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26]

Review Article

Review of the Efficacy of Ultraviolet C for Surface

Decontamination
Abba Amsami Elgujja, Haifa Humaidan Altalhi, Salah Ezreqat
Departments of Infection Control, King Saud University Medical City, Riyadh, Saudi Arabia

Abstract
Evidence has shown that the state of the patient care environment has a direct impact on heightening the risks of hospital‑acquired infections
among patients admitted in hospitals. Moreover in view of the suboptimal standard of cleanings by housekeeping staff, there has been the quest
for a better approach to reliably disinfect environmental surfaces in health‑care facilities. The ultraviolet light has been known for its antimicrobial
property and has been used in water treatment, food processing, and in‑duct cleaning of ventilations. A recent introduction of its use for surface
decontamination has raised interest among health‑care facilities. However, studies have shown that, in spite of its relative success in other applications,
there is doubt in its efficacy in decontaminating shadowed areas of the room, and therefore, may not be seen as justifying its capital intensiveness.

Keywords: Environmental disinfection, surface decontamination, ultraviolet C, ultraviolet light technology

Introduction Arabian MERS‑CoV guideline (which is the only one that

dwelt on the use of UVC and hydrogen peroxide (H2O2) for
The ultraviolet (UV) light is conventionally known for
surface decontamination) recommend using either of the two
the effectiveness of its antimicrobial activity, but there is
as a mandatory part of terminal cleaning.[7] It did not make a
significant doubt about its relative effectiveness in surface
distinction between the two in terms of preference.
disinfection. Currently, there is convincing evidence that
contaminated surfaces in hospital settings increase the risk of A quest for a better solution for environmental decontamination
the transmitting hospital‑acquired infections to other patients. has led to the application of an old concept, the UV light, for
The old argument that the environment does not contribute to decontamination of environmental surfaces. The UV light was
the transmission of infection is fast loosing credence as the well known for its antimicrobial effects and had been hitherto
plethora of evidence are abound suggesting that a new patient used for disinfection of water, food, and air ducts. Several UV
stands the risk of inheriting the pathogens left behind in a room light technology products are available in the market with even
by the previous occupant.[1]  Hence, existing studies imply that sporicidal label claim. Consequently, there is an increasing
improved environmental surface cleaning and decontamination interest in novel and more efficient technological tools which
can lower the rates of healthcare‑associated infections.[2‑4] can consistently decontaminate hospital’s environmental
surfaces.[8] This article reviews the efficacy of UVC in surface
However, evidence have also shown that housekeeping practices
decontamination and compares it with H2O2 with a view
of cleaning and disinfection of the environmental surfaces of
to proffering a practical and more efficient disinfectant for
even the best hospitals are suboptimal, and thereby missing
hospital environmental surfaces.
out on nearly half of the high‑risk environmental surfaces.[5]
Therefore, the quality environmental cleaning depends on Address for correspondence: Mr. Abba Amsami Elgujja,
the operator, and there is evidence that manual cleaning can King Saud University Medical City, Riyadh, Saudi Arabia.
spread bacteria on surfaces.[6] This is more so as many hospitals E‑mail: abelgujja@ksu.edu.sa
outsource their housekeeping tasks of environmental surface Submission: 23-04-2019 Revision: 28-06-2019
disinfection to private companies which raises the question of Acceptance: 24-07-2019 Published: 06-01-2020
whether they meet the acceptable standards. The local Saudi
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DOI: How to cite this article: Elgujja AA, Altalhi HH, Ezreqat S. Review of
10.4103/JNSM.JNSM_21_19 the efficacy of ultraviolet C for surface decontamination. J Nat Sci Med
2020;3:8-12.

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Elgujja, et al.: Review of the efficacy of ultraviolet C for surface decontamination

