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Major Article|Articles in Press
Impact of dry hydrogen peroxide on environmental bioburden reduction in a
long-term care facility
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IMPACT OF DRY HYDROGEN PEROXIDE ON ENVIRONMENTAL BIOBURDEN REDUCTION IN A
LONG-TERM CARE FACILITY

* Mary Cole, RN, MS, CNRN, CCRN, SCRN, CIC
Mary Cole
Correspondence
Address correspondence to Mary Cole, RN, MS, CNRN, CCRN, SCRN, The Highlands
at Brighton part of UR Medicine, Rochester, NY.
Contact
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The Highlands at Brighton part of UR Medicine, Rochester, NY
Search for articles by this author

Open AccessPublished:June 07, 2023DOI:https://doi.org/10.1016/j.ajic.2023.06.004
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* Highlights
* Key Words
* Background
* Methods
* Results
* Discussion
* Conclusions and implications
* References
* Article info
* Figures
* Related Articles

HIGHLIGHTS

* •
Use of dry hydrogen peroxide (DHP) significantly reduced surface bioburden in
a LTCF.
* •
DHP may be an effective environmental infection prevention solution in LTCF.
* •
DHP effectively reduces surface bioburden in an LTCF’s neurobehavioral unit.
* •
DHP effectively reduces volatile organic compound levels in an LTCF.

BACKGROUND

Environmental infection transmission is a perennial problem in long-term care
facilities (LTCFs), exacerbated by shared living arrangements, residents with
cognitive deficits, staffing shortages, and suboptimal cleaning and
disinfection. This study evaluates the impact of dry hydrogen peroxide (DHP), as
a supplement to manual decontamination, on bioburden within an LTCF
neurobehavioral unit.

METHODS

In this prospective environmental cohort study utilizing DHP in an LTCF’s 15-bed
neurobehavioral unit, 264 surface microbial samples (44 per time point) were
collected in 8 patient rooms, 2 communal areas on 3 consecutive days pre-DHP
deployment and on days 14, 28, and 55 post-DHP deployments. The microbial
reduction was evaluated by characterizing bioburden as total colony-forming
units in each sampling site pre- and post-DHP deployment. Volatile organic
compound levels were also measured in each patient area on all sampling dates.
Multivariate regression was used to analyze microbial reductions associated with
DHP exposure, controlling for sample and treatment sites.

RESULTS

A statistically significant relationship was detected between exposure to DHP
and surface microbial load (P ≤ .00001). Additionally, the average volatile
organic compound level postintervention was significantly lower than baseline
levels (P = .0031).

CONCLUSIONS

DHP can significantly reduce surface bioburden in occupied spaces, potentially
enhancing infection prevention, and control efforts in LTCFs.

KEY WORDS

* Environmental disinfection
* Microbial reduction
* Infection prevention technology

BACKGROUND

Infection transmission within long-term care facilities (LTCFs) is a perennial
problem, impacting between 1 and 3 million residents annually according to the
Centers for Disease Control and Prevention.
1

Centers for Disease Control and Prevention. Nursing homes and assisted living.
Accessed November 22, 2022. https://www.cdc.gov/longtermcare/index.html.

* Google Scholar

Infection prevention efforts face unique challenges in the LTCF setting owing to
the population’s demographics, the facility's residential nature, and resource
constraints.
1

Centers for Disease Control and Prevention. Nursing homes and assisted living.
Accessed November 22, 2022. https://www.cdc.gov/longtermcare/index.html.

* Google Scholar

,
2
* Smith P.W.
* Bennett G.
* Bradley S.
* et al.

Society for Healthcare Epidemiology of America (SHEA); association for
professionals in infection control and epidemiology (APIC). SHEA/APIC guideline:
infection prevention and control in the long-term care facility.
Am J Infect Control. 2008; 36: 504-535
* Abstract
* Full Text
* Full Text PDF
* PubMed
* Scopus (150)
* Google Scholar

,
3
* Fischer R.J.
* Morris K.K.
* McCorkel L.A.
* Case S.M.
* Pham H.H.
* Henneman B.G.

An ounce of prevention: reducing the risk of COVID-19 transmission in long-term
care facilities.
J Geriatr Med Gerontol. 2020; 6: 105https://doi.org/10.23937/2469-5858/1510105
* Crossref
* Google Scholar

,
4
* Crnich C.J.

Reimagining infection control in U.S. nursing homes in the era of COVID-19.
J Am Med Dir Assoc. 2022; 23: 1909-1915
* Abstract
* Full Text
* Full Text PDF
* Scopus (1)
* Google Scholar

The vast majority of LTCF residents are elderly and therefore suffer from
immunosenescence, an age-related deterioration in the ability to fight
infection.
2
* Smith P.W.
* Bennett G.
* Bradley S.
* et al.

,
3
* Fischer R.J.
* Morris K.K.
* McCorkel L.A.
* Case S.M.
* Pham H.H.
* Henneman B.G.

,
4
* Crnich C.J.

Reimagining infection control in U.S. nursing homes in the era of COVID-19.
J Am Med Dir Assoc. 2022; 23: 1909-1915
* Abstract
* Full Text
* Full Text PDF
* Scopus (1)
* Google Scholar

Their advanced age is also associated with a higher rate of comorbidities that
place them at increased risk for infection.
2
* Smith P.W.
* Bennett G.
* Bradley S.
* et al.

,
3
* Fischer R.J.
* Morris K.K.
* McCorkel L.A.
* Case S.M.
* Pham H.H.
* Henneman B.G.

