The New World of COVID-19 and Disinfection

THE BIG PROBLEMS

Ours is a challenging new world with both good and bad things happening around the globe. We are facing sectional wars, social upheaval, political turmoil, climate change, and, central to this paper, a biological catastrophe that will bring great disruption and challenges to society as we know it today.

That biological catastrophe is primarily related to a fundamental change evolving in microorganisms – namely, mutation – that has been occurring since inception but is currently unfolding in a more aggressive pattern.

Microorganisms, including viruses and bacteria, are, in effect, “smart”. As Nature predicts, they adapt and mutate to survive and thrive in the world, often in ways highly unfavorable to humans.

Three Problematic Examples

Mutating Viruses

The COVID-19 pandemic is caused by SARS-CoV-2, which is a newly mutated virus that originated in animals and moved to humans. COVID-19 represents only one of multiple worldwide illnesses caused by mutated pathogens.

People around the globe are facing an alarmingly changing world in which such mutations of viruses are creating human epidemics and pandemics with enormous consequences associated with human morbidity and mortality and resulting in huge societal costs.

We are now dealing with zoonotic viruses that move from animals to humans, e.g. Ebola and others, and viral mutations such as the coronaviruses that include the flu virus, MERS and SARS-CoV-1 and now SARS-

CoV-2, the virus causing the current COVID-19 pandemic and which itself appears to be mutating into a more contagious form as this is being written. Humans have little natural defense against these newly introduced pathogens. We are vulnerable.

Antibiotic Microbial Resistance (AMR)

Repeated exposure of bacteria to antibiotics has produced bacteria that have become resistant to antibiotics. Similarly, low levels of sanitizing/disinfecting biocides, inadvertently misused during efforts to sanitize the environment, can also lead to potentially lethal pathogen mutations.^1,2 The result: AMR “superbugs” that are killing 99,000 hospitalized patients annually in the United States alone. Unless major changes are made,

AMR is projected to be associated with the death of 10 million people around the globe in 2050 with a cumulative cost of over $100 trillion USD.³ That mortality rate represents the death of one person every three seconds if we do not solve this problem.

What is happening? The cost of developing new antibiotics is so great that new antibiotics are not being generated as rapidly as is needed to address the issues of “superbugs” resistant to all current antibiotics. Unless significant changes occur, the possibility of our society entering an era of “no effective antibiotics” for some deadly infectious diseases is becoming a reality.

Toxic Exposure

Toxic exposure to humans and the environment is resulting from efforts to address these pathogens with current sanitizers and disinfectants. It turns out that many of the chemicals we are currently using in our efforts to sanitize/ disinfect our environment are proving poisonous to people, especially to children, to animals including our pets, and to the environment. Ironically, the effort toward cure has become a significant problem in itself. The products we use have, until now, represented the state of the art in cleaning, sanitizing and disinfecting technology but the great majority of these products contain toxic chemicals.

Of these three issues, perhaps counter intuitively, the threat to our society of the toxicity of the chemicals we are exposing our people and children to is likely the greatest threat of all.

The worldwide costs in terms of money and of lives lost accruing from mutating pathogenic viruses, from AMR bacteria and from toxic chemicals we use for disinfection and sanitation are staggering. And the threats they pose will increasingly become greater if we fail to find and enact effective interventions to mitigate and resolve these problems. Failing at that task ultimately means eventually even jeopardizing global society itself.

ADDRESSING THESE PROBLEMS

First, consider disinfecting and sanitation products. One recommendation to address these catastrophic diseases is to defeat the pathogens where they originate before they invade our bodies: namely, targeting surfaces of all types, especially in healthcare facilities, in food preparation, in public buildings, in wound care. Essentially everywhere. Including in homes. But doing so requires effective, safe sanitizing/disinfection! However, current sanitizing/disinfection methods and products are fraught with severe problems, including:

• Ineffective results.
• Incomplete or improper use (failure to completely follow instructions or faulty implementation of cleaning procedures)
• Unintentional promotion of AMR due in part to incorrect use
• The toxic effects of cleaning products that cause serious diseases in both adults and children^4-13 and harm to animals as well as toxic harm to the environment.

Most disinfectants are effective in killing bacteria and viruses if used as directed and applied according to instructions for a sufficient period of time. But too often, those directions are not – or cannot – be adequately followed. And, again all too often, the sanitizer/disinfectants contain toxic chemicals.

And, yes, we must also consider the impact of “less than full truth in advertising.” We are told the products are safe, in part based on the fact they have been assigned an “EPA registered number.” But reviewing the EPA “N” list (https:// www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2) or the

product’s Safety Data Sheet reveals that many, if not most, of these products include chemicals that are harmful to humans, animals or to the environment – such as quaternary ammonium compounds (“QUATS”), bleach, hydrogen peroxide or ethyl alcohol. We will delve further into the issues of sanitizer/disinfectant toxicity and failures in full disclosure later in this paper.

Beyond surface disinfection, a second area for attacking pathogenic viruses is defeating them in the air we breathe. Recent medical evidence and opinion indicate that viral transmission through the air plays an important role in

disease transmission.^14-21 This finding opens many new frontiers to combat viral diseases. We will also discuss this subject in greater detail later in this paper.

PROPOSING A DRAMATIC IMPROVEMENT TO DISINFECTION AND SANITATION

Instead of dwelling on the negative issues in sanitizing/disinfection, this report details a positive alternative approach offered through the introduction of

a totally non-toxic, highly-effective sanitizer/disinfectant product powered by hypochlorous acid (HOCl) in a stabilized, near neutral pH Super Mixed Oxidant Solution (HOCl).*

_{*Super Mixed Oxidant Solution (HOCl) refers to an EPA-certified product (93392-2)}

A BRIEF HISTORY OF HOCl

In its simplest description, HOCl is produced during the electrolysis of a saltwater solution. During electrolysis, Free Available Chlorine (FAC) is produced with the chlorine being dissolved in water. The FAC is the active

agent in killing pathogens and its effectiveness is determined in great part by its concentration in solution – the higher the concentration, the greater the effectiveness.

First described by the French chemist Antoine Jérôme Balard in 1834 and then by Michael Faraday, the antibacterial effectiveness of HOCl went unrecognized for decades. Later HOCl was used successfully during WWI for wound care.²² However, the equipment to produce the HOCl was large and cumbersome, expensive and unreliable. Furthermore, the HOCl product produced by these early machines was unstable resulting in a short shelf-life.

A renewal of interest in HOCl began about 15 years ago. Since that time, product quality has improved but has still suffered from manufacturers’ inability to produce more than minimal concentrations of FAC as well a failure to establish long-term product stability. If these difficult problems had not posed such steep challenges, HOCl would have been broadly available and widely used long ago.

SIGNIFICANT TECHNOLOGICAL ADVANCES IN HOCL PRODUCTION

Recently developed and patenting proprietary technology enables production of HOCl:

• in a stable solution
• at a near-neutral pH
• with a broad range of specifically targeted FAC concentrations designed for different applications ranging from 200-2200 parts per million (ppm)

These products, with HOCl as active ingredient, meet or exceed the major criteria of the “ideal disinfectant” as characterized by the Center for Disease Control and Prevention (CDC)²³ in that they:

• rapidly and effectively kill offending pathogens including bacteria, viruses, fungi and molds
• are completely non-toxic to humans and pets
• are completely non-toxic to the environment

In fact, HOCl establishes a new industry standard for disinfection and sanitation. To reiterate and underscore, HOCl is a sanitizer/disinfectant that is stable, is more effective than existing  products, and also is completely non-toxic to people, animals, and to the environment.

MORE ON THE ISSUE OF TOXICITY OF SANITIZERS AND DISINFECTANTS

As stated earlier, even with the two major issues of mutating viruses and AMR, the threat to our society of the toxicity of the chemicals we are exposing our people and especially our children to with the use of standard sanitizers and disinfectants may be the greatest threat of the three.

Consider the following:

Increasingly, recognition of the toxicity of current cleaning, sanitizing, and disinfection products on both the environment and to adult humans is occurring, to say nothing of the amplified negative effects on children.

Examples of toxic chemicals in household and commercial cleaning, sanitizing, and disinfecting products are numerous. Many Lysol^® products, such as disinfecting wipes, sprays, and laundry sanitizers, contain QUATS. All-purpose cleaner and Kitchen Pro Antibacterial Cleaner also contain QUATS, as does Clorox^® Everest and Disinfecting Bathroom Cleaner.

Other Clorox compounds contain sodium hypochlorite (bleach). Purell^® Wipes and Hand Cleaner contain Ethanol (Ethyl alcohol), which is very drying to the skin and is unsafe for young children. Add to this the recent FDA warning against using hand sanitizers imported from Mexico that are or could be contaminated with methanol or 1-propanol.

This list is simply offered as a series of examples, inviting the reader to explore further. All a consumer has to do to “check out” a product is to use the internet to review the Safety Data Sheet for the product in question.

The results are extremely concerning as most – if not all – commonly used household and commercial cleaning/ sanitizing/disinfection products contain chemicals with potential significant, deleterious side effects that are often overlooked, unrecognized, or unappreciated by the user – since, often, the damage is not immediately noticeable because it builds slowly over time.

QUATS, hypochlorite (bleach), hydrogen peroxide in high percentage, and phenol compounds all have toxicity concerns:

• irritation or injury to eyes and skin (very common)
• a strong association with development of childhood asthma⁴
• a cause of adult onset asthma^4-8
• a cause of development of COPD (chronic obstructive pulmonary disease).^9,10 In fact, one investigator stated that “the effect of occupational cleaning (ed.: use of sprays and other cleaners) was comparable to smoking just less than 20 pack-years.” (ed: 1 pack year equals one pack of cigarettes a day).¹⁰
• a cause of thyroid cancer.¹¹
• a cause of “endocrine disruption” with a reduction in fertility in mice.¹²
• an increase in defects in neural tube (brain) developments in mice.¹³

All this paints a rather grim picture of the current state of sanitization and disinfection.

COMPARING TOXICITY: HOCL IS NON-TOXIC AND HAS NO ADVERSE EFFECT ON HUMANS

HOCL is non- toxic to people. In fact, HOCl already exists in the human body, being naturally produced by white blood cells of all mammals for the purpose of killing invading bacteria, viruses and other pathogens.

Clinical observations over decades have shown no negative effects from using HOCl for wound care or for treatment of ocular disease. HOCl has been substituted for drinking water with mice which incurred no deleterious effects. Multiple studies further substantiate the non-toxicity of HOCl to humans.

