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Antimicrobial Resistance: How VHP and UV-C Technologies Are Transforming Infection Control

Conceptual image illustrating the threat of antimicrobial resistance (AMR) with bacterial pathogens, alongside VHP and UV-C light waves symbolizing advanced infection control technologies.

Antimicrobial Resistance: How VHP and UV-C Technologies Are Transforming Infection Control

Antimicrobial resistance (AMR) is one of the most pressing threats to public health today and healthcare environments are on the front line. As pathogens evolve resistance to antibiotics, routine treatments become riskier, and the control of hospital-acquired infections (HAIs) more complex. For NHS trusts, AMR is not a future concern; it’s a current and growing pressure on both infection prevention protocols and operational delivery. 

As a result, infection control measures must go beyond the basics. While hand hygiene and surface cleaning remain essential, hospitals are increasingly adopting advanced decontamination technologies such as vapourised hydrogen peroxide (VHP) and ultraviolet-C (UV-C) light to break the chain of transmission and reduce the environmental burden of multi-drug-resistant organisms (MDROs). 

This article explores how these evidence-backed solutions can support your infection control strategy and help mitigate the rising threat of antimicrobial resistance. 

What Are Healthcare-Associated Infections
and Why Do They Matter?

Healthcare-Associated Infections (HAIs), also known as nosocomial infections, are infections that patients acquire during their stay in a healthcare facility, typically 48 hours or more after admission. These infections can occur in any clinical setting—from ICUs to outpatient clinics—and are commonly caused by organisms such as Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa. 

These infections contribute to increased morbidity, longer hospital stays, additional antimicrobial use, and in many cases, higher mortality. For NHS trusts, they also represent a significant cost burden, measured in both lost bed days and resource diversion. 

Alt text: A collage illustrating the risk of hospital-acquired infections (HAIs). Images include a patient on a stretcher, a gloved hand holding a petri dish with bacterial growth, and surgeons performing a medical procedure, all symbolizing the need for infection control in healthcare settings.
A microscopic illustration of an antibiotic-resistant bacterial biofilm. Different species of bacteria are shown clustered together in a protective slime layer, which helps them survive antibiotic treatments.

The Link Between HCAIs and Antimicrobial Resistance (AMR)

Many HCAIs are now caused by bacteria that have developed resistance to multiple classes of antibiotics. These include well-known threats like: 

  • Methicillin-resistant Staphylococcus aureus (MRSA) 
  • Vancomycin-resistant Enterococcus (VRE) 
  • Klebsiella pneumoniae carbapenemase (KPC) 

These pathogens are not only more difficult to treat but are also more likely to spread within healthcare environments. Their increasing prevalence places additional strain on infection control efforts and contributes to the broader threat of antimicrobial resistance. 

The UK Government’s O’Neill Review warned that if antimicrobial resistance continues to rise unchecked, it could cause up to 10 million deaths globally per year by 2050. For NHS decision-makers, this underscores the importance of strengthening environmental decontamination as part of a wider Antimicrobial Resistance (AMR) containment strategy. 

The Case for Enhanced Decontamination: Beyond Manual Cleaning

Traditional cleaning methods, including chlorine-based solutions, remain a cornerstone of infection control. However, factors like room layout, surface types, and time limitations can make it difficult to achieve consistent coverage, especially on high-touch areas such as bed rails, doorknobs, and medical equipment. Studies show that pathogens can persist on these surfaces for days to weeks, increasing the risk of transmission.

To address these challenges, many healthcare facilities are adopting automated decontamination technologies such as hydrogen peroxide vapour (HPV) and ultraviolet-C (UV-C) light. These systems enhance manual cleaning by delivering consistent, whole-room disinfection even in hard-to-reach areas.

Vapourised Hydrogen Peroxide (VHP): Breaking the Chain of Transmission

Vapourised Hydrogen Peroxide (VHP) disinfection involves dispersing vapourised hydrogen peroxide into a sealed room, where it settles on surfaces and effectively kills bacteria, fungi, and viruses through oxidation. The technology is particularly effective against spore-forming organisms and multidrug-resistant bacteria. 

Studies have demonstrated that, when applied at validated concentrations and exposure times, VHP can achieve up to a 6-log (99.9999%) reduction in high-risk pathogens such as MRSA, Acinetobacter baumannii, and Clostridium difficile. Case studies from NHS settings, such as one reported by Leeds Teaching Hospitals NHS Trust, have indicated that VHP use after terminal cleaning can lead to substantial reductions in environmental C. difficile contamination, correlating with a drop in reported CDI cases. 

Vapourised Hydrogen Peroxide (VHP) has demonstrated effectiveness in laboratory conditions and is increasingly utilized in various NHS hospital environments, including isolation rooms, critical care wards, and during outbreak responses. 

