Contaminated surfaces in healthcare facilities may contribute to the transmission of pathogens implicated in nosocomial infections, such as Clostridium difficile, methicillin resistant Staphylococcus aureus (MRSA), vancomycin resistant Enterococci (VRE), gram-negative rods (Acinetobacter spp. and Enterobacteriaceae) and Norovirus. While patient rooms are regularly cleaned and disinfected using manual techniques, evidence suggests that the adequacy of cleaning is often suboptimal, particularly when the focus is only on those surfaces perceived to be high-risk or frequently contacted (high-touch). As well, when cleaning, sufficient wet contact time between the surface and disinfectant is needed to ensure adequate disinfection, but is not always achieved. Wiping of all surfaces where there is hand contact, not just those that are considered to be high risk or high-touch areas, and ensuring adequate wet contact time is required for adequate disinfection of the patient environment.

Inadequate cleaning using manual techniques prompted the development of no-touch systems that can decontaminate objects and surfaces in the patient environment. These technologies employ the use of ultraviolet (UV) light or hydrogen peroxide. There are two systems that use vaporized hydrogen peroxide (VHP) in a dry or wet aerosol and one that uses a hydrogen peroxide mist (HPM), which has a larger particle size. VHP or HPM is produced using a portable generator that quickly increases the concentration of hydrogen peroxide in the room during a decontamination phase which is repeated several times. The process takes approximately two to six hours per room. The UV light systems emit UV light from portable automated units at a wave-length that is germicidal. The unit is placed in a vacant patient room in the centre and can be piloted with a remote to ensure all surfaces are reached as they must be in the line of site to be decontaminated. The units have sensors which stop the irradiation should the door be opened. The process of decontamination takes approximately 45 minutes. One application of these cleaning systems is in terminal or discharge decontamination of vacated patient rooms. They supplement, but do not replace manual cleaning of patient rooms, as surfaces must first be free of dirt and debris prior to their use. Vaporized hydrogen peroxide and UV light systems provide a higher level disinfection or decontamination of all exposed surfaces and equipment in patient rooms, and are not a standalone means of cleaning.

Vaporized hydrogen peroxide has also been used for decontamination of rooms and ward spaces in an attempt to terminate outbreaks. This report will review the evidence of clinical effectiveness of non-manual systems that use UV light or vaporized hydrogen peroxide for hospital room disinfection and identify guidelines that address the use of these techniques in healthcare facilities.

Contents

• CONTEXT AND POLICY ISSUES
• RESEARCH QUESTIONS
• KEY FINDINGS
• METHODS
  • Literature Search Strategy
  • Selection Criteria and Methods
  • Exclusion Criteria
  • Critical Appraisal of Individual Studies
• SUMMARY OF EVIDENCE
  • Quantity of Research Available
  • Summary of Study Characteristics
  • Summary of Critical Appraisal
  • Summary of Findings
  • Limitations
• CONCLUSIONS AND IMPLICATIONS FOR DECISION OR POLICY MAKING
• REFERENCES
• APPENDIX 1 Selection of Included Studies
• APPENDIX 2 Summary of Individual Study Characteristics
• APPENDIX 3 Summary of Critical Appraisal
• APPENDIX 4 Summary of Study Findings
• APPENDIX 5 Additional studies of vaporized hydrogen peroxide and ultra violet light that did not report patient outcomes

Disclaimer: The Rapid Response Service is an information service for those involved in planning and providing health care in Canada. Rapid responses are based on a limited literature search and are not comprehensive, systematic reviews. The intent is to provide a list of sources and a summary of the best evidence on the topic that CADTH could identify using all reasonable efforts within the time allowed. Rapid responses should be considered along with other types of information and health care considerations. The information included in this response is not intended to replace professional medical advice, nor should it be construed as a recommendation for or against the use of a particular health technology. Readers are also cautioned that a lack of good quality evidence does not necessarily mean a lack of effectiveness particularly in the case of new and emerging health technologies, for which little information can be found, but which may in future prove to be effective. While CADTH has taken care in the preparation of the report to ensure that its contents are accurate, complete and up to date, CADTH does not make any guarantee to that effect. CADTH is not liable for any loss or damages resulting from use of the information in the report.