,
4
* Crnich C.J.

Reimagining infection control in U.S. nursing homes in the era of COVID-19.
J Am Med Dir Assoc. 2022; 23: 1909-1915
* Abstract
* Full Text
* Full Text PDF
* Scopus (1)
* Google Scholar

This is especially true for residents of neurobehavioral units with cognitive
deficits who may suffer from a combination of urinary and fecal incontinence,
diminished cough reflex, or the inability to perform personal hygiene, including
handwashing.
2
* Smith P.W.
* Bennett G.
* Bradley S.
* et al.

,
4
* Crnich C.J.

Reimagining infection control in U.S. nursing homes in the era of COVID-19.
J Am Med Dir Assoc. 2022; 23: 1909-1915
* Abstract
* Full Text
* Full Text PDF
* Scopus (1)
* Google Scholar

,
5

Agency for Healthcare Research and Quality. A unit guide to infection prevention
for long-term care staff. Accessed February 16, 2023.

* Google Scholar

Further, residents of LTCF are often transferred to and from acute care
facilities, exposing them to broad-spectrum antibiotics and indwelling medical
devices, all of which increase residents’ odds of becoming colonized or infected
with multidrug-resistant organisms.
4
* Crnich C.J.

Reimagining infection control in U.S. nursing homes in the era of COVID-19.
J Am Med Dir Assoc. 2022; 23: 1909-1915
* Abstract
* Full Text
* Full Text PDF
* Scopus (1)
* Google Scholar

LTCFs are residential settings with group or community activities for
socialization, therapy services, and the delivery of necessary daily care. For
example, meals are traditionally served in group settings so that staff can
either assist with feeding or observe the feeding. Frequent resident-staff
interaction is also common for assistance with other activities of daily living
such as dressing, hygiene, and toileting.
3
* Fischer R.J.
* Morris K.K.
* McCorkel L.A.
* Case S.M.
* Pham H.H.
* Henneman B.G.

,
4
* Crnich C.J.

Reimagining infection control in U.S. nursing homes in the era of COVID-19.
J Am Med Dir Assoc. 2022; 23: 1909-1915
* Abstract
* Full Text
* Full Text PDF
* Scopus (1)
* Google Scholar

,
6
* Dumyati G.
* Stone N.D.
* Nace D.A.
* Crinich C.J.
* Jump R.L.P.

Challenges and strategies for prevention of multidrug-resistant organism
transmission in nursing homes.
Curr Infect Dis Rep. 2017; 19: 18
* Crossref
* PubMed
* Scopus (64)
* Google Scholar

Though necessary, these communal interactions increase the opportunity for
person-to-person infection transmission.
2
* Smith P.W.
* Bennett G.
* Bradley S.
* et al.

,
3
* Fischer R.J.
* Morris K.K.
* McCorkel L.A.
* Case S.M.
* Pham H.H.
* Henneman B.G.

,
4
* Crnich C.J.

Reimagining infection control in U.S. nursing homes in the era of COVID-19.
J Am Med Dir Assoc. 2022; 23: 1909-1915
* Abstract
* Full Text
* Full Text PDF
* Scopus (1)
* Google Scholar

,
6
* Dumyati G.
* Stone N.D.
* Nace D.A.
* Crinich C.J.
* Jump R.L.P.

Challenges and strategies for prevention of multidrug-resistant organism
transmission in nursing homes.
Curr Infect Dis Rep. 2017; 19: 18
* Crossref
* PubMed
* Scopus (64)
* Google Scholar

A study by Roghmann et al demonstrated that assistance with dressing,
transferring, providing hygiene, changing linens, and toileting was associated
with an increased risk of methicillin-resistant Staphylococcus aureus
transmission from residents to the hands and clothes of staff in an LTCF even
without overt contact with mucous membranes, skin breakdown, or body fluids.
7
* Roghmann M.C.
* Lydecker A.
* Mody L.
* Mullins C.D.
* Onukwugha E.

Strategies to prevent MRSA transmission in community-based nursing homes: a cost
analysis.
Infect Control Hosp Epidemiol. 2016; 37: 962-966
* Crossref
* Scopus (4)
* Google Scholar

Similarly, Fisch et al found that dependence upon assistance with activities of
daily living significantly increased a resident’s risk of acquiring a
multidrug-resistant organism in an LTCF.
8
* Fisch J.
* Lansing B.
* Wang L.
* et al.

New acquisition of antibiotic-resistant organisms in skilled nursing facilities.
J Clin Microbiol. 2012; 50: 1698-1703
* Crossref
* PubMed
* Scopus (67)
* Google Scholar

These inherent risk factors were underscored by the COVID-19 pandemic, which
disproportionately impacted LTCFs residents and staff, accounting for roughly
15% of all COVID-19 deaths.
9

Centers for Medicare & Medicaid Services. COVID-19 nursing home data. Accessed
February 16, 2023. 〈https://data.cms.gov/covid-19/covid-19-nursing-home-dataary.

* Google Scholar

,
10

Kaiser Family Foundation. Over 200,000 residents and staff in long-term care
facilities have died from COVID-19. Accessed November 22, 2022.
https://www.kff.org/policy-watch/over-200000-residents-and-staff-in-long-term-care-facilities-have-died-from-covid-19/.

* Google Scholar

The pandemic also highlighted and exacerbated the long-standing staffing
constraints in LTCFs.
3
* Fischer R.J.
* Morris K.K.
* McCorkel L.A.
* Case S.M.
* Pham H.H.
* Henneman B.G.

,
4
* Crnich C.J.

