Automatic environmental disinfection with hydrogen peroxide and silver ions versus manual environmental disinfection with sodium hypochlorite: a multicentre randomized before-and-after trial

J Hosp Infect. 2017 Oct;97(2):175-179. doi: 10.1016/j.jhin.2017.06.010. Epub 2017 Jun 10.


Background: New technologies for automated disinfection have been developed, including the use of hydrogen peroxide atomized by specific equipment, with associated silver compounds.

Aims: To compare the effectiveness of an automated disinfection system with hydrogen peroxide <8% and silver ion versus a manual method with 0.5% sodium hypochlorite solution when evaluating the reduction of microbial mesophilic contamination and Clostridium difficile presence; and to evaluate the time required for both of these processes.

Methods: This was a randomized multicentre trial performed in different hospital wards that had been occupied previously by patients with Clostridium difficile infection. When patients were discharged their rooms were randomized to one of two decontamination arms. The surfaces where sampled using swabs, before and after disinfection. Swab samples were cultured for quantitative detection of microbial mesophilic contamination and qualitative detection of C. difficile.

Findings: Before disinfection, 13% of surfaces decontaminated with hydrogen peroxide and silver ions and 20% of surfaces decontaminated with sodium hypochlorite showed presence of C. difficile spores. After disinfection, the samples containing C. difficile were 0% (P < 0.001) in the group decontaminated with hydrogen peroxide and silver ions, and were 3% (P < 0.001) in the group decontaminated with sodium hypochlorite. This difference was not statistically significant; nor was the difference in the reduction of the microbial mesophilic contamination.

Conclusion: The differences between the groups were not statistically significant; however, the disinfection with hydrogen peroxide and silver ions is preferable due to less dependence on operators.

Keywords: Clostridium difficile; Disinfection; Environmental; Hydrogen peroxide; Sodium hypochlorite.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Aged, 80 and over
  • Automation
  • Clostridioides difficile / drug effects*
  • Clostridioides difficile / isolation & purification
  • Clostridium Infections
  • Cross Infection / prevention & control
  • Disinfection / methods*
  • Equipment Contamination
  • Female
  • Hospitals
  • Humans
  • Hydrogen Peroxide / pharmacology*
  • Infection Control / methods*
  • Italy
  • Male
  • Middle Aged
  • Patients' Rooms
  • Silver / pharmacology*
  • Sodium Hypochlorite / pharmacology*


  • Silver
  • Hydrogen Peroxide
  • Sodium Hypochlorite