AMR Lead cautious on hydrogen peroxide vapour for CPE outbreaks

The Medical Independent (MI) understands that these technologies have been heavily marketed to healthcare facili­ties and are in frequent use in Ireland.

Prof Cormican has prepared draft guidance on the use of hydrogen peroxide vapour and similar technologies for en­vironmental decontamination in the context of carbapene­mase-producing Enterobacteriaceae (CPE), the spread of which is now the focus of a public health emergency.

Part of the guidance was seen by MI following a Freedom of Information request to the HSE. It states that these technolo­gies are being promoted and provided by a number of compa­nies as offering added value in the context of HCAI prevention.

The technologies are not a substitute for effective cleaning, nor are they presented as such, acknowledges the paper. “The tech­nologies are effective against antimicrobial-resistant, gram-nega­tive bacteria. Properly applied, the technologies are safe,” it notes.

However, Prof Cormican writes that “over many decades, outbreaks of antimicrobial-resistant, gram-negative enter­ic bacteria have been controlled effectively in many healthcare settings. Interventions that have repeatedly proven effective in control of transmission of antimicrobial-resistant enteric bacte­ria in the healthcare setting are detection of colonised cases, rig­orous application of standards and transmission-based precau­tions, adequate staff and effective, regular cleaning and decon­tamination of contact surfaces”.

The draft guidance states that a number of publications claim the application of this technology supported control of outbreaks, however, in all studies the technology was applied as part of a multi-component response. “It is worth noting that transmission of gram-negative enteric bacteria has continued in a number of acute hospitals in Ireland over a period of a year, although there has been extensive application of these technologies.”

Speaking to MI, Prof Cormican said the guidance document is still in draft format, although its conclusions will remain sub­stantially unchanged. He said “my concern about it is it can as­sume resources and it can distract from doing the things that real­ly need to be done”. Prof Cormican said the technologies do kill bacteria, but there is no evidence they assist in helping prevent transmission in a hospital.