Hospitals focus on antibiotic overuse as CMS prepares new mandate

December 30, 2014
Antibiotic resistance is a threat to national security.

That’s how President Barack Obama described the rapid growth of such resistance when he issued an executive order in September instructing HHS and the Defense and Agriculture departments to take aggressive action on the issue.

The president cited federal data showing that at least 2 million Americans are infected with drug-resistant bacteria each year and 23,000 die as a result. He emphasized the critical need for improved antibiotic stewardship—coordinated practices promoting the appropriate use of antibiotics—in healthcare facilities. Federal officials say such programs are among the most effective ways to curb resistance and reduce the number of hard- or impossible-to-treat infections.

A growing number of hospitals are instituting stewardship programs, which experts say not only improve patient outcomes, but also reduce costs and lengths of stay and lower antibiotic-resistance rates within hospitals. Those efforts have been bolstered by looming federal action that would make the inclusion of a stewardship program a requirement to participate in Medicare.

But many hospitals—especially smaller, community facilities—face tough challenges, often related to inadequate staffing and resources. Increasingly, however, those hospitals are using telemedicine, local partnerships and other creative strategies to push stewardship forward.

Intermountain Healthcare is conducting a 15-hospital study on running stewardship programs in smaller hospitals. Kenmore Mercy Hospital, a 155-bed facility in Buffalo, N.Y., is collaborating with independent physicians in its accountable care organization to educate its staff on antibiotic best practices. Other smaller hospitals in California and Minnesota have contracted with infectious-disease, or ID, specialists to lead their programs.

“We can’t control how fast bacteria develop resistance or how fast we develop new drugs, but antibiotic stewardship is 100% under our control,” said Dr. Arjun Srinivasan, associate director for healthcare-associated infection prevention programs at the Centers for Disease Control and Prevention. “I would go so far as to say antibiotic stewardship is one of the most important things we can do.”

Stewardship initiatives vary widely. But in a March report, the CDC listed the core elements for such programs, which include a commitment from senior leadership, tracking and reporting of antibiotic prescribing patterns and resistance, clinician education and the appointment of a single person to lead the effort.

Benefits of stewardship programs

Stewardship programs, the CDC recommended, should implement at least one intervention, such as prior authorization for certain restricted antibiotics, antibiotic dose optimization, or prospective audit and feedback. The last involves someone outside the treating team reviewing antibiotic orders and cultures and advising clinicians on recommended changes.

In addition to improving patient outcomes, stewardship programs save money, in most cases more than paying for themselves, Srinivasan said. According to data cited by the CDC and the Infectious Diseases Society of America, a comprehensive antibiotic stewardship program can reduce antibiotic use by 22% to 36%, with annual savings of $200,000 to $900,000. “It’s a win across the board,” Srinivasan said.

Officials estimate that roughly half of the nation’s hospitals have some kind of antibiotic stewardship program. But little is known about how robust those programs are and their interventions. “We need better data,” Srinivasan said. The CDC is planning in 2015 to add several questions about stewardship to its annual survey, distributed to the more than 4,000 hospitals that report healthcare-associated infection data to the CDC’s National Healthcare Safety Network.

He predicted that in the coming year, hospitals will look more seriously at implementing stewardship programs or beefing up the ones they already have. That’s at least partly because CMS officials have said the agency plans to add antibiotic stewardship to its hospital conditions of participation, a move Srinivasan said would have “a transformative effect.”

Dr. Shari Ling, deputy chief medical officer in the CMS’ Center for Clinical Standards and Quality, confirmed that the agency plans to propose a condition of participation for antibiotic stewardship in 2015, with an implementation window in 2017. Currently, California is the only state that mandates that hospitals have stewardship programs.

The challenge for the CMS, Ling said, will be ensuring that the new rules allow for differences in hospital size and resources. “The condition of participation has to permit flexibility so that all facilities can engage in a way that’s meaningful for them,” she said.

Large academic medical centers, for instance, usually have specialized infectious-disease doctors and pharmacists who can guide stewardship programs, while smaller hospitals rarely do. And smaller hospitals often lack the money and IT infrastructure that larger facilities can use to boost their efforts.

Srinivasan said the CDC tried to address that variation in its March report. “We tried to boil it down to program functions instead of employee titles so that it was useful to all hospitals,” he said. “Our goal was to say, ‘Here are the things you need to do, but who does them will depend on who you have available in your facility.’”

MH Takeaways

Smaller hospitals look to telemedicine and partnerships with infectious- disease experts to establish best practices on appropriate use of antibiotics.

The needs of smaller hospitals

Another challenge is that there are few studies—and no randomized controlled trials—that provide evidence-based guidance on how to implement antibiotic stewardship in smaller hospitals, said Dr. Eddie Stenehjem, medical director of antimicrobial stewardship at 21-hospital Intermountain Healthcare, headquartered in Salt Lake City. “Most of our data comes from large urban hospitals,” he said. “We have no idea what really works in a smaller hospital.”

Stenehjem and his colleagues are trying to find out. They are in the midst of a 15-month randomized trial, launched in March 2014, that includes 15 Intermountain community hospitals, some with fewer than 20 beds. Each hospital was assigned to one of three groups, receiving a high-, medium- or low-level antibiotic stewardship program.

The low-level group received a set of stewardship best practices, antibiotic usage data and training for the hospitals’ pharmacists. In contrast, hospitals in the high-level group received best practices and usage data, a more robust curriculum, monitoring of antibiotic restrictions by an off-site infectious-disease pharmacist and review of each culture by an off-site infectious-disease physician. Stenehjem said he hopes the study, scheduled to end in June, will shed light on the needs of smaller hospitals and which stewardship initiatives work best for them.

Riverton (Utah) Hospital, a 92-bed facility, is in the high-level group in Stenehjem’s study. The hospital had no formal stewardship program before the study, said Jennie Barlow, a clinical pharmacist. But 10 months in, the hospital’s pharmacists and physicians now rely on support from Stenehjem and his colleagues. “I hope the study shows that the high-level approach is the one that works best, because it’s great to have the extra help,” she said.

That support from an ID specialist is especially valuable when advising a physician about appropriate use, said Karla Snow, Riverton Hospital’s pharmacy director. “If a physician ordered a restricted antibiotic before, we didn’t always feel comfortable pushing back,” she said. “Now our physicians know we have ID physicians on board.”

Hospitals that don’t have outside help, though, still can make progress, Snow said. She advised starting small with “low-hanging fruit,” such as intravenous-to-oral conversions, when IV antibiotics are switched to their oral version. That’s a change that reduces the risk of infection, improves patients’ mobility and lowers costs. Antibiotic timeouts—when antibiotics are reviewed after 48 hours to assess whether they are being appropriately used and whether they are still necessary—are also relatively easy to implement, she said.

Creative solutions

Kenmore Mercy Hospital in Buffalo had several of those stewardship components in place but had never pulled them together into a formal program, said James Bartlett, the hospital’s lead clinical pharmacist. Then in 2012, its parent, Buffalo-based Catholic Health System, was recognized as an ACO under the Medicare Shared Savings Program, which provided financial incentives to collaborate and improve outcomes. “All of a sudden, we had all these different groups in our ACO that were looking for ways to optimize care,” Bartlett said.

Kenmore Mercy partnered with an independent physician group within its ACO to launch a stewardship program at the hospital. The physicians group provided the infectious disease support and helped to educate Kenmore Mercy’s physicians and pharmacists on antibiotic best practices. “We have a meeting every day where we review cases with an ID physician,” Bartlett said. “And every single one of our pharmacists rotates through the lead stewardship role so they can get used to it and learn from the ID physicians.”

During the first year, the program saved more than $145,000 on drug purchasing alone, he said. Pharmacist-initiated IV-to-oral conversions increased 688%, compared with the previous year. And physicians accepted the recommendations of infectious-disease physicians nearly three-quarters of the time.

Like Stenehjem, Bartlett noticed the dearth of research about antibiotic stewardship programs at community hospitals. He and a colleague wrote an article describing their experience designing an antimicrobial stewardship program, which was published in June in the American Journal of Health-System Pharmacy.

Bartlett acknowledged that Kenmore Mercy’s program would have been harder to implement without the help of its parent health system and the other members of its ACO. “Without that support, our program would not look the way it looks now,” he said.

