T. Holmdahl, MD,¹ P. Lanbeck, MD, PhD,¹ M. Wullt, MD, PhD,¹ and M. H. Walder, MD, PhD²
1. Infectious Diseases Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden
  瑞典倫德大學(xué)臨床科學(xué)系傳染疾病組
2. Medical Microbiology, Department of Laboratory Medicine, Lund University, Skåne University Hospital SUS, Malmö, Sweden
  瑞典倫德大學(xué)醫(yī)學(xué)檢驗系微生物醫(yī)學(xué)組，瑞典馬爾默斯堪大學(xué)醫(yī)院
Address correspondence to M. H. Walder, MD, PhD, Klinisk Mikrobiologi Malmö, Laboratoriemedicin Skåne, SE-20502 Malmö, Sweden ([email protected]).
New technologies have emerged in recent years for the disinfection of hospital rooms and equipment that may not be disinfected adequately using conventional methods. There are several hydrogen peroxide–based area decontamination technologies on the market, but no head-to-head studies have been performed. Objective.
研究目的： 近幾年，一些新興技術(shù)被用來對醫(yī)院的房間和傳統(tǒng)滅菌方法無法充分滅菌的設(shè)備進(jìn)行滅菌。市場上有幾種基于過氧化的區(qū)域滅菌技術(shù)，但尚沒有任何研究來對這些技術(shù)進(jìn)行一一對比。
We conducted a head-to-head in vitro comparison of a hydrogen peroxide vapor (HYDROGEN PEROXIDE VAPOUR) system and an aerosolized hydrogen peroxide (aHP) system. 
研究設(shè)計：因此，我們對汽化過氧化氫技術(shù)（HYDROGEN PEROXIDE VAPOUR）和過氧化氫干霧擴(kuò)散技術(shù)（aHP）進(jìn)行了一一對比.
The tests were conducted in a purpose-built 136-m³ test room.
場地：特意建造一個136立方米試驗間進(jìn)行試驗
One HYDROGEN PEROXIDE VAPOUR generator and 2 aHP machines were used, following recommendations of the manufacturers. Three repeated tests were performed for each system. The microbiological efficacy of the 2 systems was tested using 6-log Tyvek-pouched Methods. Geobacillus stearothermophilus biological indicators (BIs). The indicators were placed at 20 locations in the first test and 14 locations in the subsequent 2 tests for each system.
測試方法：根據(jù)廠商建議，試驗中使用一臺過氧化氫發(fā)生器和2臺過氧化氫干霧擴(kuò)散器。每種技術(shù)重復(fù)實驗三次。用特衛(wèi)強(qiáng)包裝的6-log 嗜熱脂肪芽孢桿菌生物指示劑來檢驗對于微生物的效力。第一輪測試中，生物指示劑（BIs）放置在20個位置；隨后的兩輪測試均放置于14個位置。
All BIs were inactivated for the 3 HYDROGEN PEROXIDE VAPOUR tests, compared with only 10% in the first aHP test and 79% in the other 2 aHP tests. The peak hydrogen peroxide concentration was 338 ppm for HYDROGEN PEROXIDE VAPOUR and 160 ppm for aHP. The total cycle time (including aeration) was 3 and 3.5 hours for the 3 HYDROGEN PEROXIDE VAPOUR tests and the 3 aHP tests, respectively. Monitoring around the perimeter of the enclosure with a handheld sensor during tests of both systems did not identify leakage. 
測試結(jié)果：三輪測試中所有BIs均被汽化過氧化氫（HYDROGEN PEROXIDE VAPOUR）滅活，而干霧過氧化氫擴(kuò)散器（aHP）在第一輪測試中滅活率為10%，在隨后兩輪測試中滅活率為79%。汽化過氧化氫的峰值為338ppm, 干霧過氧化氫峰值為160ppm. 整個循環(huán)時間（包括通風(fēng)時間）為，汽化過氧化氫三輪測試為3個小時，干霧過氧化氫三輪測試為3.5個小時。泄漏傳感器放置在密閉空間外圍，測試中間兩個系統(tǒng)均未發(fā)現(xiàn)泄漏。
One HYDROGEN PEROXIDE VAPOUR generator was more effective than 2 aHP machines for the inactivation of  G. stearothermophilus BIs, and cycle times were faster for the HYDROGEN PEROXIDE VAPOUR system.