Role of Ultraviolet Light in Decontamination of reported that UV light can, significantly, decrease the
bio‑burden of common multidrug‑resistant as well as
the Environment spore‑forming pathogens including MRSA, Acinetobacter
UV light is electromagnetic radiation containing 265‑nm spp.,[20] VRE, Mycobacteria, Ebola virus,[21] and Clostridium
wavelengths that are not long enough to be visible to the eyes. difficile.[22] on contaminated environmental surfaces in the
At this wavelengths, UV is capable of inducing mutation to health‑care settings by up to 4 log.[6]
bacteria, viruses, and other microorganisms due to its effects
on the molecular structures of the pathogens. Its action results The Pitfalls of UltraViolet Technologies for
in destroying the structural bonds in the DNA of the pathogens,
with a resultant rendering of the pathogens harmless or thereby Environmental Surface Disinfections
inducing a bacteriostatic action on the pathogens.[9] Studies[19,20] have shown that the UV light can reduce the
microbial load on environmental surfaces, and can potentially
UV light is conventionally used for both air disinfection
contribute to reducing infection rates, in conjunction with
and water purifications, [10] and recently, to inactivate
other infection control measures like improved housekeeping
microorganisms on surfaces. The novel application of UV
practices. However, UV light is not without its own drawbacks
gamma irradiation is the use of UV light technologies to
when applied for environmental surface decontamination. For
disinfect environmental surfaces in vacant rooms. These
instance, concerns have been raised about its effectiveness
technologies come as moveable or fixed units to disinfect an
in shadowed areas. In some of the models evaluated in the
entire vacant room.[9]
studies, items that are not in direct line of the light have a lower
Some studies [8,11,12] have evaluated the effectiveness of inactivation rate as compared to those in direct line of the
using UV technologies for disinfecting patient rooms in light. That necessitates multiple‑position or multiple‑machine
hospitals [Table 1]. All of these studies cited have variously decontamination process. A study has suggested that using

Table 1: Studies on the effectiveness of ultraviolet C

Study Method Findings
Andersen Compared the antimicrobial properties of effect UVC light and UVC was not effective in shadowed areas of the rooms, necessitating
et al., 2006[11] chemical disinfectants on surfaces of isolation units further disinfection with chemicals
Weber et al., To test the capabilities of UV light technologies to decrease the microbial Shadowed areas are more likely to unaffected by the UV disinfection
2016[13] contamination on environmental surfaces in patient care areas[8]
Memarzadeh Reviews the significance of UV light technologies in air UV technologies cannot, yet, be used as a stand‑alone intervention
et al., 2010[14] decontamination in health‑care settings to inactivate or destroy pathogens, but may be used as an adjunct the
conventional interventions for terminal cleaning
Health Reviewed the scientific evidence for the efficacy of UV light Their efficacy is dependent on the organic load and pathogen, the
Protection decontamination systems intensity and dose of the UV light, the distance from the device and the
Scotland[9] exposure time, as well as whether the surface to be cleaned is within
direct line‑of‑sight
Havill et al., Prospective observational study to compare between HPVs and In the shadowed areas, HPV is significantly more effective than the UV
2012[15] UVC to decrease microbial contamination inpatient care rooms technologies
Barbut et al., The prospective, randomized, before‑after trial, using hydrogen The hydrogen peroxide sprays have shown significant superiority over
2009[16] peroxide sprays and sodium hypochlorite solution for eradicating sodium hypochlorite solution at eliminating C. difficile spores. The
bacterial spores latter stands the chance of being a promising option eradicating C.
difficile in the room of infected or colonized patients
Weber et al. Compared the efficacy of UV technologies and hydrogen peroxide Unlike the UVC, H2O2 has shown demonstrable capability to decrease
2016[13] sprays in decreasing contamination on environmental surfaces healthcare‑associated Clostridium difficile infections
postterminal cleaning
Holmdahl The tests compared the effectiveness of hydrogen peroxide and Hydrogen peroxide vapor generator was faster in action and more
et al., sodium hypochlorite, on biological indicators effective than sodium hypochlorite machines on G. Stearothermophilus
2011[17] biological indicators
Mosci et al., A comparison of the effectiveness of manual decontamination with Both are effective against C. difficile and mesophilic microbes, though
2017[18] sodium hypochlorite solution 0.5% and an automated spray system the hydrogen peroxide and silver ions disinfection is preferable
<8% H2O2 + silver ion because, it is faster, and its effectiveness is not operator‑dependent., as
compared to the hypochlorite
Fu et al., A comparison of the effectiveness, and safety profile of H2O2 sprays The H2O2 vapor system has shown better safety profile, fast action and
2012[6] and aerosolized hydrogen peroxide, on G. Stearothermophilus added effectiveness in bacterial inactivation
biological indicators with discs containing MRSA, C. Difficile and
Acinetobacterbaumannii
Haas et al.[19] A retrospective study of the effectiveness of UV light Despite the missing about a quarter of the opportunities to
environmental disinfection as an adjunct to an improved terminal decontaminate the rooms, there was a significant reduction in the
cleaning of rooms previously occupied by isolated patients, by rates of hospital‑acquired MDRO rates was noticed during the period
comparing the rates of hospital‑acquired MDROs before and of UVD use as compared with the period before. UV technologies
during the UVD use appeared, in this study, to have some beneficial effect
UVC: Ultraviolet C, H2O2: Hydrogen peroxide, MRSA: Methicillin‑Resistant Staphylococcus aureus, MDROs: Multidrug‑resistant organisms, UVD: Ultraviolet
disinfection, HPV: Hydrogen peroxide vapor, G. Stearothermophilus: Geobacillus stearothermophilus, HVAC: Heating, ventilation and air condition

