽（HPV）房间消毒对环境和临床的影响。
我们在一家 994 床的三级保健医院的 6 个高风险病房进行了为期 30 个月的前瞻性队列干预研究。在 12 个月的干预前阶段之后，对 3 个病房使用 HPV 对已知感染或定植有重要流行病学意义的 MDRO 的患者的房间进行消毒，在患者出院后进行。在干预前的 3 个月和干预后的 6 个月，对所有研究病房每月进行 MDRO 环境样本采集。与使用标准方法进行消毒的房间相比，比较使用 HPV 消毒的房间中患者获得 MDRO 的风险。
6350 次入住中，22%的患者入住前的病房患者已知感染或定植 MDRO。使用 HPV 消毒的房间中，患者获得任何 MDRO 的可能性降低了 64%（发病率比[IRR]，0.36；95%置信区间[CI]，0.19-0.70；P < 0.001），获得 VRE 的可能性降低了 80%（IRR，0.20；95% CI，0.08-0.52；P < 0.001），调整其他因素后。个别情况下，获得艰难梭菌、耐甲氧西林金黄色葡萄球菌和多药耐药革兰氏阴性杆菌的风险有所降低，但无统计学意义。HPV 病房的 MDRO 环境污染比例显著降低（相对风险，0.65，P = 0.03），而非 HPV 病房则没有。
与标准清洁方案相比，HPV 消毒可降低环境污染和获得 MDRO 的风险。