結(jié)論: 對于嗜熱芽孢桿菌生物指示劑，一臺汽化過氧化氫發(fā)生器的滅活效力優(yōu)于兩臺過氧化氫干霧擴(kuò)散器，且更省時間。
Received January 25, 2011; accepted March 28, 2011; electronically published July 22, 2011
收稿日期：2011-01-25， 通過日期：2011-03-28； 電子刊發(fā)日期：2011-7-22
A recent editorial called for head-to-head studies comparing hydrogen peroxide vapor (HYDROGEN PEROXIDE VAPOUR) and aerosolized hydrogen peroxide (aHP) systems, and, to date, none has been published.¹ Therefore, we conducted a study to investigate and compare the efficacy of an HYDROGEN PEROXIDE VAPOUR system and an aHP system in terms of their ability to inactivate Geobacillus stearothermophilus biological indicator (BI) spores distributed around a large single- or dual-occupancy patient room to reflect our intended use.
近期，主編希望我們對汽化過氧化氫技術(shù)（HYDROGEN PEROXIDE VAPOUR）和干霧過氧化氫（aHP）做一個比較，截至今日，尚未有人發(fā)布此類文章。 因此我們對于此兩個系統(tǒng)進(jìn)行了調(diào)研，在一間比較大的單人或雙人病房，進(jìn)行嗜熱芽孢桿菌的滅活試驗。
In Skåne University Hospital (SUS) Malmö, a new infectious disease facility has been built. The facility has 50 standard isolation rooms. These rooms are larger than most single-occupancy hospital rooms and could be used as small double rooms if necessary. In this setting, we are interested in modernizing our hygiene routines and trying new equipment. During the construction phase for our new facility, we built a full-scale mock-up of an isolation room. In this mock-up, new materials and decontamination methods could be tested.
瑞典馬爾默斯堪大學(xué)醫(yī)院建造了一座新的傳染病病區(qū)。此病區(qū)有50個標(biāo)準(zhǔn)隔離室。這些房間比大多數(shù)單人病房都要大，在必要時也可用作雙人病房。在此病區(qū)，我們很希望嘗試一些新的設(shè)備來使我們的衛(wèi)生條例更現(xiàn)代化。 在我們新設(shè)施的建設(shè)階段，我們仿造了一間全尺寸的隔離病房。在此仿造病房里，新的材料和新的凈化技術(shù)可以得到檢驗。
There is now good evidence that contaminated surfaces make a significant contribution to the transmission of nosocomial pathogens, includingClostridium difficile, methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and Acinetobacter baumannii.^2,3 Surfaces in patient areas have frequently been found to be contaminated after conventional cleaning,^4,5 and, linked to these findings, patients admitted to rooms previously occupied by patients positive for VRE, MRSA, A. baumannii, and Pseudomonas aeruginosa are at increased risk of acquiring these pathogens.^6,7 Given these findings, several area decontamination methods have emerged.^4,8,9 These methods do not rely on the operator to distribute the active substance; thereby, they can achieve coverage of all surfaces in a room and are likely to be more repeatable than conventional methods.
