Role of Hydrogen Peroxide Vapor (HPV) for the Disinfection of Hospital Surfaces Contaminated by Multiresistant Bacteria

Michele Totaro, Beatrice Casini , Sara Profeti, Benedetta Tuvo, Gaetano Privitera and Angelo Baggiani *
Department of Translational Research and the New Technologies in Medicine and Surgery, University of Pisa, 56123 Pisa, Italy; micheleto@hotmail.it (M.T.); beatrice.casini@med.unipi.it (B.C.); profeti.sara@gmail.com (S.P.); tuvobenedetta@hotmail.it (B.T.); gaetano.privitera@med.unipi.it (G.P.)
* Correspondence: angelo.baggiani@med.unipi.it; Tel.: 050-221-3583; Fax: 050-221-3588
Received: 10 April 2020; Accepted: 22 May 2020; Published: 24 May 2020

The emergence of multiresistant bacterial strains as agents of healthcare-related infection in hospitals has prompted a review of the control techniques, with an added emphasis on preventive measures, namely good clinical practices, antimicrobial stewardship, and appropriate environmental cleaning. The latter item is about the choice of an appropriate disinfectant as a critical role due to the difficulties often encountered in obtaining a complete eradication of environmental contaminations and reservoirs of pathogens. The present review is focused on the effectiveness of hydrogen peroxide vapor, among the new environmental disinfectants that have been adopted.
 

The disinfection of hospital surfaces is a complex operation aimed at reducing the pathogenic microorganism load. An ideal disinfectant must be safe for human health. It may have a good stability in the environment and may be free of toxic activity .

Hydrogen peroxide is a versatile disinfectant, since it can be used in several environmental matrices: air, water, wastewater, surfaces, soil, etc. It may be used in combination with other agents increasing the disinfection times. Hydrogen peroxide is more oxidizing than chlorine and chlorine dioxide. The disinfection mechanism is based on the release of oxygen free radicals, which cause genomic damage in bacterial cells.

Hydrogen peroxide in the vaporized form (HPV) is used for surface disinfection. It may be combined with higher or lower concentrations of silver ions.
HPV bactericidal activity may be experimentally evaluated in vitro or in hospital settings , in order to provide scientific data related to:

• the type of microbial strains sensitive or resistant to the compound;
• the adequate chemical concentrations; and
• the contact time.

The management of the spread of multidrug-resistant bacteria (MDR) in the hospital setting is a crucial issue that needs the evaluation of HPV activity.
The incidence of infectious outbreaks from antibiotic resistant microorganisms is becoming one of the main problems in hospital contexts.