One option for small, stand-alone hospitals looking to implement stewardship programs is telemedicine, said Dr. Javeed Siddiqui, founder and chief medical officer of TeleMed2U, a Roseville, Calif.-based company that offers a telemedicine-based antimicrobial stewardship program. His company provides stewardship services for three California hospitals, including 65-bed Sonoma (Calif.) Valley Hospital and 48-bed Ukiah (Calif.) Valley Medical Center. California hospitals are especially motivated to try telemedicine, he said, because state law requires that hospitals have antibiotic stewardship programs.

Siddiqui serves as the infectious-disease physician for all three hospitals, working with each facility’s pharmacists, hospitalists and microbiology staff. “Telemedicine is just the vehicle,” he said. “Those hospitals have an ID physician—me. I’m part of their medical staff.”

Since its program began, Sonoma Valley Hospital has seen its use of flouroquinolones and piperacillin/tazobactam—two categories of broad-spectrum antibiotics—drop by 80% and 70%, respectively, Siddiqui said. The hospital’s resistance rates also dropped.

Despite the evidence of the benefits of stewardship, Siddiqui has encountered pushback from a few physicians. “There are still some physicians at Sonoma who don’t want my input, but I think we have about 90% of them on board and I’ll take that any day,” he said.

The CDC’s Srinivasan pointed to another antibiotic stewardship model that might work for community hospitals. Dr. Gary Kravitz, an infectious-disease specialist with St. Paul (Minn.) Infectious Disease Associates, runs stewardship programs at five local hospitals, including 192-bed St. John’s Hospital and 232-bed St. Joseph’s Hospital, both in St. Paul, and 86-bed Woodwinds Health Campus, Woodbury, Minn. He started in 2002 by developing a stewardship program for 398-bed United Hospital in St. Paul, where he was on staff. “I think we were getting paid about $50,000 to do the program and the hospital saved that much just on pharmacy costs in the first year,” he said.

His results were so strong that over the next few years, he took the business proposition to other hospitals, negotiating renewable contracts to design and oversee stewardship programs.

With the right training, general pharmacists can lead antibiotic stewardship efforts as long as they have access to an infectious-disease specialist to review difficult cases, such as when they are unsure about which drug is appropriate, Kravitz said. “There’s a lot of ways to make this work, but you need people who are really interested in doing it.”

Srinivasan said 2015 promises to be a big year for advancing stewardship programs. “There is much more awareness of the problem now and stewardship efforts that have been underway for a long time seem to be coming to fruition,” he said. “I think we’re going to see a lot of good work that will carry us into the future.”

Follow Maureen McKinney on Twitter: @MHmmckinney


The Magic of Microfiber

December 30, 2014

microfibreHere’s the truth about why microfiber towels and mops work so well and it’s not magic (sorry about the headline).

If you took a microfiber towel, cut off one fiber, then cut that fiber into tiny pieces and looked at them under a really powerful microscope, they would look like an asterisk (*). Which means that each fiber has a ton of surface area to pick up soils that you can and can’t see. Conversely, cotton towel or paper towel fibers have much less surface area, and cannot pick up a large variety of soils.

Microfiber picks up watery and oily soils. That’s why new, clean microfiber towels stick to your hand. If you were to fold several of microfiber towels after washing (we have thousands) after about 5 minutes your hands would be so dry they might start cracking.

In our public health seminar we demonstrate the magic of microfiber with a little contest. We have a mirror smeared with butter. One person tries to clean it with water and a paper towel and the other person uses a microfiber towel. After about 7 seconds the microfiber side is clean and the paper towel side is a smudgy mess.

Recommended uses of microfiber

All general cleaning activities
Sometimes, microfiber will leave extra fibers on glass, if you don’t like how that looks I recommend using a squeegee for glass cleaning

Carpet, upholstery, and fabric spotting
Next time you have a spill or drip, try to transfer the soil from your fabric to a clean microfiber towel. Use a little water, if necessary. It won’t work every time, but it good to try this first before using any product that may do more harm than good.

Dry dusting
Using a microfiber towel or duster for dusting can eliminate more standard options that simply push the dust around or lift it back into the airspace to land on a different object or breathe in.

Vehicle interior and exterior cleaning
Many people keep microfiber towels in their car for drying water drops after a car wash or detailing the interior of their car. Use a dry microfiber towel to remove the haze from interior glass.

How to care for your microfiber towels

-Wash your microfiber towels and mops together and do not combine them with other fabrics. Lint from the other fabrics will stick to the microfiber

-Use half of the amount of detergent you would normally use. Microfiber will release the soils they are holding very easily in water and minimal detergent. When you use too much detergent you risk not rinsing all of it out and your microfiber towel will be streaky

-Do not use fabric softener or dryer sheets. The residue from these products will stay in the microfiber and will then streak on your surfaces

-Dry on low heat. Microfibers can melt under high heat and lose surface area.

With proper usage and care you microfiber towels and mops can last from 50 to 100 washings. When your microfiber towels stop sticking to your dry hands, you know they are losing their surface area and it’s time to retire them into the slop rag/really dirty cleaning pile.

This entry was posted in Cleaning & Disinfecting by Anthony Fors. Bookmark the permalink.

The Future Of Infection Control

February 16, 2014

Studies prove hand hygiene importance while monitoring technology improves program compliance.
By Phillip Lawless

