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Authored By: Helene Paxton, MS, MT(ASCP),PhD, CIC

Most citations for disinfection of C. diff in the environment states that bleach should be used or compares against bleach. So my question is if bleach is so effective, why does C. diff continue to haunt us and sicken our patients? It is the fastest growing infection in our hospitals. The fact is that there are other chemicals that also work as sporicidals for C. diff as listed on the EPA K list. Other agents do work so why does bleach continue to be the mainstay?

A few reasons:
1. Bleach is easy to obtain and is cheap.
2. Bleach has been in the healthcare arena for many years.
3. The smell is familiar and not viewed as harmful by users, although data would suggest that respiratory problems are common in healthcare workers.

The fact is that bleach is hard on the environment. It oxidizes metals, leaves a white film, has a strong odor, is unstable when diluted and, when used, is rarely left on the surface long enough to be effective. Even when sprayed, bleach misses many spores and allows continued contamination. Bleach does work when used properly, but the pitfalls are many and other methodologies may be superior in their delivery. Data suggests that 7% peroxide is as effective as bleach and does not leave a residue, does not oxidize the metals, is safer to use, and has no smell.
• TOMI Environmental Solutions SteraMistTM offers a technology that is both effective and safe for
the environment. Importantly, it is a safe for people, as well. Developed by the Defense Advanced Research Projects Agency (DARPA), the technology is registered by the EPA as a hospital-healthcare disinfectant and general disinfectant and works against many resistant pathogens including C. diff, MRSA, Pseudomonas, Staphylococcus aureus, etc.
• The only active ingredient is 7.8% H202 which is ionized to a reactive oxygen species consisting mostly of neutral hydroxyl radicals by passage through an atmospheric cold plasma arc. The by- products of the activated hydrogen peroxide are oxygen and water…Far safer to handle than those left by conventional methods including bleach.

Recently, one of our TOMI Service Network (TSN) members, Moore Restoration Advanced Services Group (Indianapolis, Indiana ), trialed TOMI’s SteraMistTM technology in an Indianapolis hospital, IU West, and compared it to a peroxide containing product known as Oxycide by Ecolab. This product is
composed of hydrogen peroxide and Peroxyacetic acid.

Oxycide is classed by the EPA as a daily disinfectant. It too, like bleach, has a strong odor and can cause respiratory issues.

The Moore Group case studies in IU West are as follows:

1. Two patient rooms were selected. One was cleaned by the hospital’s regular process and then treated with SteraMist. The High touch areas were cultured before each step. The second room was not cleaned and just treated with SteraMist. Colony counts were performed for each step. Testing was done by an outside vendor using a swab applied to a growth media pre-and post- cleaning.

EVS Oxycide Cleaning:

- Pre sample - 26 (Gram positive cocci, Micrococcus)
- Post sample - 11 (Micrococcus)
Left bedrail
- Pre - None detected
- Post - None detected Trash lid
- Pre - 1410 (Micrococcus)
- Post - 152 (Micrococcus, Staph)
Decrease of 88.65%
SteraMist alone:

- Pre sample - 69 (Micrococcus)
- Post sample - None detected Left bedrail
- Pre - None detected
- Post - None detected Trash lid
- Pre - 19,000 (Pantoea)
- Post - None detected

2. A second protocol was performed where only gross contamination was removed. Linens were removed, and then the room had the SteraMist treatment.

Both rooms were pre and post sampled for organisms from four of the following areas: Phone
Countertop Footboard Floor
Soiled linen lid Bathroom door handle

SteraMist results - Room 3110

- Pre sample - 30,000 (Bacillus, Pseudomonas)
- Post sample - None detected Counter
- Pre - 1150 (Brevibacterium, Micrococcus)
- Post - None detected Footboard
- Pre - 5300 (Micrococcus)

- Post - None detected Floor
- Pre - 5000 (Acinetobacter)
- Post - 1 (Staphylococcus)

SteraMist results - Room 3228
- Pre sample - 3900 (Paenibacillus, Microbacterium, Micrococcus)
- Post sample - None detected Soiled linen lid
- Pre - 490 (Micrococcus, Gram positive rod)
- Post - None detected Footboard
- Pre - None detected
- Post - 1 (Staphylococcus)
Bathroom door handle
- Pre - 24 (Staphylococcus)
- Post - None detected
3. In another trial at IU West, after water intrusion into an OR suite, SteraMist was used after mold testing with a Mold spore Trap.

In summary:

- Courtesy: Moore Restoration Advanced Services Group, IN ND= None Detected

What is noteworthy in the second room trial (2) is that no disinfectant was used to clean room prior to applying SteraMist. Gross contamination was removed with microfiber rag and a cleaner. The SteraMist process removed all the contaminants.

Tomi has had similar success with other studies done by clients in a variety of hospitals and other settings.

The bottom line….SteraMist™ saves you time, leaves no residuals and is effective in removing all organisms! There is no residual smell or film, the room is disinfected and ready for use in less than 20 minutes. Who needs bleach or other strong smelling chemical that endangers our patients and staff!

Helene Paxton, MS, MT(ASCP),PhD, CIC

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