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Elgujja, et al.: Review of the efficacy of ultraviolet C for surface decontamination

a reflective coated wall could reduce the time limit by room must be vacant prior to decontamination, they do not
about 50%, but it did not further increase its log reduction remove dust and stains, and hence, proper cleaning must
capability.[23] be completed before the disinfection as part of a terminal
cleaning (as the room should remain vacant prior using the
Furthermore, the presence of organic matter on the environmental
UV technology).
surface can decrease the lethal effect of the UV radiation on
pathogens.[24] Accordingly, none of the studies or reviews However, H2O2 is a relatively better choice for the following
suggests that UV light technology can be used as a stand‑alone reasons:
measure, but perhaps, as a supplement to the existing 1. There is no prospective (known to authors) clinical study
housekeeping practices. This requires that the surface must be to show that UV light decontamination can decrease the
physically cleaned before applying the UV light as an adjunct. rates of hospital‑acquired infections. Clinical trials have
This is in addition to its other disadvantage that the room must shown that using the H2O2 for surface disinfection can
be vacated before using the technology because of its effects on, decrease the rates of hospital‑acquired infections
among others, the skin of humans (cutaneous inflammation),[25] 2. No reported study that suggests that UVC is effective in
of some adverse inflammatory responses, including the creation shadowed areas, even when the room contents have been
of inflammatory mediators, and changes to vascular responses.[26] moved away from the walls. H2O2 can be conveniently
The UV light also has effects on the eyes and visual systems,[27] used for disinfecting room with complex equipment and
including potential changes to the cornea, pterygium, and acute furniture without necessarily moving the contents away
photokeratitis (snow blindness), among others.[28] around
3. H 2O 2 has no harmful residue. Hydrogen Peroxide
Discussion: UltraViolet C versus Hydrogen is converted into oxygen and water with conducive
environmental impact
Peroxide 4. The automated dispersal system ensures uniform
An alternative surface disinfectant with similar antimicrobial distribution in the room, including all corners, crannies,
action, including sporicidal property, is the vaporized H2O2 that and openings, including even air vents
destroys pathogens, including spores by degrading the bacterial 5. At the concentration of 3%, it can be safely and effectively
cell.[29] H2O2, which is commercially available in a range of used as an intermediate level surface and semi‑critical
concentrations from 3% to 90%, is also considered eco‑friendly, items disinfectant.
as it can quickly disintegrate into harmless by‑products: water
and oxygen.[30] Published literature have attributed good
antimicrobial activity to H2O2 and have confirmed its biocidal
Recommendations
activity against a wide range of pathogens, including bacteria, 1. Making a choice
yeasts, fungi, viruses, and spores.[5] It also has an additional a. As can be seen in this review, a better alternative to
advantage of overcoming the drawbacks arising from the use UVC for surface decontamination is the vaporized
of UVC; The ability to reach all nooks and corners of the room, H2O2 in the concentration of 3%–6% which can
including part of the air vents when the air conditioners are permeate its sporicidal property in all areas of the
not operating.[31] room, including shadows and ventilation ducts
b. Apart from using it for decontaminating inanimate
When compared to its peers, for example, glutraldehyde, environmental surfaces, H 2 O 2 vapors can be
peracetic acid, and orthophthaldehyde, it has far better effectively used for high‑level disinfection of
favorable chemical characteristics, including its use as a medical devices such as soft contact lenses,
sterilant (at the concentration of 6%–25%, and a contact time ventilators, and endoscopes. Furthermore, it can
of 6 h), and has a high level of disinfection claim (sporicidal). also be used for spot‑disinfecting fabrics in patients’
In addition, it has a longer reuse life (2 days), a long shelf rooms[5]
life (2 years), it does not require activation, and has a good c. Manual terminal cleaning of patient rooms using
materials compatibility.[5] neutral detergent according to the standard hospital
Furthermore, a study, in which a new activated H2O2 wipe protocol should always precede the use of H2O2
disinfectant was used to disinfect high‑touch surfaces d. Apply the H2O2 vapor according to the manufacturer’s
in patient rooms has demonstrated that 99% of surfaces recommendations.
yielded <2.5 colony‑forming units/cm, 75% yielded no
2. If the choice is for UVC, then follow these steps[9]
growth.[32]
a. UV light systems can be used as an additional measure
Analyzing Table 2, it could be deduced that both the when performing terminal room decontamination
UV and the H 2O 2 technologies can be used for room b. The use of UV light systems for environmental
surfaces and equipment decontamination because of their decontamination should only be undertaken following
broad‑spectrum antimicrobial activity against pathogens, completion of a manual clean as residual dirt can
including C.  difficile for. Furthermore, in both cases, the reduce efficacy