有充分證據(jù)表明被感染的表面是院內(nèi)致病菌感染傳播的重要因素，包括艱難梭狀芽孢桿菌，抗藥性金黃色葡萄球菌（MRSA）,耐萬古霉素腸球菌（VRE）和鮑氏不動桿菌。 即便在傳統(tǒng)方法清潔后，病房表面也經(jīng)常發(fā)現(xiàn)有病菌感染。因此，如果前一個病人上述病菌呈陽性，新病人入住后，會有很大風(fēng)險感染這些致病菌。
根據(jù)這些發(fā)現(xiàn)，出現(xiàn)了幾種新的區(qū)域凈化方法。這些方法不需要操作人員去噴灑活性物質(zhì)，就可以覆蓋房間內(nèi)所有表面。并且相對于傳統(tǒng)方法來說，更容易重復(fù)再現(xiàn)。
There are 2 commonly used hydrogen peroxide–based methods on the market, the HYDROGEN PEROXIDE VAPOUR system and the aHP system.^1,10These systems have important differences that have been outlined in recent correspondence.^10-12 The HYDROGEN PEROXIDE VAPOUR system generates HYDROGEN PEROXIDE VAPOUR by adding 35% liquid hydrogen peroxide to a vaporizer heated to 130°C. This produces a vapor, which is distributed in the gas phase until it begins to condense on surfaces in the room.^4,12 After the exposure, an active aeration unit catalyzes the breakdown of HYDROGEN PEROXIDE VAPOUR to oxygen and water vapor. The HYDROGEN PEROXIDE VAPOUR achieves a 6-log reduction on bacterial endospores, including C. difficile; common hospital bacteria such as MRSA, VRE, and A. baumannii; and viruses.^13,14 Surface sampling after HYDROGEN PEROXIDE VAPOUR shows that it usually eradicates contamination with C. difficile and other hospital pathogens.^12,15 Several studies have linked the use of HYDROGEN PEROXIDE VAPOUR with the control of outbreaks,^16,17 and the use of HYDROGEN PEROXIDE VAPOUR has been shown to reduce the incidence of C. difficileinfection.¹²
目前市場有兩種常用的基于過氧化氫的方法，一種是汽化過氧化氫（HYDROGEN PEROXIDE VAPOUR）,另一種是過氧化氫干霧（aHP）. 這兩種方法截然不同。汽化過氧化氫將35% 的過氧化氫液體通過加熱至130攝氏度形成蒸汽，氣相過氧化氫在空間中擴(kuò)散。經(jīng)過曝露后，使用一種活性曝氣裝置將過氧化氫催化分解成氧氣和水。此汽化過氧化氫可以對細(xì)菌孢子達(dá)到6-log的殺滅率，包括艱難梭菌以及其他醫(yī)院常見細(xì)菌，如MRSA, VRE，鮑氏不動桿菌以及病毒。汽化過氧化氫滅菌后，通過對表面取樣顯示其可以根除艱難梭菌等醫(yī)院常見病菌的病原體。 還有些研究也表明在使用汽化過氧化氫對暴發(fā)性疫情進(jìn)行控制時，其可以有效減少艱難梭菌的感染。
The aHP system uses pressure to produce an aerosol with a particle size of approximately 8–10 μm from a mixture of 5% hydrogen peroxide, less than 50 ppm silver cations, and less than 50 ppm orthophosphoric acid. After the exposure period, the aerosol is left to decompose passively. The aHP system results in a 4-log reduction of C. difficile spores and incomplete inactivation in situ.^8,18 The efficacy of the aHP system against common hospital bacteria such as MRSA and A. baumannii has to be fully established. The efficacy against Mycobacterium tuberculosis is uncertain.^19,20 
 aHP 過氧化氫干霧使用5%濃度的過氧化氫、50ppm的銀離子以及50ppm正磷酸的混合溶液，用壓力產(chǎn)生8-10微米的顆粒。曝氣后，干霧遺留在空間里被動分解。
過氧化氫干霧可以達(dá)到4-log的艱難梭菌孢子殺滅率，不能充分滅活。 過氧化氫干霧對于醫(yī)院常見細(xì)菌的效力，如MRSA以及鮑氏不動桿菌，已經(jīng)得到充分證實。但對于結(jié)核桿菌的效力尚未確認(rèn)。
Methods 方法
Description of the Test Facility 測試場所描述
The tests were conducted in a 136-m³ test room in Malmö, Sweden. The area was split into 4 rooms: 2 air locks, a main room, and a bathroom. The area had a dedicated air-handling system that extracted to the outside of the building.
測試在瑞典馬爾默斯堪大學(xué)醫(yī)院136立方米的測試間里進(jìn)行。此區(qū)域被分割成4個房間，2件氣閘室，1間主試驗室，以及一個洗手間。此區(qū)域有專用的通風(fēng)系統(tǒng)。
Biological Indicators 生物指示劑
The microbiological efficacy of the 2 systems was tested using 6-log Tyvek-pouched G. stearothermophilus BIs (Apex Laboratories). The BIs were placed at 20 locations in the first test and 14 locations in the subsequent 2 tests for each system. BIs were located in the main room, the bathroom, the air locks in opposing high and low corner locations, and several challenging locations, such as inside cupboards and drawers, to test the distribution of the systems (see Table 1 for specific BI locations). After exposure to either HYDROGEN PEROXIDE VAPOUR or aHP, the BIs were transferred into tryptone soya broth, incubated, and read according to the manufacturer’s instructions.