However, clinical observation is often anecdotal. True, scientific, peer-reviewed data is required when stating a product used in treating humans is non-toxic and not harmful.

Scientific studies at the cellular level are extremely important in evaluating toxicity to humans. Independent  cytotoxicity studies performed by e.g. an independent lab in four different studies have demonstrated no toxicity to lung cells (A549 cell line) when heavily exposed or fogged with HOCl. In addition, Ionogen LLC is currently undertaking detailed cellular metabolic toxicity studies performed by an independent, certified lab to scientifically determine if there is any acute or chronic human lung cell toxic effects from exposure to HOCL. Given the four previous studies on lung cell viability, no concerns are anticipated. Results are expected to be available by the end of 2020 and will be reported as an addendum to this paper.

Furthermore, Ionogen LLC is initiating the processes for a human clinical trial to further study the safety and effectiveness of HOCl in fogging and misting of patients with and without COVID-19.

HOCL TESTING RESULTS WITH THREE TARGET PATHOGENS: SUPERBUGS, BACTERIA, AND VIRUSES

Ionogen LLC has engaged an independent laboratory to study the effectiveness of using HOCl with a range of three main pathogen categories: superbugs, bacteria, and viruses.

Research Results from a Tough Challenge – A Representative Superbug

The Center for Disease Control (CDC) has identified Chloridoids difficile (C. diff) as one of its current top three superbugs. One of their press-release summaries indicates C. diff causes roughly half a million intestinal infections yearly, manifested by persistent diarrhea, with almost 30,000 patients in the United States dying within 30 days of diagnosis of C. diff and with 15,000 of those being directly attributable. It has been noted as the most common microbial cause of healthcare-associated infections in U.S. hospitals, resulting in upwards of

$4.8 billion every year in excess health care costs for acute care facilities alone.²⁴

C. diff is exceptionally hard to kill as it forms spores for protection when attacked by an antibiotic. The spores can enable it to survive in the absence of air for two years. This 2020 article title says it all:

Hospital disinfectants struggling to kill C. diff bacteria colonies: Clorox comes close, but none completely eliminates superbug.²⁵

In tests performed by an independent, certified laboratory, HOCl (Ionopure^™ Disinfecting Spray) achieves a remarkable log-6 (99.99996%) kill of Chloridoids Difficile spores in 1 minute. Again, C. diff is the most difficult of bacteria to kill as it forms resistant spores when “attacked.” No other disinfectant has achieved this level of C. diff kill in 1 minute in a safe, non-toxic, and effective way.

OTHER HOCL BACTERIOLOGY / VIRAL STUDIES USING AEROSOL HOCL

Testing results against other viruses and bacteria is equally important and demonstrates a broad spectrum of pathogen kill by fogged HOCl. The table below details results of the use of aerosolized HOCL at various concentrations on bacteria that cause many of the hospital-acquired bacterial illnesses.

Pathogen Kill Rates Following Exposure to Aerosolized HOCl (Dry-Fogging)

Bacteria	Results
Klebsiella pneumoniae (best known for respiratory infections)	>99.99% Reduction
Staphylococcus aureus (skin infections)	>99.99% Reduction
Pseudomonas aeruginosa (common UTI/kidney infections)	>99.99% Reduction

Norovirus is another virus of particular interest. It is highly infectious and is one of the most common causes of outbreaks of gastroenteritis with vomiting and diarrhea. It is particularly notorious for rampant gastrointestinal illness on cruise ships and in schools. Transmission can be by hand to mouth but also vomiting can result

in aerosolized norovirus that can “travel” across a room in the air. Once established, the virus is difficult to completely eliminate so attempts at cleaning facilities exposed to norovirus require very strong chemicals including bleach (1.5 – 7.5%) in water.

Since human norovirus cannot be grown in a laboratory environment, HOCl was previously tested against surrogate viruses for human norovirus (Bacteriophage and Murine Norovirus) and was found to readily kill those viruses on surfaces, thereby potentially slowing down and perhaps even preventing norovirus outbreaks of gastroenteritis. Further studies on the use of aerosolized HOCL against norovirus surrogates are in process.

Based on these results, HOCl demonstrates and establishes a baseline for new industry-wide disinfection standards. And, like the ability to safely destroy the most difficult-to-kill C. diff so effectively, HOCl can

kill essentially any bacteria, virus, fungus or mold on surfaces in a timely manner, generally in a matter of seconds while remaining completely safe for humans.

These studies, and those described below, combined with clinical experience, provide a solid scientific foundation for treatment of and

prevention strategies for human diseases with HOCL, including (norovirus) gastroenteritis and, possibly, pulmonary diseases like COVID-19.

HOCL DRY-FOGGING KILLS CORONAVIRUS BOTH IN THE AIR AND ON SURFACES

HOCL solutions administered via a free-standing, portable ultrasonic aerosolizer produces a light fog covering up to 5,000 square feet. The mist consists of aerosolized particles, 2-4 microns in size, which hang in the air, creating a very slight haze, while also effectively coating surfaces without wetting (“dry-fogging”).

The EPA has protocols for determining pathogen kill rates on surfaces but none for the efficacy of sanitizing/ disinfecting the air, because, until now, standard cleaning solutions were too toxic to continually aerosolize into our rooms while we were living in them, so why would anyone trying to measure the results of what we are proposing?

In an initial fogging experiment, an EPA-approved surrogate for the COVID virus (Human Coronavirus OC43) was continuously injected along with a fogged HOCl solution. After infusion was begun, viral concentration measurements were taken at 10, 20 and 30 minutes. This means fresh virus constantly replaced what was killed. Thus, the air in the room was never completely without live virus.

Second, HOCl quickly dispatches pathogens more difficult to kill than Coronavirus. So, in order to seriously test the effectiveness of the fogging process, an enormous viral concentration of about 33,000,000 times that of a sneeze from a SARS-CoV-2-infected person was injected into the air on a continuous basis.

Even with those two extreme challenges, before the first measurement at 10 minutes, the misting procedure was established and an average equilibrium point of almost 95.6% kill was maintained throughout the 30-minute trial, effectively counterbalancing an exponentially increasing virus load in the room. Further research into efficacy of viral kill is in process. Below is a graph of the balanced equilibrium with the blue line tracking the viral injection and the green line tracking the kill rate.

In the context of the pandemic health crisis, these results offer a promising advance in mitigation strategy, available while people are congregating together in a room.

In a second fogging experiment, the virus (again, Human Coronavirus OC43) was placed on a glass plates surface and the room was continuously fogged in a manner simulating a standard workday, resulting in a >99.999%* reduction of the virus.

Surface Viral Kill Rates Following Exposure to Aerosolized HOCl (Dry-Fogging)

Virus	Results
Human Coronavirus 0C43	99.999% Reduction*

*Value represents the method’s detection limit.

HIGHLIGHTING A MAJOR NEW TREATMENT IMPLICATION:

• Vaporized HOCl dry-fogging will attack and kill viruses both in the air and on surfaces.

• The CDC has acknowledged spread of the virus both through surface contact and from transmission through the air, so talking could result in droplets staying airborne for 5-10 minutes, thereby resulting in viral transmission.^14-21 Smaller, aerosol sized droplets have been shown to stay suspended for several hours and can carry viruses such as SARS-CoV-2. But vaporized HOCL, when used in dry fogging, effectively attacks and kills viruses both in the air (droplets or aerosolized) and on surfaces within seconds to minutes.

HOCL MISTING ALSO REDUCES BIOFILM – AND IMPROVES CLEANING AND DISINFECTION

Biofilm is defined as a thin, microscopic layer of microorganisms, both dead and alive, that bind together and accumulate on essentially any surface, forming a mat of organic and inorganic material. This mat is primarily composed of polysaccharides and provides a material matrix for bacteria to accumulate, grow and multiply. The bacteria are also partially “protected” by the matrix, thereby becoming more difficult to access, a factor which, in turn, provides opportunities for development of resistance to antibacterial treatments and disinfectants. These opportunities are likely enhanced if antibacterial treatments and disinfectants are applied incorrectly.

Biofilm accumulation can be indirectly determined by measuring Adenosine Triphosphate (ATP), the energy molecule found in living cells – thereby providing an indirect measure of organic material and bacterial presence. Sterile swabs are rubbed over a surface and then placed in an ATP-measuring device, yielding a digital readout of ATP quantity. A low readout value indicates a clean surface. A high readout value implies dirtiness, i.e., biological contamination. A reduction in ATP scores following cleaning and disinfection, in part, reflects a reduction in the surface biofilm.

To achieve maximal cleaning and disinfection of a surface, the biofilm must be removed. Classically, any reduction in biofilm for cleaning/disinfection purposes has required two steps – both a manual wiping step with a cleaning agent followed by an application of a true disinfectant for a specified period of time (up to

4-10 minutes). This process is more challenging in practice than it sounds in theory and, therefore, it is seldom successfully followed,² a cleaning implementation failure that takes us back to the concern about antibiotic microbial resistance.

Fortunately, new developments in cleaning and sanitation indicate that if one is using HOCl, the manual wiping step is no longer mandatory to achieve a significant reduction of biofilm.

In addition to the dry-fogging technology mentioned above, the utility of spraying its product by employing a portable, hand-held misting machine has been studied. Study results have demonstrated that an HOCL spraying treatment successfully equates to an additional full cleaning step, without wiping, that significantly reduces biofilm and facilitates deep cleaning. The effectiveness and efficiency of this streamlined protocol has been demonstrated through research projects undertaken both in school buildings and in Ambulatory Surgery Centers (ASCs), each very challenging and crucial environments to clean and disinfect.

In a study of two comparable schools, one serving as a control and the other as the test school. Compared was standard school cleaning methods (control school) versus standard school cleaning methods plus spraying of the school (test school) using an EPA certified disinfectant (93392-2) at the  end of the school day, three times weekly.

Both schools started with high ATP (hence, biological contamination) scores but, over the 5-month duration of the study, the HOCl sprayed school’s ATP scores dropped significantly and remained at

substantially lower levels during the duration of the study, demonstrating a statistically significant improvement in cleaning and disinfection. The only intervention difference involved power misting the entire school with HOCL three times weekly.

Likewise, in our study of Ambulatory Surgery Centers (ASCs), we used two comparable ASCs. The control ASC underwent standard cleaning with Cavicide wipes* between procedures and a terminal cleaning with both wipes and a Lysol disinfectant* spray at the end of the day. The test ASC underwent the same cleaning process but used HOCl solutions and wipes. Also, an additional step of power misting of the rooms with HOCl was done after the terminal cleaning at the end of the day. The misting required an additional 1-2 minutes per room.

