汽化过氧化氢消毒灭菌与干雾灭菌系统比较
T. Holmdahl, MD,1 P. Lanbeck, MD, PhD,1 M. Wullt, MD, PhD,1 and M. H. Walder, MD, PhD21. Infectious Diseases Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden
瑞典伦德大学临床科学系传染疾病组
2. Medical Microbiology, Department of Laboratory Medicine, Lund University, Skåne University Hospital SUS, Malmö, Sweden
瑞典伦德大学医学检验系微生物医学组，瑞典马尔默斯堪大学医院
Address correspondence to M. H. Walder, MD, PhD, Klinisk Mikrobiologi Malmö, Laboratoriemedicin Skåne, SE-20502 Malmö, Sweden (mats.walder@med.lu.se).
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： 近几年，一些新兴技术被用来对医院的房间和传统灭菌方法无法充分灭菌的设备进行灭菌。市场上有几种基于过氧化的区域灭菌技术，但尚没有任何研究来对这些技术进行一一对比。
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.
研究设计：因此，我们对汽化过氧化氢技术（HYDROGEN PEROXIDE VAPOUR）和过氧化氢干雾扩散技术（aHP）进行了一一对比.
The tests were conducted in a purpose-built 136-m3 test room.
场地：特意建造一个136立方米试验间进行试验
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 locationss in the first test and 14 locationss in the subsequent 2 tests for each system.
测试方法：根据厂商建议，试验中使用一台过氧化氢发生器和2台过氧化氢干雾扩散器。每种技术重复实验三次。用特卫强包装的6-log 嗜热脂肪芽孢杆菌生物指示剂来检验对于微生物的效力。第一轮测试中，生物指示剂（BIs）放置在20个位置；随后的两轮测试均放置于14个位置。
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.
测试结果：三轮测试中所有BIs均被汽化过氧化氢（HYDROGEN PEROXIDE VAPOUR）灭活，而干雾过氧化氢扩散器（aHP）在第一轮测试中灭活率为10%，在随后两轮测试中灭活率为79%。汽化过氧化氢的峰值为338ppm, 干雾过氧化氢峰值为160ppm. 整个循环时间（包括通风时间）为，汽化过氧化氢三轮测试为3个小时，干雾过氧化氢三轮测试为3.5个小时。泄漏传感器放置在密闭空间外围，测试中间两个系统均未发现泄漏。
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.
结论: 对于嗜热芽孢杆菌生物指示剂，一台汽化过氧化氢发生器的灭活效力优于两台过氧化氢干雾扩散器，且更省时间。
Received January 25, 2011; accepted March 28, 2011; electronically published July 22, 2011
收稿日期：2011-01-25， 通过日期：2011-03-28； 电子刊发日期：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，主编希望我们对汽化过氧化氢技术（HYDROGEN PEROXIDE VAPOUR）和干雾过氧化氢（aHP）做一个比较，截至今日，尚未有人发布此类文章。 因此我们对于此两个系统进行了调研，在一间比较大的单人或双人病房，进行嗜热芽孢杆菌的灭活试验。
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.
瑞典马尔默斯堪大学医院建造了一座新的传染病病区。此病区有50个标准隔离室。这些房间比大多数单人病房都要大，在必要时也可用作双人病房。在此病区，我们很希望尝试一些新的设备来使我们的卫生条例更现代化。 在我们新设施的建设阶段，我们仿造了一间全尺寸的隔离病房。在此仿造病房里，新的材料和新的净化技术可以得到检验。
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.