Infection control — though the concept sounds simple enough, it is actually a serious cleaning industry issue that includes a multitude of responsibilities.
Through cleaning and prevention, education and action, facility managers and building service contractors use sound infection control practices to prevent illness outbreaks and treat “sick buildings.”
From surface disinfection and sanitization to restroom cleaning and hand hygiene programs, there are many important links in the chain of effective facility infection control.
This is especially true in hospitals and the healthcare market.
Various scientific studies have proven the importance of hand hygiene in this arena, and new ideas and technology stand ready to improve practices and strengthen the chain of infection control.
Unhealthy Hospitals?
While most people think of hospitals and other healthcare facilities as places to receive treatment and regain strength, cleaning quality and safe infection control can have a large impact on patients’ overall wellbeing.
In fact, around 2 million patients acquire hospital-related infections every year, according to the U.S. Centers for Disease Control (CDC), and almost 100,000 die from these infections.
Recognizing hand hygiene’s contribution to a strong healthcare infection control program, one group set out to study and improve hand hygiene compliance in this market.
Klaus Nether is center solutions development director with the Joint Commission Center for Transforming Healthcare.
“The Center for Transforming Healthcare is an entity under the Joint Commission Enterprise,” Nether says. “It was created in 2008 to address some of healthcare’s safety and quality issues.”
The center works with participating organizations — hospitals and healthcare organizations — to address important issues, Nether notes, and hand hygiene was the first program that the participating organizations identified to address.
Studying The Issue
Using a scientific approach, the group:
• Looks at what the issues are
• Measures these issues to gauge their severity
• Identifies contributing factors
• Targets solutions specifically to these factors
• Develops a control plan to sustain improvements over time.
Working with eight healthcare organizations across the United States, the commission developed a measurement system to monitor employee wash ins/wash outs in patient areas using the same parameters, Nether states.
A measurement system was created that used secret observers to collect data, and training modules taught them how to observe, how to fill out the forms and included a test for them to take.
According to Nether, employees who were expected to wash in/wash out at the facilities included laboratory workers, nutritionists, dieticians and environmental employees.
Using this system, baseline wash in/wash out compliance at the eight organizations was, as an aggregate, 47.5 percent, Nether explains.
Looking at the eight healthcare facility participants, different contributing factors were identified at each location.
Over 20 different hand hygiene contributing factors were found, including:
• Inoperable or empty soap dispensers
• Perception of excessive hand cleaning being required
• Broken sinks
• A lack of accountability
• Distractions and forgetfulness
• Issues with wearing gloves.
To address the specific issues at each location, targeted solutions were developed and a control plan was created to sustain hand hygiene improvements over time.
“One of the things that we learned is that best practices don’t always work,” Nether reveals. “Best practices were created to address specific contributing factors that were identified at that organization that developed those best practices. And sometimes, as you adopt those best practices, they may not work at your organization. Although we all had the similar problem with hand hygiene, the contributing factors were different from one organization to the next.”
Maintaining Improvement
According to Nether, the eight hospitals that started with an aggregate wash in/wash out compliance of 47.5 percent ended the study with an aggregate of 81 percent and sustained that performance for 11 months.
“There is a correlation with hand hygiene and health acquired infections, so one of the organizations that actually implemented the targeted solutions tool … they actually saw that as their hand hygiene compliance rates went up, their blood stream infections actually decreased by 66 percent,” Nether states.
While there is definitely a correlation between hand hygiene and infections, there are other factors that can affect the rate of health acquired infections (HAIs), Nether notes.
Using these findings, the commission created a Targeted Solutions Tool to help individual healthcare organizations decrease HAIs and increase hand hygiene compliance in approximately 12 weeks, according to Nether.
The next challenge is sustaining the improvement, Nether says.
To guarantee the hand hygiene program moving forward, organizations should continue measuring and develop a control plan to monitor the process.
If any dips are seen in the hygiene program measurements, an organization must react before it gets too bad, Nether concludes.
New Monitoring Technology
New technology has changed almost every facet of the cleaning industry, and now it stands ready to improve facility hand hygiene programs as well.
Jeff Hall, compliance program director, North America, with GOJO Industries Inc., says hand hygiene has become a subject of high importance in the cleaning and healthcare industries.
This is due to the huge impact that it can have on health and well-being — possibly even saving lives.
Hall notes it has been proven through multiple studies that hand hygiene is the number one way to prevent the spread of infection1 and that hand hygiene compliance rates in healthcare average less than 50 percent nationally.2
The bottom line is that HAIs are a chronic and costly problem that require quantitative data to demonstrate performance, Hall states.
That is the biggest reason newer electronic monitoring system technology is now necessary; it allows for measurement and accountability.
“In order to improve hand hygiene, we need to give hospitals the tools to measure it and the clinical education resources to interpret the data,” Hall explains. “One solution does not fit all hospitals; we work individually with each hospital to find a solution and technology that works for them.”
How It Works
Healthcare personnel function in an environment of heavy workloads, enormous responsibilities, multitasking and being constantly pressed to do more things in less time, according to Hall.
This challenges their time management, priority setting and efficiency of practice.
That is why Hall’s company was committed to providing hand hygiene solutions that make compliance easier.
Hand hygiene technology systems that became available earlier this year measure and improve hand hygiene compliance.
Hall states his type of technology can include:
• An activity monitoring systemthat measures compliance on a community level providing real-time actionable data by floor, unit or room.
• Technology that monitors and measures hand hygiene compliance at an individual level through Real-Time Locating System (RTLS)-enabled employee badges. (A system can integrate with existing third-party RTLS systems.)
• In addition, some companies provide a representative or employee who becomes part of the hospital’s infection prevention team and provides customized implementation, on-site audits, setup, baseline measurements and detailed improvement plans
• Finally, software can allow users to automatically upload, visualize and analyze data from a free application for portable devices used to electronically collect hand hygiene events.
Compliance Study
Hall’s company conducted an independent research study at the John Peter Smith Hospital in Fort Worth, Texas, to determine the impact on hand hygiene compliance rates when the hospital hand hygiene program included an electronic compliance activity monitoring system.
During the study, the system was installed to monitor all patient room entries and exits and all hand hygiene events from touch-free soap or hand sanitizer dispensers.
Compliance was measured as number of events in contrast to number of opportunities, and included the entire community, not only healthcare workers.
The study duration was three months during which a comprehensive hand hygiene program for healthcare workers, patient and visitors was implemented.
Additional education was established including the development of a hand hygiene improvement goal, leadership support and feedback opportunities for the staff.
Results of the study were presented at the APIC 2013 Conference.
The authors concluded that during the study period of June to September 2012, there was a 92 percent increase in hand hygiene compliance rates — from 16.5 percent at baseline to 31.7 percent — when an electronic monitoring system was included in a hand hygiene program.
During the post-study period the rate decreased to 25.8 percent, still significantly above baseline.
Through the study, it was found that the implementation of an electronic hand hygiene compliance monitoring system as part of a clinical hand hygiene program can significantly increase hand hygiene compliance.
“We also are aware that additional data is needed to better understand the impact of electronic compliance monitoring programs on clinical outcomes, such as infection rates,” Hall says.
Today, it is clear that safer facilities equal improved employee production, increased profitability and healthier communities.
Thankfully facility managers, service contractors and workers are not fighting this important battle alone.
New technologies, scientific studies and updated approaches offer the promise of safer, cleaner and healthier facilities in the future.

1 According to the CDC, “Hand Hygiene Project: Best Practices for Hospitals …” Joint Commission, Nov. 2010.
2 Herbert C. Weber SG. Common approaches to the control of multidrug-resistant organisms other than methicillin-resistant Staphylococcus aureus Mar:25(1): 181-200. Epub 2010 Dec. 17.

Hypochlorous Acid as a Potential Wound Care Agent

October 11, 2013

Hypochlorous acid (HOCl), a major inorganic bactericidal compound of innate immunity, is effective against a broad range of microorganisms. Owing to its chemical nature, HOCl has never been used as a pharmaceutical drug for treating infection. In this article, we describe the chemical production, stabilization, and biological activity of a pharmaceutically useful formulation of HOCl.

Stabilized HOCl is in the form of a physiologically balanced solution in 0.5-1.0% saline at a pH range of 3.5 to 7.0. Chlorine species distribution in solution is a function of pH. In aqueous solution, HOCl is the predominant species at the pH range of 4 to 6. At pH values less than 3.5, the solution exists as a mixture of chlorine in aqueous phase, chlorine gas, trichloride (Cl3−), and HOCl. At pH greater than 5.5, sodium hypochlorite (NaOCl) starts to form and becomes the predominant species in the alkaline pH. To maintain HOCl solution in a stable form, maximize its antimicrobial activities, and minimize undesirable side products, the pH must be maintained at 5 to 5.5.

Using this stabilized form of HOCl, the potent antimicrobial activities of HOCl are demonstrated against a wide range of microorganisms. The in vitro cytotoxicity profile in L929 cells and the in vivo safety profile of HOCl in various animal models are described. On the basis of the antimicrobial activity and the lack of animal toxicity, it is predicted that stabilized HOCl has potential pharmaceutical applications in the control of soft tissue infection.  A remarkable feature of the immune system is its ability to launch an effective response against invading pathogens by deploying a group of highly reactive chemicals, including oxidized halogens, oxidizing radicals, and singlet oxygen.

The precursor of these reactive oxygen species (ROS) is the oxygen radical (O2), which is generated by specialized immune cells—neutrophils, eosinophils, mononuclear phagocytes, and B lymphocytes. Production of ROS in these cells is accompanied by a significant rise in oxygen consumption, a series of events collectively referred to as the oxidative burst. The primary enzyme responsible for ROS production is a mitochondrial-membrane–bound enzyme known as respiratory burst NADPH oxidase. Patients with chronic granulomatous disease have oxidase defective genes, which makes them susceptible to repeated infection.10,11 During a respiratory burst, neutrophils produce H2O2, which is converted to HOCl by the activity of the granule enzyme myeloperoxidase.

HOCl is known to be the major strong oxidant produced by neutrophils, and is a potent microbicidal agent within these cells. Experimentally, it has been estimated that 106 neutrophils stimulated in vitro can produce 0.1 μM HOCl. This quantity of HOCl can kill 1.5 × 107 Escherichia coli in less than 5 minutes. HOCl reacts readily with a range of biological molecules, particularly those with thiol, thiolether, heme proteins, and amino groups and may lead to tissue injury. Taurine, a nonessential amino acid naturally found at roughly 15 mM within neutrophils acts as a scavenger molecule for HOCl via the following mechanism, and effectively dampens the collateral damage to cellular macromolecules caused by HOCl.

To date, pure HOCl has not been developed as a commercial pharmaceutical formulation presumably because of the challenge of maintaining storage stability. In this article, we describe a method for the preparation and stabilization of a pure form of HOCl for potential use as a pharmaceutical agent. We show here that when compared to the commercially available disinfectants hydrogen peroxide and sodium hypochlorite (NaOCl), this formulation has improved in vitro antimicrobial activity and therapeutic index. Furthermore, we present data demonstrating an excellent safety profile for HOCL in animal toxicology studies. We believe the improved properties of our pure physiologically balanced stabilized form of HOCl may allow for its use in a clinical situation such as in the treatment or prevention of infection in burn or other wounds.

