Historically, many surgical facilities and hospitals have encountered a trade-off when it comes to choosing cleaning and disinfecting agents: efficacy versus safety and environmental sustainability. For years, facilities have struggled to find a solution to effectively clean and disinfect, killing bacteria and viruses on surfaces, hands and instruments, without putting staff, patients or the environment at risk.

Historically, many surgical facilities and hospitals have encountered a trade-off when it comes to choosing cleaning and disinfecting agents: efficacy versus safety and environmental sustainability. For years, facilities have struggled to find a solution to effectively clean and disinfect, killing bacteria and viruses on surfaces, hands and instruments, without putting staff, patients or the environment at risk.

These obstacles were some of what scientists at Virox Technologies, Inc. found as they conducted market research in pursuit of developing a new cleaning and disinfecting solution for healthcare facilities. What resulted from this research is a selection of cleaning and disinfecting products for various areas of a healthcare facility all centered around one technology: Accelerated Hydrogen Peroxide (AHP).

The AHP background
It has long been known in the medical industry that hydrogen peroxide can kill germs with minimal risk to users. However, for years, the chemical was never considered stable, fast or active enough to be used as a viable disinfectant cleaner for hospitals. In the 1990s, a new technology known as Accelerated Hydrogen Peroxide was developed in Canada by Michael Rochon. In 1998, the company Virox Technologies, Inc. was formed and acquired the rights to this technology platform, which was still in development. Since then, it has grown from just a cleaning chemistry into various disinfectant products for the healthcare space in over 65 countries with seven issued patents.

According to Nicole Kenny, Director of Professional and Technical Services at Virox, AHP is a synergistic blend of low-levels of hydrogen peroxide with other safe, environmentally-friendly ingredients to achieve disinfection.

“We’ve been able to harness the killing power of hydrogen peroxide to decrease the contact time to achieve disinfection,” Kenny says.

Kenny explains that during the company’s research, healthcare facilities pointed to key areas where they said their current cleaning-disinfecting solutions may be lacking.

“Facilities would say, ‘We have a great disinfectant, it’s not a very good cleaner,’” Kenny says. “They also had concerns about contact time. If a disinfectant has a 10-minute contact time, facilities don’t have time for cleaning staff to wipe a surface multiple times to keep the surface wet, so a faster contact time improves efficiencies.”
Furthermore, Kenny says safety was “vitally important.” Other solutions such as phenolics are labeled as carcinogens and are contraindicated for children.

Bleach in varying concentrations has been linked to occupational asthma and respiratory issues, and can damage surfaces from repeat applications. Meanwhile, quaternary ammonium compounds have been linked to resistance development.

“When you are using chemicals, there are a lot of issues with indoor air quality,” Kenny says, “as well as different chemicals that have been linked to other health risks.”

Finally, sustainability was a concern for hospitals in a cleaning-disinfecting agent, and finding a solution that was as ‘green’ as possible.
With this in mind, Virox set out to use its AHP technology to develop a cleaner-disinfectant that would address these four core issues of hospitals. Today, Virox differentiates AHP technology — now in its third generation — from other cleaning-disinfection solutions used in hospitals in four areas:

1. Cleaning efficacy
2. Contact time and spectrum of kill
3. Safety for the user, occupants and substrates
4. Sustainability

On the cleaning front, AHP is able to “lift up bioburden,” Kenny says, and achieves 93 to 94 percent efficacy according to testing standards, where 80 percent is typically the threshold of defining a good cleaner.

In terms of contact time and spectrum of kill, AHP disinfectants range from one minute to eight minutes for hospital-grade disinfection, and it has efficacy claims against both envelope viruses, such as HIV, hepatitis C and influenza, and non-envelope viruses like norovirus and rhinovirus.

Safety-wise, AHP has toxicity ratings of zero for respiratory inhalation and ingestion, and is considered non-irritating to eyes and skin. Finally, because hydrogen peroxide breaks down into water and oxygen, there is no active chemical left in the waste of AHP, making it a green product. In Canada, AHP is a certified green disinfectant cleaner.

Once the core AHP technology was developed, Virox began partnering with various industry companies to apply the technology to different aspects of cleaning and disinfecting in which they specialized. Currently, as it relates to the medical and surgical arena, AHP can be found in surface disinfectants, instrument sterilizing/reprocessing solutions, high-level disinfectants, food contact sanitizers and hand hygiene products.
In the various products in which AHP is used, the technology’s same benefits and principles apply, helping to provide hospitals with an efficient, safe and sustainable disinfectant cleaner solution.

