Hydrogen peroxide for disinfection

This is the information from the CDC

Hydrogen Peroxide Overview.

The literature contains several accounts of the properties, germicidal effectiveness, and potential uses for stabilized hydrogen peroxide in the health-care setting. Published reports ascribe good germicidal activity to  and attest to its bactericidal, virucidal, sporicidal, and fungicidal properties 653-655. (Tables 4 and 5) The FDA website lists cleared liquid chemical sterilants and high-level disinfectants containing  and their cleared contact conditions.

 

Mode of Action.

Hydrogen peroxide works by producing destructive hydroxyl free radicals that can attack membrane lipids, DNA, and other essential cell components. Catalase, produced by aerobic organisms and facultative anaerobes that possess cytochrome systems, can protect cells from metabolically produced hydrogen peroxide by degrading hydrogen peroxide to water and oxygen. This defense is overwhelmed by the concentrations used for disinfection 



Concentrations of hydrogen peroxide from 6% to 25% show promise as chemical sterilants

Concentrations of hydrogen peroxide from 6% to 25% show promise as chemical sterilants. The product marketed as a sterilant is a premixed, ready-to-use chemical that contains 7.5% hydrogen peroxide and 0.85% phosphoric acid (to maintain a low pH) 69. The mycobactericidal activity of 7.5% hydrogen peroxide has been corroborated in a study showing the inactivation of >105 multidrug-resistant M. tuberculosis after a 10-minute exposure 666. Thirty minutes were required for >99.9% inactivation of poliovirus and HAV 667. Three percent and 6% hydrogen peroxide were unable to inactivate HAV in 1 minute in a carrier test 58. When the effectiveness of 7.5% hydrogen peroxide at 10 minutes was compared with 2% alkaline glutaraldehyde at 20 minutes in manual disinfection of endoscopes, no significant difference in germicidal activity was observed 668. ). No complaints were received from the nursing or medical staff regarding odor or toxicity. In one study, 6% hydrogen peroxide (unused product was 7.5%) was more effective in the high-level disinfection of flexible endoscopes than was the 2% glutaraldehyde solution 456. A new, rapid-acting 13.4% hydrogen peroxide formulation (that is not yet FDA-cleared) has demonstrated sporicidal, mycobactericidal, fungicidal, and virucidal efficacy. Manufacturer data demonstrate that this solution sterilizes in 30 minutes and provides high-level disinfection in 5 minutes669. This product has not been used long enough to evaluate material compatibility to endoscopes and other semicritical devices, and further assessment by instrument manufacturers is needed.


Under normal conditions, hydrogen peroxide is extremely stable when properly stored (e.g., in dark containers). The decomposition or loss of potency in small containers is less than 2% per year at ambient temperatures 670.


Uses.

Commercially available 3% hydrogen peroxide is a stable and effective disinfectant when used on inanimate surfaces. It has been used in concentrations from 3% to 6% for disinfecting soft contact lenses (e.g., 3% for 2–3 hrs) 653, 671, 672, tonometer biprisms 513, ventilators 673, fabrics 397, and endoscopes 456. Hydrogen peroxide was effective in spot-disinfecting fabrics in patients’ rooms 397. Corneal damage from a hydrogen peroxide-soaked tonometer tip that was not properly rinsed has been reported 674. Hydrogen peroxide also has been instilled into urinary drainage bags in an attempt to eliminate the bag as a source of bladder bacteriuria and environmental contamination 675. Although the instillation of hydrogen peroxide into the bag reduced microbial contamination of the bag, this procedure did not reduce the incidence of catheter-associated bacteriuria 675.


A chemical irritation resembling pseudomembranous colitis caused by either 3% hydrogen peroxide or a 2% glutaraldehyde has been reported 621. An epidemic of pseudomembrane-like enteritis and colitis in seven patients in a gastrointestinal endoscopy unit also has been associated with inadequate rinsing of 3% hydrogen peroxide from the endoscope 676.

As with other chemical sterilants, dilution of the hydrogen peroxide must be monitored by regularly testing the minimum effective concentration (i.e., 7.5%–6.0%). Compatibility testing by Olympus America of the 7.5% hydrogen peroxide found both cosmetic changes (e.g., discoloration of black anodized metal finishes) 69 and functional changes with the tested endoscopes (Olympus, written communication, October 15, 1999).

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