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After cleaning (old fashion way), all areas remained contaminated, with 66% of 124 swabs yielding MRSA, 74% by direct plating. In contrast, after exposing six rooms to hydrogen peroxide vapour, only one of 85 (1.2%) swabs yielded MRSA, by enrichment culture only. The hospital environment can become extensively contaminated with MRSA that is not eliminated by standard cleaning methods. In contrast, hydrogen peroxide vapour decontamination is a highly effective method of eradicating MRSA from rooms, furniture and equipment.

French, Gary L., et al. "Tackling contamination of the hospital environment by methicillin-resistant Staphylococcus aureus (MRSA): a comparison between conventional terminal cleaning and hydrogen peroxide vapour decontamination."Journal of Hospital Infection 57.1 (2004): 31-37.


Hydrogen Peroxide Vapour  (HPV) could be used to decontaminate cabinets and rooms where Clostridium botulinum has been handled. The cycle parameters should be based on studies carried out with relevant spores of this organism, rather than based on inactivation data for G. stearothermophilus spores, which have been used in the past as a standard biological challenge for disinfection and sterilisation procedures. HPV could provide an attractive alternative to other decontamination methods, as it was rapid, residue-free and did not give rise to the health and safety concerns associated with other gaseous decontamination systems.
Johnston, M. D., S. Lawson, and J. A. Otter. "Evaluation of hydrogen peroxide vapour as a method for the decontamination of surfaces contaminated with Clostridium botulinum spores." Journal of microbiological methods 60.3 (2005): 403-411.


Meticillin-resistant Staphylococcus aureus (MRSA) persists in the hospital environment and conventional cleaning procedures do not necessarily eliminate contamination. A prospective study was conducted on an intensive care unit to establish the level of environmental contamination with MRSA, assess the effectiveness of hydrogen peroxide vapour (HPV) decontamination and determine the rate of environmental recontamination. MRSA was isolated from 11.2% of environmental sites in the three months preceding the use of HPV and epidemiological typing revealed that the types circulating within the environment were similar to those colonising patients. After patient discharge and terminal cleaning using conventional methods, MRSA was isolated from five sites (17.2%). After HPV decontamination but before the readmission of patients, MRSA was not isolated from the environment. Twenty-four hours after readmitting patients, including two colonized with MRSA, the organism was isolated from five sites. The strains were indistinguishable from a strain with which a patient was colonized but were not all confined to the immediate vicinity of the colonized patient. In the eight weeks after the use of HPV, the environment was sampled on a weekly basis and MRSA was isolated from 16.3% sites. Hydrogen peroxide vapour is effective in eliminating bacteria from the environment but the rapid rate of recontamination suggests that it is not an effective means of maintaining low levels of environmental contamination in an open-plan intensive care unit.
Hardy, K. J., et al. "Rapid recontamination with MRSA of the environment of an intensive care unit after decontamination with hydrogen peroxide vapour."Journal of Hospital Infection 66.4 (2007): 360-368.

This suggests that the home environment might be a high cause of contamination. Getting rid of MRSA from the home needs more research.


The inanimate hospital environment can become contaminated with nosocomial pathogens. Hydrogen peroxide vapour (HPV) decontamination has proven effective for the eradication of persistent environmental contamination. We investigated the extent of meticillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE) and gentamicin-resistant Gram-negative rod (GNR) contamination in a ward side-room occupied by a patient with a history of MRSA, VRE and GNR infection and colonisation and investigated the impact of HPV decontamination. Fifteen standardised sites in the room were sampled using a selective broth enrichment protocol to culture MRSA, VRE and GNR. Sampling was performed before cleaning, after cleaning, after HPV decontamination and at intervals over the subsequent 19 days on two separate occasions. Environmental contamination was identified before cleaning on 60, 30 and 6.7% of sites for MRSA, GNR and VRE, respectively, and 40, 10 and 6.7% of sites after cleaning. Only one site (3.3%) was contaminated with MRSA after HPV decontamination. No recontamination with VRE was identified and no recontamination with MRSA and GNR was identified during the two days following HPV decontamination. Substantial recontamination was identified approximately one week after HPV decontamination towards post-cleaning levels for GNR and towards pre-cleaning levels for MRSA. HPV is more effective than standard terminal cleaning for the eradication of nosocomial pathogens. Recontamination was not immediate for MRSA and GNR but contamination returned within a week in a room occupied by a patient colonised with MRSA and GNR. This finding has important implications for the optimal deployment of HPV decontamination in hospitals.
Otter, J. A., et al. "Assessing the biological efficacy and rate of recontamination following hydrogen peroxide vapour decontamination." Journal of Hospital Infection 67.2 (2007): 182-188.