Reimagining infection control in U.S. nursing homes in the era of COVID-19.
J Am Med Dir Assoc. 2022; 23: 1909-1915
* Abstract
* Full Text
* Full Text PDF
* Scopus (1)
* Google Scholar

These high turnover and vacancy rates have been associated with significant
quality of care challenges.
3
* Fischer R.J.
* Morris K.K.
* McCorkel L.A.
* Case S.M.
* Pham H.H.
* Henneman B.G.

While much attention has been brought to the shortage of clinical staff,
nonclinical staff, including housekeepers or environmental service (EVS)
workers, have also been impacted.
11
* National Academies of Sciences, Engineering, and Medicine

The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment
to Residents, Families, and Staff. The National Academies Press,
2022https://doi.org/10.17226/26526
* Crossref
* Scopus (44)
* Google Scholar

,
12

Cleaning and Maintenance Management. Nursing home staff shortages among reasons
for nationwide closings. Accessed March 8, 2023.
https://cmmonline.com/news/nursing-home-staff-shortage-among-reasons-for-nationwide-closings.

* Google Scholar

EVS staff represent a very small percentage of the LTCF workforce, but their
work is vital to the health of residents and staff alike given the robust
evidence demonstrating the risk between environmental contamination and
infection acquisition in health care settings.
11
* National Academies of Sciences, Engineering, and Medicine

,
13
* Müller B.
* Armstrong P.
* Lowndes R.

Cleaning and caring: contributions in long-term residential care.
Ageing Int. 2018; 43: 53-73
* Crossref
* Scopus (10)
* Google Scholar

,
14

Centers for Disease Control and Prevention. Healthcare-associated infections:
healthcare environmental infection prevention and control. Accessed March 8,
2023. https://www.cdc.gov/hai/prevent/environment/index.html.

* Google Scholar

This environmental infection transmission risk is of special concern in LTCFs
owing to a variety of factors including, but not limited to, the high rate of
incontinence, shared bathrooms and rehabilitation facilities, restricted space
for isolating residents with communicable diseases, suboptimal ventilation
systems, and residents’ reduced ability to perform hygienic activities of daily
living.
4
* Crnich C.J.

Reimagining infection control in U.S. nursing homes in the era of COVID-19.
J Am Med Dir Assoc. 2022; 23: 1909-1915
* Abstract
* Full Text
* Full Text PDF
* Scopus (1)
* Google Scholar

Routine cleaning and disinfection are often inadequate in these settings as
evidenced by a recent study which found over 90% of the sampled surfaces in 11
LTCFs had either failing adenosine triphosphate (ATP) scores or tested positive
for crAssphage, the DNA bacteriophage found in the human gut and used as a tool
for detecting fecal contamination.
15
* Cannon J.L.
* Park G.W.
* Anderson B.
* et al.

Hygienic monitoring in long-term care facilities using ATP, crAssphage, and
human noroviruses to direct environmental surface cleaning.
Am J Infect Control. 2022; 50: 289-294
* Abstract
* Full Text
* Full Text PDF
* Scopus (2)
* Google Scholar

Several outbreaks have been linked to breaches in the cleaning and disinfection
of equipment and the environment in LTCF settings.
16
* Wise M.E.
* Marquez P.
* Sharapov U.
* et al.

Outbreak of acute hepatitis B virus infections associated with podiatric care at
a psychiatric long-term care facility.
Am J Infect Control. 2012; 40: 16-21
* Abstract
* Full Text
* Full Text PDF
* PubMed
* Scopus (22)
* Google Scholar

,
17
* Lee M.H.
* Lee G.A.
* Lee S.H.
* Park Y.H.

A systematic review on the causes of the transmission and control measures of
outbreaks in long-term care facilities: back to basics.
PLoS One. 2020; 15e0229911
* Crossref
* Scopus (38)
* Google Scholar

Research has also shown that there is significant variation in cleaning
practices in these settings, including among products used, number of rooms
assigned to each staff member, time spent cleaning per room, and education or
training
18
* Saeb A.
* Mody L.
* Gibson K.

How are nursing homes cleaned? Results of a survey of 6 nursing homes in
Southeast Michigan.
Am J Infect Control. 2017; 45: e119-e122
* Abstract
* Full Text
* Full Text PDF
* PubMed
* Scopus (7)
* Google Scholar

Accordingly, there has been a call for a renewed focus on environmental hygiene
and research evaluating the impact of interventions designed to improve it.
4
* Crnich C.J.

Reimagining infection control in U.S. nursing homes in the era of COVID-19.
J Am Med Dir Assoc. 2022; 23: 1909-1915
* Abstract
* Full Text
* Full Text PDF
* Scopus (1)
* Google Scholar

,
19
* McKinnell J.A.
* Singh R.D.
* Miller L.G.
* et al.

The SHIELD Orange County project: multidrug-resistant organism prevalence in 21
nursing homes and long-term acute care facilities in Southern California.
Clin Infect Dis. 2019; 69: 1566-1573
* Crossref
* PubMed
* Scopus (37)
* Google Scholar

Supplemental technologies that reduce environmental contamination, particularly
those that do not rely on staff oversight and operation, may offer a benefit to
risk reduction in these settings. One such technology utilizes oxygen and
humidity from ambient air to generate dry hydrogen peroxide (DHP) that reduces
the presence of bacteria, viruses, and fungi, as well as volatile organic
compounds, in occupied settings.
20
* Ramirez M.
* Matheu L.
* Gomez M.
* et al.

