A Systematic Review on the Efficacy of Vaporized Hydrogen Peroxide as a Non-Contact Decontamination System for Pathogens Associated with the Dental Environment.

Rukshana Ahmed,Riaan Mulder

doi:10.3390/ijerph18094748

Abstract

Aerosol generation and a wide range of pathogens originating from the oral cavity of the patient contaminate various surfaces of the dental clinic. The aim was to determine the efficacy of vaporized hydrogen peroxide fogging on pathogens related to the dental environment and its possible application in dentistry. PICOS statement (Population, Intervention, Comparison/Control, Outcome and Study design statement) was used in the review. Six electronic databases were searched for articles published from 2010 to 2020. Articles written in English reporting vaporized hydrogen peroxide on pathogens deemed to be relevant to the dental environment were assessed. The quality of the studies was assessed using the risk-of-bias assessment tool designed for the investigation of vaporized hydrogen peroxide application in dentistry. A total of 17 studies were included in the qualitative synthesis. The most commonly reported single bacterial pathogen was Methicillin-resistant Staphylococcus aureus in five studies, and the viruses Feline calicivirus, Human norovirus, and Murine norovirus were featured in three studies. The results of the studies reporting the log kill were sufficient for all authors to conclude that vaporized hydrogen peroxide generation was effective for the assessed pathogens. The studies that assessed aerosolized hydrogen peroxide found a greater log kill with the use of vaporized hydrogen peroxide generators. The overarching conclusion was that hydrogen peroxide delivered as vaporized hydrogen peroxide was an effective method to achieve large levels of log kill on the assessed pathogens. The hydrogen peroxide vapor generators can play a role in dental bio-decontamination. The parameters must be standardized and the efficacy assessed to perform bio-decontamination for the whole clinic. For vaporized hydrogen peroxide generators to be included in the dental bio-decontamination regimen, certain criteria should be met. These include the standardization and efficacy assessment of the vaporized hydrogen peroxide generators in dental clinics.

Highlights

Infection control has always been a core objective in dentistry; it has risen to greater importance given the SARS-CoV-2 pandemic
Some studies did not report on the hydrogen peroxide liquid and/or the percentage used in the machines [12,15,16,17,18] nor on the model of the machine [12]
The overarching conclusion is that H2 O2 delivered as vaporized hydrogen peroxide (VHP) was an effective method to achieve large levels of log kill on the assessed pathogens

Summary

Introduction

Infection control has always been a core objective in dentistry; it has risen to greater importance given the SARS-CoV-2 pandemic. Aerosolized viruses and bacteria, such as Tuberculosis, Candida auris, and Staphylococcus aureus, once inhaled by either patient or healthcare worker, can result in far-reaching health consequences [1,2,3]. Infected droplets can be spread by dental instruments from the mouth of the dental patient, such as high-speed rotating handpieces and ultrasonic devices. The contaminated aerosol settle on exposed surfaces, resulting in environmental contamination. Virus or bacterial pathogens may survive on inanimate surfaces for prolonged periods of time and, as a result, serve as reservoirs for cross-contamination. These aforementioned surfaces increase the risk of transferring pathogens to patients through hand contact [3]. The surfaces most frequently touched in the dental environment include switches/buttons on the dental

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Conclusion