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Peer-Reviewed Studies

Stay current on scientific literature covering strategies to reduce pathogens that cause healthcare-associated infections. Use the filters on the left to refine your search, and expand or collapse sections using the plus/minus button.

The following studies examined methods to reduce pathogens on surfaces in healthcare environments.

Effectiveness of Improved Hydrogen Peroxide in Decontaminating Privacy Curtains Contaminated with Multidrug-Resistant Pathogens

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Publish Date April 2014
Facility University of North Carolina School of Medicine—Affiliated Hospital, Chapel Hill, NC
Intervention An improved hydrogen peroxide cleaner-disinfectant was evaluated for its ability to reduce microbial contamination of privacy curtains with healthcare-associated pathogens that were potentially present in inpatient and outpatient areas of a hospital.
Findings Use of the improved hydrogen peroxide cleaner-disinfectant on privacy curtains reduced the microbial contamination of the curtains by 96.8% in 37 patient rooms. Overall, the level of microbial contamination of privacy curtains was 260.6 colony-forming units per curtain. All 37 privacy curtains tested contained microbial contamination.
Full citation Rutala, WA, et al. “Effectiveness of Improved Hydrogen Peroxide in Decontaminating Privacy Curtains Contaminated with Multidrug-Resistant Pathogens.” American Journal of Infection Control 42.4 (2014): 426–428.
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Reducing Clostridium difficile Incidence, Colectomies, and Mortality in the Hospital Setting: A Successful Multidisciplinary Approach

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Publish Date July 2013
Facility Warren Alpert Medical School, Brown University, Providence, RI
Intervention The use of a hospitalwide infection control bundle for prevention of Clostridium difficile infections included enhanced environmental cleaning of patient rooms and equipment using sodium hypochlorite-based cleaning agents.
Findings After implementing the infection control bundle, the facility cited a 70% decrease in the incidence of healthcare-associated C. difficile infection rates and a 63% decrease in yearly mortality in patients with healthcare-associated C. difficile infections.
Full citation Mermel, LA, et al. “Reducing Clostridium difficile Incidence, Colectomies, and Mortality in the Hospital Setting: A Successful Multidisciplinary Approach.” Joint Commission Journal on Quality and Patient Safety 39.7 (2013): 298–305.
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An Environmental Disinfection Odyssey: Evaluation of Sequential Interventions to Improve Disinfection of Clostridium difficile Isolation Rooms

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Publish Date May 2013
Facility Louis Stokes Cleveland VA Medical Center, Cleveland, OH
Intervention Three-stage intervention strategy involving the use of a 0.55% sodium hypochlorite cleaner-disinfectant wipe product for rooms of patients who had Clostridium difficile infection.
Findings During a 21-month period, three sequential tiered interventions were implemented to improve disinfection of C. difficile isolation rooms. Intervention 3, the enhanced daily and terminal disinfection measure using bleach wipes, resulted in an immediate and dramatic reduction in the percentage of rooms with positive cultures. Relative to the baseline period, there was an 89% decrease in the prevalence of CDI patient rooms with positive cultures.
Full citation Sitzlar, B, et al. “An Environmental Disinfection Odyssey: Evaluation of Sequential Interventions to Improve Disinfection of Clostridium difficile Isolation Rooms.” Infection Control and Hospital Epidemiology 34.5 (2013): 459–465.
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Evaluation of a New Hydrogen Peroxide Wipe Disinfectant

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Publish Date May 2013
Facility Yale-New Haven Hospital Affiliated Hospital, New Haven, CT
Test Method The cleaning and bactericidal efficacy of a new activated hydrogen peroxide cleaner-disinfectant wipe was evaluated on 10 high-touch surfaces in each of 72 patient rooms throughout a hospital. Aerobic colony counts and adenosine triphosphate (ATP) bioluminescence assays were used to evaluate efficacy.
Findings After cleaning, 99% of surfaces yielded less than 2.5 colony-forming units/cm2, 75% yielded no growth, and 70% yielded ATP counts of less than 250 relative light units — all of which are levels that are considered clean. The authors described the new disinfectant as “highly effective.”
Full citation Boyce, JM, and Havill, NL. “Evaluation of a New Hydrogen Peroxide Wipe Disinfectant.” Infection Control and Hospital Epidemiology 34.5 (2013): 521–523.
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Prevention of Hospital-Onset Clostridium difficile Infection in the New York Metropolitan Region Using a Collaborative Intervention Model

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Publish Date January 2013
Facility 35 acute-care hospitals in the New York metropolitan area
Intervention Evidence-based infection control bundle — a standardized environmental cleaning protocol, including use of sodium hypochlorite-based products for disinfecting high-touch surfaces in patient rooms and bathrooms — as well as evidence-based infection control procedures for suspected or confirmed cases of Clostridium difficile infection.
Findings Implementation of this infection control bundle was associated with a reduction in the incidence of hospital-onset C. difficile infections.
Full citation Koll, BS, et al. “Prevention of Hospital-Onset Clostridium difficile Infection in the New York Metropolitan Region Using a Collaborative Intervention Model.” Journal for Healthcare Quality 36.3 (2014): 35–45.
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Efficacy of Improved Hydrogen Peroxide Against Important Healthcare-Associated Pathogens

