Methicillin-resistant Staphylococcus aureus decontamination: is ultraviolet radiation more effective than vapor-phase hydrogen peroxide?

Abstract

Methicillin-resistant Staphylococcus aureus (MRSA) is an increasing problem for patients, clinicians, and epidemiologists. Patients risk MRSA colonization upon admittance in areas not properly disinfected. As high-level decontaminants, both ultraviolet (UV) radiation in the UV-C waveband as well as vapor-phase hydrogen peroxide (VHP) have been utilized to limit nosocomial infection cost and concomitant disease. In order to determine whether UV irradiation is more effective than VHP in the control and prevention of MRSA infection, 12 studies with N = 20 discrete data points were analyzed to determine efficacy based on log₁₀ reductions in MRSA colonies on medically relevant surfaces reported in colony forming unit per unit area achieved within reported decontamination times. The search retrieved studies searching all databases of the Web of Science using the terms ‘hydrogen peroxide^∗ AND MRSA^∗’ and ‘ultraviolet AND MRSA^∗’ within all time periods. A Student's t test determined a statistically significant difference in log reductions of MRSA achieved by each treatment (P = 0.0117), with a rejection of the null hypothesis of no statistical difference. A second t test determined no significant difference between reduction rates when decontamination time was factored into the analysis (P = 0.1701), supporting the null. Provisionally, the results indicate VHP having greater amounts of MRSA reduction than UV, with no difference between treatment reduction rates. However, each is considered effective in MRSA sterilization. Practical significance should be determined by biosafety officers and individual hospital policy as related to sterilization cutoffs. Further investigation and direct experimental comparisons are warranted considering the limitations of this study.