Hydrogen Peroxide as a Disinfectant in Medical and Healthcare Buildings
When entering a hospital or a healthcare building of any kind, it is usually a presumption that the environment is sterile. With this presumption in mind, patients are usually struck with false confidence that they have little risk of contracting an illness. In reality, hospitals can be dangerous, especially to those who are at high risk to contract infections. Even those with a strong immunity can fall victim to the numerous bacteria, fungi, and other virulent organisms that call medical facilities home.
This unfortunate reality is kept in check by effective disinfection and sterilization of the environment within the facilities. Effective cleaning, however, is a controversial topic considering the wide variety of choices that can be made. Although there are many disinfectants and sterilants out there, many pale in comparison to the superior effects of hydrogen peroxide.
It is an all-natural powerful disinfecting cleaner that is safe for people, pets and the environment having many many uses in a healthcare setting. It targets and effectively kills 99.9% of all types of microorganisms including the Corona Virus and a whole host of other harmful pathogens. It is versatile, safe, relatively inexpensive, and has few side downsides. For these reasons, it can easily be used in many healthcare settings on many different types of materials.
Considering surfaces one may come into contact with in medical facilities or tools used by medical professionals, the need for disinfection and a sterile environment is absolutely necessary. Increasing evidence suggests that the environment within health care facilities plays a large role in the spread of infections (1). Because of this, there is now more focus on cleaning and improving the efficacy of cleaning than ever. The problem, however, arises when it comes to actually disinfecting these facilities; infection is often spread through improper cleaning.
Many experts are in agreement that the careful cleaning and disinfection of surfaces are essential elements in preventing the spread of infection. Unfortunately, traditional manual cleaning and disinfection practices in hospitals are often suboptimal. Furthermore, the lack of antimicrobial activity of some disinfectants against healthcare-associated pathogens may also affect the efficiency of disinfection practices (2). Regardless of cleaning techniques, these disinfectants simply do not meet the standards to maintain a healthy environment within hospitals and healthcare facilities.
There exists some information showing that environmental surfaces in medical facilities can be contaminated with epidemiologically important microbes, including but not limited to VRE and MRSA (3). This implies that if medical facilities fail to maintain a clean environment, as is the case in some instances, patients are at extreme risk of infection that can potentially lead to death. Because these deadly organisms survive on various surfaces within healthcare facilities, such surfaces should be disinfected regularly.
Because of its antimicrobial properties, hydrogen peroxide is active against a wide range of microorganisms, including bacteria, yeasts, fungi, viruses, and spores. Reports from the Center for Disease Control and Prevention (CDC) demonstrate the effectiveness of hydrogen peroxide as a disinfection and sterilization tool. Considering its germicidal effectiveness, hydrogen peroxide has been proven to be a successful tool in eradicating potential pathogens. In fact, published reports from the CDC ascribe good germicidal activity to hydrogen peroxide and attest to its bactericidal, virucidal, sporicidal, and fungicidal properties.
Hydrogen peroxide works by creating destructive hydroxyl free radicals that kill dangerous microbes. These free radicals attack membrane lipids, DNA, and other essential cell components that the microbes cannot live without (3). Because of the ability to produce hydroxyl free radicals, hydrogen becomes an extremely effective choice for making an environment sterile. This makes hydrogen peroxide an ideal choice for use in hospitals and healthcare facilities because only sterilization can eliminate all forms of microbial life, including spores (4).
According to the CDC, one study involving the potential of hydrogen peroxide reduced bacterial populations and demonstrated sporicidal effects. These effects, observed when spores were exposed to a solution containing hydrogen peroxide, is a testimonial to the sporicidal and fungicidal properties of hydrogen peroxide. Another study demonstrated the antiviral activity of hydrogen peroxide against rhinovirus.
The CDC report on chemical disinfectants includes protocols for using hydrogen peroxide as low as .05% for a normal disinfecting cleaner and as a high-level disinfectant, the user must employ 7.5% hydrogen peroxide for 30 minutes at 20 degrees Centigrade. To be used as a high-grade sterilizer, the user must use the same concentration for 6 hours at 20 degrees centigrade. It can be used for 21 days and has a stable shelf life of 2 years.
The time required for inactivating three serotypes of rhinovirus using a 3% hydrogen peroxide solution was six to eight minutes; this time increased with decreasing concentrations. In fact, a 0.5% accelerated hydrogen peroxide demonstrated bactericidal and virucidal activity in one minute and mycobactericidal and fungicidal activity in five minutes (3). The studies demonstrate the increasing effectiveness of hydrogen peroxide at increasing concentrations and time intervals.
As stated above, hydrogen peroxide is effective against a variety of microorganisms, including catalase-positive bacteria. To be effective against these bacteria, a higher concentration of hydrogen peroxide must be used to overcome the bacteria’s cytochrome systems generating the catalase. Hydrogen peroxide has been shown to be bactericidal against organisms with high cellular catalase activity, like S. aureus, S. marcescens, and Proteus mirabilis, but only at certain dosages. Specifically, these organisms need to be targeted for 30-60 minutes with 0.6% hydrogen peroxide. Organisms with lower catalase activity, like E. coli, Streptococcus species, and Pseudomonas species, do not need as long of an exposure. They require only 15 minutes of exposure of the same 0.6% hydrogen peroxide.