Effectiveness of dry hydrogen peroxide on reducing environmental microbial
bioburden risk in a pediatric oncology intensive care unit.
Am J Infect Control. 2021; 49: 608-613
* Abstract
* Full Text
* Full Text PDF
* PubMed
* Scopus (5)
* Google Scholar

,
21
* Melgar M.
* Ramirez M.
* Chang A.
* Antillon F.

Impact of dry hydrogen peroxide on hospital-acquired infection at a pediatric
oncology hospital.
Am J Infect Control. 2022; 50: 909-915
* Abstract
* Full Text
* Full Text PDF
* Scopus (2)
* Google Scholar

,
22
* Sanguinet J.
* Edmiston C.

Evaluation of dry hydrogen peroxide in reducing microbial bioburden in a
healthcare facility.
Am J Infect Control. 2021; 49: 985-990
* Abstract
* Full Text
* Full Text PDF
* PubMed
* Scopus (3)
* Google Scholar

,
23
* Huang Y.S.
* Bilyeu A.N.
* Hsu W.W.
* et al.

Treatment with dry hydrogen peroxide accelerates the decay of severe acute
syndrome coronavirus-2 on non-porous hard surfaces.
Am J Infect Control. 2021; 49: 1252-1255
* Abstract
* Full Text
* Full Text PDF
* PubMed
* Scopus (6)
* Google Scholar

,
24
* Sanguinet J.
* Lee C.

An effective and automated approach for reducing infection risk from
contaminated privacy curtains.
Am J Infect Control. 2021; 49: 1337-1338
* Abstract
* Full Text
* Full Text PDF
* PubMed
* Scopus (2)
* Google Scholar

The present study aims to assess the impact of DHP in reducing surface
environmental bioburden within the neurobehavioral unit of LTCFs in New York
State.

METHODS

SETTING

This study was conducted in the 15-bed neurobehavioral health unit shown in
Figure 1 at the Highlands at Brighton in Rochester, NY over a 3-month period
between November 2022 and January 2023. Each resident of the unit has a private
room. All of the windows are sealed on this unit; therefore, ventilation is
strictly through the heating, ventilation, and air conditioning (HVAC) system.
Intervention units included 8 occupied patient rooms and 2 communal spaces
within the neurobehavioral health unit. The DHP devices were installed in each
resident room up high near the TV (television). The placement was chosen for
resident safety as the infrastructure was already there for electricity and
cords would not be within the resident’s reach. Anything that would pose a risk
of strangulation needs to be removed (or secured to the wall). DHP units were
also installed in the common area and dining room (Fig. 1, Fig. 2, Fig. 3).
Fig. 1Blueprint of the neurobehavioral unit.
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Fig. 2Dry hydrogen peroxide devices installed throughout the neurobehavioral
unit; resident room in neurobehavioral unit.
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Fig. 3Dry hydrogen peroxide devices installed throughout the neurobehavioral
unit; communal milieu with the view of the dining room.
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ENVIRONMENTAL SAMPLING

To assess the impact of DHP on surface environmental bioburden, microbial load
counts yielded by baseline surface sampling before DHP deployment (Study days
−3, −2, −1) were compared to counts yielded by surface sampling post-DHP
deployment (Study days 14, 28, 55). A total of 264 surface samples were
collected, evenly divided between periods before and after the implementation of
DHP (132 preintervention; 132 postintervention). Additionally, measurements of
volatile organic compound (VOC) levels were collected in each of the 10
intervention units on each study sampling date using a VOC meter (Tiger, Ion
Science), for a total of 60 measurements. These measurements were collected to
further assess DHP’s impact on overall air quality. It is well established that
even at low concentrations, VOCs can cause unpleasant odors, particularly those
associated with human waste and emanations in health care settings. At higher
concentrations, VOCs can cause adverse health symptoms ranging from acute
respiratory symptoms with short-term exposure to permanent organ damage with
long-term exposure.
25

Environmental Protection Agency website. What are volatile organic compounds?
Accessed May 24, 2023.
https://www.epa.gov/indoor-air-quality-iaq/what-are-volatile-organic-compounds-vocs.

* Google Scholar

During each measurement, the range of VOC levels detected in the room was
recorded, with the minimum and maximum values of each range recorded as
individual data points, yielding a total of 120 data points (60 preintervention;
60 postintervention).
Surface samples were collected using Hi-cap neutralization swabs from 4 sites
within each intervention patient room and 6 sites within each intervention
communal space at each time point. Swabs containing neutralization buffers were
chosen to mitigate any impact of residual disinfectants present on the sample
surface during the time of collection. Sampling was collected before the
facility’s standard, daily, manual cleaning, and disinfection of the
intervention units. There were no changes to the cleaning and disinfection
protocols between the pre and postintervention periods.

AUTOMATED DHP SYSTEMS

The intervention consisted of deploying 19 standalone DHP devices in the
intervention unit after the completion of baseline sampling. Each unit was
plugged into a standard 120 VAC/220VAC outlet and operated continuously
throughout the study period. The DHP devices were installed in each resident
room up high near the TV, a placement chosen for resident safety. Electrical
outlets were already in place at this height to prevent cords from being within
the resident’s reach given concerns of strangulation risk among the population.
DHP units were also installed in the common area and dining room. The DHP
concentration generated by the units falls well below the 1 parts per million
(ppm) human exposure safety threshold established by Occupational Safety and
Health Administration (OSHA).
26

Occupational Safety and Health Administration website. Hydrogen peroxide.
Accessed February 17, 2023. https://www.osha.gov/chemicaldata/630.