測試用BIs是Apex公司的用特衛(wèi)強(qiáng)Tyvek包裝的，6-log嗜熱脂肪芽孢桿菌。第一輪測試中，指示劑放置于20個位置，隨后兩輪測試指示劑放置于14個位置。BIs被放置于主試驗室，洗手間以及氣閘室的高低對角，以及其他幾個位置，比如衣柜里和抽屜里，以便測試系統(tǒng)的分布情況。（具體位置見表1）。 在汽化過氧化氫和干霧過氧化氫曝氣后，BIs轉(zhuǎn)移至大豆肉湯里進(jìn)行培養(yǎng)，然后根據(jù)廠商的說明書進(jìn)行細(xì)菌計數(shù)。
Table 1. Biological Indicator (BI) Location and the Number of BIs Inactivated by the Hydrogen Peroxide Vapor (HYDROGEN PEROXIDE VAPOUR) and Aerosolized Hydrogen Peroxide (aHP) Systems
表1  BI位置以及被滅活數(shù)量

HYDROGEN PEROXIDE VAPOUR汽化過氧化氫				aHP過氧化氫干霧
Test no.	1	2	3	1	2	3
Main room, top right, near corner主試驗室右上，近角	−	−	−	+	−	−
Main room, bottom right, far corner主試驗室右下，遠(yuǎn)角	−	−	−	+	−	+
Main room, top left, far corner主試驗室左上，遠(yuǎn)角	−	−	−	+	−	−
Main room, bottom left, near corner主試驗室左下，近角	−	−	−	+	−	−
“In” air lock, top left, near corner進(jìn)氣室，左上近角	−	−	−	+	+	−
“In” air lock, bottom left, far corner進(jìn)氣室，左下遠(yuǎn)角	−	ND	ND	+	ND	ND
“In” air lock, top right, far corner進(jìn)氣室，右上遠(yuǎn)角	−	ND	ND	+	ND	ND
“In” air lock, bottom right, near corner進(jìn)氣室，右下近角	−	ND	ND	+	ND	ND
“In” air lock, bottom right, far corner進(jìn)氣室，右下遠(yuǎn)角	ND	−	−	ND	−	−
Bathroom, top left, near corner洗手間，左上，近角	−	ND	ND	+	ND	ND
Bathroom, bottom left, far corner洗手間，左下，遠(yuǎn)角	−	ND	ND	+	ND	ND
Bathroom, top right, far corner洗手間，右上，遠(yuǎn)角	−	ND	ND	+	ND	ND
Bathroom, top left, far corner洗手間，左下，遠(yuǎn)角	ND	−	−	ND	+	−
Bathroom, bottom right, near corner洗手間，右下，近角	−	−	−	−	−	−
“Out” air lock, top left, near corner排氣室，左上，近角	−	ND	ND	+	ND	ND
“Out” air lock, bottom left, far corner排氣室，左下，遠(yuǎn)角	−	ND	ND	+	ND	ND
“Out air lock, bottom left, near corner排氣室，左下近角	ND	−	−	ND	−	−
“Out” air lock, top right, far corner排氣室，右上遠(yuǎn)角	−	−	−	+	+	+
“Out air lock, bottom right, near corner排氣室，右下，近角	−	ND	ND	+	ND	ND
“Out” air lock, inside cupboard排氣室，櫥柜內(nèi)	−	−	−	+	−	−
Main room, inside cupboard主試驗室，櫥柜內(nèi)	−	−	−	+	−	−
Back of drawer, open 10 cm 抽屜深處，打開10cm	−	−	−	−	−	−
Bathroom, underneath washer/disinfector洗手間洗手臺下面	−	−	−	+	−	+
Total positive 陽性總數(shù)	0	0	0	18	3	3
No. of BIs 指示劑數(shù)量	20	14	14	20	14	14
% Positive 陽性比率	0	0	0	90	21	21
Control 1 陽性對照1	+	+	+	+	+	+
Control 2 陽性對照2	+	+	+	+	+	+
Control 3 陽性對照3	+	+	+	+	+	+

ND=未測試
 Decontamination Equipment and Configuration 滅菌設(shè)備和配置
Two aHP machines were used, following recommendations of the manufacturer. The 2 generators were placed in the center of the main room, and external doors were sealed using adhesive tape. The concentration of hydrogen peroxide was measured by a Draegar sensor (Polytron 7000) inside the enclosure. For each of the 3 tests, 3 back-to-back injections of 6 mL/m³ hydrogen peroxide were performed. Aeration was assisted using the air-handling system. The test was considered ended when the readings on the handheld sensor were less than or equal to 1 ppm in the air lock and less than or equal to 2 ppm at any point in the room. (The Health and Safety limit for hydrogen peroxide exposure in Sweden is 1 ppm for a working day or 2 ppm for 15-minute period.)²¹