The Hydrogen Peroxide Vapour system was safer, faster and more effective for biological inactivation.
Fu, T. Y., P. Gent, and V. Kumar. "Efficacy, efficiency and safety aspects of hydrogen peroxide vapour and aerosolized hydrogen peroxide room disinfection systems." Journal of Hospital Infection 80.3 (2012): 199-205.


Meticillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) are capable of surviving for days to weeks on environmental surfaces in healthcare facilities. Environmental surfaces frequently touched by healthcare workers are commonly contaminated in the rooms of patients colonized or infected with MRSA or VRE. A number of studies have documented that healthcare workers may contaminate their hands or gloves by touching contaminated environmental surfaces, and that hands or gloves become contaminated with numbers of organisms that are likely to result in transmission to patients. Pathogens may also be transferred directly from contaminated surfaces to susceptible patients. There is an increasing body of evidence that cleaning or disinfection of the environment can reduce transmission of healthcare-associated pathogens. Because routine cleaning of equipment items and other high-touch surfaces does not always remove pathogens from contaminated surfaces, improved methods of disinfecting the hospital environment are needed. Preliminary studies suggest that hydrogen peroxide vapour technology deserves further evaluation as a method for decontamination of the environment in healthcare settings.
Boyce, John M. "Environmental contamination makes an important contribution to hospital infection." Journal of Hospital Infection 65 (2007): 50-54.


Hydrogen peroxide vapour is effective against FCV and is active on a range of surfaces. Therefore, it may represent a suitable decontamination system for use following a hospital outbreak of norovirus.
Bentley, K., et al. "Hydrogen peroxide vapour decontamination of surfaces artificially contaminated with norovirus surrogate feline calicivirus." Journal of Hospital Infection 80.2 (2012): 116-121.


Clostridium difficile spores are shed in high numbers by infected patients and are resistant to desiccation and some disinfectants. We explored the in vitro activity of hydrogen peroxide vapour (HPV) against several strains of C. difficile spores using a spore-carrier test. Spores were dried on polyvinyl chloride or laminate carriers at mean concentrations of 4.7–6.9 log10 spores/carrier, which were then decontaminated using HPV.C. difficile was completely eradicated from the exposed carriers regardless of the C. difficile strain or surface used. HPV can be considered for the eradication of C. difficile spores from the hospital environment.

Barbut, F., S. Yezli, and J. A. Otter. "Activity in vitro of hydrogen peroxide vapour against Clostridium difficile spores." Journal of Hospital Infection 80.1 (2012): 85-87.


HPV disinfection resulted in complete inactivation of all viruses tested, characterized by >4 log10 reduction in infectious particles for poliovirus, rotavirus, adenovirus and murine norovirus on stainless steel and framing panel carriers, and >2 log10 reduction for influenza A virus on stainless steel and framing panel carriers, and for all viruses on gauze carriers. Complete inactivation of poliovirus was demonstrated at several locations in the room. Reductions in viral genomes were minimal on framing panel and gauzecarriers but significant on stainless steel carriers; human norovirus GII.4 genome was most resistant to HPV treatment.

HPV could be an effective virucidal against enteric and respiratory viruses contaminating in-house environments.

Tuladhar, Era, et al. "Virucidal efficacy of hydrogen peroxide vapour disinfection." Journal of Hospital Infection 80.2 (2012): 110-115.