Hypochlorous acid was prepared in 154 mM NaCl by acidifying reagent-grade NaOCl to the pH range of 3.5 to 4.0 with dilute HCl. A Beckman pH meter was used to accurately measure the final pH values. The concentration of active total chlorine species in solution expressed as [HOCl]T (where [HOCl]T = [HOCl] + [Cl2] + [Cl3−] + [OCl−]) in 0.9% saline was determined by converting all the active chlorine species to OCl− with 0.1 M NaOH and measuring the concentration of OCl−. The concentration of OCl− was determined spectrophotometrically at 292 nm (ε = 362 M− 1 cm− 1)15 with an Agilent 8453 UV-visible spectrophotometer.

All microorganisms used in these studies were purchased from the American Type Culture Collection (ATCC), grown and propagated according to the recommendations for each strain by ATCC. Bacterial cells were harvested at stationary phase and concentrations were determined by 10-fold dilution as direct colony count. To prepare inoculum, bacteria were diluted in sterile saline before use to minimize the effect of broth on HOCl.

A modification of the National Committee Consensus on Laboratory standardized protocol “Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically” was used in these studies. Sterile 0.9% saline at pH 3.5 to 4.0 (vehicle) was used as the diluent. Use of such a diluent allows for the determination of the intrinsic activity of HOCl in the absence of any interfering molecules. Specifically, each test article is diluted using 2-fold serial dilution in acid-washed glass tubes to give a range of concentrations from approximately 2 to 0.002 mM in a final volume of 1 mL. Each dilution is inoculated with 5 × 105 CFU/mL test bacteria and co-incubations were carried out at room temperature for 60 minutes. At 60 minutes post-treatment, 0.1 mL of each reaction was immediately transferred into pre-labeled 1.5-mL microfuge tubes containing 0.9 mL Dey and Engley (D/E) neutralizer broth (Hardy Diagnostic, Santa Maria, CA). Minimum bactericidal concentration (MBC) is determined by plating 0.1 mL of each sample onto an agar plate. Plates were then incubated overnight at 35°C, and examined for colony growth. The concentration at which there was a complete absence of colony growth is determined to be the MBC. Comparative MBC results provide estimates of the susceptibility of various test articles against test organisms.

For time kill studies, 5 mL of test article at an approximate MBC concentration was inoculated with approximately 106 CFU/mL of each test organism and incubated for 0, 5, 10, 15, 20, 30, 60, and 90 minutes at room temperature. For each time point, 0.1 mL was transferred into 0.9 mL of D/E neutralizer broth and 0.1 mL of this mixture was plated and incubated as previously described.

L929 (ATCC CCL-1, NCTC clone 929) is a connective-tissue cell line derived from normal subcutaneous areolar and adipose tissue of a 100-day-old male C3H mouse. L929 cells were purchased from ATCC and propagated according to supplier’s recommendations. These cells were then seeded at 1.5 × 104 cells per well in 96-well plates and incubated overnight at 37°C. On the day of testing, growth medium was aspirated from each well, and 30 μL fresh medium was added per well. Test articles were diluted by 2-fold serial dilution using 154 mM saline at the desired pH for each test article. Following that, 170 μL of each dilution was added to each well for a total volume of 200 μL per well. After 60 minutes’ exposure at 37°C, test articles were replaced with 200 μL of fresh tissue culture media and incubated for 24 hours at 37°C. Cell viability was determined by addition of WST-8 (Dojindo, Japan) reagent and the absorption at 450 nm read spectro-photometrically. Orange-red formazan, which is produced by live cells, is a direct measure of cell viability in this assay.

The therapeutic Index of an antimicrobial agent is defined as the ratio of the concentration to achieve 50% cell toxicity (CT50) to MBC.

Ocular irritation, skin sensitization, and wound toxicology studies were performed. A preliminary (non–good laboratory practice [non-GLP]) study with a development formulation of HOCl (2.5 mM; 0.013% w/v) was carried out at the Brookdale Eye Clinic (K. Najafi, MD, unpublished data). Dutch pigmented rabbits received either 5% ophthalmic povidone-iodine (Betadine) (15 eyes) or the development formulation (15 eyes). Each eye received 0.1 mL of solution every 8 hours for a total of 72 hours and observations were made periodically during this time. The effect of the development formulation was compared to 5% ophthalmic-grade Betadine.
A GLP ocular irritation study (NAMSA, Toledo, OH) was designed to determine the potential for ocular irritation following a single instillation in the rabbit. New Zealand White rabbits (5 per group) were used. Hypochlorous acid (NVC-101) was instilled in the right eye at concentrations of 0.01%, 0.03%, and 0.1% w/v (pH 3.5). The left eyes were used as the controls and were untreated, vehicle (saline) or positive control treated. In all cases, the volume used was 0.1 mL, which was placed into the lower conjunctival sac. Evaluations for irritation were made at 24, 48, and 72 hours. At 24 hours, the cornea was examined using fluorescein stain. GLP repeat-dose wound toxicity studies (Charles River, Spencerville, OH) were designed to provide maximum exposure to full-thickness wounds in rats and mini-pigs. Wounds were treated with NVC-101 at concentrations of 0.01%, 0.03%, and 0.1% w/v (pH 3.5). The test material was applied to the wounded area directly using soaked gauze. The treated site was covered for approximately 24 hours per day for 28 days. Wounds achieving 75% closure were kept open by abrasion. Parameters used to assess systemic toxicity included clinical signs (including observations of the site), body weights, food intake, clinical chemistries (blood and urine), hematology, organ weights, and gross and microscopic tissue evaluations.

The molar percentage of each species in physiologically balanced HOCl solution is a function of pH. A low pH and high [Cl−] favors the formation of Cl2. Once Cl2 is formed in the aqueous phase, it migrates into the headspace. The transfer of Cl2 from the solution to the headspace of the container results in a decrease in active chlorine concentration in solution. Therefore, the degassing of Cl2 becomes a major path for loss of HOCl in an open system (nonsealed). This is a potential problem for clinical use of HOCl. To stabilize the physiologically balanced HOCl solution, minimizing the formation of Cl2 is essential.

Stabilized HOCl demonstrates broad-spectrum antimicrobial activity at concentrations ranging from 0.1 to 2.8 μg/mL.

Minimum bactericidal concentration (μg/mL) of HOCl for a broad spectrum of microorganisms tested at room temperature for 60 min
The exception is Aspergillus niger, where a higher concentartion of HOCl (86.6 μg/mL) was required for effective killing of the organism under the same assay conditions. Time kill is an in vitro measure of how fast a given antimicrobial can kill test bacteria. The rate of kill by stabilized HOCl was first demonstrated at the MBC values for each microorganism using an inoculum size of 1 × 106 mL−1 for each test bacteria. The majority of test organisms were killed (>99.99%) within the first 2 minutes of exposure. Among the bacterial species tested, Streptococcus pyogenes 49399 was the only exception, which required approximately 10 minutes of exposure for effective killing, under the same assay conditions. The killing rate of stabilized HOCl with NaOCl and H2O2 was then determined against 3 specific test organisms—E. coli 25922, P. aeruginosa 27853, and S. aureus 29213—at room temperature for a total of 90 miniutes.

Comparative time kill studies of HOCl, NaOCl, and H2O2 against 3 test organisms at room temperature for a total of 90 min. It is worth mentioning that all these time kill studies were also performed with an inoculum size of 1 × 107/mL for each test bacteria.

Comparative MBC (μM) of HOCl, NaOCl, and H2O2 tested against 3 organisms at room temperature for 60 min. As the results show, HOCl at its MBC values for different test organisms (5.6–12.5 μM) was able to kill all 3 test bacteria in less than 1 minute, with no significant bacterial killing effect from its excipient, saline at pH 4.0. However, the kill time for NaOCl at MBC values 10 to 50 μM varied from 5 to 15 minutes for the same 3 test organisms. In contrast, H2O2was only able to kill P. aeruginosa 27853 at 7500 μM in about 10 minutes, but did not kill S. aureus 29213 at its highest concentration tested (20,000 μM) even up to 90 minutes’ exposure time under the same assay conditions.