根據(jù)廠商建議，2臺過氧化氫干霧擴(kuò)散器放置在主試驗室的中心位置，外面的門用膠帶密封。使用德爾格 Polytron 7000 放置在室內(nèi)進(jìn)行濃度監(jiān)測。三輪測試的每次測試，均注入3次6mL/m3 過氧化氫溶液。 用通風(fēng)系統(tǒng)進(jìn)行輔助擴(kuò)散。當(dāng)手持傳感器監(jiān)測到氣閘室的濃度小于或等于1ppm，或者房間內(nèi)任一點濃度小于或等于2ppm時，測試結(jié)束。（瑞典規(guī)定1ppm的過氧化氫濃度是工作中健康和安全的限值，2ppm濃度下可停留15分鐘）
One HYDROGEN PEROXIDE VAPOURsuite was used, following recommendations of the manufacturer. The HYDROGEN PEROXIDE VAPOUR generator was placed in the center of the main room, the aeration unit was placed in the doorway of the main room air lock, oscillating pedestal fans were placed in the doorway of the bathroom and the other air lock, and the control pedestal was placed outside the door of the main room. External doors were sealed using adhesive tape, and the handheld sensor was used to monitor for leakage periodically. The concentrations of hydrogen peroxide, temperature, and relative humidity in the room were monitored, and readings were recorded every 5 minutes during the injection phases and regularly during aeration (the removal of HYDROGEN PEROXIDE VAPOUR). For the 3 tests, 900 mL of hydrogen peroxide was injected, with 30 minutes dwell, which equates to approximately 6.6 g/m³. Aeration was assisted using the air-handling system. The test was considered ended when the readings on the handheld sensor were less than or equal to 1 ppm in the air lock and less than or equal to 2 ppm at any point in the room.
根據(jù)廠商建議，使用1臺汽化過氧化氫發(fā)生系統(tǒng)進(jìn)行測試。放置在主試驗室正中位置，其通風(fēng)裝置放置在主試驗室氣閘間的門口。搖頭電風(fēng)扇分別放置于洗手間門口以及另一個氣閘室內(nèi)。操控臺放置于主試驗室外面，門用膠帶密封。手持傳感器用于監(jiān)測泄漏。 室內(nèi)的過氧化氫濃度，溫度以及相對濕度由設(shè)備監(jiān)測。在加藥和通風(fēng)排殘期間，每5分鐘記錄一次數(shù)值。三輪測試中，共使用900mL過氧化氫溶液，持續(xù)30分鐘，相當(dāng)于6.6g/ m³。測試中使用通風(fēng)系統(tǒng)進(jìn)行輔助通風(fēng)。當(dāng)氣閘室的濃度小于或等于1ppm，或者房間內(nèi)任一點濃度小于或等于2ppm時，測試結(jié)束。
Results 結(jié)果
Data from the HYDROGEN PEROXIDE VAPOUR cycles are presented in Figure 1. The increase and plateau in relative humidity and HYDROGEN PEROXIDE VAPOUR concentration are consistent with the saturation of the air with hydrogen peroxide and subsequent condensation onto surfaces.²² The peak hydrogen peroxide concentration was 338 ppm. The total cycle time (including aeration) for the 3 HYDROGEN PEROXIDE VAPOUR tests was 3 hours. All BIs were inactivated in each of the 3 tests (Table 1).