*Both Cavicide wipes and Lysol Disinfecting Spray contain Quaternary ammonium compounds (QUATS), which are known toxic chemicals.

At the end of the regular terminal cleaning, the control ASC rooms were very clean, averaging an ATP score of

15.4. The HOCl-cleaned rooms were even cleaner, producing an average ATP score of 3.1. Adding the power misting of HOCl to these rooms as a last step yielded a further statistically significant drop in ATP values to 1.7. In the words of the non-medical bio-statistician reviewing these results, “The improvement (3.1 to 1.7) was comparable to an additional manual wiping step.”

Bottom line: cleaning and sanitizing/disinfecting with HOCl produced significantly improved results in reducing ATP scores in endoscopic ASCs.

PROPOSING A NEW CLEANING AND SANITIZING/DISINFECTING PARADIGM

• Power misting and dry-fogging with vaporized HOCl reduces biofilm without manual wiping and also effectively kills bacteria and viruses, molds and fungi, quickly and thoroughly on surfaces. This remarkable finding literally changes the way we think about cleaning, sanitizing, and disinfecting of those surfaces.

• Dry-fogging with vaporized HOCl attacks and kills viruses in the air as well as on surfaces creating a new modality for treating and preventing airborne viral infections such as the common cold, flu, SARS- CoV-2 and others.

• Dry-fogging and misting with vaporized HOCl provides these powerful effects safely so that sanitizing/disinfecting a space can occur with no ill effects while people (e.g., patients or families at home or children and teachers and administrators in schools) remain present.

HOCL ALSO PROVIDES A MEANS TO ADDRESS BOTH “SUPERBUGS” AND MUTATING VIRUSES

One approach to addressing the daunting challenges of “superbugs” and mutating viruses is to use a non-toxic, highly effective disinfectant at the source where the pathogens exist – namely the environment.³ In essence, the aim is to kill the pathogen before it has the opportunity to invade the human body – and to do it in a way that is both safe for humans and for that environment.

HOCl does just this: it is a non-toxic product which is a highly effective sanitizer/disinfectant that kills all pathogens without producing any adverse effects on humans.

A SPECULATIVE IDEA CALLING FOR FURTHER RESEARCH: THIS SECTION IS NOT INTENDED TO ADVOCATE A MEDICAL POSITION, RATHER, SIMPLY TO INTRODUCE A PROSPECTIVE RESEARCH AREA.

BASED ON WHAT IS KNOWN ABOUT PULMONARY MEDICINE, THE RESEARCH CITED IN THIS WHITE PAPER ALONG WITH SUBSTANTIAL ANECDOTAL OBSERVATIONS, SUGGEST THE POSSIBILITY OF IMPROVING TREATMENT OF SELECTED LUNG DISEASES BY USING AEROSOLIZED HOCL AS AN INHALATION THERAPY. FURTHER RESEARCH IS PLANNED TO EVALUATE THIS APPROACH. 26, 27, 28

Viruses are very small particles (20-400 microns). When they invade the human body, it is typically by way of the respiratory tract: nose and mouth, throat, trachea, bronchi and with some viral particles ending in the smallest lung structures, the acinar sacs lined with alveolar cells, where the transfer of oxygen and carbon dioxide occurs.

The viruses can attach anywhere along that tract, likely first in the nose, throat, and trachea. 26, 27 From there, spread can occur to the lower regions of the lung (bronchioles, alveolae) depending on multiple factors including particle size and shape, humidity, and depth of inspiration. Major and serious infections such as pneumonia occur when alveolar infection occurs in a widespread manner throughout the segments of the lungs. Our laboratory studies have showing that HOCL can be vaporized in aerosolized-sized particles equal to or less than 4 microns, which are small enough to reach the alveolae. Separately, as reported earlier in this paper, our studies have also shown that vaporized HOCL will kill coronavirus in the air (Figure 2, p. 12) and on surfaces (Table 3, p. 12).

Logically and plausibly, albeit speculatively, it follows that vaporized HOCL could be used adjunctively to treat or even prevent lung infections such as COVID-19 pneumonia. Clinical studies are being developed to test this hypothesis. Until that time, clinical observations have shown a dramatic improvement in patients with viral sore throats or those with flu-like symptoms through simply using

HOCl prepared for use as a nasal spray, gargling and/or dry-fogging in a small room.

HONESTY IN DISINFECTION – HOW MUCH IS LACKING?

As a current standard practice, the proper process of manual wiping of a surface with a cleaning agent followed by application of a disinfectant and, subsequently, allowing that disinfectant time to work (typically 4 -10 min) is recommended by companies selling cleaners and disinfectants. Although effective, in everyday practice that is a process seldom followed correctly by the user.²

This is a well-known problem but one that is not addressed adequately either by the companies or by the end users. As pointed out previously, a serious consequence of this failure to follow the proper usage protocol is that bacteria and viruses are exposed to the disinfectants in an attenuated fashion that often proves inadequate for killing the pathogens. The result: some of the pathogens survive with limited exposure to the disinfectant, and, in the process, develop resistance to the intended killing agents. And resistance to disinfectants most likely contributes to more bacteria developing antibiotic resistance, contributing ultimately to the problem of “superbugs.”

This is the not-so-secret secret, and it is neither honestly nor openly discussed.

Furthermore, as previously reviewed, most disinfectants that are used today, have toxic chemical ingredients in them that are harmful to the environment and to humans (even more so to children and the infirm). For example, after drying on a surface, “QUATS” (quaternary ammonium compounds) can remain active as a disinfectant on a hard surface for days, a point that is proudly touted in advertisements. Children and adults who touch that surface during that time have varying degrees of transfer of the chemical to their skin – with likely at least some absorption. Over time, levels of the chemical can build up in the body and have their effect on human health.

Add to the not-so-secret secret, the clear reality that the problem of disinfectant toxicity inflicted on the environment, animals and people is also not discussed with forthcoming honesty by the companies producing and distributing these.

Is this failure to discuss problematic unintended, health-threatening effects of their products directly acknowledged by the companies that make these disinfectants? Do they take even partial responsibility for the serious problems of microbial resistance to disinfectants that is becoming more prominent?

Or to the contribution to the problem of antibiotic microbial resistance? Or the enormous problem of hospital acquired infections? Or to the crisis the world will be facing in one-two decades with superbugs and who knows what else might be arising? And what about the huge issue of toxic disinfectant chemicals that remain on surfaces and expose children, adults and pets to those chemicals resulting in diseases we already know about?

Equally important is collectively determining how to address these questions now that we are realizing and acknowledging them. How do we deal with these issues? The answer requires a logical, science-based, stepwise progression toward achieving solutions. We must start with honesty and truth in recognizing the causes. Then we need to move to actions like those recommended by the World Health Organization and in the report from the United Kingdom.³

CONCLUSION

Our new world of pandemics and antibiotic microbial resistance, complicated by the toxicity of existing disinfectants to people and to the environment, requires new preventive measures and new medical therapies if we are to remain a vibrant, progressive society while successfully protecting our citizens from unnecessary diseases and toxic exposure.

One action to take in addressing this burgeoning crisis is to use a truly “ideal” sanitizer/disinfectant – one that is non-toxic while also being highly effective. We propose that sanitizer/disinfectant is HOCl. Pathogens simply cannot develop resistance to free chlorine. It is too operationally efficient as a pathogen killing agent.

HOCl solutions provide Free Available Chlorine in precise concentrations previously unobtainable, and which have demonstrated effective lethality to bacteria, viruses, molds, and fungi – while being entirely safe to humans and the environment.

IN SUMMARY: HOCl sanitizing and disinfectant products provide the revolutionary solution. They are non-toxic, safe and highly effective in eliminating viruses, bacteria, fungus and mold both on surfaces and in the air. Accordingly, they provide the foundation for solving challenges emerging from the deeply concerning evolution of viruses, bacteria, and other problematic microorganisms in our world while preserving our environment and our safety from toxic chemical sanitizers and disinfectants.

November 18, 2020

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• Review on Antimicrobial Resistance. Tackling Drug-Resistant Infections Globally: Final Report and Recommendations. Chair: Jim O’Neill. May, 2016.
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• Dumas O, Wiley AS, Quinot C, Varraso R, Zock J, Henneberger PK, Speizer FE, Le Moual N, Camargo CA Jr. Occupational exposure to disinfectants and asthma control in US nurses. European Respiratory Journal 2017 50: 1700237; DOI:10.1183/13993003.00237-2017.
• Gonzalez M, Jegu J, Kopferschmitt MC, Donnay C, Hedelin G, Matzinger F, Veltin M, Guilloux L, Cantineau A, de Blay F. Asthma among workers in healthcare settings: role of disinfection with quaternary ammonium. Clin and Experimental Allergy. 2014. 44: 393–406. DOI: 10.1111/ cea.12215.
• Dumas O, Varraso R, Boggs KM, Quinot C, Zock J, Henneberger PK, Speizer FE, Camargo CA, Moual NL. Occupational exposure to disinfectants and COPD incidence in US nurses: a prospective cohort study. European Respiratory Journal 2017 50: OA1774; DOI: 10.1183/1393003.congress-2017.OA1774.

1. Svanes Ø, Bertelsen RJ, Lygre SH, Carsin AE, Antó JM, Forsberg B, García-García JM, Gullón JA, Heinrich J, Holm M, Kogevinas M, Urrutia I, Leynaert B, Moratalla JM, Le Moual N, Lytras T, Norbäck D, Nowak D, Olivieri M, Pin I, Probst- Hensch N, Schlünssen V, Sigsgaard T, Skorge TD, Villani S, Jarvis D, Zock JP, Svanes C. Cleaning at Home and at Work in Relation to Lung Function Decline and Airway Obstruction. Am J Respir Crit Care Med. 2018 Feb 16. doi: 10.1164/rccm.201706- 1311OC

1. Zeng F, Lerro C, Lavoué J, et al. Occupational exposure to pesticides and other biocides and risk of thyroid cancer. Occupational and Environmental Medicine 2017;74:502-510.