有充分证据表明被感染的表面是院内致病菌感染传播的重要因素，包括艰难梭状芽孢杆菌，抗药性金黄色葡萄球菌（MRSA）,耐万古霉素肠球菌（VRE）和鲍氏不动杆菌。 即便在传统方法清洁后，病房表面也经常发现有病菌感染。因此，如果前一个病人上述病菌呈阳性，新病人入住后，会有很大风险感染这些致病菌。
根据这些发现，出现了几种新的区域净化方法。这些方法不需要操作人员去喷洒活性物质，就可以覆盖房间内所有表面。并且相对于传统方法来说，更容易重复再现。
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
目前市场有两种常用的基于过氧化氢的方法，一种是汽化过氧化氢（HYDROGEN PEROXIDE VAPOUR）,另一种是过氧化氢干雾（aHP）. 这两种方法截然不同。汽化过氧化氢将35% 的过氧化氢液体通过加热至130摄氏度形成蒸汽，气相过氧化氢在空间中扩散。经过曝露后，使用一种活性曝气装置将过氧化氢催化分解成氧气和水。此汽化过氧化氢可以对细菌孢子达到6-log的杀灭率，包括艰难梭菌以及其他医院常见细菌，如MRSA, VRE，鲍氏不动杆菌以及病毒。汽化过氧化氢灭菌后，通过对表面取样显示其可以根除艰难梭菌等医院常见病菌的病原体。 还有些研究也表明在使用汽化过氧化氢对暴发性疫情进行控制时，其可以有效减少艰难梭菌的感染。
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 过氧化氢干雾使用5%浓度的过氧化氢、50ppm的银离子以及50ppm正磷酸的混合溶液，用压力产生8-10微米的颗粒。曝气后，干雾遗留在空间里被动分解。
过氧化氢干雾可以达到4-log的艰难梭菌孢子杀灭率，不能充分灭活。 过氧化氢干雾对于医院常见细菌的效力，如MRSA以及鲍氏不动杆菌，已经得到充分证实。但对于结核杆菌的效力尚未确认。
Methods 方法
Description of the Test Facility 测试场所描述
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.
测试在瑞典马尔默斯堪大学医院136立方米的测试间里进行。此区域被分割成4个房间，2件气闸室，1间主试验室，以及一个洗手间。此区域有专用的通风系统。
Biological Indicators 生物指示剂
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 locationss in the first test and 14 locationss 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 locationss, and several challenging locationss, such as inside cupboards and drawers, to test the distribution of the systems (see Table 1 for specific BI locationss). 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.
测试用BIs是Apex公司的用特卫强Tyvek包装的，6-log嗜热脂肪芽孢杆菌。第一轮测试中，指示剂放置于20个位置，随后两轮测试指示剂放置于14个位置。BIs被放置于主试验室，洗手间以及气闸室的高低对角，以及其他几个位置，比如衣柜里和抽屉里，以便测试系统的分布情况。（具体位置见表1）。 在汽化过氧化氢和干雾过氧化氢曝气后，BIs转移至大豆肉汤里进行培养，然后根据厂商的说明书进行细菌计数。
Table 1. Biological Indicator (BI) locations and the Number of BIs Inactivated by the Hydrogen Peroxide Vapor (HYDROGEN PEROXIDE VAPOUR) and Aerosolized Hydrogen Peroxide (aHP) Systems
表1 BI位置以及被灭活数量
|
HYDROGEN PEROXIDE VAPOUR汽化过氧化氢 |
aHP过氧化氢干雾 |
|||||
|---|---|---|---|---|---|---|
| Test no. | 1 | 2 | 3 | 1 | 2 | 3 |
| Main room, top right, near corner主试验室右上，近角 | − | − | − | + | − | − |
| Main room, bottom right, far corner主试验室右下，远角 | − | − | − | + | − | + |
| Main room, top left, far corner主试验室左上，远角 | − | − | − | + | − | − |
| Main room, bottom left, near corner主试验室左下，近角 | − | − | − | + | − | − |
| “In” air lock, top left, near corner进气室，左上近角 | − | − | − | + | + | − |
| “In” air lock, bottom left, far corner进气室，左下远角 | − | ND | ND | + | ND | ND |
| “In” air lock, top right, far corner进气室，右上远角 | − | ND | ND | + | ND | ND |
| “In” air lock, bottom right, near corner进气室，右下近角 | − | ND | ND | + | ND | ND |
| “In” air lock, bottom right, far corner进气室，右下远角 | ND | − | − | ND | − | − |
| Bathroom, top left, near corner洗手间，左上，近角 | − | ND | ND | + | ND | ND |
| Bathroom, bottom left, far corner洗手间，左下，远角 | − | ND | ND | + | ND | ND |
| Bathroom, top right, far corner洗手间，右上，远角 | − | ND | ND | + | ND | ND |