汽化過氧化氫（HYDROGEN PEROXIDE VAPOUR）數(shù)據(jù)參看圖1, 隨著相對濕度和濃度的增加以及穩(wěn)定,空氣中的過氧化氫達(dá)到飽和并凝結(jié)在表面。 過氧化氫的峰值是338ppm. 三輪測試總的循環(huán)時間（包括通風(fēng)排殘）為3小時。三輪測試中，每次測試BIs都被完全滅活。
Discussion  探討
Hydrogen peroxide is a potent disinfectant and sterilant that penetrates the bacterial cell wall by passive diffusion and then acts by denaturing proteins, DNA, and other components inside the bacterial cell.²³ It is not harmful to the environment because it breaks down to water and oxygen, leaving no toxic by-products. We consider hydrogen peroxide decontamination an important method in terminal disinfection of rooms previously occupied by patients positive for MRSA, VRE, Acinetobacter spp., C. difficile, or other problem bacteria.
過氧化氫是一種強(qiáng)效消毒和殺菌劑，它可以通過被動擴(kuò)散滲透入細(xì)胞壁，然后使蛋白質(zhì)、DNA以及細(xì)菌細(xì)胞中其他部分變性。它能分解成氧氣和水，對環(huán)境無害，也沒有有毒副產(chǎn)品。我們認(rèn)為過氧化氫滅菌是一項非常重要的空間滅菌方法，可以為殺滅病房的MRSA, VRE, 不動桿菌屬種,艱難梭菌或其他細(xì)菌
We tested 2 different types of hydrogen peroxide–based whole-room decontamination systems. The main difference between the 2 technologies is the formation of the HYDROGEN PEROXIDE VAPOUR or aerosol. HYDROGEN PEROXIDE VAPOUR creates a vapor in gaseous form from 35% w/w hydrogen peroxide, whereas aHP creates an aerosol from 5% hydrogen peroxide, with drops of 8–10 μm. The aHP aerosol is stabilized using silver ions and other chemicals to avoid aggregation before the drops reach the target. Other differences between the 2 systems are the peak hydrogen peroxide concentration, which is twice as high in HYDROGEN PEROXIDE VAPOUR as in aHP, and the total hydrogen peroxide concentration (measured as area under the curve), which is higher for HYDROGEN PEROXIDE VAPOUR.
我們測試了兩種基于過氧化氫的空間滅菌技術(shù)。兩種技術(shù)的主要區(qū)別在于形成機(jī)制的不同，汽化過氧化氫技術(shù)（HYDROGEN PEROXIDE VAPOUR）將35%的過氧化氫溶液轉(zhuǎn)變?yōu)闅庀唷６^氧化氫干霧技術(shù)(aHP)將5%濃度的過氧化氫混合液霧化成8-10微米的液滴。并采用銀離子和其他化學(xué)品作為穩(wěn)定劑，以防止液滴在達(dá)到目標(biāo)位置之前凝聚。另外一個不同就是，過氧化氫峰值濃度，汽化過氧化氫的峰值濃度是過氧化氫干霧的兩倍。而且汽化過氧化氫總的濃度也高于過氧化氫干霧
Bacterial endospore BIs are typically used to monitor the effectiveness of sterilization and high-level disinfection procedures, such as autoclaves and vapor-phase decontamination methods.²⁴ In our study, the HYDROGEN PEROXIDE VAPOUR system inactivated BIs at all locations in each of the 3 tests, suggesting a homogenous and repeatable distribution. BIs are used routinely to monitor HYDROGEN PEROXIDE VAPOUR decontamination systems.^4,12,22
生物指示劑經(jīng)常被用來監(jiān)測消毒以及更高級別滅菌的效果，比如高壓蒸汽滅菌和汽化滅菌方法。在我們的研究中，汽化過氧化氫對于三輪測試中所有位置的生物指示劑均能滅活。
生物指示劑被用于監(jiān)測常規(guī)的過氧化氫滅菌。
Several studies have used BIs to monitor aHP systems. After 3 back-to-back cycles, 13% of 146 BIs grew in hospital rooms in 1 study, although 3 cycles inactivated all BIs in separate experiments in 22 rooms in a surgery department and inside ambulances.²⁵ In this study, 1 or 2 cycles had little impact on the BIs. Therefore, we chose to use 3 back-to-back cycles for each test of the aHP machine. However, even after 3 back-to-back cycles were used, the aHP system inactivated only 10% of BIs on the first test and 79% of BIs on the subsequent tests. According to the manufacturer, the failure in decontamination in the first aHP test was probably a result of miscalculation of air humidity, which should be done automatically by the system. This was corrected by the machine for the following tests. Even with optimal function, the aHP system failed to inactivate 3 of 14 BIs in the second and third tests. The BIs that grew were not always in the same location, suggesting that the distribution was not consistent between tests.