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Publish Date November 2012
Facility University of North Carolina School of Medicine—Affiliated Hospital, Chapel Hill, NC
Test Method A laboratory-based study looked at the effectiveness of new activated hydrogen peroxide cleaner-disinfectants against important healthcare-associated pathogens, including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE) and multidrug-resistant Acinetobacter baumannii. The efficacies of two activated hydrogen peroxide-based formulated products were evaluated along with dilutions of standard hydrogen peroxide and a quaternary ammonium disinfectant product.
Findings The active hydrogen peroxide products demonstrated greater log reduction against all test microorganisms when compared with the three concentrations of standard hydrogen peroxide (0.5%, 1.4% and 3.0%) and greater than or parity log reduction as compared to the quaternary ammonium-based product tested. These results proved true regardless of the contact time tested or whether or not fetal calf serum (FCS) soil was present.
Full citation Rutala, WA, Gergen, MF, and Weber, DJ. “Efficacy of Improved Hydrogen Peroxide Against Important Healthcare-Associated Pathogens.” Infection Control and Hospital Epidemiology 33.11 (2012): 1,159–1,161.
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Significant Reduction in Vancomycin-Resistant Enterococcus Colonization and Bacteraemia after Introduction of a Bleach-Based Cleaning-Disinfection Programme

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Publish Date August 2012
Facility Tertiary Hospital, Melbourne, Australia
Intervention Multimodal infection control intervention, including hospitalwide, standardized cleaning-disinfection practices using bleach-based products, employment of cleaning supervisors and changes to hand hygiene practices.
Findings Implementation of the multimodal infection control program was associated with the following outcomes: • 24% reduction in newly recognized vancomycin-resistant Enterococci (VRE) colonization of patients. • 66% reduction in VRE contamination of environmental surfaces. • 83% reduction in VRE-associated bacteraemia.
Full citation Grabsch, E A et al. “Significant Reduction in Vancomycin-Resistant Enterococcus Colonization and Bacteraemia after Introduction of a Bleach-Based Cleaning-Disinfection Programme.” The Journal of Hospital Infection 82.4 (2012): 234-242.
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Impact of the Reduction of Environmental and Equipment Contamination on Vancomycin-Resistant Enterococcus Rates

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Publish Date December 2011
Facility University of Londrina Teaching Hospital, Paraná, Brazil
Intervention Implementation of a multidisciplinary infection prevention process including staff education about the importance of environment and equipment cleaning. Bleach and peracetic acid products were used for environmental cleaning and 70% alcohol was used for equipment cleaning.
Findings 75% reduction in VRE infection rates was associated with implementation of the infection prevention process.
Full citation Perugini, MR, et al. “Impact of the Reduction of Environmental and Equipment Contamination on Vancomycin-Resistant Enterococcus Rates.” Infection 39.6 (2011): 587–593.
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A Targeted Strategy to Wipe Out Clostridium difficile

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Publish Date November 2011
Facility Mayo Clinic Hospital, Saint Marys Campus, Rochester, MN
Intervention Environmental cleaning strategy involving daily and discharge cleaning of all patient rooms using a 0.55% sodium hypochlorite active ingredient and monitoring cleaning efficacy using adenosine triphosphate (ATP) bioluminescence.
Findings The authors concluded that targeting the use of daily bleach wipe cleaning for units with increased C. difficile colonization pressure was effective.
Full citation Orenstein, R, et al. “A Targeted Strategy to Wipe Out Clostridium difficile.” Infection Control and Hospital Epidemiology 32.11 (2011): 1137–1139.
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Significant Impact of Terminal Room Cleaning with Bleach on Reducing Nosocomial Clostridium difficile

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Publish Date June 2010
Facility NorthShore University HealthSystem, Evanston, IL (three hospitals)
Intervention Implementation of a terminal cleaning program for Clostridium difficile patient rooms, including use of a 1:10 dilution of household bleach and room cleaning checklist for cleaning compliance.
Findings Implementation of the terminal cleaning program was associated with a 48% reduction in the prevalence density of patients with C. difficile infection.
Full citation Hacek, DM, et al. “Significant Impact of Terminal Room Cleaning with Bleach on Reducing Nosocomial Clostridium difficile.” American Journal of Infection Control 38.5 (2010): 350–353.
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Proposed Checklist of Hospital Interventions to Decrease the Incidence of Healthcare-Associated Clostridium difficile Infection

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Publish Date November 2009
Facility Brigham and Women's Hospital, Boston, MA
Intervention Implementation of an infection control strategy — an educational campaign; a prevention bundle, including a 0.65% sodium hypochlorite cleaner-disinfectant product; and a treatment bundle — for environmental cleaning and disinfection after discharge or transfer of a patient with a Clostridium difficile infection.
Findings Use of this infection control bundle was associated with a 40% reduction in healthcare-associated C. difficile infections.
Full citation Abbett, SK, et al. “Proposed Checklist of Hospital Interventions to Decrease the Incidence of Healthcare-Associated Clostridium difficile Infection.” Infection Control and Hospital Epidemiology 30.11 (2009): 1062–1069.
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Impact of Infection Control Interventions and Antibiotic Use on Hospital MRSA: A Multivariate Interrupted Time-Series Analysis