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Elgujja, et al.: Review of the efficacy of ultraviolet C for surface decontamination

Table 2: Comparing the merits and demerits of ultraviolet light and hydrogen peroxide for surface disinfection
Product Advantage Disadvantage
H2O2 Broad‑spectrum activity against pathogens involved in Cannot be used in an occupied room
healthcare‑associated infections
Can be used for disinfecting both environmental surface as well as It is labor‑intensive as it requires closing the HVAC system and
medical devices sealing the doors to prevent its escape
Has a sporicidal activity It cannot be routinely used, but only as part of the terminal
cleaning after the patient has vacated the room
Can be used for decontaminating complex devices and rooms Expensive
Does not require the manipulation of room furniture and other items Time‑consuming: requires about 2.5 to 5 h
in the room before decontamination
Has no residual health, disposal or safety concerns (residue: Oxygen Its effectiveness dependents on specific use parameters (e.g.,
and water) concentration, contact time, etc.)
The system distributes the product in the room uniformly
There is evidence that it can reduce the rate of hospital‑acquired
Clostridium difficile infections
Can potentially reduce the environmental impact because of little or
no water used, no residue and its versatility with the same result
No odor or irritation issues
Does not coagulate blood or fix tissues to surfaces
Inactivates cryptosporidium
May enhance the removal of organic matter and organisms[5]
UVC Broad‑spectrum activity against pathogens involved in The room must be vacated for decontamination
healthcare‑associated infections
Can be used for disinfecting both environmental surface as well as Cannot be used as stand‑alone disinfection, but as an adjunct to
medical devices terminal disinfection after the patient vacates the room
Rapid contact time, for example, 15 min for vegetative bacteria High capital costs
Has a sporicidal activity after longer exposure of up to 50 min Proper cleaning must be done before UV decontamination
Plug and play: Does not require closing the HVAC system, nor Its effectiveness dependents on specific use parameters (e.g.,
sealing the room wavelength, UV dose delivered)
Eco‑friendly, with no residue Equipment and furniture must be moved away from the walls
Low recurrent running costs No prospective studies that demonstrate that the use of UV
light technology for decontamination reduce the rates of
healthcare‑associated infections
H2O2: Hydrogen peroxide, UVC: Ultraviolet C, HVAC: Heating, ventilation and air condition