1. Melin VE, Potineni H, Hunt P, Griswold J, Siems B, Werre SR, Hrubec TC. Exposure to common quaternary ammonium disinfectants decreases fertility in mice. Reproductive Toxicology; 2014; 50:163-170.
2. Hrubec TC, Melin VE, Shea CS, Ferguson EE, Garofola C, Repine CM, Chapman TW, Patel HR, Razvi RM, Sugrue JE, Potineni H, Magnin- Bissel G, Hunt PA. Ambient and Dosed Exposre to Quaternary Ammonium Disinfectants Causes Neural Tube Defects in Rodens. Birth Defects Res. 2017 Aug 15;109(14):1166-1178. doi: 10.1002/bdr2.104. Epub 2017 Jun 15.
3. Bourouiba L. Turbulent gas clouds and respiratory pathogen emissions: potential implications for reducing transmission of COVID-19. JAMA. 2020;323(18):1837-1838. doi:10.1001/jama.2020.4756

1. Stadnytskyi V, Bax CE, Bax A, and Anfinrud P. The airborne lifetime of small speech droplets and their potential importance in SARS-CoV-2 transmission. PNAS June 2, 2020 117 (22) 11875-11877; first published May 13, 2020 https://doi.org/10.1073/pnas.2006874117
2. Morawska L, Cao J. Airborne transmission of SARS-CoV-2: The world should face the reality. Environment International. Volume 139, June 2020, https://doi.org/10.1016/j.envint.2020.105730
3. Klompas M; Baker MA; Rhee C. Airborne Transmission of SARS-CoV-2. Theoretical Considerations and Available Evidence. JAMA. 2020;324(5):441-442. doi:10.1001/jama.2020.12458.

1. Schijven J, Vermeulen LC, Swarta A, Meijera A, Duizera E, de Roda Husmana AM. Exposure assessment for airborne transmission of SARS- CoV-2 via breathing, speaking, coughing and sneezing. https://www.medrxiv.org/content/10.1101/2020.07.02.20144832v1.full.pdf
2. Van Doremalen N, Bushmaker T, Morris DH, Holbrook MG, Ganble A, Williamson BN et al. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. N Engl J Med. 2020;382:1564-7.
3. Fears SC, Klimstra WB, Duprex P, Hartman A, Weaver SC, Plante KS, et al. Persistence of severe acute respiratory syndrome coronavirus 2 in aerosol suspensions. Emerg Infect Dis. 2020 Sep [date cited]. https://doi.org/10.3201/eid2609.201806
4. Nardell EA, Nathavitharana RR. Airborne spread of SARS-CoV-2 and a potential role for air disinfection. JAMA. 2020;324:141- 142.
5. Smith JL, Drennan AM, Rettie T, Campbell W. Experimental observation on the antiseptic action of hypochlorous acid and its application to wound treatment. Br Med J, 1915; 2(2847):129-136.
6. Properties of an ideal disinfectant. https://www.cdc.gov/infectioncontrol/guidelines/disinfection/tables/table2.html
7. CDC Press Release (2015), Retrieved 6 October 2020, from https://www.cdc.gov/media/releases/2015/p0225-clostridium-difficile.html
8. Hospital disinfectants struggling to kill C. diff bacteria colonies: Clorex comes close, but non completely eliminates superbug (2019). Retrieved 6 October 2020, from https://www.sciencedaily.com/releases/2019/11/191106130342.htm

• Penn State study finds mouthwashes, oral rinses may ‘inactivate’ coronavirus . (2020). Retrieved 10 November 2020, from https://www.pennlive. com/news/2020/10/penn-state-study-finds-mouthwashes-oral-rinses-may-inactivate-coronavirus.html
• Wölfel, R., Corman, V. M., Guggemos, W., Seilmaier, M., Zange, S., Müller, M. A., Niemeyer, D., Jones, T. C., Vollmar, P., Rothe, C., Hoelscher, M., Bleicker, T., Brünink, S., Schneider, J., Ehmann, R., Zwirglmaier, K., Drosten, C. and Wendtner, C.Wölfel, R., Corman, V., Guggemos, W., Seilmaier, M., Zange, S., & Müller, M. et al. (2020). Virological assessment of hospitalized patients with COVID-2019. Nature, 581(7809), 465-469. doi: 10.1038/s41586-020-2196-x https://www.nature.com/articles/s41586-020-2196-x
• Hou, Y. J., Okuda, K., Edwards, C. E., Martinez, D. R., Asakura, T., Dinnon, K. H., Kato, T., Lee, R. E., Yount, B. L.,

Mascenik, T. M., Chen, G., Olivier, K. N., Ghio, A., Tse, L. V., Leist, S. R., Gralinski, L. E., Schäfer, A., Dang, H., Gilmore, R., Nakano, S., Sun, L., Fulcher, M. L., Livraghi-Butrico, A., Nicely, N. I., Cameron, M., Cameron, C., Kelvin, D. J., de Silva, A., Margolis, D. M., Markmann, A., Bartelt, L., Zumwalt, R., Martinez, F. J., Salvatore, S. P., Borczuk, A., Tata, P. R., Sontake, V., Kimple, A., Jaspers, I., O’Neal, W. K., Randell, S. H., Boucher,

R. C. and Baric,R. S.Hou, Y., Okuda, K., Edwards, C., Martinez, D., Asakura, T., & Dinnon, K. et al. (2020). SARS-CoV-2 Reverse Genetics Reveals a Variable Infection Gradient in the Respiratory Tract. Cell, 182(2), 429-446.e14. doi: 10.1016/ j.cell.2020.05.042 https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC7250779/

SUPPLEMENTAL READING

Block, M., & Rowan, B. (2020). Hypochlorous Acid: A Review. Journal Of Oral And Maxillofacial Surgery, 78(9), 1461-1466. https://doi. org/10.1016/j.joms.2020.06.029

Buonanno, G., Morawska, L., & Stabile, L. (2020). Quantitative assessment of the risk of airborne transmission of SARS- CoV- 2 infection: Prospective and retrospective applications. Environment International, 145, 106112. https://www.medrxiv.org/ content/10.1101/2020.06.01.20118984v1

Disinfectants Can Make Bacteria Resistant To Treatment. ScienceDaily. (2020). Retrieved 8 October 2020, from https://www.sciencedaily.com/ releases/2008/10/081005203059.htm

Green Cleaning, Sanitizing, and Disinfecting: A Curriculum for Early Care and Education. (2020).. Epa.gov. (2020). Retrieved 8 October 2020, from https://www.epa.gov/sites/production/files/documents/ece_curriculumfinal.pdf

List N: Disinfectants for Coronavirus (COVID-19) | US EPA. US EPA. (2020). Retrieved 8 October 2020, from https://www.epa.gov/pesticide- registration/list-n-disinfectants-coronavirus-covid-19

We are no Longer in the Cleaning Business.

To understand what we are talking about, let’s step back for a second and review what has happened since March 20202, starting with the following clichés:
· “Nothing will be the same”
· “Everything has changed”
· “We are in a ‘new normal'”
· “We should expect more ‘new normals’ in the future”

While these are all clichés, they have all come true. Everything has changed, and that includes the professional cleaning industry.
We notice it when we meet with prospects to discuss their cleaning needs. A year ago, whether a bank on the corner or a major corporation, invariably, the facility manager told us they were looking for a new cleaning contractor to do all the “usual” things:

· Collect the trash.
· Clean and sanitize restrooms.
· Make sure the lunch and break rooms are clean.
· Dust mop/damp mop hard surface floors; vacuum all carpeted areas.

Today, the first thing that comes up when meeting with a prospect is infection control. In fact, disinfecting and disinfectants will be the only thing they want to discuss.

A year ago, infection control discussions were not even on the radar. I am sure many cleaning contractors around the country and the world are experiencing the same thing.

We are fortunate at Aquaox LLC because we have had infection control strategies in place for several years. More than a decade ago, the ISSA, the worldwide cleaning association, wanted to change people’s impression of professional cleaning. Their goal was to impress upon building owners and facility managers that cleaning was not a commodity – meaning anyone could perform cleaning tasks, so accept the lowest bidder – but that cleaning was an investment in human health and building assets.

To accomplish this, they produced a very respected white paper, The Value of Clean. In it, they outlined several important benefits effective, professional cleaning can bring to a facility.

Professional cleaning:
· Protects the health of building users using state-of-the-art infection control tools, equipment, and strategies
· In schools, it improves student performance
· Reduces absenteeism
· Improves worker productivity
· Helps eliminate “presenteeism,” which is when someone is compelled to go to work even though they do not feel well
· Protects and extends the life of building assets such as carpet and hard surface floors,
· Helps facilities make a great first impression for building users and visitors
· Results in greater customer satisfaction and fosters customer loyalty
· Saves money.

This white paper had a significant impact on our company. It made clear what we have believed for decades that effective, professional cleaning does have great value. Further, that value is even greater today than a decade ago when the white paper was published, all because of the pandemic.

In a nutshell, it proved beyond any reasonable doubt that proper cleaning, performed using EPA-registered disinfectants, smart-applicators such as electrostatic spraying equipment, along with effective infection control procedures, is an investment with a huge return on the investment for your company.

This being the case, we encourage you to ask your current cleaning service provider to answer these questions:

· How specifically are they cleaning and disinfecting your facility?
· What products are being used?

Then, follow up on their responses by taking these steps yourself:

1. Google these products and evaluate for yourself how effective, how safe an how environmental these products are.
2. Check the supply room to ensure the products the contractor says they are using are being used.
3. Look at their equipment to see if they are using the most advanced disinfecting technologies such as electrostatic sprayers?
4. And finally, take the time to observe your cleaning contractor’s crew in action as they go about their duties.
   Professional cleaning is a skill that must be learned. Even if they are using all the recommended products, if they do not know how to use them, your building users’ health could be at risk.

Frequently asked Questions

Q. What are AQUAOX^™ solutions?

A. AQUAOX^™ solutions are produced by combining two simple ingredients, purified water and Sodium Chloride (NaCl) that are processed by two Electrochemical Activation generators to produce three types of solutions.

AQUAOX^™ Cleaning Solutions (AX-112, AX-122):

Reducing Water (cleaner) is a non-toxic, non-hazardous, chlorine-free cleaning solution that does not produce fumes or contain hazardous “butyl” solvents or other potentially dangerous substances such as phosphates or ammonia. It removes grease, dirt and oil deposits from virtually all surfaces, cleans without scrubbing and does not leave a residue, such as that with chemicals.

AQUAOX^™ Disinfecting Solutions (AX-275, AX-525):

Oxidizing Water (disinfectant/sanitizer) is produced at a near neutral pH where the predominant antimicrobial agent is Hypochlorous Acid (HOCl), an efficient and efficacious species of chlorine that kills bacteria, fungi, molds, viruses, and spores. It is particularly effective because it can achieve a degree of disinfection that cannot be achieved with traditional chemicals while being biodegradable, non-toxic, non-corrosive and absent of residue.