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Publish Date June 2007
Facility Two hospitals (one with the interventions, the other serving as a control) in the United Kingdom
Intervention Implementation of an infection control bundle, including methicillin-resistant Staphylococcus aureus screening, environmental swabbing for MRSA and sodium hypochlorite-based terminal cleaning for MRSA patient isolation rooms and cohort areas.
Findings Use of the chlorine product for terminal cleaning of MRSA isolation rooms and cohort rooms in combination with environmental swabbing to check for cleaning and disinfection compliance was associated with a 27% reduction in the prevalence of MRSA immediately and a 32% reduction three months later.
Full citation Mahamat, A, et al. “Impact of Infection Control Interventions and Antibiotic Use on Hospital MRSA: A Multivariate Interrupted Time-Series Analysis.” International Journal of Antimicrobial Agents 30.2 (2007): 169–176.
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Reduction of Clostridium difficile and Vancomycin-Resistant Enterococcus Contamination of Environmental Surfaces after an Intervention to Improve Cleaning Methods

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Publish Date June 2007
Facility Cleveland Veterans Affairs Medical Center, Cleveland, OH
Intervention Implementation of a bundled infection prevention program — staff education and a cleaning strategy, including the use of 0.65% sodium hypochlorite cleaner-disinfectant product — for vancomycin-resistant Enterococci patient rooms.
Findings After intervention, 17 of 17 VRE patient rooms tested negative for VRE contamination of environmental surfaces.
Full citation Eckstein, BC, et al. “Reduction of Clostridium difficile and Vancomycin-Resistant Enterococcus Contamination of Environmental Surfaces after an Intervention to Improve Cleaning Methods.” BMC Infectious Diseases 7 (2007): 61.
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Use of Hypochlorite Solution to Decrease Rates of Clostridium difficile-Associated Diarrhea

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Publish Date February 2007
Facility Barnes-Jewish Hospital, St. Louis, MO
Intervention Two sodium hypochlorite-based environmental cleaning interventions were implemented in intensive care units. Intervention 1 included the use sodium hypochlorite for all patient rooms. Intervention 2 included the use of sodium hypochlorite for rooms housing patients with Clostridium difficile-associated diarrhea.
Findings Intervention 1 was associated with a 77% decrease in C. difficile-associated diarrhea rates. Intervention 2 was associated with 62% decrease in C. difficile-associated diarrhea rates.
Full citation McMullen, KM, et al. “Use of Hypochlorite Solution to Decrease Rates of Clostridium difficile-Associated Diarrhea.” Infection Control and Hospital Epidemiology 28.2 (2007): 205–207.
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Environmental Control to Reduce Transmission of Clostridium difficile

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Publish Date October 2000
Facility Barnes-Jewish Hospital, St. Louis, MO
Intervention Infection control strategy including staff education and environmental disinfection protocol using a 1:10 sodium hypochlorite solution in hospital rooms of patients with Clostridium difficile-associated diarrhea.
Findings Implementation of the infection control strategy was correlated with a 61% decrease in C. difficile-associated diarrhea incidence rates.
Full citation Mayfield, JL, et al. “Environmental Control to Reduce Transmission of Clostridium difficile.” Clinical Infectious Diseases 31.4 (2000): 995–1000.
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Acquisition of Clostridium difficile from the Hospital Environment

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Publish Date June 1998
Facility University of Michigan Associated Hospital
Intervention Environmental sampling for Clostridium difficile-contaminated surfaces coupled with surface disinfection with diluted sodium hypochlorite solutions in hospital rooms of patients with C. difficile-associated diarrhea.
Findings Implementation of this environmental disinfection process using a 500 ppm sodium hypochlorite solution was associated with a 79% decrease in C. difficile surface contamination, and C. difficile infection outbreak ended. The use of a 1600 ppm sodium hypochlorite solution resulted in a 98.2% reduction in surface contamination.
Full citation Kaatz, GW, et al. “Acquisition of Clostridium difficile from the Hospital Environment.” American Journal of Epidemiology 127.6 (1988): 1289–1294.
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An Outbreak of Vancomycin-Resistant Enterococci in a Hematology-Oncology Unit: Control by Patient Cohorting and Terminal Cleaning of the Environment

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Publish Date August 2002
Facility Ottawa Hospital (University of Ottawa), Ottawa, Canada
Intervention Multimodal infection control interventions, including patient screening for vancomycin-resistant Enterococci, VRE patient cohorting and terminal cleaning of VRE patient rooms using 0.5% sodium hypochlorite solution.
Findings After implementation of interventions, a 77% reduction in VRE incidence rate was reported.
Full citation Sample, ML, et al. “An Outbreak of Vancomycin-Resistant Enterococci in a Hematology-Oncology Unit: Control by Patient Cohorting and Terminal Cleaning of the Environment.” Infection Control and Hospital Epidemiology 23.8 (2002): 468–470.
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