The system gives infection preventionists another tool to combat the pathogen despite implementation challenges.
Combating the spread of Clostridioides difficile (formerly Clostridium difficile) infections (CDIs) in the hospital setting has long been an issue for infection preventionists (IPs). CDI is the most common hospital-acquired infection (HAI). Patients with CDI typically experience frequent diarrhea as CDI forms an endospore in the human gastrointestinal tract. Because there is no specific best practice environmental intervention, Christopher L. Truitt, PhD, and colleagues conducted a retrospective analysis of CDI rates at an acute care facility that utilized an aerosolized hydrogen peroxide (aHP) disinfection system over a 10-year period.
Truitt, a professor of biochemistry and microbiology at Wayland Baptist University, Lubbock, Texas, and lead author of the study, spoke with Infection Control Today® about the study published in the American Journal of Infection Control.
Infection Control Today®: What is the overview of the study, the importance of the study? And what were the findings?
Christopher L. Truitt, PhD, Professor of BioChemistry/Microbiology: I think the biggest takeaway from this study was that the use of this new or novel aerosolized hydrogen peroxide system, along with a rigorous, standardized cleaning protocol, showed a significant reduction in C diff rates throughout our hospital. And this actually just gives the infection control personnel another option in terms of controlling C diff in the environment.
ICT®: Wow, that's impressive. So, what are the biggest takeaways of the study?
CT: I think the biggest takeaway is that if you're really persistent and focused on controlling, in this case, Clostridium difficile, which the biggest concern with C diff is the endospores. These endospores are long-lived in the environment; they're very difficult to eradicate. And that's always been a challenge. And so, with implementation of this aerosolized hydrogen peroxide, I think it just helped out the environmental service technicians in doing their job and actually eradicating this endospore. So, throughout our study, and we showed a significant reduction, we did a before- and after-study at the first part. Then we just continued using the system; we got better at using it. And as we continued use it, our rates just kept going down and down. And so, I was very excited with our results.
ICT®: I bet you were. So what surprised you about these results?
CT: Probably the biggest thing was the amount of reduction that we actually achieved. Overall, in our last five years of the study, we saw a 74% reduction in CDI infections hospital-wide. And so that really surprised me at the end, when I was going through and analyzing the data.
ICT®: Wow. So, while you're doing this study, what were the difficulties that you ran into?
CT: There's quite a few difficulties in this. One of it was the implementation, having the buy-in of everybody in the process, from the top, all the way down to EBS [environment building solutions] personnel, and just getting people trained in using the device correctly. Once we got that hurdle out of the way, [the challenge] was becoming adapted, and it was widely accepted that this was part of our protocol in going through [the process], and this is how we did our terminal cleaning of C. difficile rooms. And so that was one obstacle. Another one was that in the middle of a study, there was a change in definition of what's considered a C diff infection. And so that caused some concern, especially in the data analysis on trying to keep everything consistent throughout the study.
ICT®: Wow. Was this used in patient rooms as well as laboratory rooms or only in labs?
CT: It was strictly in a clinical setting. Yes, it was using hospital rooms. We implemented in the process of our terminal cleans.
ICT®: Infection Control Today® has done a couple of articles on this topic. So, it's quite fascinating to our readers, and so, I wanted to clarify that. What, if any further, studies do you anticipate being done on this particular topic?
CT: I think there are quite a few. One would be to look at other hospital-associated infections like MRSA [Methicillin-resistant Staphylococcus aureus], VRE [vancomycin resistant enterococci]. See the effectiveness of the aerosolized hydrogen peroxide plan. Another study I would really love to do is a larger, randomized controlled study with different arms that we can go through and get a better feel for how this technology compares to other no-touch disinfection technologies such as UV light that’s very common. So, we could do a study with where we looked at an arm where we studied just bleach only for standard cleaning, then we could do maybe a bleach plus UV light, and then do a bleach plus the aerosolized hydrogen peroxide and get a better feel for how this compares.
ICT®: Wonderful. Do you anticipate this being widespread used? Like in other hospitals and other states, even other countries, do you anticipate it being used?
CT: I think, I mean, C diff is a has been a major hospital social infection for years. And the difficulty to kill in the environment is a problem. There's just not an easy way to do that. And I think hydrogen peroxide will just play another role in helping us control these infections.
ICT®: Wonderful. Yes, I hope that you do because that will be certainly beneficial in the future. Do you have anything to add to what you've spoken before?
CT: Like I said earlier, the implementation process is a little challenging, but once you overcome that, the EBS, everybody understood the importance of keeping our patients safe, and preventing the spread of Clostridioides difficile in the environment. And so, granted, there's a little bit more in terms of turnaround for the room. But that was just factored in, in the overall process. And so, I think if there's an IP person out there, that is looking at a means of trying to control C Diff in their environment, this is something to look into.
ICT®: Wonderful. Thank you for speaking with me today.
CT: Thank you very much.
The interview was edited for clarity and length.