For less difficult organisms, less hydrogen peroxide is needed. Specifically, 0.5% accelerated hydrogen peroxide has bactericidal and virucidal activity in 1 minute. It has mycobactericidal and fungicidal activity in 5 minutes. The upper limits tested and proven to be antimicrobial are as follows: 7% stabilized hydrogen peroxide for 6 hours of exposure is sporicidal, 20 minutes is mycobactericidal, 5 minutes of fungicidal and virucidal, and bactericidal at 3 minutes.
Hydrogen peroxide is even effective against multiple types of resistant organisms. Specifically, it has been shown to inactivate cryptosporidium. It has also been shown to reduce the chance of spreading drug-resistant bacteria room-to-room in hospital wards. Researchers found that using hydrogen peroxide vapor as a means of disinfecting patient rooms prevented the spread of vancomycin-resistant enterococci (VRE), methicillin-resistant Staphylococcus aureus, Clostridium difficile, and Acinetobacter baumannii. This study does not suggest that hydrogen peroxide eradicates these organisms. Rather, it reduces the number of logarithmic cell counts so that it decreases the likelihood of spreading these organisms from patient-to-patient.
It is unfair to assume that hospitals and healthcare buildings do not take precautions to disinfect and make their environments sterile. The issue arises when the sterilant is not effective, or less effective when used in cleaning and common practices. One of the current sterilants used in medical facilities is a compound named alkaline glutaraldehyde.
A study was conducted comparing the effectiveness of hydrogen peroxide versus the effectiveness of alkaline glutaraldehyde as sterilants. A 6% hydrogen peroxide was more effective in the high-level disinfection of flexible endoscopes than was the 2% glutaraldehyde solution. The results of the study showed that hydrogen peroxide at ten minutes was superior compared with alkaline glutaraldehyde at twenty minutes, so long as the proper concentration was used in sterilization (3).
For a concentration of hydrogen peroxide that achieves the status of a chemical sterilant, the CDC recommends a concentration from 6% to 25%. Despite this fact, the CDC reports that even commercially available 3% hydrogen peroxide is a stable and effective disinfectant when used on inanimate surfaces.
Advantages and Disadvantages
Beyond its effectiveness, hydrogen peroxide has many advantages and few disadvantages. As a disinfectant, it does not require activation. It may enhance removal of organic tissue and organisms. It does not require any special disposal protocols. It does not have a strong odor and is not a particular irritant to many people. It does not coagulate blood. If the disinfecting and sterilizing is done manually, using hydrogen peroxide is inexpensive. If done through automated machinery, using hydrogen peroxide is still less expensive than many other options, but does cost slightly more than the manual cost.
Hydrogen peroxide does have minor disadvantages. It may damage certain materials, specifically metals like brass, zinc, copper, and nickel/silver plating. Sometimes this damage is cosmetic, but sometimes it is functional. Hydrogen peroxide can also seriously damage eyes if the user is not wearing eye protection.
Conclusion
Hydrogen peroxide is an inexpensive, effective disinfectant and sanitizing agent in healthcare settings. It has relatively few disadvantages. Much research has been done on which concentrations and durations are effective against certain organisms. It is a viable option for manual disinfecting and sanitization.
Another reason hydrogen peroxide is superior comes from the quality of being a sustainable and economical choice. Under normal conditions, it is extremely stable when stored and the decomposition or loss of potency in small containers is less than 2% per year at ambient temperatures (3). This means that hydrogen peroxide can be properly kept for years without significant loss. Hydrogen peroxide benefits the health of the average patient without impacting the financial sustainability of medical facilities.
Of the different sterilants that can be used to clean and kill bacteria, fungi, viruses, and spores, it is difficult to argue with the effectiveness and sustainability of hydrogen peroxide. It has proven time and time again to be superior at disinfecting and sterilizing an environment. For the health of patients within a hospital or any healthcare building, hydrogen peroxide should be the main choice for use in cleaning.
Resources:
1. American Journal of Infection Control
2. National Center for Biotechnological Information
3. Center for Disease Control and Prevention
4. California Department of Social Services
Other Cited Works:
Works Cited
“Chemical Disinfectants.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 18 Sept. 2016, www.cdc.gov/infectioncontrol/guidelines/disinfection/disinfection-methods/chemical.html#Hydrogen.
“Hydrogen Peroxide Vapor Enhances Hospital Disinfection of Superbugs - 12/31/2012.” Johns Hopkins Medicine, Based in Baltimore, Maryland, www.hopkinsmedicine.org/news/media/releases/hydrogen_peroxide_vapor_enhances_hospital_disinfection_of_superbugs.
Lineback, Caitlinn B., et al. “Hydrogen Peroxide and Sodium Hypochlorite Disinfectants Are More Effective against Staphylococcus Aureus and Pseudomonas Aeruginosa Biofilms than Quaternary Ammonium Compounds.” Antimicrobial Resistance & Infection Control, vol. 7, no. 1, 2018, doi:10.1186/s13756-018-0447-5.
Rutala, William A., et al. “Efficacy of Improved Hydrogen Peroxide against Important Healthcare-Associated Pathogens.” Infection Control & Hospital Epidemiology, vol. 33, no. 11, 2012, pp. 1159–1161., doi:10.1086/668014.