Following an outbreak of Acinetobacter baumannii in the centre for treatment of burns at the Saint Louis hospital in Paris, the CEDIT and the CCLIN-Paris Nord (1) were requested by the director of the hospital group to give an opinion on a disinfection process based on vaporization of hydrogen peroxide originating from the company Bioquell. The aim of this report is to provide information for decision making regarding the use of the process.
Method (of work): in the light of the reply from the CCLIN Nord in February 2015, the CEDIT makes the assumption that all procedures currently applied are in compliance with guidelines regarding infection control and cleaning of surfaces in hospitals, thus limiting the scope of the evaluation to the performance of the Bioquell system.
Technical aspects : the Bioquell airborne disinfection system uses a 35 % water solution of hydrogen peroxide which is vaporized on two heated plates, aspirated and projected towards the volume to disinfect. The Bioquell system comprises four elements: a hydrogen peroxide vapour generator, a probe, a ventilation unit and a remote control module. A single automated and remotely controlled generator is capable of treating volumes up to 250 m3 in the temperature range from 15 to 30 °C.
The ventilation units catalytically convert the hydrogen peroxide vapour to water vapour and oxygen with no residues. The technology can be used either by health facility staff or by the staff of an external service provider recommended by Bioquell.
Clinical aspects : according to available data, airborne hydrogen peroxide surface disinfection using the system promoted by Bioquell seems to be microbiologically effective. The lack of clinical studies comparing the effectiveness of Bioquell with that of hospital surface cleaning and disinfection only, limits the reach of the conclusions that can be drawn. One study explored the effectiveness of Bioquell in rooms that had been previously occupied by patients infected with multi-resistant germs excluding systematic airborne disinfection of all rooms
In any case Bioquell can only be used as complement and is not a substitute for surface cleaning and surface disinfection. The studies report no secondary (toxic) effects of the Bioquell disinfection process on patients and health care staff.
Health economic aspects: The monthly cost for a complete service (including the intervention by a technician from the company) at the Saint-Louis hospital would be 13,700 euros excluding tax. The service consists of disinfection of all rooms liberated on patient discharge (approx. 5 rooms to disinfect every week). No economic evaluation, making it possible to estimate the economic impact of Bioquell use in the Saint-Louis burns centre, is available.
It is possible that resource optimization may take place with a disinfection strategy giving priority to rooms previously occupied by patients infected by multi-resistant germs.
Organizational aspects: the centre for treatment of burns in adults at the Saint Louis hospital is the only centre of its kind within AP-HP, the only other centre in Ile-de-France is the Percy military training hospital in Clamart. At the Saint Louis centre, two actions successively need to be taken: application of very strict rules for infection control for the staff, patients and visitors, and high quality surface cleaning and disinfection. Reinforcement of these aspects would be a prerequisite for using any complementary method. The regular use of hydrogen peroxide raises a number of practical issues such as the need for making the rooms available (Bioquell disinfection is not expected to significantly prolong room occupation) and the need for hiring qualified staff specifically dedicated to the task.
Recommendations from the CEDIT :
- Compliance with the infection control guidelines regarding surface cleaning and surface disinfection is a prerequisite for effectively combating nosocomial infections (health care related infections) and the use of the Bioquell airborne disinfection procedure cannot be a substitute.
- As a complement to current infection control practice (surface cleaning and surface disinfection), hydrogen peroxyde may increase the level of disinfection at the Saint Louis centre for treatment of burns.
- Vaporization could be performed either systematically in all rooms at discharge or in a more selective manner in the rooms previously occupied by patients carrying a micro-organism known for its ability to persist in the environment and/or presenting a particular resistance profile to antibiotics. Taking into account data showing a more convincing level of evidence where the Bioquell disinfection procedure is applied selectively, the CEDIT cannot give priority to systematic disinfection of all rooms.
- However the CEDIT underscores that the Bioquell procedure would need to undergo further evaluation. It recommends the implementation of a study in the department for treatment of burns at the Saint-Louis hospital in order to evaluate the effectiveness and efficiency of the procedure.
(1) Advisory body regarding healthcare related infections for the region of Greater Paris and the north of France