* Google Scholar

Each device includes a sail and filter, which are a combination of a Merv 11 and
an activated carbon filter. These components were replaced on day 7 per the
manufacturer’s recommended usage. No changes were made to the facility’s
existing ventilation parameters.

MICROBIOLOGICAL METHODS

Surface samples were shipped overnight to a third-party lab for processing (US
Microsolutions) with an ice pack to minimize any growth. Surface samples were
plated to sheep blood agar plates and incubated at 20°C-25°C for 5 days.
Microbial recovery was reported in total colony-forming units (CFU). The sample
collection and microbial methods were selected in accordance with Centers for
Disease Control and Prevention (CDC) recommendations for sample collection
within health care facilities.
27
* Sehulster L.M.
* Chinn R.Y.W.
* Arduino M.J.
* et al.

Guidelines for Environmental Infection Control in Health-care Facilities.
Recommendations from CDC and the Healthcare Infection Control Practices Advisory
Committee (HICPAC). American Society for Healthcare Engineering/American
Hospital Association, 2004
* Google Scholar

STATISTICAL ANALYSIS

A multivariate regression model was created using Stata 17 to assess the
potential relationship between exposure to DHP and changes in microbial load
while controlling for measurable covariates (ie, type of sample location and
patient area). Both covariates were represented in the model using categorical
variables, with 5 types of sample locations (patient safety gates, dressers,
doors, handrails, and wall-mounted fire alert systems in communal areas) and 10
different patient areas (2 communal areas and 8 patient rooms). Before insertion
into the model, the counts yielded by the microbial samples were logarithmically
transformed to reduce the skewness of the data caused by high outliers.
Additionally, each preintervention VOC datapoint was paired with a
postintervention datapoint based on the patient area, sequence, and position in
the range of the measurement (minimum or maximum), yielding a total of 60 pairs
(n = 60). In this study, the first baseline time point was paired with day 14,
the first postintervention time point, with days 28 and 55 subsequently paired
with the second and third baseline time points, respectively. A paired t-test
was then conducted using Stata 17 to analyze the difference between the average
VOC measurements observed before and after the intervention.

RESULTS

Of the 264 surface samples collected, 262 were successfully shipped to the lab
and analyzed. Two samples at the day 55 timepoint leaked during transit,
preventing their ability to be cultured and counted. As shown in Figure 4, the
average CFU count yielded by the surface samples steadily decreased over the
course of the study. On day 14, the average CFU count was observed to be 61.6%
lower than the baseline average (baseline average: 297 CFU, SD: 1673 CFU, min:<2
CFU, max: 18,300 CFU; day 14 average: 114 CFU, SD: 424 CFU, min:<2 CFU, max:
2,700 CFU), which further decreased on days 28 and 55%-86.6% and 89.8% lower
than the baseline average, respectively (day 28 average: 39.7 CFU, SD: 95 CFU,
min:<2 CFU, max: 550 CFU; day 55 average: 30.4 CFU, SD: 88 CFU, min:<2 CFU, max:
520 CFU). Further, the multivariate regression model indicated a statistically
significant relationship between exposure to DHP and reductions in the
logarithmically transformed microbial counts during the study, controlling for
sample location and patient area (P < .001). The relationships between microbial
load and individual covariates included in the model (patient area and type of
sample location) were also analyzed. Samples collected from patient safety gates
and patient dressers yielded significantly higher CFU counts than the other
location types when controlling for exposure to DHP and the patient area
(P < .001). Of the patient areas, only 1 area yielded counts that were
significantly different from the others: the communal milieu area of the ward
yielded counts that were significantly higher than the counts yielded from other
patient areas when controlling for exposure to DHP and type of sample location
(P < .001).
Fig. 4Average bacterial count on sampled surfaces over time; Note: dry hydrogen
peroxide units installed after completion of day −1 sampling.
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* Figure Viewer
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Fig. 5 demonstrates the drastic decrease in the average VOC measurement after
exposure to DHP during the course of the study. On day 14, the average VOC level
was 76.1% lower than the baseline average (baseline average: 0.61 ppm, std err:
0.17, min: 0.00 ppm, max: 4.40 ppm), which further decreased to 91.5% and 98.6%
lower than the baseline average on days 28 and 55, respectively
(postintervention average: 0.08 ppm, std err: 0.01, min: 0.00 ppm, max:
0.35 ppm). The paired t-test indicated that the average VOC level after the
intervention was significantly lower than the average VOC level prior to
intervention (P = .003), with an average difference between the paired samples
of 0.53 ppm.
Fig. 5Average volatile organic compound levels over time; Note: dry hydrogen
peroxide installed after completion of day −1 sampling.
* View Large Image
* Figure Viewer
* Download Hi-res image
* Download (PPT)