The relative cell toxicity of HOCl, NaOCl, and H2O2 was assessed following a standard method used to examine the cytotoxicity of liquid disinfectants. This toxicity assay utilizes an established adherent cell line, L929, and the end point is relative cell viability measured by addition of WST-8 (Dojindo, Japan) colorimetric reagent. Orange-red formazan, which is produced by live cells, is a direct measure of cell viability in this assay. Cytotoxicity was measured using 2-fold dilutions of HOCl, NaOCl, and H2O2 as compared to untreated or vehicle-treated control L929 cells. The CT50 was calculated for each test article. The CT50 values for HOCl (15–25 μg/mL) and NaOCl (38–42 μg/mL) were reproducible and closely matched published results for NaOCl.However, the CT50 values for H2O2 were more variable (5–35 μg/mL), probably due to the chemical instability of H2O2 under these assay conditions.

Relative cell toxicity of hypochlorous acid (HOCl; pH 4.0), hypochlorite (OCl−; pH 10.5), and hydrogen peroxide (H2O2; pH 7.0) on L929 cells. Cytotoxicity measured in a cell proliferation assay is expressed as the concentration (μg/mL) . The therapeutic indices for HOCl, NaOCl, and H2O2 were assessed using L929 cells and 3 clinically relevant bacterial strains—E. coli 25922, P. aeruginosa 27853, and S. aureus 29213. Relative therapeutic index of hypochlorous acid (HOCl; pH 4.0), hypochlorite (OCl−; pH 10.5), and hydrogen peroxide (H2O2; pH 7.0). The value for stabilized HOCl is approximately 98-fold higher than that for H2O2 for the gram-negative bacterium E. coli 25922, and more than 1000-fold higher than H2O2 for gram-positive organisms like S. aureus 29213.

Stabilized HOCl is reactive, and therefore is not persistent. To evaluate its potential toxicity, several well-established animal models were used. Stabilized HOCl was found to be nonirritating in (rabbit eye) and non-sensitizing in (guinea pig) animal models. No ocular irritation was observed following the instillation of a development formulation (0.013% HOCl) into the eyes of Dutch pigmented rabbits every 8 hours for 72 hours (data not shown). Stabilized HOCl at concentrations of 0.01%, 0.03%, and 0.10% w/v in a standard Buehler-design dermal sensitization study in guinea pigs showed no evidence of dermal reaction. Similarly, 28-day toxicity studies in full-thickness wounded rats and mini-pigs with daily application of stabilized HOCl at 0.01%, 0.03%, and 0.1% w/v together with a 24-hour occluded dressing showed no evidence of systemic toxicity. Microscopic examination of the wound area showed the expected signs of wounding and subsequent wound repair.

The germicidal properties of HOCl have been well reported. Hypochlorous acid is widely used as a disinfectant, for example, in sanitizing wash solutions and swimming pools. In these applications, the reactive chemical is formed in solution by the addition of chlorine to water. Similarly, HOCl is used to treat drinking water and is formed following addition of chlorine gas or NaOCl. Between pH levels of 3 and 6, the predominant species is HOCl. At higher pH, hypochlorite ion (OCl−) is formed, whereas at lower pH, the solution exists as a mixture of chlorine (Cl2) in solution, chlorine gas in the headspace, and HOCl. The control of this reaction has been utilized in industrial practices to optimize the availability of the active antimicrobial, HOCl.
Stabilized HOCl is a dilute solution of HOCl in 150 mM (0.9%) sodium chloride at an unbuffered pH of 3.5. The solution is stored in inert sealed containers designed for maximum product stability. In a pH range of 3 to 6 the predominant species is HOCl. At pH values greater than 5.5, hypochlorite ion (OCl−) is formed, and around pH 7.5 (the pKa of HOCl of the chlorine species in solution is at 50/50% mixture [HOCl/OCl−]). As the pH increases from 9.5, the concentration of OCl− in solution reaches its maximum level, becoming 100% hypochlorite (also referred to as bleach). However, on the acidic side at pH less than 4, the solution exists as a mixture of chlorine (Cl2) in aqueous phase, chlorine gas in the headspace, trichloride (Cl3−), and HOCl. At pH less than 3, an appreciable amount of Cl2 gas forms, which may cause the rapid loss of all active chlorine in an open container. To keep the solution stable and maintain its desired activity, the pH of the solution should remain between 5 and 5.5 and the solution should be stored in a tightly sealed container. For the first time, we have been able to determine these conditions to stabilize HOCl and to assess its biological properties as a pharmaceutical product.

The biological effect of HOCl on bacteria has been extensively studied. HOCl has broad-spectrum antimicrobial activity and is able to kill microorganisms very rapidly. Respiratory loss in bacterial cell membrane as a result of an irreversible reaction of HOCl with sulfur- and heme-containing membrane enzymes and structural proteins lead to cell death and non-viability.

Topical antiseptics with a long history of use, such as NaOCl (Dakins’ solution), hydrogen peroxide, acetic acid, and povidone-iodine remain in widespread use today. These antimicrobial agents used at typical concentrations are cytotoxic and impede wound healing, and so are now discouraged by some experts for use on chronic ulcers. Stabilized HOCL is a low-concentration, acidified, unbuffered solution of HOCl in saline. Under the conditions of the formulation, the active ingredient is primarily HOCl in equilibrium with a small amount of dissolved chlorine. The studies presented here have shown that stabilized HOCl exhibits rapid, concentration-dependent activity against a wide variety of gram-negative and gram-positive bacteria, yeast, and fungal pathogens, as long as the narrow effective pH range is maintained. In vivo, HOCl is produced intracellularly in abundance in response to phagocytosis of pathogens by neutrophils and plays an important role in the destruction of pathogens.

HOCl, the active ingredient has rapid and broad-spectrum antimicrobial activity against clinically relevant microorganisms in vitro and in vivo. Although vegetative bacteria are more susceptible to HOCL than endospore-forming bacteria and fungi, HOCL is fully capable of inactivating all groups of gram-negative and gram-positive bacteria, yeast, and fungi, including S. aureus, methicillin-resistant S. aureus, vancomycin-resistant E. faecium and Bacillis anthracis spores . HOCL has been shown to be nonirritating and non-sensitizing in animal models. There was no evidence of ocular irritation following a single instillation of NVC-101 in the eyes of New Zealand White rabbits at concentrations of 0.01%, 0.03%, and 0.1% w/v. No ocular irritation was observed following the instillation of a development formulation in the eyes of Dutch pigmented rabbits every 8 hours for 72 hours (data not shown). HOCL at concentrations of 0.01%, 0.03%, and 0.1% w/v in a standard Buehler-design dermal sensitization study in guinea pigs showed no evidence of dermal reaction. The active ingredient is reactive, and therefore is not persistent. Its persistence of antimicrobial properties has not yet been tested in the in vivo wound environment. Thus, absorption and systemic toxicity are expected to be insignificant. Therefore, in the 28-day wound toxicity studies in rats and mini-pigs with daily application of HOCL at 0.01%, 0.03%, and 0.1% w/v, with 24-hour occluded dressing, there was no evidence of systemic toxicity. Furthermore, microscopic examination of the wound area showed the expected signs of wounding and subsequent wound repair.

Heggers and colleagues have investigated the toxic effects of various concentrations of NaOCl (at pH 7.5, this was actually a 50:50 mixture of NaOCl and HOCl) in vitro and in vivo in the rat incision model. Concentrations used in previous studies were often quite high and although they had antimicrobial properties, they also exhibited some local toxicity that was not desirable. Heggers et al. conducted their experiments in the range of concentrations they expected to be active but not toxic to the cells or detrimental to wound healing. The concentrations evaluated were 0.25%, 0.025%, and 0.0125% w/v in the in vitro studies and 0.25% and 0.025% w/v in the in vivo studies. Ten clinical isolates were used in the in vitro studies (both gram-positive and gram-negative species). The bactericidal potential of the 3 concentrations was determined. All concentrations killed gram-positive bacteria within 30 minutes, but the lowest concentration did not kill gram-negative bacteria. Mouse fibroblasts were exposed to various concentrations of NaOCl for 10-, 20-, or 30-minute intervals. These cells remained viable except at the highest concentration, where cell death by 10 minutes was noted. In the incision rat model, 3 (2.5-cm) full-thickness wounds were created on each animal. The incisions were closed and the covered gauze was saturated every 4 hours with the NaOCl or saline. Subsets of animals were sacrificed on days 3, 7, and 14. Tissue sections were collected. Breaking strength was measured (force required to rupture the scar, in kilograms). The values for the breaking strength were higher as a function of duration, but the treated and control groups were not different. This study concluded that the concentration of 0.025% retains its bactericidal property without causing injury to the fibroblast cells.