AQUAOX^™ Water Treatment solutions (AX-5000)

Mixed Oxidant Water contains a mixture of chlorine-oxygen compounds which kill harmful pathogens in water at a very fast rate. Users dilute the HOCL/NaOCL solution with water to get the desired ppm for a specific task or dose it into a water distribution system for disinfecting and removal of biofilm.

Q. How does HOCl kill? … compare with bleach?

A. Nature gives a negative charge to the cell wall of a pathogenic microorganism. The negative charge of the pathogenic microorganism’s cell wall repulses the negative charge of the hypochlorite ions (OCL-) in bleach making it a weak disinfectant.

The AQUAOX^™ neutral Hypochlorous acid (HOCl) molecule easily penetrates the cell wall, making it a very effective disinfectant. HOCl effectively penetrates slime layers, cell walls and protective layers of microorganisms.  Microorganisms quickly die or are made non-functional by reproductive failure.  HOCl is 80-100 times more effective and exceeds the disinfecting properties of bleach by up to 300 times.

Q. Is HOCl safe for humans, animals and environment?

A. Yes,  HOCl is non-toxic, non-corrosive, biodegradable, environmentally friendly and absent of residue.

Q. Is HOCL effective against Covid-19?

A. Yes, CDC recommends the use of >200ppm free available chlorine.

Q. What (other) viruses are killed by exposure to HOCL?

A. There are multiple independent laboratory data that confirm efficacy against enveloped and non-enveloped viruses E.g. Aquaox tested its HOCL solutions at a 225ppm strength and these tests confirm 99.9999% efficacy in 30 seconds against e.g.: Coronavirus, Adenovirus, Hepatitus virus, bovine viral virus, polio virus, herpes virus and HIV.

Q. What is kill-time of HOCL against viruses?

A. Most viruses are fully destroyed within 5 to 60 seconds contact time under clean conditions.

Q. Is HOCL is effective against bacteria?

A. Yes, there are multiple independent laboratory data that confirm efficacy against all kinds of bacteria. (a really long list)

Q.What bacteria are killed by exposure to HOCL?

A. Independent test data confirm that HOCL is effective against gram-negative, gram-positive as well aerobic and anaerobic bacteria.

Q. What is kill-time of HOCL against bacteria?

A. Most bacteria are fully destroyed within 5 to 60 seconds contact time under clean conditions.

Q. Is HOCL effective against fungi?

A. Yes, there are multiple independent laboratory data that confirm efficacy against . (another long list)

Q. What fungi is killed by HOCL exposure?

A. Most fungi are fully destroyed within 5 to 60 seconds contact time under clean conditions.

Q. Is HOCL is effective against spores?

A. Yes, independent test data confirm that HOCL is effective against e.g. C.Diff and Candida Aurus within 5 to 10 minutes contact time.

 Q. Are HOCL solutions FDA approved?

A. FDA approved several HOCL solutions for topical (skin) usage, for direct food contact as well for sanitizing food contact surfaces. FDA requires HOCL producers to submit a formulation for either a 510k device approval or submit formulation with FDA for obtaining a Food Contact Notice (FCN)

Q. Are Aquaox solutions FDA approved?

No, simply as Aquaox has not applied for FCN. Aquaox has submitted and obtained a 510k device application, but this approval is exclusively licensed to Innovacyn Inc., that markets AX-250 formulation under one or more of its brand names.

Q. Is use of HOCL allowed by USDA?

A. HOCL is permitted for usage in food preparation, direct food contact as well for sanitizing food contact surfaces. USDA provides guidelines for ppm-level not to exceed.

Q. Is use of Aquaox solutions allowed by USDA?

A. USDA permits usage of HOCL, but puts limits on concentration

Q. Is usage of HOCL recommended by CDC?

A.  CDC recommends the use of sodium hypochlorites with >200ppm for disinfecting hard (non-porous) services as well aerosols.

Q. Is HOCL approved by EPA?

A. EPA does not approve nor endorse any disinfectant or active ingredient. EPA certifies efficacy of pesticides (disinfectants, sanitizers) for use on hard (non-porous) surfaces.

Q. Are AQUAOX^™ solutions EPA certified?

A. AQUAOX^™ has (2) anti-microbial solutions that are registered with the EPA as hospital grade, broad spectrum hard surface disinfectants. AX Disinfectant 275 (AX-275) and AX Disinfectant 525 (AX-525)

Q. What does it mean that AX-275 and AX-525 are both EPA certified Hospital-Grade Broad-Spectrum disinfectants?

A. This means that efficacy of Aquaox disinfectants against target organisms have been verified by EPA.

Q. What is the active ingredient(s) in AX-275 or AX-525?

A. The only active ingredient in AX-275 and AX-525 is Hypochlorous Acid (HOCL) generated by electrolysis of a dilute sodium chloride solution.

Q. What is the difference between AX-275 and AX-525?

A. AX-275 contains 248 to 302ppm HOCL and AX-525 contains 477-577ppm HOCL, measured as Free Available Chlorine (FAC).

Q. What is the pH of AX-275 or AX-525?

A. The pH of both AX-275 and Ax-525 is near neutral; between. 6.3 to 7.3

Q. How many parts per million Free Available Chlorine is in AX-275 or AX-525?

A. AX-275 contains 275 ± 10% ppm HOCL. AX-525 contains 525 ± 10% ppm HOCL.

Q. When do I us AX-275 and when do I use AX-525?

A. We recommend usage of AX-525 in the presence of blood or bodily liquids. We recommend AX-525 on surfaces that have not been pre-cleaned and thus contain a high level on contaminants (organic matter).

Q. How is AX-275 or AX-525 supplied?

A. Both AX-275 or AX-525 solutions can be supplied in: 2,3.5,4,8,16,24 or 32oz bottles. Both AX-275 or AX-525 solutions can be supplied in 1, 5, 15,30,55,275 or 330 gallon containers.

Q. What is the shelf-life of AX-275 or AX-525?

A. The shelflife is not absolute. The shelflife of AX-275 and AX-525 is determined by the lower concentration level as set by the EPA. Thus, as long as AX-275 contains >248ppm FAC, AX-275 is effective as a Hospital Grade Broad Spectrum disinfectant. As long as the AX-525 contain >477ppm FAC, AX-525 is effective as a Hospital Grade Broad Spectrum disinfectant. AX-275 and AX-525 shelflife is minimal 30 days from production.

Q. What do I use to measure PPM of AX-275 or AX-525?

A. Use 0-300ppm chlorine test strips for AX-275. Use 0-1000ppm chlorine test strips for AX-525.

Q. Where do I purchase these Chlorine strips?

A. Purchase with chlorine test strip manufacturer or purchase from Aquaox website

Q. How do I apply AX-275 or AX-525 on surfaces?

A. Wipe, spray or dip Aquaox Disinfectant on a surface with a cloth, wipe, mop, sponge, sprayer or spray applicator. Allow surfaces to air-dry.

Q. Do I need to dilute AX-275 or AX-525?

A. AX-275 and AX-525 are Ready-To-Use disinfectants. No dilution.

Q. Can I fill and use re-fillable spray bottles with AX-275 or AX-525?

A. It is permitted to spray-bottles, sprayers or spray applicators.

Q. For how long are these spray bottles filled with AX-275 or AX-525 effective? What is the shelf-life?

A. Remove AX-275 or AX-525 at or over 1-week-old from the bottle or storage tank. 1 week.

Q. How do I best store AX-275 or AX-525?

A. Store in a closed plastic container in a cool area away from direct sunlight.

Q. Can I spray and let air-dry AX-275 and AX-525?

A. Spray cleaned surfaces and let air-dry. No wiping needed.

Q. Do I need an electrostatic sprayer to disinfect surfaces?

A. No, not at all. An electrostatic sprayer is more efficiently in covering surfaces, but has no effect on efficacy.

Q. How long do I spray surfaces? How frequent?

A. Spray at 1.4-4ft distance from target area. Spray daily or weekly as needed.

Q. How many square feet surface does 1-gallon AX-275 or AX-525 disinfect?

A. Please, refer to instructions of (electrostatic) sprayer, as output of sprayers may vary between 3-9oz/minute.

Q. How long does the surface need to be wet?

A. Sprayed surfaces must remain wet for 10 minutes.

Q. What PPE is required when spraying AX-275 or AX-525?

A. Only precautionary statement is to avoid contact with eyes, so wear safety glasses. Wash hands with soap and water after handling and before eating.

Q. How long one has to wait before it is safe to enter the (sprayed) area?

A. Area can be entered immediately.

Q. Can I spray AX-275 or AX-525 of fabrics, such as upholstery and curtains?

A. Yes, HOCL will not harm surfaces. When applying to a large non-porous surface, allow an overlap of 50% when spraying from top to bottom using a 3ft side-by-side motion.

Q. Can I spray AX-275 or AX-525 on toys, instruments, tools and equipment?

A. Yes, HOCL will not harm surfaces. Will not harm titanium coated, medical grade stainless steel. AX-275 and Ax-525 can be used to decontaminate critical devices prior to sterilization.

Q. Can I spray AX-275 or AX-525 on all materials or surfaces? Are there materials to be avoided?

A. HOCL can be used on all materials. Avoid Brass, Copper, Silver and Gold.

Q. Is AX-275 or AX-525 corrosive?

A. No, unless it reacts with quaternary ammonium, so do not use quaternary ammonium cleaners to pre-clean surfaces.

Q. Can I use AX-275 or AX-525 in a fogger or humidifier?

A Yes, refer to instructions of fogger or humidifier

Q. Is AX-275 or AX-525 toxic or cytotoxic?

A. No, Independent laboratory data confirms biocompatibility of HOCL

Q. Does AX-275 or AX-525 cause allergic and/or asthmatic reactions?

A. No, independent laboratory data confirm biocompatibility of HOCL

Q. The label says AX-275 or AX-525 is a cleaner and disinfectant in one. Does this mean that surfaces do not need to be pre-cleaned?

A. No, this means that efficacy is warranted under dirty circumstances, so that the solution can overcome the bioload (contaminants) on the surfaces when surface remain wet for 10 minutes.