| Bathroom, top left, far corner洗手间，左下，远角 | ND | − | − | ND | + | − |
| Bathroom, bottom right, near corner洗手间，右下，近角 | − | − | − | − | − | − |
| “Out” air lock, top left, near corner排气室，左上，近角 | − | ND | ND | + | ND | ND |
| “Out” air lock, bottom left, far corner排气室，左下，远角 | − | ND | ND | + | ND | ND |
| “Out air lock, bottom left, near corner排气室，左下近角 | ND | − | − | ND | − | − |
| “Out” air lock, top right, far corner排气室，右上远角 | − | − | − | + | + | + |
| “Out air lock, bottom right, near corner排气室，右下，近角 | − | ND | ND | + | ND | ND |
| “Out” air lock, inside cupboard排气室，橱柜内 | − | − | − | + | − | − |
| Main room, inside cupboard主试验室，橱柜内 | − | − | − | + | − | − |
| Back of drawer, open 10 cm 抽屉深处，打开10cm | − | − | − | − | − | − |
| Bathroom, underneath washer/disinfector洗手间洗手台下面 | − | − | − | + | − | + |
| Total positive 阳性总数 | 0 | 0 | 0 | 18 | 3 | 3 |
| No. of BIs 指示剂数量 | 20 | 14 | 14 | 20 | 14 | 14 |
| % Positive 阳性比率 | 0 | 0 | 0 | 90 | 21 | 21 |
| Control 1 阳性对照1 | + | + | + | + | + | + |
| Control 2 阳性对照2 | + | + | + | + | + | + |
| Control 3 阳性对照3 | + | + | + | + | + | + |
Decontamination Equipment and Configuration 灭菌设备和配置
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
根据厂商建议，2台过氧化氢干雾扩散器放置在主试验室的中心位置，外面的门用胶带密封。使用德尔格 Polytron 7000 放置在室内进行浓度监测。三轮测试的每次测试，均注入3次6mL/m3 过氧化氢溶液。 用通风系统进行辅助扩散。当手持传感器监测到气闸室的浓度小于或等于1ppm，或者房间内任一点浓度小于或等于2ppm时，测试结束。（瑞典规定1ppm的过氧化氢浓度是工作中健康和安全的限值，2ppm浓度下可停留15分钟）
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.
根据厂商建议，使用1台汽化过氧化氢发生系统进行测试。放置在主试验室正中位置，其通风装置放置在主试验室气闸间的门口。摇头电风扇分别放置于洗手间门口以及另一个气闸室内。操控台放置于主试验室外面，门用胶带密封。手持传感器用于监测泄漏。 室内的过氧化氢浓度，温度以及相对湿度由设备监测。在加药和通风排残期间，每5分钟记录一次数值。三轮测试中，共使用900mL过氧化氢溶液，持续30分钟，相当于6.6g/ m3。测试中使用通风系统进行辅助通风。当气闸室的浓度小于或等于1ppm，或者房间内任一点浓度小于或等于2ppm时，测试结束。
Results 结果
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).
汽化过氧化氢（HYDROGEN PEROXIDE VAPOUR）数据参看图1, 随着相对湿度和浓度的增加以及稳定,空气中的过氧化氢达到饱和并凝结在表面。 过氧化氢的峰值是338ppm. 三轮测试总的循环时间（包括通风排残）为3小时。三轮测试中，每次测试BIs都被完全灭活。
Discussion 探讨
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.
过氧化氢是一种强效消毒和杀菌剂，它可以通过被动扩散渗透入细胞壁，然后使蛋白质、DNA以及细菌细胞中其他部分变性。它能分解成氧气和水，对环境无害，也没有有毒副产品。我们认为过氧化氢灭菌是一项非常重要的空间灭菌方法，可以为杀灭病房的MRSA, VRE, 不动杆菌属种,艰难梭菌或其他细菌
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.
我们测试了两种基于过氧化氢的空间灭菌技术。两种技术的主要区别在于形成机制的不同，汽化过氧化氢技术（HYDROGEN PEROXIDE VAPOUR）将35%的过氧化氢溶液转变为气相。而过氧化氢干雾技术(aHP)将5%浓度的过氧化氢混合液雾化成8-10微米的液滴。并采用银离子和其他化学品作为稳定剂，以防止液滴在达到目标位置之前凝聚。另外一个不同就是，过氧化氢峰值浓度，汽化过氧化氢的峰值浓度是过氧化氢干雾的两倍。而且汽化过氧化氢总的浓度也高于过氧化氢干雾
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 locationss 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
生物指示剂经常被用来监测消毒以及更高级别灭菌的效果，比如高压蒸汽灭菌和汽化灭菌方法。在我们的研究中，汽化过氧化氢对于三轮测试中所有位置的生物指示剂均能灭活。
生物指示剂被用于监测常规的过氧化氢灭菌。
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 locations, suggesting that the distribution was not consistent between tests.