Dakins’ solution (NaOCl) has been used as an antimicrobial for decades. A study to assess the bactericidal activity and toxicity of 0.5% and 0.1% NaOCl was undertaken. Only the toxicity portion of the study is discussed here. The insult to guinea pig skin was assessed following application of 0.5% solution of NaOCl buffered to a pH of 7.49 for up to 2 weeks (soaked gauze resoaked every 8 hours). The animals were sacrificed on day 1, 4, 7, or 14. The hair was removed from the skin before application but the skin was intact. The application of 0.5% solution resulted in basal cell toxicity (15% decrease in viability after 2 weeks of treatment), and so a lower concentration of 0.1% solution was evaluated (pH 7.4). This lower concentration did not result in toxicity to the basal cells. Control and treated skin sites were similar when the microscopic morphology was evaluated. Epidermal hyperplasia and an inflammatory influx were noted in the treated animals at 2 weeks. The authors concluded that the solutions were therapeutic candidates for thermal injury. It is important to note that at pH 7.4, these solutions will have approximately equimolar quantities of HOCl and NaOCl.

In the present comparative studies, we have demonstrated that H2O2 and hypochlorite (NaOCl) are effective against certain bacteria (more effective against gram negatives, but not gram positives). However, those effective antimicrobial concentration ranges begin to correlate with higher cytotoxicity on mammalian cells, as compared tostabilized HOCL. This antiseptic profile of NaOCl resemble some of the over-the-counter antiseptics: silver nitrates or silver ions, Betadine, and acetic acid (data not shown). Moreover, there are other antiseptics that are less toxic to mammalian cells but at the same time have lower antimicrobial activity (ethanol, hydrogen peroxide, and 5% mafenide acetate solution) as compared toHOCL. The Department of Health and Human Services discourages the use of commonly used antiseptic solutions to treat wound infection in general and chronic nonhealing wounds in particular because, for reasons mentioned above, their uses are contraindicated. Therefore data presented in this study should help in selecting safer antimicrobial agents for wound disinfection, irrigation, and dressing. This reevaluation of accumulated evidence is intended as a basis to help practitioners make informed decisions for choosing the appropriate topical antimicrobial for wound care management.

As the development of bacterial resistance to antibiotics continues and controversy regarding the use of topical antiseptics persists, the need for research and development of new classes of antimicrobial agents that are safe and broadly effective and have low toxicity and low propensity to induce antimicrobial resistance becomes inevitably critical. Currently, the use of broad-spectrum topical antibiotics to treat wounds that are failing to heal or those at risk for getting infected is not recommended by the Department of Health and Human Services. These recommendations are based on the following reasons: antibiotics may cause allergic reactions; especially when applied topically may have lower tissue distribution; greater effect on endogenous microflora (disturbance of the normal commensal microflora); induce resistance; and eventually have reduced therapeutic efficacy. By the same token, antiseptics are not encouraged because of their higher toxicity, potential development of resistance (like antibiotics), and, more important, direct impact on wound healing process.

Efficacy of topical antimicrobial agents in the management of serious infections, for example, biofilm- and catheter-related wounds, particularly when chronic and non-healing, is inconclusive. These observations vary greatly because of (a) inconsistent in vitro test specifications, (b) use of different animal species models, (c) use of different organisms for determining the efficacy outcome. Therefore, overall results make direct comparisons less than ideal. While in vitro testing is required to select potential agents for clinical trials, these models will never totally mimic in vivo conditions. Thus, in light of published results on HOCl and data obtained in the present investigations, there is enough compelling evidence to show that Stabilized HOCl, which resembles the HOCl molecule made by neutrophils during oxidative burst (a natural defense process against invading microorganisms), could lend itself for safe and effective treatment modalities of infection. Because of HOCL’s broad-spectrum, fast-acting antimicrobial activity, the chances of developing resistance would be minimal and based on its safety profile the potential for collateral damage to infected tissues is also very low. Therefore, in vivo experiments in a chronic infected granulating wound model are planned to determine HOCL’s ability to persist in a hostile environment where the pH range may not be ideal and where inflammation may produce exudates that limit its use as a wound care agent.

This article has been compiled from published articles which has been cited by other articles (public domain)

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Defining the ideal disinfectant against microorganisms and the development to create this superior environmental friendly disinfectant.

September 15, 2013


An ideal disinfectant should posses high bactericidal activity, long shelf life, be ready for use without any preliminary activation and utilized after use without negative effect to the environment. Long storing of stable chemicals is available, but their utilization requires equivalent activation by another agent or energy. Therefore, combination of stability and easy utilization is impossible.

In order to exclude the preliminary activation stage before usage of a liquid chemical germicide, it should be noted that all variety of biocidal agents are belong to few classes of chemicals well-known for tens of years.

Appearance of new class of chemicals, which will meet the requirement, is unlikely. Modern tendency in developing new disinfectants is in search for activation means of known disinfectants, and not the creation of new ones. Addition of activators using an extra physical influence, i.e. creating conditions converting active ingredients into metastable state at the moment of disinfection, is one of main directions for the disinfection efficacy improvement.

Interaction disinfectants and microorganisms’ cell membrane.

Due to complexity and multi-functionality of microorganisms’ membrane specific interaction between membrane’s biopolymers and abovementioned chemicals is hardly studied at all.

Cytoplasmic membrane is extremely vitally important structure of any cells including microbes. Organic compounds are part of it and have many reactive groups that cause a high sensitiveness of membrane to damaging factors of different nature. It is known that high concentration of membrane-attacking agents destroy biopolymers of membrane, resulting in damaging lysis of microbe’s cell. The same chemicals in small doses affect membrane functions – change osmotic pressure, permeability, transport processes of molecules and ions through membrane, inhibit metabolic processes, bio-oxidation and cell divisions.

Cationic surfactants (quarternary ammonium compounds) are concentrated at membrane and bind with phosphatidic groups of its lipids; anionic surfactants such as alkaline detergents, alkyl- and arylsulfones, iodophors react with membrane lipids. Phenols and alcohols dissolve lipid’s fragments of membrane.

After disinfection treatment is completed, the moist surfaces get dry, so organic compounds are concentrated in a volume of porous material and turn into superfine and invisible to the eye film. Then it evaporates by sublimation with less intensity than under evaporation during wet treatment. Formed aerosol frequently has no smell that creates illusions of its harmlessness. One should take into account that in accordance with known physical laws each liter of the air in the room contains about some milliards of molecules of matter vaporized with natural course or due to sublimation even if its concentration could be hardly measured and does not exceed hundreds or thousands parts from maximum permissible concentration (MPC). During breathing as well as through the skin and mucous membrane such molecules penetrate to human organism (patients or medical staff) and each one of it keeps realizing its main function – suppression of vital function of cells, but this time in a human body. Stability of liquid chemical germicides creates their accumulation in organism followed by migration through digestive cycle.

Colonies of microorganisms form resistance to dry inefficient disinfectant and start using it as a nutrient medium. Processes as described above have recently become an object of attention; so it is in a stage of study now.

It is quite evident that the development of new liquid chemical germicides which allow bacteria to develop resistance in a short period of time, creates conditions for improvement of mutability mechanism of pathogens and initiates appearance of new isolates of microorganisms.

Today by efficacy of disinfectants is implied its spectrum of biocidal activity. Efficacy also relates to exposure time required for disinfection. However, taking a broad view on the subject we should say that disinfectant is effective only in the case it has a broad spectrum of biocidal activity and does not stimulate microorganism’s adaptation during a long-term use. In other words, effective disinfectant must be used for years with certainty that microorganisms could not form adaptation to it for principal reasons.

Mechanism of Antibacterial defence

Let us consider a mechanism of antibacterial defense created by nature and functions in internal environment of life organisms – from unicellular organisms up to human – over million of years and without any fail.

It is proved that leading role in bactericidal effect of neutrophils belongs to hypochlorous acid (HOCL) made by phagocytes. Under respiratory burst about 28% of oxygen used by neutrophils is spent for formation of HOCL. HOCL is generated from hydrogen peroxide and chloride-ions in neutrophils. Catalyst of this reaction is myeloperoxidase (MPO):

H2O2 + Cl [Cat (МPО)] HOCL + OH [9, 10].

Hypochlorous acid dissociates in aqueous media with formation of hypochlorite-anion and hydrogen-ion:

HOCL ClO + Н+.