Q. Can I use any cleaner to preclean surfaces?

A. No, do not use quaternary ammonium cleaners and hydrogen peroxide.

Q. Can I use (Clorox, Lysol, Cavi) wipes to pre-clean surfaces?

A. Yes, as these wipes are all bleach wipes, which active ingredient is free available chlorine.

Q. What cleaner is recommended to wipe surfaces clean prior to applying AX-275 or AX-525 disinfectant?

A. AX-112 is recommended to pre-clean all surfaces. A 1:10-1:20 dilution of AX-122 is also recommended.

Q. What is difference between AX-112 and AX-122 cleaner?

A. AX-112 contains ~170ppm Sodium Hydroxide (NaOH). AX-122 contains ~3400ppm Sodium Hydroxide (NaOH). AX-122 is 20 time more concentrated that Ax-112.

Q. What is shelf life of AX-112 or AX-122?

A. At least 2 years from production date.

Q. Can I use AX-112 or AX-122 on any surface?

A. AX-112 can be used on any surface. AX-122 MUST be diluted 1:10-1:20 to be used on any surface

Q. What is the active ingredient(s) of AX-112 and AX-122?

A. Sodium Hydroxide (NaOH) generated from electrolyses of a sodium chloride solution.

Q. What is the pH of AX-112 or AX-122?

A. PH of Ax-112 is 11-12. PH of AX-122 is 12-13

Q. How do I apply AX-112 or AX-122 on surfaces?

A. Wipe, spray, immerse on surfaces with cloth, mop, wipe, sponge or sprayer.

Q. Do I need to dilute AX-112 or AX-122?

A. AX-112 is a ready-to-use multipurpose cleaner; no dilution needed. AX-122 MUST be diluted 1:10-1:20

Q. Can I fill and use re-fillable spray bottles with AX-112 or AX-122?

A. Yes, permitted.

Q. For how long are these spray bottles filled with AX-112 or AX-122 effective? What is the shelf-life?

A. For at least a year.

Q. How do I best store AX-122 or AX-122?

A. Store in a closed plastic container in a cool area away from direct sunlight.

Q. Can I spray and let air-dry AX-112 and AX-122?

A. Yes, but this make no sense as both cleaners emulsify dirt and debris that then need to wiped off the surface using a greenspeed microfiber cloth or mop.

Q. What PPE is required when using applying AX-112 or AX-122?

A. Only precautionary statement is to avoid contact with eyes, so wear safety glasses. Wash hands with soap and water after handling and before eating.

Q. Do I need to apply AX-112 or AX-122 on microfiber cloth or can I use paper, cotton towels or wipes?

A. You can use paper, cotton towels or wipes. However, the absorbency and adherence of a microfiber cloth is superior. Thus removing dirt and debris far more effectively that paper or cotton towels or even wipes that ‘smear’ the surface.

Biocompatibility

Hypochlorous acid is a weak, highly unstable acid which can only exist in a solution.[1]  Aquaox LLC produces hypochlorous acid by electrolysis of a dilute salt solution passing through an electrolytic cell.   At an acidic to neutral pH, the predominant chemical species is hypochlorous acid (HOCl). [2]  Hypochlorous acid has demonstrated antimicrobial activity against numerous bacterial, viral and fungal pathogens, including antibiotic-resistant strains.[3]

Hypochlorous acid has a history of safe use as a disinfectant in numerous applications including household, hospital, food preparation, industrial and pharmaceutical applications.  Hypochlorous acid is approved by the FDA for direct patient tissue contact as a wound care agent. It has also been used in root canal therapy.[4]

Aquaox LLC manufactures a number of electrochemically generated hypochlorous acid products at concentrations up to 0.0525% (525 ppm free available chlorine) for multiple uses. Some of our clients, we supply bottled solutions as one-step cleaners and disinfectants for general cleaning and disinfecting hard, non-porous surfaces.[5]  These products can be applied using a mop/bucket, a trigger spray bottle or a pressurized spray system. Some of our clients choose to have Aquaox LLC install a device within their facility to produce on-site solution for the same. Some of our clients, obtained FDA approval for bottling Hypochlorous acid solutions used for topical applications. Some of our clients use bottled or on-site generated Hypochlorous acid for water treatment or in food preparation.

This review was conducted to evaluate the risk of daily applying Hypochlorous acid on skin, for e.g. disinfecting people by spraying them when entering buildings.

Aquaox LLC has evaluated AQUAOX Disinfectant 275/525, its most concentrated hypochlorous acid product, in a series of preclinical toxicology studies which were conducted in compliance with the ISO 10993 Standards.  Testing included the evaluation of cytotoxicity, acute oral toxicity, repeat dose (28 day) dermal toxicity, dermal sensitization, acute inhalation toxicity as well as skin and eye irritation.

The results of these studies confirmed that AQUAOX Disinfectant 275/525, and by extrapolation all AQUAOX Disinfectant products marketed at hypochlorous acid concentrations less than 0.0525% are not cytotoxic, nor do they demonstrate signs of acute systemic toxicity or irritation following oral or inhalation exposure. AQUAOX Disinfectant 275/525 is not a dermal sensitizer nor is it a skin or eye irritant.  It failed to exhibit any signs of local or systemic toxicity following 28 days of repeated dermal administration to intact and abraded skin.[6]

The preclinical testing described above has demonstrated that AQUAOX Disinfectant 275/525, and by extrapolation all AQUAOX Disinfectant products marketed at hypochlorous concentrations less than 525 ppm are not irritants following inhalation, dermal or ocular exposure.  Based on these findings AQUAOX Disinfectant products are not considered to represent a risk to the health of applicators, patients or other potentially exposed individuals by daily skin contact.

[1] National Center for Biotechnology Information―NCBI (2015) Hypochlorous Acid, PubChem 867 Compound Database; CID=24341, https://pubchem.ncbi.nlm.nih.gov/compound/24341 868 (accessed Aug. 9, 2015).

[2] Sansebastiano, G. et al. Page 262 in Food Safety: A Practical and Case Study Approach (Ed: R. J. Marshall) 2006, Springer Science & Business Media, Berlin.

[3] Wang TX, Kelly MD, Cooper JN, Beckwith RC, Margerum DW. Equilibrium, kinetic, and UV-spectral characteristics of aqueous bromine chloride, bromine, and chlorine species. Inorg Chem. 1994; 33:5872– 5878.

[4] European Union Risk Assessment Report, Sodium Hypochlorite, CAS No: 7681-52-9, EINECS No: 231-668-3, Final Report, November 2007.

[5] http://www.aquaox.com/sustainable-cleaning-disinfecting-sanitizing-products/

[6] AQUAOX LLC., Technical Summary – Aquaox On-Site Generated Disinfectants. http://www.aquaox.com/wp-content/uploads /2017/04/ Technical-Summary_On-site_Disinfectants_vf.pdf

Aerosol Disinfection Capacity of Slightly Acidic Hypochlorous Acid Water Towards Newcastle Disease Virus in the Air: An In Vivo Experiment

Abstract

Existence of bioaerosol contaminants in farms and outbreaks of some infectious organisms with the ability of transmission by air increase the need for enhancement of biosecurity, especially for the application of aerosol disinfectants. Here we selected slightly acidic hypochlorous acid water (SAHW) as a candidate and evaluated its virucidal efficacy toward a virus in the air. Three-day-old conventional chicks were challenged with 25 doses of Newcastle disease live vaccine (B1 strain) by spray with nebulizer (particle size ❤ μm in diameter), while at the same time reverse osmosis water as the control and SAHW containing 50 or 100 parts per million (ppm) free available chlorine in pH 6 were sprayed on the treated chicks with other nebulizers. Exposed chicks were kept in separated cages in an isolator and observed for clinical signs. Oropharyngeal swab samples were collected from 2 to 5 days postexposure from each chick, and then the samples were titrated with primary chicken kidney cells to detect the virus. Cytopathic effects were observed, and a hemagglutination test was performed to confirm the result at 5 days postinoculation. Clinical signs (sneezing) were recorded, and the virus was isolated from the control and 50 ppm treatment groups, while no clinical signs were observed in and no virus was isolated from the 100 ppm treatment group. The virulent Newcastle disease virus (NDV) strain Sato, too, was immediately inactivated by SAHW containing 50 ppm chlorine in the aqueous phase. These data suggest that SAHW containing 100 ppm chlorine can be used for aerosol disinfection of NDV in farms.

Keywords: Newcastle disease virus; aerosol disinfectant; biosecurity; spray; virus inactivation.

Hakimullah Hakim  ^{1   2} , Chanathip Thammakarn  ^{1   2} , Atsushi Suguro  ¹ , Yuki Ishida  ¹ , Katsuhiro Nakajima  ¹ , Minori Kitazawa  ¹ , Kazuaki Takehara  ^{1   2}

Affiliations

• PMID: 26629621
• DOI: 10.1637/11107-042115-Reg.1

New Approaches to Infection Control

By Robert Elsenpeter

Bob Dylan was 100 percent right – The Times They Are a-Chaingin’, and dentists must be able to change with those times.

The COVID-19 pandemic forced dental practices to re-think the ways in which they approach infection control. While traditional methods were, certainly, effective means of controlling infection transmission, when the doors do finally reopen on a regular basis, practices are likely going to want new, more effective, ways to keep themselves, and patients, safe. If anything positive can be taken from the pandemic, it’s that new approaches to infection control are receiving closer attention.

Surfaces

Aquaox offers a unique product for surface disinfection. Their solutions utilize electrolysis-treated salt brine to create two types of solutions. The main component of the first is hypochlorous acid.

“That’s a chemical in our bodies that we generate to ward off any types of infections when we get cut,” Mark Nagano, Aquaox Vice President Operations says. “It’s generated by white blood cells, and they use hypochlorous acid to fight any pathogen trying to invade into our body. Hypochlorous acid is the main ingredient in bleach that does all the killing, but ours is up to 300 times stronger than bleach.”

Their other solution is a high-alkaline water that emulsifies grease and oil very quickly.

“It does have antimicrobial properties, but both solutions are considered all-natural,” Nagano says. “Our solutions are non-toxic, non-corrosive. As you can imagine, because we only use salt and water to make these solutions, we are actually considered organic.”

Aquaox’s solutions are registered with the EPA as a hospital-grade, broad spectrum disinfectant. They recently were approved in Canada to treat COVID-19. They are waiting for a similar US approval.

“We’re just waiting for the paperwork to go through,” Nagano says, “but we know we’re going to get it.”

Rather than just spraying the solutions on specific surfaces, Aquaox utilizes electrostatic spraying to treat an entire room. Nagano compares electrostatic spring to rubbing a balloon on someone’s hair and then hair standing up.