UV-C Light: Fast, Chemical-Free Decontamination for Daily Use

Ultraviolet-C (UV-C) light (typically at a wavelength of 254 nm) inactivates microorganisms by damaging their nucleic acids, preventing replication. This method is fast, chemical-free, and safe for surfaces, making it an ideal option for routine disinfection. 

At Barnsley Hospital NHS Foundation Trust, UV-C decontamination with the Ultra-V system reduced average total viability counts (TVCs) from 73.6 (post-cleaning) to just 1.06—even in areas partially obstructed from direct exposure. 

In validated conditions, UV-C was also shown to prevent photoreactivation, a process where bacteria repair UV-induced damage. Doses of 9.66 to 12.68 mJ/cm² were sufficient to inactivate MRSA, P. aeruginosa, and K. pneumoniae. 

As NHS trusts look for scalable, evidence-backed methods to support antimicrobial resistance (AMR) containment, UV-C disinfection offers a fast, reliable, and residue-free solution to reduce microbial burden between patient cases and support safer clinical environments. 

Why Combine VHP and UV-C?

A comparison chart of HPV and UV-C disinfection technologies. HPV is noted for superior efficacy but requires a sealed, unoccupied room. UV-C is described as a rapid solution for routine use, but its effectiveness can be reduced by shadows.

Many NHS trusts now employ both, using UV-C for routine disinfection and VHP for outbreak response or high-containment areas. This layered strategy provides broader protection against MDROs and helps control the spread of AMR within healthcare environments. 

Implementation Considerations for NHS Trusts

Accessing funding for UV and VHP technology is usually agreed upon by the executive team. A comprehensive business case will outline the current HCAI situation, demonstrate compliance with government targets, and acknowledge the negative impact HCAIs have on patients and the number of lost bed days.  A well-constructed business case should also calculate the cost each HCAI incurs for the organisation. 

Lastly, it is important to incorporate a recommended UV and HPV cleaning model into the paper, outlining how it will work seamlessly with bed management teams.  The model should reflect the severity of the situation and ensure empty bed capacity is brought back into use as soon as possible. 

Strengthening the Front Line of Infection Control

In the face of rising antimicrobial resistance, healthcare environments must strengthen their defences beyond conventional methods. Technologies like vapourised hydrogen peroxide (VHP) and UV-C light are evidence-based, non-antibiotic tools that complement manual cleaning and help reduce the risk of hospital-acquired infections. 

By integrating these systems into routine infection prevention protocols, healthcare providers not only improve environmental hygiene but also take a proactive step toward protecting patients, supporting staff safety, and preserving the effectiveness of life-saving antibiotics for the future. 

References:

  1. Best, E. L., Sandoe, J. A. T., & Wilcox, M. H. (2014). Effectiveness of deep cleaning followed by hydrogen peroxide decontamination during high Clostridium difficile infection incidence – 92% reduction in environmental contamination. Journal of Hospital Infection, 87(1), 25–33. https://doi.org/10.1016/j.jhin.2013.12.007 
  2. Gibson, D., Rao, J., Burns, S., & Wright, L. (n.d.). Evaluation of Ultra-V decontamination as an adjunct to manual cleaning at Barnsley Hospital. Barnsley Hospital NHS Foundation Trust. [Unpublished internal report]. 
  3. Hu, X.-Y., Logue, M., & Robinson, N. (2020). Antimicrobial resistance is a global problem – A UK perspective. European Journal of Integrative Medicine, 36, 101136. https://doi.org/10.1016/j.eujim.2020.101136 
  4. Pulingam, T., Parumasivam, T., Mohd Gazzali, A., Mohd Sulaiman, A., Chee, J. Y., Lakshmanan, M., Chin, C. F., & Sudesh, K. (2022). Antimicrobial resistance: Prevalence, economic burden, mechanisms of resistance and strategies to overcome. European Journal of Pharmaceutical Sciences, 170, 106103. https://doi.org/10.1016/j.ejps.2021.106103 
  5. Russo, C., Bartolini, D., Corbucci, C., Stabile, A. M., Rende, M., Gioiello, A., Cruciani, G., Mencacci, A., Galli, F., & Pietrella, D. (2021). Effect of a UV-C automatic last-generation mobile robotic system on multi-drug resistant pathogens. International Journal of Environmental Research and Public Health, 18(24), 13019. https://doi.org/10.3390/ijerph182413019 
  6. Totaro, M., Casini, B., Profeti, S., Tuvo, B., Privitera, G., & Baggiani, A. (2020). Role of hydrogen peroxide vapor (HPV) for the disinfection of hospital surfaces contaminated by multiresistant bacteria. Pathogens, 9(5), 408. https://doi.org/10.3390/pathogens9050408 

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