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.

Conclusions. HPV decontamination reduced environmental contamination and the risk of acquiring MDROs compared with standard cleaning protocols.
Passaretti, Catherine L., et al. "An evaluation of environmental decontamination with hydrogen peroxide vapor for reducing the risk of patient acquisition of multidrug-resistant organisms." Clinical infectious diseases 56.1 (2013): 27-35.



Multidrug-resistant gram-negative rods (MDR-GNR) are an increasing cause for concern in intensive care units (ICUs). We used hydrogen peroxide vapor (HPV) to decontaminate our entire ICU in an attempt to eradicate undetected environmental contamination during outbreaks of MDR-GNR. Surface sampling identified GNR, including MDR strains, on 10 (48%) of 21 areas cultured after intensive cleaning but before decontamination with HPV, and on no areas after HPV. No new cases of Acinetobacter were identified for approximately 3 months after HPV.

Otter, Jonathan A., et al. "Hydrogen peroxide vapor decontamination of an intensive care unit to remove environmental reservoirs of multidrug-resistant gram-negative rods during an outbreak." American journal of infection control38.9 (2010): 754-756.



Hydrogen peroxide vapour (HPV) has been proposed as an alternative to formaldehyde fumigation for the decontamination of biosafety level (BSL) III laboratories. The aim of this study was to evaluate the efficacy of HPV against the dimorphic fungi Histoplasma capsulatum, Blastomyces dermatitidis and Coccidioides immitis. Working inside a class II biological safety cabinet (BSC) within a BSL III laboratory, inocula containing approximately 5-log10 cfu/ml from the mould form of each organism suspended in RPMI medium were deposited on stainless steel discs and allowed to air dry. The organisms were exposed to HPV inside a BSC using a BIOQUELL ClarusS HPV generator. In three replicate experiments, individual discs were transferred into liquid media at timed intervals during a 105 minute HPV exposure period. Control- and HPV-exposed discs were incubated in RPMI media at 30°C for 6 weeks to determine if any viable organisms remained. Positive cultures were confirmed using specific nucleic acid hybridization probes. Results indicate that H. capsulatum, B. dermatitidis and C. immitis were killed within 30 minutes of HPV exposure.

Hall, Leslie, et al. "Deactivation of the dimorphic fungi Histoplasma capsulatum, Blastomyces dermatitidis and Coccidioides immitis using hydrogen peroxide vapor1." Medical mycology 46.2 (2008): 189-191.



The efficacy of vapor-phase hydrogen peroxide in a pass-through box for the decontamination of equipment and inanimate materials potentially contaminated with exotic animal viruses was evaluated. Tests were conducted with a variety of viral agents, which included representatives of several virus families (Orthomyxoviridae, Reoviridae, Flaviviridae, Paramyxoviridae, Herpesviridae, Picornaviridae, Caliciviridae, and Rhabdoviridae) from both avian and mammalian species, with particular emphasis on animal viruses exotic to Canada. The effects of the gas on a variety of laboratory equipment were also studied. Virus suspensions in cell culture media, egg fluid, or blood were dried onto glass and stainless steel. Virus viability was assessed after exposure to vaporphase hydrogen peroxide for 30 min. For all viruses tested and under all conditions (except one), the decontamination process reduced the virus titer to 0 embryo-lethal doses for the avian viruses (avian influenza and Newcastle disease viruses) or less than 10 tissue culture infective doses for the mammalian viruses (African swine fever, bluetongue, hog cholera, pseudorabies, swine vesicular disease, vesicular exanthema, and vesicular stomatitis viruses). The laboratory equipment exposed to the gas appeared to suffer no adverse effects. Vaporphase hydrogen peroxide decontamination can be recommended as a safe and efficacious way of removing potentially virus-contaminated objects from biocontainment level III laboratories in which exotic animal disease virus agents are handled.

​Heckert, R. A., et al. "Efficacy of vaporized hydrogen peroxide against exotic animal viruses." Applied and environmental microbiology 63.10 (1997): 3916-3918.

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