對于過氧化氫干霧（aHP）之前已經(jīng)有一些研究。雖然在另一個單獨實驗中，三輪測試中，22間外科門診和救護(hù)車?yán)锏乃蠦Is都被滅活。但是其中有一個研究，醫(yī)院的一間病房，在經(jīng)過三輪連續(xù)測試后，使用了146個BIs, 只有13%的BIs被滅活。
在我們這個研究中，由于1輪或2輪測試對于BIs的影響較小，我們選擇采用3輪連續(xù)測試來觀測過氧化氫干霧（aHP）的效果。然而，在第一輪測試中只有10%的BIs被滅活，在隨后的兩輪中有79%的BIs被滅活。廠商對于第一輪測試失敗原因的解釋是，或許是因為設(shè)備對于濕度的檢測有誤。此誤差在隨后的測試中得以糾正。然后即使調(diào)整到工作狀態(tài)，過氧化氫干霧（aHP）對于第二輪和第三輪測試中的14個BIs，仍各有3個沒有滅活。并且那些經(jīng)培養(yǎng),細(xì)菌可以生長的BIs，并未總是來自于相同的位置，我們認(rèn)為過氧化氫干霧在測試中不能均勻分布。
One conclusion of our study can be that a higher hydrogen peroxide concentration during a longer time is superior for achieving disinfection.
我們的另一個結(jié)論是，越高的過氧化氫濃度持續(xù)越長的時間，滅菌效果越好
One HYDROGEN PEROXIDE VAPOUR generator was used, but 2 aHP machines were used. Despite this, the HYDROGEN PEROXIDE VAPOUR system was more effective for the inactivation of BIs and produced a shorter total cycle time (3 vs 3.5 hours). Turnaround time is a crucial component of vapor-phase disinfection technologies. Several recent studies have used a single cycle rather than the 3 back-to-back cycles that we used for the aHP system.^8,18 The use of 1 cycle for the aHP system would have reduced the total cycle time but would have further reduced the microbiological impact of the system; on the basis of the results from Andersen et al,²⁵ it is unlikely that any BIs could have been inactivated using fewer than 3 cycles.
試驗中用了一臺過氧化氫發(fā)生器（HYDROGEN PEROXIDE VAPOUR）,兩臺過氧化氫干霧擴(kuò)散器（aHP）。盡管如此，一臺汽化過氧化氫發(fā)生器對于生物指示劑的滅活效果也優(yōu)于兩臺aHP，且循環(huán)周期更短（3小時VS3.5小時）.循環(huán)周期是汽態(tài)滅菌技術(shù)很重要的一個部分。近期有幾個關(guān)于過氧化氫干霧擴(kuò)散器（aHP）的研究，只測試一輪。這雖然會減少總的循環(huán)時間，但會進(jìn)一步減少微生物對于系統(tǒng)的影響。 根據(jù)Andersen et al的研究，少于三輪試驗，BIs幾乎不可能被aHP滅活.