对于过氧化氢干雾（aHP）之前已经有一些研究。虽然在另一个单独实验中，三轮测试中，22间外科门诊和救护车里的所有BIs都被灭活。但是其中有一个研究，医院的一间病房，在经过三轮连续测试后，使用了146个BIs, 只有13%的BIs被灭活。
在我们这个研究中，由于1轮或2轮测试对于BIs的影响较小，我们选择采用3轮连续测试来观测过氧化氢干雾（aHP）的效果。然而，在第一轮测试中只有10%的BIs被灭活，在随后的两轮中有79%的BIs被灭活。厂商对于第一轮测试失败原因的解释是，或许是因为设备对于湿度的检测有误。此误差在随后的测试中得以纠正。然后即使调整到工作状态，过氧化氢干雾（aHP）对于第二轮和第三轮测试中的14个BIs，仍各有3个没有灭活。并且那些经培养,细菌可以生长的BIs，并未总是来自于相同的位置，我们认为过氧化氢干雾在测试中不能均匀分布。
One conclusion of our study can be that a higher hydrogen peroxide concentration during a longer time is superior for achieving disinfection.
我们的另一个结论是，越高的过氧化氢浓度持续越长的时间，灭菌效果越好
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.
试验中用了一台过氧化氢发生器（HYDROGEN PEROXIDE VAPOUR）,两台过氧化氢干雾扩散器（aHP）。尽管如此，一台汽化过氧化氢发生器对于生物指示剂的灭活效果也优于两台aHP，且循环周期更短（3小时VS3.5小时）.循环周期是汽态灭菌技术很重要的一个部分。近期有几个关于过氧化氢干雾扩散器（aHP）的研究，只测试一轮。这虽然会减少总的循环时间，但会进一步减少微生物对于系统的影响。 根据Andersen et al的研究，少于三轮试验，BIs几乎不可能被aHP灭活.
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.
过氧化氢发生器的浓度峰值可以达到338ppm。根据其他研究发现，即使相对湿度发生变化，其峰值也可以保持一致。然而，在此次测试中过氧化氢干雾扩散器的峰值高于其他研究中的峰值。比如，有一个研究记录的峰值是2-60ppm，另外一个研究记录的峰值是43-114pm，而在本次研究中的峰值为150ppm.考虑到两种设备溶液浓度的不同（汽化过氧化氢 35% VS aHP 5%）, 汽化过氧化氢浓度的峰值高也是理所应当的。
我们在测试中使用了两种不同类型的过氧化氢传感器，它们的性能也有差异，要准确直接的比较它们的数值是不可能的。
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
此次测试中没有测量两种设备的腐蚀性。目前的文献报告中也没有对于腐蚀性的描述。但已知的是，过氧化氢干雾发生器（aHP）溶液中的银离子如果残留在环境中，会引发细菌的耐药性。
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 prevalsence 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-prevalsence hospitals, it might be more rational to hire the equipment only for outbreak situations.
由于灭菌过程中，通风装置被关闭，门被密封，汽化过氧化氢 和aHP过氧化氢达到的浓度对病人和职员会产生毒害。因此灭菌过程应当有专业训练过的，经验丰富的人员进行操作和监控。对于细菌传染性高的医院，需要购买此类设备，并培训专门的人员来进行日常灭菌。对于传染性较低的医院，可以在疫情突发情况下租用设备。
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.
我们的研究表明：1台汽化过氧化氢系统比2台aHP系统对于嗜热脂肪芽孢杆菌BIs灭活效力好,而且循环周期快。由于研究数据表明临床应该采用汽化过氧化氢系统，aHP系统对于院感细菌的灭活率（特别是氧化酶阳性菌）低。因此基于我们的研究，汽化过氧化氢更优。