DISCUSSION

This neurobehavioral unit was chosen for intervention by the facility due to the
unique infection prevention and control challenges it presents. The residents
housed in this unit lack the capacity to understand and co-operate with
traditional infection control measures such as isolation, gowning, gloving, and
respiratory etiquette. Further, severe cognitive impairment often results in
impulsive and intrusive behavior and an inability to respond to verbal
redirection. These factors, in conjunction with the inherent intrusive
behaviors, represent the majority of resident-perpetuated infection prevention
challenges in long-term care facilities. This neurobehavioral unit represents
the majority of resident-perpetuated infection prevention issues in long-term
care facilities.
Another motivator for implementing new technology in this area was the
significant devastation during the COVID-19 pandemic. Outbreaks in this unit
during the pandemic resulted in a death rate of approximately 50%. Even after
all residents were up to date with their vaccinations, the attack rate reached
nearly 90%. Despite concerted efforts by the facility, the behavioral
characteristics of the residents combined with the environmental contamination
created an impossible situation.
During previous outbreaks, the facility attempted to enhance manual cleaning
protocols; however, staffing has always been a limiting factor even for
accomplishing standard cleaning and disinfection. The same factors that
precipitated the COVID outbreak within the facility caused significant staff
illness. The illnesses only exacerbated the staffing challenges in EVS; thereby
limiting the ability to enhance manual cleaning and disinfection efforts.
LTCF residents’ heightened vulnerability to infection, coupled with the evidence
demonstrating the inadequacy of manual cleaning and disinfection in these
settings, has prompted other investigations of supplemental technologies to
enhance environmental decontamination.
28
* Kovach C.R.
* Taneli Y.
* Neiman T.
* Dyer E.M.
* Arzaga A.J.A.
* Kelber S.T.

Evaluation of an ultraviolet room disinfection protocol to decrease nursing home
microbial buren, infection and hospitalization rates.
BMC Infect Dis. 2017; 17: 186
* Crossref
* PubMed
* Scopus (49)
* Google Scholar

,
29
* Shapey S.
* Machin K.
* Levi K.
* Boswell T.C.

Activity of a dry mist hydrogen peroxide system against environmental
Clostridium difficile contamination in elderly care wards.
J Hosp Infect. 2008; 70: 136-141
* Abstract
* Full Text
* Full Text PDF
* PubMed
* Scopus (93)
* Google Scholar

Kovach et al report reductions in bioburden and infection rates with the use of
pulsed xenon UV light in an LTCF; however, they describe the need for staff to
not only deploy the technology in unoccupied rooms but to prepare the rooms for
disinfection by opening cabinet drawers, opening closet doors, pulling curtains,
and moving furniture into the line of sight of the UV device in order to achieve
more comprehensive disinfection. Shapey et al demonstrated a reduction of
environmental contamination with Clostridioides difficile utilizing aerosolized
hydrogen peroxide mist, but deployment similarly required rooms to be vacated
and staff to oversee the technology. While it is critical for environmental
solutions in the LTCF setting to be effective, it is also vitally important that
they be efficient given the ongoing staffing constraints. Specifically,
technologies that require staff to move patients out of rooms for deployment,
manually deploy the devices in patient rooms, and/or prepare the room for
treatment add to the already burdensome workload LTCF shoulders. This is
particularly relevant when considering that these technologies supplement but do
not replace manual cleaning and disinfection.
DHP is an environmental strategy that avoids these constraints by virtue of its
automated operation and ability to be used in occupied settings. DHP deployment
did not require staff operation or disrupt staff workflows or resident
schedules, effectively supporting our EVS staff’s regular cleaning, and
disinfection protocol without adding to it.
Staffing constraints in long-term care facilities are not limited to
environmental services. Skilled caregivers, including medical providers and
registered nurses, are a limited resource in these settings both for providing
patient care and in investigating and addressing outbreaks. An observed benefit
with DHP was decreased utilization of staffing resources as well as reduced
staff absenteeism. In 2020, prior to the study period, the neurobehavioral unit
experienced an outbreak that was devastating and overwhelming. With almost a
100% attack rate and a 40% death rate, the unit ended up being closed due to
unit census and staffing issues related to a COVID outbreak among staff. By
contrast, in December 2022 of the study period, during which the community
transmission level of COVID-19 remained ‘substantial to high’ per CDC
categorization, the neurobehavioral unit experienced a COVID-19 outbreak that
was very different from previous events. Over a period of 7 days, 6 residents
became COVID-positive. These residents became positive 2 at a time. The total
attack rate for the unit was 40% and COVID-positive residents experienced mild
to moderate symptoms.
The reduction in resource utilization was realized in decreased requirements for
acute investigations by skilled caregivers. With a moderate attack rate and zero
death rate, the 2022 outbreak required fewer visits by medical providers and
minimal intervention by registered nursing professionals. Interventions needed
to address resident’s symptoms were well within the scope of practice for
licensed practical nurses in long-term care.
In comparison, the facility experienced consecutive, progressive outbreaks
during the following months on a 40-bed long-term care unit and a 30-bed skilled
rehabilitation unit in which DHP was not deployed. In January 2023, the 40-bed
long-term care unit had a rolling outbreak that lasted over 3 weeks before new
cases stopped developing. This involved a significant amount of nursing and
provider effort to identify, rule out, and treat all residents. Optimal
infection control interventions were in place; however, the resident population
was not consistently co-operative with maintaining isolation. In the
rehabilitation unit, the February 2023 outbreak was rapid with an attack rate of
70%. This high attack rate occurred despite optimal infection control
interventions in an environment where the residents were able to comply. The
only difference between the areas was the implementation of DHP in the
environment for the neurobehavioral unit.
It is important to note that this study did not track infection rates, so the
differences in rates between the various units described herein cannot
definitively be attributed to the use of DHP. However, with the well-established
link between environmental contamination and infection acquisition, DHP’s
efficacy in reducing environmental bioburden in this study supports its
potential as an infection prevention and control strategy.

CONCLUSIONS AND IMPLICATIONS

The statistically significant reductions in surface microbial load and VOC
levels observed within the occupied facility after exposure to DHP provide
evidence of the intervention’s ability to positively impact indoor environmental
quality both in the air and on surfaces. In an environment in which standard,
let alone enhanced, cleaning and disinfection is widely recognized to be
challenging, DHP provides an opportunity to supplement efforts through the
continuous passive reduction of microbial burden.