 
The peak concentration of HYDROGEN PEROXIDE VAPOUR (338 ppm) and other cycle parameters such as changes in relative humidity during the HYDROGEN PEROXIDE VAPOUR cycles are consistent with the findings of others.^4,22 However, the concentration of hydrogen peroxide identified in the aHP tests was higher than that in other studies. For example, 1 study recorded hydrogen peroxide concentration peaks of 2–60 ppm²³ and another 43–114 ppm,¹⁹ compared with greater than 150 ppm in our study. Given the higher concentration of liquid hydrogen peroxide used in the HYDROGEN PEROXIDE VAPOUR system (35% vs 5%), the higher concentration of hydrogen peroxide measured in the air when using the HYDROGEN PEROXIDE VAPOUR system is not surprising. Hydrogen peroxide sensors differ in their performance,²⁶ and since 2 different types of sensor were used, it is not possible to compare these values accurately and directly.
過氧化氫發(fā)生器的濃度峰值可以達(dá)到338ppm。根據(jù)其他研究發(fā)現(xiàn)，即使相對濕度發(fā)生變化，其峰值也可以保持一致。然而，在此次測試中過氧化氫干霧擴(kuò)散器的峰值高于其他研究中的峰值。比如，有一個研究記錄的峰值是2-60ppm，另外一個研究記錄的峰值是43-114pm，而在本次研究中的峰值為150ppm.考慮到兩種設(shè)備溶液濃度的不同（汽化過氧化氫 35% VS aHP 5%）, 汽化過氧化氫濃度的峰值高也是理所應(yīng)當(dāng)?shù)摹?br /> 我們在測試中使用了兩種不同類型的過氧化氫傳感器，它們的性能也有差異，要準(zhǔn)確直接的比較它們的數(shù)值是不可能的。
The aim of this study was not to measure whether there was any corrosive activity attributable to either of the systems. There are no reports on this important question in the literature. It is possible that the residues of silver ions left after the aHP cycle are problematic in the environment because silver exposure is known to trigger resistance in bacteria.²⁷
此次測試中沒有測量兩種設(shè)備的腐蝕性。目前的文獻(xiàn)報告中也沒有對于腐蝕性的描述。但已知的是，過氧化氫干霧發(fā)生器（aHP）溶液中的銀離子如果殘留在環(huán)境中，會引發(fā)細(xì)菌的耐藥性。
Since hydrogen peroxide reaches levels that would be toxic for patients and staff during decontamination with both the HYDROGEN PEROXIDE VAPOUR and aHP systems, ventilation and doors have to be sealed during treatment. It is also important that the process is monitored and handled by specially trained and experienced staff. In hospitals with a high prevalence of these bacteria, it might be rational for departments to own their equipment, to train dedicated persons of their staff, and to run disinfection cycles on a regular basis. In low-prevalence hospitals, it might be more rational to hire the equipment only for outbreak situations.
由于滅菌過程中，通風(fēng)裝置被關(guān)閉，門被密封，汽化過氧化氫 和aHP過氧化氫達(dá)到的濃度對病人和職員會產(chǎn)生毒害。因此滅菌過程應(yīng)當(dāng)有專業(yè)訓(xùn)練過的，經(jīng)驗豐富的人員進(jìn)行操作和監(jiān)控。對于細(xì)菌傳染性高的醫(yī)院，需要購買此類設(shè)備，并培訓(xùn)專門的人員來進(jìn)行日常滅菌。對于傳染性較低的醫(yī)院，可以在疫情突發(fā)情況下租用設(shè)備。
Our study has showed that 1 HYDROGEN PEROXIDE VAPOUR system was more effective than 2 aHP systems for the inactivation of G. stearothermophilus BIs and that cycles were faster for the HYDROGEN PEROXIDE VAPOUR system. Since the data suggesting a clinical impact relate to the HYDROGEN PEROXIDE VAPOUR system and not to the aHP system, the aHP system lacks published in vitro efficacy against key nosocomial bacteria (especially the catalase-positive bacteria¹³), and on the basis of the results of our study, the HYDROGEN PEROXIDE VAPOUR system was superior in our setting.
我們的研究表明：1臺汽化過氧化氫系統(tǒng)比2臺aHP系統(tǒng)對于嗜熱脂肪芽孢桿菌BIs滅活效力好,而且循環(huán)周期快。由于研究數(shù)據(jù)表明臨床應(yīng)該采用汽化過氧化氫系統(tǒng)，aHP系統(tǒng)對于院感細(xì)菌的滅活率（特別是氧化酶陽性菌）低。因此基于我們的研究，汽化過氧化氫更優(yōu)。