Prospective cluster controlled crossover trial to compare the impact of an improved hydrogen peroxide disinfectant and a quaternary ammonium-based disinfectant on surface contamination and health care outcomes

Am J Infect Control. 2017 Sep 1;45(9):1006-1010. doi: 10.1016/j.ajic.2017.03.010. Epub 2017 Apr 18.


Background: Quaternary ammonium-based (Quat) disinfectants are widely used, but they have disadvantages.

Methods: This was a 12-month prospective cluster controlled crossover trial. On 4 wards, housekeepers performed daily cleaning using a disinfectant containing either 0.5% improved hydrogen peroxide (IHP) or Quat. Each month, 5-8 high-touch surfaces in several patient rooms on each ward were tagged with a fluorescent marker and cultured before and after cleaning. Hand hygiene compliance rates and antimicrobial usage on study wards were obtained from hospital records. Outcomes included aerobic colony counts (ACCs), percent of wiped surfaces yielding no growth after cleaning, and a composite outcome of incidence densities of nosocomial acquisition and infection caused by vancomycin-resistant enterococci, methicillin-resistant Staphylococcus aureus, and Clostridium difficile infection. Statistical analysis was performed using χ2 test, Fisher exact test, Welch test, and logistic regression methods.

Results: Mean ACCs per surface after cleaning were significantly lower with IHP (14.0) than with Quat (22.2) (P = .003). The proportion of surfaces yielding no growth after cleaning was significantly greater with IHP (240/500; 48%) than with Quat (182/517; 35.2%) (P < .0001). Composite incidence density of nosocomial colonization or infection with IHP (8.0) was lower than with Quat (10.3) (incidence rate ratio, 0.77; P = .068; 95% confidence interval, 0.579-1.029).

Conclusions: Compared with a Quat disinfectant, the IHP disinfectant significantly reduced surface contamination and reduced a composite colonization or infection outcome.

Keywords: Controlled trial; Disinfectants; Disinfection/*methods; Environmental microbiology; Hydrogen peroxide; Prospective studies; Quaternary ammonium; Surface disinfection.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Bacterial Infections / diagnosis
  • Bacterial Infections / prevention & control*
  • Clostridioides difficile / drug effects
  • Clostridioides difficile / growth & development
  • Clostridioides difficile / pathogenicity
  • Colony Count, Microbial
  • Cross Infection / diagnosis
  • Cross Infection / prevention & control*
  • Cross-Over Studies
  • Disinfectants / pharmacology*
  • Guideline Adherence / statistics & numerical data
  • Hand Hygiene / methods
  • Health Personnel
  • Humans
  • Hydrogen Peroxide / pharmacology*
  • Methicillin-Resistant Staphylococcus aureus / drug effects
  • Methicillin-Resistant Staphylococcus aureus / growth & development
  • Methicillin-Resistant Staphylococcus aureus / pathogenicity
  • Outcome Assessment, Health Care / statistics & numerical data*
  • Patients' Rooms
  • Prospective Studies
  • Quaternary Ammonium Compounds / pharmacology*
  • Vancomycin-Resistant Enterococci / drug effects
  • Vancomycin-Resistant Enterococci / growth & development
  • Vancomycin-Resistant Enterococci / pathogenicity


  • Disinfectants
  • Quaternary Ammonium Compounds
  • Hydrogen Peroxide