REFERENCES

1. Centers for Disease Control and Prevention. Nursing homes and assisted
living. Accessed November 22, 2022.
https://www.cdc.gov/longtermcare/index.html.

View in Article
* Google Scholar

2. * Smith P.W.
* Bennett G.
* Bradley S.
* et al.
Society for Healthcare Epidemiology of America (SHEA); association for
professionals in infection control and epidemiology (APIC). SHEA/APIC
guideline: infection prevention and control in the long-term care facility.
Am J Infect Control. 2008; 36: 504-535
View in Article
* Scopus (150)
* PubMed
* Abstract
* Full Text
* Full Text PDF
* Google Scholar

3. * Fischer R.J.
* Morris K.K.
* McCorkel L.A.
* Case S.M.
* Pham H.H.
* Henneman B.G.
An ounce of prevention: reducing the risk of COVID-19 transmission in
long-term care facilities.
J Geriatr Med Gerontol. 2020; 6:
105https://doi.org/10.23937/2469-5858/1510105
View in Article
* Crossref
* Google Scholar

4. * Crnich C.J.
Reimagining infection control in U.S. nursing homes in the era of COVID-19.
J Am Med Dir Assoc. 2022; 23: 1909-1915
View in Article
* Scopus (1)
* Abstract
* Full Text
* Full Text PDF
* Google Scholar

5. Agency for Healthcare Research and Quality. A unit guide to infection
prevention for long-term care staff. Accessed February 16, 2023.

View in Article
* Google Scholar

6. * Dumyati G.
* Stone N.D.
* Nace D.A.
* Crinich C.J.
* Jump R.L.P.
Challenges and strategies for prevention of multidrug-resistant organism
transmission in nursing homes.
Curr Infect Dis Rep. 2017; 19: 18
View in Article
* Scopus (64)
* PubMed
* Crossref
* Google Scholar

7. * Roghmann M.C.
* Lydecker A.
* Mody L.
* Mullins C.D.
* Onukwugha E.
Strategies to prevent MRSA transmission in community-based nursing homes: a
cost analysis.
Infect Control Hosp Epidemiol. 2016; 37: 962-966
View in Article
* Scopus (4)
* Crossref
* Google Scholar

8. * Fisch J.
* Lansing B.
* Wang L.
* et al.
New acquisition of antibiotic-resistant organisms in skilled nursing
facilities.
J Clin Microbiol. 2012; 50: 1698-1703
View in Article
* Scopus (67)
* PubMed
* Crossref
* Google Scholar

9. Centers for Medicare & Medicaid Services. COVID-19 nursing home data.
Accessed February 16, 2023.
〈https://data.cms.gov/covid-19/covid-19-nursing-home-dataary.

View in Article
* Google Scholar

10. Kaiser Family Foundation. Over 200,000 residents and staff in long-term
care facilities have died from COVID-19. Accessed November 22, 2022.
https://www.kff.org/policy-watch/over-200000-residents-and-staff-in-long-term-care-facilities-have-died-from-covid-19/.

View in Article
* Google Scholar

11. * National Academies of Sciences, Engineering, and Medicine
The National Imperative to Improve Nursing Home Quality: Honoring Our
Commitment to Residents, Families, and Staff. The National Academies Press,
2022https://doi.org/10.17226/26526
View in Article
* Scopus (44)
* Crossref
* Google Scholar

12. Cleaning and Maintenance Management. Nursing home staff shortages among
reasons for nationwide closings. Accessed March 8, 2023.
https://cmmonline.com/news/nursing-home-staff-shortage-among-reasons-for-nationwide-closings.

View in Article
* Google Scholar

13. * Müller B.
* Armstrong P.
* Lowndes R.
Cleaning and caring: contributions in long-term residential care.
Ageing Int. 2018; 43: 53-73
View in Article
* Scopus (10)
* Crossref
* Google Scholar

14. Centers for Disease Control and Prevention. Healthcare-associated
infections: healthcare environmental infection prevention and control.
Accessed March 8, 2023.
https://www.cdc.gov/hai/prevent/environment/index.html.

View in Article
* Google Scholar

15. * Cannon J.L.
* Park G.W.
* Anderson B.
* et al.
Hygienic monitoring in long-term care facilities using ATP, crAssphage, and
human noroviruses to direct environmental surface cleaning.
Am J Infect Control. 2022; 50: 289-294
View in Article
* Scopus (2)
* Abstract
* Full Text
* Full Text PDF
* Google Scholar

16. * Wise M.E.
* Marquez P.
* Sharapov U.
* et al.
Outbreak of acute hepatitis B virus infections associated with podiatric
care at a psychiatric long-term care facility.
Am J Infect Control. 2012; 40: 16-21
View in Article
* Scopus (22)
* PubMed
* Abstract
* Full Text
* Full Text PDF
* Google Scholar

17. * Lee M.H.
* Lee G.A.
* Lee S.H.
* Park Y.H.
A systematic review on the causes of the transmission and control measures
of outbreaks in long-term care facilities: back to basics.
PLoS One. 2020; 15e0229911
View in Article
* Scopus (38)
* Crossref
* Google Scholar

18. * Saeb A.
* Mody L.
* Gibson K.
How are nursing homes cleaned? Results of a survey of 6 nursing homes in
Southeast Michigan.
Am J Infect Control. 2017; 45: e119-e122
View in Article
* Scopus (7)
* PubMed
* Abstract
* Full Text
* Full Text PDF
* Google Scholar