On the surface
By 2001, Diversey, Inc. (at the time Johnson Wax Professional) recognized the potential of the AHP technology in the surface disinfectant space, bought a minority ownership stake in Virox, and partnered with the company to implement AHP into its products. With its AHP-based surface disinfectants, Diversey targets hard surfaces with an intermediate-level disinfectant to assure the bacteria and viruses posing risks in hospitals are killed.

According to Peter Teska, Americas Portfolio Lead for Infection Prevention, Diversey, Inc., the company’s AHP surface disinfectants, marketed as Oxivir TB, a ready-to-use disinfectant, and Oxivir Five 16, the dilutable version, targets the pathogens — both envelope and non-envelope — likely to be on surfaces causing infection with a contact time ranging from one to five minutes.

“The shorter contact time is important because if you just do a single application, which in reality, is what most facilities are doing,” Teska says, “you are more likely to achieve disinfection on the surface.”

In terms of cleaning, Teska says many traditional surface disinfectants found in hospitals are very lean-dilution products, which supplies good disinfecting qualities, but very little cleaning power. The cleaning power of AHP makes it a significant benefit for hospital surfaces.

“Any time you have any sort of bioload in the environment, many disinfectants don’t do a good job of removing the soil,” Teska says. “If it doesn’t remove the soil, it’s not going to disinfect the surface.”

Teska points out that AHP can be used on most surfaces in the OR and the entire hospital, but not on copper or brass, and be careful with devices with electronic displays. Furthermore, AHP has actually been known to remove the residues left behind by other surface disinfectants. As it’s doing this, it tends to give off a sulfurous odor. Once the residue has been removed, the odor goes away. Furthermore, Teska says, it’s important for facilities to recognize that AHP is generally more expensive than a low-level disinfectant, because a facility is paying for a higher-level disinfectant with AHP.

“Evaluate within the facility the highest risk areas and use the higher-level disinfectant in those areas,” he advises. “The facility is still getting significant benefits for making the switch, even if they don’t use it on all surfaces.”

Instrument disinfection
In 2006, STERIS began partnering with Virox to implement AHP technology into a high-level instrument disinfection solution.

“The ability to use low-levels of liquid hydrogen peroxide as a high-level disinfectant led to the introduction of a product with an improved safety profile as an alternative to aldehydes,” says Anthony Fiorello, scientific manager, STERIS Science & Technology.

Using AHP, the company developed the Resert™, an FDA-approved, high-level disinfectant for medical devices, including flexible endoscopes. According to Nancy Kaiser, senior manager of product technologies, STERIS Healthcare division, the overall formulation of Resert™ products allows for rapid, eight-minute, room-temperature high-level disinfection (HLD). The HLD can be used on semi-critical devices including flexible endoscopes, ultrasound probes and scope accessories. There are materials in which AHP is not compatible, including copper, brass, tungsten carbide and silver.

“By formulating with a much lower amount of hydrogen peroxide, we have improved the materials compatibility profile,” Kaiser says. “In addition, the use of less active ingredients in this formulation generally reduces the required number of rinses.”

Furthermore, Jason Tirey, senior scientist, STERIS  Science & Technology division, AHP-based HLD formulation is “more sensitive to the environment” by being biodegradable, since it breaks down to oxygen and water as by-products and is non-toxic to fish.

“The same cannot be said of other HLD glutaraldehyde-based products,” Tirey says. “In most municipalities, used Resert solution can be disposed of straight into the municipal sewage system. Most municipalities consider aldehydes a hazardous waste that requires detoxification with another chemical agent before disposal.”

AHP in the future
Looking ahead, the experts representing the various applications for AHP foresee the technology only getting better. Teska predicts improved efficacy for surface disinfectants, and the ability to kill bugs that are tough to kill today with leaner dilution rates.

For Kenny, AHP will continue to provide facilities with a multi-faceted solution to cleaning and disinfection.

“AHP provides facilities a solution for a holistic approach in being a sustainable green facility,” she says. “But also, from a health and safety standpoint, facilities can improve health by choosing products that are not harmful. And, from an auditing and accreditation perspective, facilities should be using a product that can achieve disinfection during the cleaning process.”