Concentrations of HOCL and hypochlorite-anions ClO are almost equal at neutral pH. A decrease in pH shifts reaction balance towards to HOCL, and an increase of pH raises concentration of hypochlorite-anions.

A formation of H2O2 and HOCL in a short time (fractions of a second) in a little volume of aqueous media (parts of microliter, in a volume of active zone of phagocytosis) – inevitably must be followed by reactions of spontaneous decomposition and interaction of reaction products with formation of active particles similar to once formed by radiolysis or electrolysis of water.

Spontaneous decomposition of hydrogen peroxide in aqueous media is followed by formation of highly active biocides (in parenthesis appropriate reactions are presented):

HO2 – hydroperoxide-anion (H2O2 + OH HO2 + H2O);

О22 – peroxide-anion (OH + HO2 O22 + H2O);

О2 – superoxide-anion (O22 + H2O2 O2 + OH + OH );

НО2 – hydrogen peroxide radical (НO + H2O2 H2O + HO2);

HO2 – hydrogen super-oxide (O2 + H2O HO2 + OH).

At the same time it is possible the formation of extremely reactive singlet oxygen 1О2 : (ClO + H2O2 1О2 + H2O + Cl ). Participation of molecular oxygen ion-radical О2 in reactions of phagocytosis is determined experimentally. One of the described above could be the way of its formation.

Formation of free radicals СlO, Сl, НО is possible in aqueous media in presence of НСlО and СlO

HOCL + ClO ClO + Cl + НO.

By modern theory of catalytic processes, a formation of interim activated complex with myeloperoxidase as a catalyst seems also to be most possivle. A dissociation of this complex is followed by formation of О , and medium acidification:

HOCL + ClO [HOCL Cat (МПО) ClO ] 2Сl + 2O + Н+

Active hypochlorite radical СlO can participate in reactions of atomic oxygen (O ) and hydroxyl radical (НO ) formation:

СlO + СlO + ОН Сl + 2O + ОН.

Followed by formation of chlorine radicals:

OH + Cl Cl + OH.

Formed radicals and atomic oxygen take part in microbe’s destruction, oxidizing biopolymers, for example, by the following:

RH2 + OH RH + H2O;

RH2 + Cl RH + HCl;

RH2 + O RH + OH .

A metastable mixture of compounds formed during phagocytosis is a very effective mean for microbe’s destruction due to many spontaneous realized possibilities of changing (irreversible damage) of essential functions of microorganism’s biopolymers at a level of electron transmission. Metastable particles with different values of electrochemical potential possess universal spectrum of action, i.e. they are able to damage all large systematic groups of microorganisms (bacteria, mycobacteria, viruses, funguses, spores) and without damaging of human tissues and other multicellular system organisms.

That can be explained by texture and living activities of cells of that living organisms. Cells of multicellular organisms during their life process, for example, in oxygenase’s reactions of cytochrome P-450, during phagocytosis under microbe’s adhesion and cidal action produce a range of highly efficient oxidants. These cells have a strong chemical system of antioxidant protection with preventing a toxic effect of such compounds on vitally important cellular structures. Antioxidant properties of somatic cells are related to a presence of a strong three-layered lipoprotein’s shell that contains diene conjugates (–С=С–) possessing electron-donor properties and sulfhydric groups (SH). Microorganisms do not have strong mechanisms of antioxidant protection due to absence of mentioned chemical groups.

All somatic cells of living organisms are heterotrophs: their trophism depends on availability of nutritive materials in extracellular medium – glucose, amino acids, fatty acids. Though biological well-being of any somatic cell is up to place it keeps in a process of dispensing of trophic functions of all elements of multicellular system (cell is supported by cell).

Trophic functions of multicellular organisms cells are obeyed to interchangeability law. If a trophism of single cell is disturbed, then this disturbance can be corrected by neurotrophic regulation, functions of adjoining cells, reparative processes, nutritive function of blood and so on.

All microbe’s cells are autotrophs, so their nutrition depends on their own activity, in other words if enzymatic processes in microbe’s cell are depressed, it dies since there is no compensatory mechanism. Microbial cell gets all its trophic functions by enzymatic reactions only. An interaction between microbial cells in their habitat is not a compensatory one, that is to say susceptibility of microbe is in its autonomy.

Natural production of HOCL

Investigations carried out in recent decades indicate that all higher multi-cellular organisms including humans synthesize hypochlorous acid and highly-active meta-stable chlorine-oxygen and hydroperoxide compounds (a meta-stable oxidants’ mixture) in special cellular structures to combat microorganisms and foreign substances. Hypochlorous acid dissociates in aqueous medium forming hypochlorite-anion and hydrogen ion: НOСl OCl + Н+. When рН values are close to neutral, concentrations of НOСl and hypochlorite-anions OCl are approximately equal. Lower рН leads to shift of this reaction equilibrium towards higher concentration of НOСl; higher — towards higher concentration of hypochlorite-anions. Sodium hypochlorite demonstrates a considerably lower bactericidal ability than hypochlorous acid.

The highest bactericidal effect of oxygen chlorine compounds is observed with рН varying from 7.0 to 7.6, where concentrations of hypochlorite-ions and hypochlorous acid are comparable. This is due to the fact that the above compounds being conjugated acid and base (НOCl + Н2О + Н3О+ + OCl; OCl + Н2О + НOСl + ОН) form in the given range a meta-stable system capable of generating a number of compounds and particles possessing a much higher antimicrobial ability than hypochlorous acid: 1O2 — singlet molecular oxygen; СlO — hypochlorite-radical; Сl• — chlorine-radical (atomic chlorine); О — atomic oxygen; ОН — hydroxyl radical. Catalysts of reactions with chlorine-oxygen compounds are Н+ and ОНions present in water also in approximately equal quantity at рН value close to neutral one.

Chemical production of HOCL

A unique ability of hypochlorous acid to form meta-stable, universal in its scope of antimicrobial action oxidant mixture is widely employed in many disinfectant agents based on cyanuric acid salts (Aquatabs, Deochlor, Chlorsept, Presept, Javelion, Chlor-Clean, Sanival and others) making it possible to decrease active chlorine content in disinfectant working solutions at least 10-fold as compared to sodium hypochlorite solutions, antimicrobial activity of the former being higher. Let us take the mechanism of action of Johnson & Johnson’s Presept tablets as an example. The active ingredient is hypochlorous acid formed in the process of sodium dichloroisocyanurate interaction with water at a рН value of 6.2, maintained by adipic acid contained in the tablets.

However, the use of mentioned disinfectant agents based on cyanuric acid salts is unsafe for human and other warm-blooded organisms since it contain a chlorine organic compound, in particular, sodium dichloroisocyanurate, which, unlike inorganic chlorine-oxygen compounds, does not disappear leaving no traces during desiccation, but accumulates in the environment and human body.

The most efficient antimicrobial agents among all generally known liquid sterilizing and disinfectant means, which demonstrate very low toxicity or no toxicity at all for warm-blooded animals, are electrochemically activated solutions, in particular Neutral electrolyzed Water.

Electrochemical activated HOCL

Maximum use of fundamental difference between living organisms of micro- and macro-biological life is an ideological basis of electrochemical activated biocidal liquids.

As physicochemical process electrochemical activation is an electrophysical and electrochemical influence on water that contains ions and molecules of dissolved substances in it. It takes place under conditions of minimal heat release in the area of dimensional charge at the electrode surface (anode or cathode) of electrochemical system at non-equilibrium charge transfer through the interface “electrode – electrolyte” by electrons.

As a result of electrochemical activation water converts into a metastable (activated) condition showing increased reactivity in different physical-chemical processes during some tens hours. Electrochemical activation allows directly change a composition of dissolved gases, acid-base and redox characteristics of water within the bigger scale then under the equivalent chemical regulation. Chemical reagents (oxidants or reducing agents) in metastable condition can be generated from water and dissolved substances. It is used in processes of water purification and disinfection as well as for water or diluted electrolyte solution transformation into ecologically friendly biocidal (disinfecting/sterilizing solution), cleaning, extractive and other functionally useful liquids.

An Electrolytic Flow Cell is used for electrochemical transformation of water and dissolved substances. A distinctive feature of a Flow Cell is in combination of properties of ideal displacement reactor and ideal mixing reactor in one element as well as high technical and economic characteristics at processing of fresh water and low-mineralized liquids.