19. * McKinnell J.A.
* Singh R.D.
* Miller L.G.
* et al.
The SHIELD Orange County project: multidrug-resistant organism prevalence
in 21 nursing homes and long-term acute care facilities in Southern
California.
Clin Infect Dis. 2019; 69: 1566-1573
View in Article
* Scopus (37)
* PubMed
* Crossref
* Google Scholar

20. * Ramirez M.
* Matheu L.
* Gomez M.
* et al.
Effectiveness of dry hydrogen peroxide on reducing environmental microbial
bioburden risk in a pediatric oncology intensive care unit.
Am J Infect Control. 2021; 49: 608-613
View in Article
* Scopus (5)
* PubMed
* Abstract
* Full Text
* Full Text PDF
* Google Scholar

21. * Melgar M.
* Ramirez M.
* Chang A.
* Antillon F.
Impact of dry hydrogen peroxide on hospital-acquired infection at a
pediatric oncology hospital.
Am J Infect Control. 2022; 50: 909-915
View in Article
* Scopus (2)
* Abstract
* Full Text
* Full Text PDF
* Google Scholar

22. * Sanguinet J.
* Edmiston C.
Evaluation of dry hydrogen peroxide in reducing microbial bioburden in a
healthcare facility.
Am J Infect Control. 2021; 49: 985-990
View in Article
* Scopus (3)
* PubMed
* Abstract
* Full Text
* Full Text PDF
* Google Scholar

23. * Huang Y.S.
* Bilyeu A.N.
* Hsu W.W.
* et al.
Treatment with dry hydrogen peroxide accelerates the decay of severe acute
syndrome coronavirus-2 on non-porous hard surfaces.
Am J Infect Control. 2021; 49: 1252-1255
View in Article
* Scopus (6)
* PubMed
* Abstract
* Full Text
* Full Text PDF
* Google Scholar

24. * Sanguinet J.
* Lee C.
An effective and automated approach for reducing infection risk from
contaminated privacy curtains.
Am J Infect Control. 2021; 49: 1337-1338
View in Article
* Scopus (2)
* PubMed
* Abstract
* Full Text
* Full Text PDF
* Google Scholar

25. Environmental Protection Agency website. What are volatile organic
compounds? Accessed May 24, 2023.
https://www.epa.gov/indoor-air-quality-iaq/what-are-volatile-organic-compounds-vocs.

View in Article
* Google Scholar

26. Occupational Safety and Health Administration website. Hydrogen peroxide.
Accessed February 17, 2023. https://www.osha.gov/chemicaldata/630.

View in Article
* Google Scholar

27. * Sehulster L.M.
* Chinn R.Y.W.
* Arduino M.J.
* et al.
Guidelines for Environmental Infection Control in Health-care Facilities.
Recommendations from CDC and the Healthcare Infection Control Practices
Advisory Committee (HICPAC). American Society for Healthcare
Engineering/American Hospital Association, 2004
View in Article
* Google Scholar

28. * Kovach C.R.
* Taneli Y.
* Neiman T.
* Dyer E.M.
* Arzaga A.J.A.
* Kelber S.T.
Evaluation of an ultraviolet room disinfection protocol to decrease nursing
home microbial buren, infection and hospitalization rates.
BMC Infect Dis. 2017; 17: 186
View in Article
* Scopus (49)
* PubMed
* Crossref
* Google Scholar

29. * Shapey S.
* Machin K.
* Levi K.
* Boswell T.C.
Activity of a dry mist hydrogen peroxide system against environmental
Clostridium difficile contamination in elderly care wards.
J Hosp Infect. 2008; 70: 136-141
View in Article
* Scopus (93)
* PubMed
* Abstract
* Full Text
* Full Text PDF
* Google Scholar

ARTICLE INFO

PUBLICATION HISTORY

Published online: June 07, 2023

PUBLICATION STAGE

In Press Journal Pre-Proof

FOOTNOTES

Conflicts of interest: Synexis, LLC provided funding for the third-party,
independent laboratory costs. There are no other conflicts of interest to
report.

IDENTIFICATION

DOI: https://doi.org/10.1016/j.ajic.2023.06.004

© 2023 The Author(s). Published by Elsevier Inc. on behalf of Association for
Professionals in Infection Control and Epidemiology, Inc.

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Impact of dry hydrogen peroxide on environmental bioburden reduction in a
long-term care facility
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FIGURES

* Fig. 1Blueprint of the neurobehavioral unit.
* Fig. 2Dry hydrogen peroxide devices installed throughout the neurobehavioral
unit; resident room in neurobehavioral unit.
* Fig. 3Dry hydrogen peroxide devices installed throughout the neurobehavioral
unit; communal milieu with the view of the dining room.
* Fig. 4Average bacterial count on sampled surfaces over time; Note: dry
hydrogen peroxide units installed after completion of day −1 sampling.
* Fig. 5Average volatile organic compound levels over time; Note: dry hydrogen
peroxide installed after completion of day −1 sampling.

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www.ajicjournal.org Open in urlscan Pro 104.18.123.114 Public Scan

Form analysis 3 forms found in the DOM

POST /action/doLogin?redirectUri=https%3A%2F%2Fwww.ajicjournal.org%2Farticle%2FS0196-6553%2823%2900405-4%2Ffulltext

POST /action/requestResetPassword

Name: quickSearchBar — GET https://www.ajicjournal.org/action/doSearch?journalCode=ymic

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www.ajicjournal.org Open in urlscan Pro
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