Aerosolized Hydrogen Peroxide reduces C. difficile infections

Hydrogen peroxide vapors utilized in patient hospital rooms may be a significant way to control this deadly disease.

The 2019 edition of the Center for Disease Control and Prevention’s Antibiotic Resistance Threats Report estimated that Clostridioides difficile is responsible for almost half a million infections per year in the United States, with approximately six percent of those cases leading to death.(1) More commonly referred to as C. diff, this bacterium is gram-positive, bacillus-shaped, and able to produce spores and toxins. It can be found in human or animal feces, contaminated water or air, and hospitals, with the most common transmission route being fecal-oral. Infection symptoms can range from mild diarrhea to colon inflammation and in extreme cases, death. Those with compromised immune systems, like the elderly or hospitalized individuals, are at the highest risk of infection. When these conditions are coupled with antibiotic administration, the risk of a C. diff infection (CDI) can greatly increase. Also alarming, is that 30% to 50% of antibiotics used to combat C. diff are unnecessary or incorrectly prescribed.(2) 

High incidence reports of C. diff highlight the importance of incorporating alternative measures to prevent and treat infections. While there has been an increase of community-acquired infections, the majority of cases still occur nosocomially and hospitals are looking for new disinfection methods that are safe and easy to administer.

Hydrogen peroxide is a commonly used chemical disinfectant that attacks lipid membranes, DNA, and other cell structures via the release of hydroxyl free radicals. Some species of bacteria may evade the consequences of hydrogen peroxide by secreting the enzyme catalase, but a specific disinfecting concentration of the chemical will override all bacterial defense mechanisms.(4) In March of 2022, a new study published by Truitt et al. suggested that aerosolized hydrogen peroxide (aHP) may be the key to reducing CDIs in acute-care facilities. (3) According to Christopher L. Truitt, Ph.D., “[Their] study showed that persistence in utilizing an aerosolized hydrogen peroxide system had a significant impact on reducing C. difficile infections hospital-wide.”(5) 

The 10-year study began in Philadelphia, Pennsylvania, where researchers monitored the CDI rates in a large, acute-care hospital. To evaluate the effectiveness of aHP on C. diff presence, a hydrogen peroxide aerosolization system was then implemented into the facility. This system generates an aerosolized dry-mist fog comprised of a specific concentration of hydrogen peroxide and 0.01% ionic silver, covering all surfaces of the room. (5,6) Over the first five years of the study, Dr. Truitt and his colleagues compared C. diff incidence data from before and after aHP system implementation. The team continued to monitor the CDI rates with consistent aHP usage for the following five years. (3) Standard CDI patient room-cleaning procedures were followed per the regular protocol in place.  

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Up to a 74% reduction in C. diff was found after

utilizing aerosolized hydrogen peroxide.

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Over the first 33 months, the retrospective study showed a 41% decrease in the facility’s CDI rate, dropping from 4.6 per 10,000 patient days to 2.7 per 10,000 patient days following the implementation of the aHP system. During the second study period of consistent aHP use, CDI rates further decreased from 5.4 per 10,000 patient days to 1.4 per 10,000 patient days, an overall 74% reduction.(3,6) 

Other infection control factors may have been contributory, but the data suggests aHP has a positive impact on decreasing CDI rates as a supplemental procedure and would be instrumental in controlling this troublesome hospital acquired disease. Truitt’s current goal is to further compare its effectiveness to that of ultraviolet light. (6) 

by Nikki Chin

References: 1, 2, 3, 4, 5, 6

May 11^th of 2023 marked the end of both the public health emergency and the national state of emergency for the COVID-19 pandemic. However, health professionals are concerned with the rise of the EG.5 variant, an up-and-coming SARS-CoV-2 strain that is potentially more transmissible than any of the current circulating strains in the United States. (1) EG.5 is a descendant of the Omicron lineage XBB.1.9.5 and was first reported to the World Health Organization (WHO) on February 17 of 2023. On August 9, the WHO has designated it as a variant of interest. (2)

EG.5 may be more capable of evading host immunity compared to the previous subvariants of COVID, regardless of whether that immunity is acquired through past infection or vaccination. According to WHO, this variant carries a mutation in the spike protein amino acid F456L, which accounts for the evasiveness as well as the rapid rise in cases. (1,2) EG.5 was responsible for about 12.5% of the United States COVID cases at the end of July, and the Centers for Disease Control and Infection estimates a 20.6% share by the third week of August. (3) While the disease symptoms of EG.5 seem to be similar to those of its predecessors, there has been a 14.3% increase of COVID-related hospitalizations, which may also be due to EG.5’s ability to evade defense systems. (1)

So, how should we approach this new variant and what can we expect as we enter the fall and winter seasons? Although it is true that EG.5’s cases have increased faster than others before it, WHO has determined that the threat level is no greater than any other variant that is currently active. (2)

For now, EG.5’s presence should serve as a reminder that COVID is still here and still dangerous. Researchers are predicting the usual peak in cases as the weather gets colder, but anticipation of a “triplendemic” (SARS-CoV-2, influenza, and respiratory syncytial virus) are means for more precautions. Preventative measures are the key to stopping the spread, and personal protection is of utmost importance, especially for those who are immunocompromised or at higher risk of infection. (1)

References: 1, 2, 3, 4

By Nikki Chin

Leprosy, or Hansen’s disease, is a chronic infectious disease that primarily affects the skin and peripheral nervous system by the acid-fast rod Mycobacterium leprae.(1) It is not known exactly how Hansen’s disease spreads between people. Scientists currently think it may happen when a person repeatedly breathes in the droplets containing the bacteria over many months.(2) Overall, the risk of getting Hansen’s disease is very low since 95% of all people have natural immunity to the disease. According to the National Hansen’s Disease Program, 159 new cases were reported in the United States in 2020 with Central Florida, in particular, accounting for one fifth of nationally reported cases.(3) Worldwide, there are over 200,000 cases per year, mainly occurring in India, Brazil, Indonesia, Nepal, and Bangladesh.(8)

In one case, a 54-year-old man sought treatment for painful erythematous rash, lesions on the distal extremities and progressed to involve trunk and face. The patient denied any travel, exposure to armadillos (a common zoonotic link) or connections with someone known to have leprosy or leprosy-endemic countries.(4) A previous study down by Sharma R. et.al. has shown that armadillos east of the Mississippi river rarely harbor the bacterium for leprosy.(5) “The fact that this patient had never traveled outside of the state of Florida was something that we just wanted to bring to light to those clinicians and physicians that are in the area,” said Dr. Rajiv Nathoo, a dermatologist and senior author on the study.(6) In some cases in Florida, the patients report contact with armadillos, but others to not. These are the only animals known to harbor the disease and have been known to spit when people get too close.(8,9)

Historically, leprosy is one of the most socially stigmatizing diseases, although early diagnosis and treatment often prevents complications. The cure rate is over 99% when appropriate antibiotics are administered, which are usually rifampacin, dapzone, and clofazamine. All current research and literature point to central Florida having an environmental reservoir of Mycobacterium leprae as a potential source of transmission.(4)  Health care providers must be aware of the increasing incidence of cases of leprosy in Florida and have a high degree of suspicion for leprosy. The public must take precautions against direct contact with armadillos and indirect agricultural contact in armadillo-inhabited areas until the possible role of the environment in the transmission of leprosy is better understood.(7)

References: 1, 2, 3, 4, 5, 6, 7, 8, 9

By Francisco Pinon