c. Before a UV light system being considered, an j. Ensure appropriate time is given to the UV light
assessment of the area to be decontaminated must be decontamination process. Use of UV light systems
undertaken to ensure the area can be sealed and the will increase the overall decontamination time for
use of UV light made safe cleaning. Additional time should be included in
d. UV light systems must only be used in an area which cleaning specification guidance [Table 2].
has been cleared of all patients and staff. No entry
to the decontamination area is allowed once the Conclusions
decontamination process has commenced Although both UVC and H 2 O 2 are broad‑spectrum
e. Manufacturers’ instructions for use must be followed antimicrobial agents that are used for room surfaces
to reduce the risk of sub‑optimal UV light dosage on and equipment decontamination, for their effect against
microorganisms. This could result in the mutation of pathogens, including C. difficile, in both cases, the room
the remaining microbes must be completely vacated before decontamination.
f. UV light systems in use must be maintained in However, H2O2 is a relatively better choice for the following
good working order and a system of programmed reasons:
maintenance in place with documented evidence 1. There is no prospective clinical study that demonstrates
g. A quality assurance mechanism should be in place that UV room disinfection can reduce the rate of
to monitor the functionality of the UV light system healthcare‑associated infections.[13] One retrospective
using samples before and after cleaning study showed a decrease in rates, but other infection
h. UV light systems should not be used for routine prevention measures were also implemented along with
cleaning the use of UV light. Some studies have shown that the
i. Risk assessments should be in place for possible use of H2O2 for surface disinfection can reduce the rate of
exposure of staff or patients to UV light healthcare‑associated infections[19]

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Elgujja, et al.: Review of the efficacy of ultraviolet C for surface decontamination