“Electrostatic spraying puts a charge on to the product coming out,” Nagano says. “That charge is 70 times greater than gravity. When it comes out, that droplet won’t just fall to the ground. That droplet has a positive charge on it and everything, inherently, has a negative charge, so it adheres to everything – the ceiling, the wall, the table top, under the table, the legs. We are getting total room coverage with our disinfectant.”

It is also non-corrosive.

“You can spray the whole room and walk away,” Nagano says. “With regular disinfectants, like bleach, you can’t do that. If you did that for a week, everything in that room would start being corroded, not to mention you can’t breathe it. Using our products, dentists can extend the life of their equipment and their furniture.”

Air

In addition to new technologies, now’s a good time to revisit the efficacy of some existing practices, like air treatment.

“Doctors always use high volume evacuation, because they have an assistant to manage that for them,” infection prevention speaker, author, and consultant Mary Govoni says. “The hygienists, on the other hand, especially when they’re using an ultrasonic scaler, don’t necessarily have someone or some way to manage that, so they use low-volume suction or the saliva ejector. There are lots of devices now that are available that don’t require the hygienist to hold onto them while they’re using their ultrasonic scaler. They can be placed in the mouth and secured. There are a number of them on the market, and as long as they work with the high-volume suction, then that alleviates again about 90 percent of that aerosol. And then, of course, there’s the old tried-and-true dental dam. But they are not very popular, because it’s a little time consuming to apply it. It doesn’t work with every procedure, but nonetheless, it’s a great way to control air assault.”

Best practices

Given the tumultuous times, doctors may be hesitant to invest in any new technologies – at least not yet.

“The difficulty that I see right now for dentists is that we don’t have any firm guidance either from the CDC or from OSHA that says what is going to be required, going forward,” Govoni says. “What we have in place is interim guidance. That is geared toward treating emergency patients only. The American Dental Association has really been pushing CDC to update their interim guidance. I’m guessing they’ve done the same thing with, with OSHA, but that’s the struggle.”

Another concern is to what extent, and for how long, stepped-up efforts will be necessary.

“We may not have to do extra things forever,” Govoni observes. “Once the pandemic has died down, maybe we will see that we won’t see that there’s such a great threat. Maybe we don’t have to wear N95 masks all the time, or maybe we don’t have to worry the aerosols, but I think there are better ways. I think mitigating the aerosol production in the first place so that we don’t have the contaminants in the air.”

Are we just worried about COVID-19 or is there another bogeyman hiding under the bed for whom we have to prepare?

“We know that, in laboratory settings, aerosols can stay in the environment for up to three hours,” Govoni says. “So, it’s not just about COVID, it’s about colds, flu possible tuberculosis infections. And what about when we’re removing amalgam restorations and the potential for mercury to be separated out from that amalgam and potentially aerosolized? So, I think what COVID has done is really shined a very bright light on the issue of aerosols in dentistry, in general. As we keep hearing from some of the public health officials, there will be another Coronavirus out there or a pandemic influenza out there. If we start looking at what we can use long-term, in terms of containing or mitigating the aerosols, then we’re going to make a healthier environment in this era and planning for the future. It’s not just about COVID, it’s about what comes next, which is a scary thought.”

Dentists would be wise to heed Bob Dylan’s advice and to be able to change with these times, maybe even embracing new technologies.

HOCL is synonymous with infection control

BETTER THAN BLEACH 

Compared to hypochlorite ions (OCL-), hypochlorous acid (HOCL) kills microorganisms faster and is 50-100 times more effective.

HOCL is the effective disinfection agent

Rather than think of the 5.25% chemical concentration of bleach, think of it as 94.75% water.  When diluted, bleach becomes 99.998% water with only 0.002% (20 ppm) chemical concentration.

AX-525 with 0.0525% HOCL has 525 ppm HOCL

AX-275 with 0.0275% HOCL has 275 ppm HOCL

BLEACH with <0.0002% HOCL has <20 ppm HOCL

The disinfecting level of hypochlorous acid (HOCL) in Aquaox^TM AX-275 “electrolyzed water” -Øis capable of killing bacteria (cidal activity) 50 to 100 times that of household bleach –Øaddresses the growing resistance to chemical terminal cleaning agents -Øis an efficient disinfecting adjunct to standard terminal cleaning … and -Øoptimizes infection prevention in hospital environments.

As a disinfectant, hypochlorous acid (HOCL), is much stronger and more reactive than hypochlorite ions (OCL-) because hypochlorous acid (HOCL) splits into hydrochloric acid (HCl) and an oxygen atom – also a powerful disinfectant.

The electrically neutral hypochlorous acid (HOCL) ion easily penetrates pathogenic microorganism cell walls, slime layers and other microorganism protective layers to make the cells die or suffer from reproductive failures.

Conversely, the pathogenic microorganism cell wall is negatively charged by nature … and thus repulses negatively–charged hypochlorite ions (OCL-).

Hypochlorous Acid

Guarantees Optimal Disinfection

At 6.5 pH, AQUAOX™ produces hypochlorous acid (HOCL) that is 90% Free Available Chlorine (FAC) and only 10% hypochlorite ion (OCL-), which does not gas off in the form of chlorine (CL2).

Hypochlorous acid (HOCL) combines with the oxidizing power of oxygen to optimize the disinfection properties of chlorine (CL2) in water (H2O).

Compressed air is used to electrostatically spray/ disperse micro-droplets of HOCL (and Oxygen) at precisely the optimum pH level for disinfection (6.0-6.5).

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When comparing the disinfecting power of bleach to Aquaox AX-275 (275 ppm HOCL), the Aquaox solution is far more effective than undiluted bleach (12 pH), which has 52,500-60,000 ppm, but <20 ppm (0.0002% HOCL) of Free Available Chlorine (FAC) … or no disinfecting power.

– – – – – – – – – – – – – –

FACT:  To improve cleaning and disinfecting capability, Aquaox’s proprietary Electrochemical Activated Water generation system introduces nanobubbles into the electrolyzed solution to greatly increase bioactivity, area-to-volume surface ratio and decrease the viscosity and surface tension.  Nanobubbles further explain why Aquaox electrolyzed solutions are actually 80-300 times more effective than 200 ppm diluted bleach.

When bottled, Aquaox nanobubbles stay submerged, with no off-gassing, for at least 24 months.

Bleach is toxic, corrosive, irritates skin/eyes/respiratory, destroys metal, burns holes in and discolors clothing.

Aquaox solutions do none of these.

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THE STATEMENT:  The general public fears hospitalization and contracting superbugs.  It is completely reasonable to assure room disinfection to the best of our current technological availabilities.

THE QUESTION:  Do you want bleach (or even ‘green’ chemicals) in your face … or do you prefer odorless, safe and healthy Aquaox solutions that are highly effective disinfecting solutions and revert to ordinary water for safe discharge into the environment?

Given the choice, would your employees, customers, members, patients, students, athletes choose to have chemicals in their environment?  The socially conscious decision is yours.

Adding Aquaox’s proprietary ADJUNCT disinfecting step within the Hospital protocol is effective, cost-efficient, quick, safe and actually reduces training time, labor hours and room turnover time for (all) patient care rooms . . . with the significant bonus of substantially improving patient satisfaction scores.

Be ahead of the curve; adopt the Aquaox Infection Control System^TM to move your organization into a competitive advantage.

+1. 800. 790.7520 / info@aquaox.net

Does AQUAOX Protect Against Coronavirus?

Absolutely … AQUAOX kills Coronavirus

“AQUAOX demonstrates a 99.994% reduction in the stock virus titer as compared to the titer of the corresponding virus control. The log reduction in viral titer was 4.25 log10”

Since 2014, AQUOAX cleaning and sanitizing solutions have been used by hospitals to “basically eliminate cross contamination and hospital acquired infections (HAI) from superbugs such as MRSA, C-Diff and VRE.”

When adhering to our protocol, the AQUOAX solution a better, cleaner, safer way to protect against Coronavirus exposure than using chemicals and/or alcohol-based hand-sanitizers.

Further, AQUOAX Infection Control Systems delivers better coverage in less time when using electrostatic sprayers* to kill ‘superbugs’, etc.  *Aquaox can be sprayed, misted, fogged or otherwise applied on surfaces

AQUOAX provides a cleaning/disinfection protocol as well as an elevated (in-the-air) protection system … [noting that applicators are presently in short supply, as well].

CLAIMS:

Aquaox’ EPA-registered broad-spectrum disinfectant AX-275 is effective against H1N1 virus.

See:  EPA-registration 93392-1 for AX-275 disinfectant

Aquaox’ EPA-registered broad-spectrum disinfectant AX-525 is effective against HIV virus and H1N1 virus.

See:  EPA-registration 93392-2 for AX-525

Aquaox on-site generated Hypochlorous Acid solutions are effective against all viruses and when used as directed can be effective against a host of germs in as little as 30 seconds.

See:  https://www.aquaox.com/wp-content/uploads/2017/04/Technical-Summary_On-site_Disinfectants_vf.pdf

This an official acceptation of Aquaox in Canada, since April 29th 2020

https://www.canada.ca/en/health-canada/services/drugs-health-products/disinfectants/covid-19/products-accepted-under-interim-measure.html#wb-auto-

To order online Aquaox (bottled) HOCL solutions, , visit our website:

https://www.aquaox.com/shop

Then contact us for further guidance regarding execution of health/safety protocols for correct use of solutions and applicators.

+1 800.790.7520 / info@aquaox.net

 

 

‘White Paper’ … Dental Clinic Advisory (you may share this perspective with your colleagues)

Dentist,

We now understand the difficulties and risks of reopening dental clinics, having listened and spoken to several of your colleagues to hear their reopening plans and the requirements they must follow to comply with updated Covid-19 guidelines.

For 30 years, I have been working in the field of Electrolyzed Water – an engineered water that is generated solely by electrolysis of water and salt – and safely returns to water and salt when its cleaning/sanitizing job is complete.  Our company, AQUAOX^TM, is a manufacturer of such generating equipment as well as a producer/distributor of EPA-certified disinfectants in containers.

HOCL:

HOCL (Hypochlorous Acid) is immediately effective and leaves no residue.  HOCL has many clear benefits, such as safety and biodegradability.  HOCL is produced by the human body.  However, HOCL has some disadvantages, as it reacts quickly with organic matter and its shelf life is rapidly compromised by UV-light.  In a way, these disadvantages are also advantages, as these properties explain why HOCL is biodegradable, sustainable and safe … as it reverts to water and salt.