2. None of the studies suggest that UVC is effective in peroxide systems for terminal room decontamination: Focus on clinical
shadowed areas, even when the equipment and furniture trials. Am J Infect Control 2016;44:e77‑84.
14. Memarzadeh F, Olmsted RN, Bartley JM. Applications of ultraviolet
are moved around germicidal irradiation disinfection in health care facilities: Effective
3. H2O2 can be used for disinfecting rooms that contain adjunct, but not stand‑alone technology. Am J Infect Control
complex equipment and furniture without moving them 2010;38:S13‑24.
around. The automated dispersal system ensures uniform 15. Havill NL, Moore BA, Boyce JM. Comparison of the microbiological
efficacy of hydrogen peroxide vapor and ultraviolet light processes
distribution in the room, including all corners, crannies, for room decontamination. Infect Control Hosp Epidemiol
and openings, including event air vents 2012;33:507‑12.
4. H2O2 has no residue the HP is converted into oxygen and 16. Barbut F, Menuet D, Verachten M, Girou E. Comparison of the efficacy
water with conducive environmental impact. of a hydrogen peroxide dry‑mist disinfection system and sodium
hypochlorite solution for eradication of Clostridium difficile spores.
Financial support and sponsorship Infect Control Hosp Epidemiol 2009;30:507‑14.
Nil. 17. Holmdahl T, Lanbeck P, Wullt M, Walder MH. A head‑to‑head comparison
of hydrogen peroxide vapor and aerosol room decontamination systems.
Conflicts of interest Infect Control Hosp Epidemiol 2011;32:831‑6.
18. Mosci D, Marmo GW, Sciolino L, Zaccaro C, Antonellini R, Accogli L,
There are no conflicts of interest. et al. Automatic environmental disinfection with hydrogen peroxide
and silver ions versus manual environmental disinfection with sodium
References hypochlorite: A multicentre randomized before‑and‑after trial. J Hosp
Infect 2017;97:175‑9.
1. Weber DJ, Rutala WA, Miller MB, Huslage K, Sickbert‑Bennett E. 19. Haas JP, Menz J, Dusza S, Montecalvo MA. Implementation and impact
Role of hospital surfaces in the transmission of emerging health of ultraviolet environmental disinfection in an acute care setting. Am J
care‑associated pathogens: Norovirus, Clostridium difficile, and Infect Control 2014;42:586‑90.
Acinetobacter species. Am J Infect Control 2010;38:S25‑33. 20. Anderson DJ, Gergen MF, Smathers E, Sexton DJ, Chen LF, Weber DJ,
2. Carling PC, Briggs JL, Perkins J, Highlander D. Improved cleaning et al. Decontamination of targeted pathogens from patient rooms
of patient rooms using a new targeting method. Clin Infect Dis
using an automated ultraviolet‑C‑emitting device. Infect Control Hosp
2006;42:385‑8.
Epidemiol 2013;34:466‑71.
3. Dancer SJ, White L, Robertson C. Monitoring environmental cleanliness
21. Sagripanti JL, Lytle CD. Sensitivity to ultraviolet radiation of
on two surgical wards. Int J Environ Health Res 2008;18:357‑64.
Lassa, Vaccinia, and Ebola viruses dried on surfaces. Arch Virol
4. Griffith CJ, Obee P, Cooper RA, Burton NF, Lewis M. The effectiveness
2011;156:489‑94.
of existing and modified cleaning regimens in a welsh hospital. J Hosp
22. Miller SL. Efficacy of ultraviolet irradiation in controlling the spread of
Infect 2007;66:352‑9.
tuberculosis; submitted to: Centers for Disease Control and Prevention
5. Rutala WA, William A, Weber DJ, David J. Guideline for Disinfection
National Institute for Occupational Safety and Health 2002.
and Sterilization in Healthcare Facilities; 2008.
23. Rutala WA, Gergen MF, Tande BM, Weber DJ. Rapid hospital room
6. Fu  TY, Gent  P, Kumar  V. Efficacy, efficiency and safety aspects of
decontamination using ultraviolet (UV) light with a nanostructured
hydrogen peroxide vapour and aerosolized hydrogen peroxide room
disinfection systems. J Hosp Infect 2012;80:199‑205. UV‑reflective wall coating. Infect Control Hosp Epidemiol
7. Scientific Advisory Board. Middle East Respiratory Syndrome 2013;34:527‑9.
Coronavirus; Guidelines for Healthcare Professionals. Riyadh; 2018. p. 10. 24. Nerandzic MM, Cadnum JL, Eckart KE, Donskey CJ. Evaluation of
8. Boyce JM, Havill NL, Moore BA. Terminal decontamination of patient a hand-held far-ultraviolet radiation device for decontamination of
rooms using an automated mobile UV light unit. Infect Control Hosp Clostridium difficile and other healthcare-associated pathogens. BMC
Epidemiol 2011;32:737‑42. Infect Dis 2012;16:12:120.
9. Scotland HP. Literature Review and Practice Recommendations: 25. Urbanski A, Schwarz T, Neuner P, Krutmann J, Kirnbauer R, Köck A,
Existing and Emerging Technologies Used for Decontamination of the et al. Ultraviolet light induces increased circulating interleukin‑6 in
Healthcare Environment – UV Light. Health Protection Scotland; 2016. humans. J Invest Dermatol 1990;94:808‑11.
Available from: https://www.hps.scot.nhs.uk/web‑resources‑container/ 26. Clydesdale GJ, Dandie GW, Muller HK. Ultraviolet light induced
literature‑review‑and‑practice‑ recommendations‑existing‑and‑emergin injury: Immunological and inflammatory effects. Immunol Cell Biol
g‑technologies-used‑for‑decontamination‑of‑the‑healthcare‑environme 2001;79:547‑68.
nt‑uv‑light/. [Last accessed on 2019 Apr 20]. 27. Stark WS, Tan KE. Ultraviolet light: Photosensitivity and other effects
10. Monarca S, Faretti D, Collivignarelli C, Guzzella L, Zerbini I, Bertanza on the visual system. Photochem Photobiol 1982;36:371‑80.
G, et al. The Influence of Different Disinfectants on Mutagenicity and 28. Taylor HR. The biological effects of uv‑b on the eye. Photochem
Toxicity of Urban Wastewater. Water Res 2000;34:4261. Photobiol 1989;50:489.
11. Andersen BM, Bånrud H, Bøe E, Bjordal O, Drangsholt F. Comparison 29. Maris P. Modes of action of disinfectants. Rev Sci Tech 1995;14:47‑55.
of UV C light and chemicals for disinfection of surfaces in hospital 30. McDonnell G, Russell AD. Antiseptics and disinfectants: Activity,
isolation units. Infect Control Hosp Epidemiol 2006;27:729‑34. action, and resistance. Clin Microbiol Rev 1999;12:147‑79.
12. Mahida N, Vaughan N, Boswell T. First UK evaluation of an automated 31. Chan HT, White P, Sheorey H, Cocks J, Waters MJ. Evaluation of the
ultraviolet‑C room decontamination device (Tru‑D™). J Hosp Infect biological efficacy of hydrogen peroxide vapour decontamination in
2013;84:332‑5. wards of an australian hospital. J Hosp Infect 2011;79:125‑8.
13. Weber DJ, Rutala WA, Anderson DJ, Chen LF, Sickbert‑Bennett EE, 32. Boyce JM, Havill NL. Evaluation of a new hydrogen peroxide wipe
Boyce JM, et al. Effectiveness of ultraviolet devices and hydrogen disinfectant. Infect Control Hosp Epidemiol 2013;34:521‑3.

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