Rarely are countries aligned toward this critically important HOCL opportunity … because HOCL is better than chemical cleaning, the HOCL industry is severely handicapped by regulations requiring each HOCL manufacturer to state their individual claims for their own label.  The unfortunate outcome is that EPA and FDA have allowed claims for chemical companies and denied the exact same claims for HOCL having the same pH and FAC (Free Available Chlorine).

Critically Important:

HOCL has been pronounced by the Center of Disease Control as 100x more powerful than any other disinfectant known to mankind.  Approved by the Environmental Protection Agency (EPA), AQUAOX’s solutions, within seconds, eliminate all known bacteria, viruses and fungi … and (HAI) Super Bugs which are documented as killing millions of Americans in hospitals.

Common Sense:

We offer to your question our humble opinion.

50ppm for surface disinfecting should be sufficient, provided that the surface has been thoroughly pre-cleaned, leaving no organic matter to interfere with the HOCL.  GLP (Good Laboratory Practices) efficacy data shows no difference in kill times and kill claims, whether using a 500ppm or a 10ppm HOCL, as long as the surfaces meet clean conditions requirements.  However, in the presence of organics, HOCL efficacy is compromised, as HOCL is consumed (dissipated) while overcoming the organic load.  Apparently anticipating sloppy cleaning or no cleaning, EPA tests HOCL disinfectants under dirty conditions (noting that disinfecting claims hold up only if the FAC is above 200ppm.

When spraying HOCL in the air, UV-light and micro-organisms consume (HOCL) FAC.  Although 50ppm will oxidize airborne microbes, we have measured a quick drop in FAC when HOCL is aerosolized.  For this reason, 50ppm may be insufficient and is not recommended.

In an acute healthcare facility for the last 6 years, Aquaox has been spraying 525ppm HOCL in OR, ER and ICU … and using 275ppm HOCL in all other areas.  Periodically, we take ATP tests as well as culture tests to determine if bacteria remains on surfaces.  Although not all ATP tests have been satisfactory (directly due to sloppy or no cleaning), the culture tests show no alarming levels of bacteria or no bacteria at all … thus validating that disinfecting by means of (electrostatic) spraying has been effective.

Therefore, the cleaning protocol that we propose is similar to what Aquaox has been doing in hospitals, with emphasis on cleaning.

(Yes, you correctly read this statement … ‘cleaning’ is the removal of debris and dirt.)

Just as we are advised to wash hands with soap and water for 20 sec., staff must clean surfaces more frequently and more thoroughly.

After surfaces are thoroughly cleaned, the second part of the protocol, disinfecting, is simply applied by spraying AX-275 and let air-dry.

Explanation: 

If we disinfect without cleaning, chemical residue gets layered on the top of surfaces, hiding a biofilm full of micro-organisms that are being fed and protected … and leaving ineffective chemicals or electrolyzed water disinfectant.  Without leaving residue, Aquaox works better by removing the layers of residue and biofilm.

• Daily after hours, our protocol is … wipe all high-touch surfaces with wetted microfiber cloth using an alkaline cleaner (such as AX-112), followed by spraying AX-275 and let air-dry.
• Between patients, our protocol is … (electrostatically) spray the patient room with AX-275 and let-air dry. After spraying high touch surfaces with AX-275, wipe dry the patient chair and make sure the floor is not wet (to avoid slip/fall accidents).  With a re-usable microfiber mop, apply AX-275 to floors.  And, just before entering the patient room, spray your own gown…clothing…shoes.

You can do quite a bit better by substituting AX-275 for 50ppm, then aerosolize (spray) HOCL to eliminate odors and give a clean/crisp scent to your dental practice.

Finally, Aquaox recognizes the importance of high quality microfiber cloth/mops. All buyers of Aquaox Disinfectant AX-275, etc. earn a 15% discount from Greenspeed microfiber products. (www.greenspeed.biz)

I hope this ‘White Paper’ helps you stay safe, as being a dentist suddenly became a dangerous profession

+1. 800.790.7520 / info@aquaox.net

Hypochlorous Acid in the Fight Against COVID-19

Alan G. Kabat, OD, FAAO

As news of COVID-19, the worldwide pandemic associated with severe acute respiratory syndrome coronavirus-2 (SARS CoV-2) continues to dominate the headlines well into April of 2020, eye care providers have witnessed a tremendous alteration of their practices and lifestyles. Upon recommendations from both the American Academy of Ophthalmology and the American Optometric Association, ophthalmologists and optometrists have been advised to restrict their care to urgent and emergent cases only. This has resulted in many eye care practices across the country closing entirely, not only because of fear of the virus, but because of difficulties in obtaining personal protective equipment (PPE) and lacking appropriate protocols for patient flow and disinfection. Protection against this unforgiving virus has become a paramount concern for healthcare providers and patients alike.

At present, the United States Centers for Disease Control and Prevention (CDC) have made the following recommendations for all individuals to slow/stop the spread of COVID-19: ¹

1. Wash your hands often with soap and water for at least 20 seconds. If soap and water are not readily available, use a use a hand sanitizer that contains at least 60% alcohol. Avoid touching your eyes, nose, and mouth with unwashed hands.
2. Stay home as much as possible. Practice social distancing by keeping at least six feet (2 meters) between yourself and other people.
3. Cover your mouth and nose with a cloth face cover when around others, and especially if you go out in public.
4. If you do not have a face covering, remember to always cover your mouth and nose with a tissue when you cough or sneeze, or use the inside of your elbow.
5. Clean and disinfect frequently touched surfaces daily. This includes tables, doorknobs, light switches, countertops, handles, desks, phones, keyboards, toilets, faucets, and sinks.

As a disinfectant, the CDC recommends dilute household bleach solution (5 tablespoons per gallon of water) or solutions containing at least 70% alcohol. The agency has also endorsed a litany of other common Environmental Protection Agency (EPA)-registered household disinfectants which, although not formally tested against the SARS CoV-2 pathogen, have shown efficacy against harder to kill viruses (e.g. Norovirus and Hepatitis A).^1,2 If one reviews the published list, he may recognize several active ingredients that have broad antiseptic properties, including hydrogen peroxide, quaternary ammonium and thymol in addition to many alcohol and bleach derivatives. But of particular interest, especially to eye care providers, is the inclusion of hypochlorous acid.

Most of us will recognize hypochlorous acid (chemical formula: HOCl) as a now widely-utilized agent for the management of blepharitis in the United States. First introduced for ophthalmic use in 2014, HOCl is a natural antibacterial agent that is produced during the human immune response as white blood cells target pathogens within the body.^3,4 This simple chemical compound has a broad spectrum of activity and exhibits rapid kill kinetics against a wide range of bacterial and viral organisms.⁵ Despite their efficacy however, ophthalmic formulations of HOCl are safe and extremely well-tolerated by patients.

Some of the earliest information regarding HOCl being used to contain the spread of COVID-19 came in the form of reports from South Korea. On March 3, 2020, a story by CNN about workers at drive-through corona testing stations reported that “When their shifts ends, they step fully clothed into a small portable booth called the ‘Clean Zone,’ in which they are showered in hypochlorous acid disinfectant.”⁶

In reviewing the EPA’s listing,² HOCl appears a total of six times in unique products; these include such names as Cousteau (Reckitt Benckiser; Parsippany, NJ), Excelyte VET (Paradigm Convergence Technologies; Little River, SC), Danolyte (Danolyte Global; Overland Park, KS) and Cleansmart (Simple Science Limited; Edina, MN). The amount of HOCl in each of these products varies, with some as high as 500 parts per million (0.05%), but both Cousteau and Cleansmart weigh in at 0.017%. If we compare this concentration with that of known ophthalmic products containing HOCl, HypoChlor (OCuSOFT; Rosenberg, TX) meets and exceeds this percentage in that it contains 0.02% HOCl.

To be clear, at this date, none of the commercially available hypochlorous acid eyelid formulations have been specifically tested for efficacy against SARS CoV-2, either in vitro or in vivo. Nonetheless, as doctors and patients alike look for alternative disinfection solutions that are safe and well-tolerated on human skin – including the face and skin around the eyes – this information is very compelling. Gloves and masks provide excellent barriers to COVID-19 spread, but contamination remains an issue when removing these items. Moreover, the CDC has warned individuals that touching the nose, mouth or eyes increases the risk of potential infection. Since products like HypoChlor are readily available and easily applied to the face via a convenient spray bottle, this provides great peace of mind for those of us who still need to venture out into the community during this challenging time. Admittedly, due to the overwhelming evidence, this author has been regularly using HypoChlor on both his face and precious N95 masks following trips to the supermarket or other vital destinations where the potential for contamination exists.

Until we have effectively “flattened the curve” and social distancing can be relaxed, we must remain diligent in the fight against this unparalleled pandemic. Sometimes, in order to do that, we need to be creative. It is nice to know that a simple product like HypoChlor, which many of us employ routinely for blepharitis, may have additional utility against this potentially deadly disease.

Dr. Kabat is a Professor of Optometry at Salus University in Philadelphia, Pennsylvania. He is a member of OCuSOFT’s Optometric Scientific Advisory Board.

1. Centers for Disease Control and Prevention. Coronavirus disease 2019 (COVID-19) – Prevention & treatment. Updated April 4, 2020. Available at: https://www.cdc.gov/coronavirus/2019- ncov/prevent-getting-sick/prevention.html. Accessed April 7, 2020.
2. United States Environmental Protection Agency (EPA). List N: Disinfectants for use against SARS-Cov-2. Updated April 2, 2020.  Available at: https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2. Accessed April 7, 2020.
3. Stroman DW, Mintun K, Epstein AB, et al. Reduction in bacterial load using hypochlorous acid hygiene solution on ocular skin. Clin Ophthalmol. 2017;11:707-714.
4. Hurst JK. What really happens in the neutrophil phagosome? Free Radic Biol Med. 2012;53:508–520.
5. Wang L, Bassiri M, Najafi R, et al. Hypochlorous acid as a potential wound care agent: part I. Stabilized hypochlorous acid: a component of the inorganic armamentarium of innate immunity. J Burns Wounds. 2007;6:e5.
6. Watson I, Jeong S. CNN. South Korea pioneers coronavirus drive-through testing station. CNN. Updated March 3, 2020. Available at: https://www.cnn.com/2020/03/02/asia/coronavirus-drive-through-south-korea-hnk-intl/index.html. Accessed April 8, 2020.