Very seldom electrochemically activated solutions (Electrolyzed Water or Super-Oxidized Water) is identified with hypochlorous acid. This is due to inadequate awareness and natural tendency to simplify comprehension by classifying electrochemically activated solutions to well-known hypochlorite ones on the basis of their formal resemblance.

Neutral Electrolyzed Water, unlike 0.5-5.0% hypochlorite solutions possessing only disinfectant ability, is a sterilizing solution at oxidant concentration 0.005 to 0.05%.(5-500ppm)

Benefits of Electrochemical activated HOCL

Active ingredients of Electrochemical activated HOCL (Neutral Electrolyzed Water) are chlorine-oxygen compounds НOСl (hypochlorous acid) and OCl (hypochlorite-ion).

The combination of active these active chlorine-oxygen substances avoid that microorganisms adapt or become resistant to Neutral Electrolyzed Water, while low total concentration of chlorine-oxygen compounds guarantee absolute safety for man and the environment in the process of its long-term application.

In other words, a mixture of metastable chlorine-oxygen compounds eliminates microbes’ ability for adaptation to bactericidal effect of Neutral Electrolyzed Water. Thus, only a small concentration of chlorine-oxygen compounds guarantees for absolute safety for man and environment under long-term use of Electrolyzed Water.

Neutral Electrolyzed Water is considered non-toxic due to low content of active substances HOCL and OCL, therefore there is no need to remove it from treated surfaces after treatment.

Total content of active chlorine-oxygen compounds in Neutral Electrolyzed Water oxidant content varies from 50 to 500ppm which is many times lower than in most working solutions of disinfectants routinely used today. Neutral Electrolyzed Water causes no coagulation of protein protecting microorganisms and thanks to its loose structure easily penetrates into micro-channels of living and nonliving matter.

Environmentally friendly electrochemically-activated Neutral Electrolyzed Water has “life time” that is necessary for procedure of disinfection. After its use it spontaneously degrades without formation of toxic xenobiotics and does not require any neutralization before discharging to sewerage.

A chemical potential of molecules and ions in Neutral Electrolyzed Water is much higher than in hypochlorite solutions. A low mineralization of Neutral Electrolyzed Water and its hydration ability helps penetration through cell membrane, creates conditions for intensive osmotic and electro-osmotic oxidant’s transfer into intracellular media. The osmotic transfer of oxidants through shells and membranes of microbe’s cells is more intensive than through membranes of somatic cells due to inherent difference in osmotic gradient of these types of cells. Electrically charged cluster structures formed by dissolved gas molecules in water and electron-active components of medium promote high-speed electro-osmotic carry of oxidants into bacterial cell, because this clusters produce strong local electric fields with high heterogeneity in zones of contact with biopolymers.

Neutral Electrolyzed Water kills microorganisms of bacterial, viral and fungous etiology (Staphylococcus aureus, Pseudumonas aeruginosa, Escherichia coli, hepatitis B virus, poliomyelitis virus, HIV, adenovirus, pathogens of tuberculosis, salmonellosis, dermatomycosis and others). By its efficacy Electrolyzed Water greatly exceeds chloramines, sodium hypochlorite and overwhelming majority of other disinfectants and sterilizing agents.

A sum of active chlorine-oxygen compounds in Neutral Electrolyzed Water (total oxidant content) is within 50 to 500 mg/l, that is many times less than in most solutions of currently used disinfectants. Neutral Electrolyzed Water does not cause coagulation of protein that protects microorganisms and, due to its loosened structure, easily penetrate into pinholes of living and lifeless matter.

Neutral Electrolyzed Water is produced from dilute solution of sodium chloride in drinking water. Total mineralization of initial solution for Neutral Electrolyzed Water is within 0,5 to 5,0 g/l.


To sum up, it can be concluded that the most effective disinfecting liquid in terms of their functional properties and simultaneously very low-toxicity is Neutral Electrolyzed Water (meta-stable low-mineralized chlorine-oxygen antimicrobial solutions), which have no alternative as long as life on Earth is represented by various forms of protein bodies existing in electrolyte of aqueous solutions of mainly sodium and chlorine ions.


September 8, 2013


There is an epidemic of healthcare acquired infections within hospitals, out-patient surgical centers, nursing homes and medical clinics. The number of hospital acquired infections alone is staggering. About 1 in every 15 patients get an infection while hospitalized and up to 98,000 Americans die from these infections each year. That makes infections the most common complication in hospital care and one of the nation’s top 10 causes of death. In California, an estimated 200,000 patients develop hospital infections each year, resulting in 12,000 deaths.

The problem is much larger than official statisitcs because the numbers fail to account for millions of patients treated in outpatient surgery centers, community clinics, nursing homes and other care facilities.

About six and one half percent of patients admitted to US hospitals—nearly 5,500 daily, or two million annually—get sick from a hospital-acquired infection. This adds 19 days of hospitalization and $43,000 in costs totaling more than $45 billion a year to U.S. medical bills

Under the new Affordable Healthcare Law consumers will be able to learn hospital infection rates. Hospital Infection rate information will be posted on a Department Health and Human Services website called Hospital Compare. This new reporting requirements applies to hospitals that participate in Medicare and Medicaid programs which are virtually every hospital in the country. Beginning in October 2012, Medicare payments to hospitals will be tied to how well they protect patients from these infections. Hospitals with infection rates exceeding national averages will lose 1 percent of their Medicare funding, starting in 2015. This is a huge dollar amount considering the federal government spent $563 billion last year on 49 million recipients and Medicare spending is expected to grow to $970 billion by 2021.

II        MARKET

Hospital Cleaning is the removal of all dust, oil, and organic materials such as blood, secretions, excretions and microorganisms. Cleaning reduces or eliminates the populations of potential pathogenic organisms. It is accomplished with water, detergents and mechanical action. Hospital Disinfection is the inactivation of disease producing organisms. Disinfection does not destroy high levels of bacterial spores. Disinfectants are used on inanimate objects. Disinfection usually involves chemicals, heat or ultraviolet light. Levels of chemical disinfection vary with the type of product used.

 There are three types of cleaning and disinfection markets within hospitals and healthcare facilities. These are critical, semi-critical and non-critical.

A.        Critical Applications

Medical devices and items that represent a high risk for infection if they are contaminated with any microorganism. Objects that enter sterile tissue or the vascular system must be sterile because any microbial contamination could transmit disease. Critical cleaning and disinfection includes surgical instruments, cardiac and urinary catheters, implants, and ultrasound probes used in sterile body cavities. These items are to be sterilized with steam if possible. Heat-sensitive objects can be treated with EtO, hydrogen peroxide gas plasma; or if other methods are unsuitable, by liquid chemical sterilants.

B.         Semi-Critical Application

Devices to include vaginal-rectal ultrasound probes, endoscopes, laryngoscope blades, cystoscopes, esophageal manometry probes, anorectal manometry catheters, respiratory/anesthesia equipment, all GI scopes, transesophageal echocardiogram probes and rhinoscopes. Medical devices and equipment that contact mucous membranes or non-intact skin minimally require high-level disinfection.

C.        Non-Critical Applications

Devices are those that come in contact with intact skin but not mucous membranes.  Intact skin acts as an effective barrier to most microorganisms; therefore, the sterility of items coming in contact with intact skin is “not critical.”  Non-critical items are divided into non-critical patient care items and non-critical environmental surfaces.  Non-critical patient-care items are bedpans, blood pressure cuffs, crutches and computers.


 A segment within the non-critical environmental surfaces market is Terminal Room Cleaning. Terminal Room Cleaning means a thorough cleaning of a patient room after being discharged. The concept is to eliminate the residual bacteria left in a “contaminated room” whether it is a hospital room, OR room, ER room, nursing home room or any room in which another patient can potentially come into contact. The potential market of Terminal Room Cleaning is huge. For example, there are 35,000,000 patient “discharges” per year in more than 7000 hospitals and 15,000 outpatient surgery centers.

Transmission of many healthcare acquired infections are related to contamination of patient surfaces, in-room equipment, high touch surfaces with patient rooms.

Patients shed microorganisms into their environment by coughing, sneezing or having diarrhea. Bacteria and viruses can survive for weeks or months on dry surfaces in a patient environment. When another patient, doctor, nurse or visitor, touches that surface the microorganisms are transmitted throughout the hospital. The following are example of “at-risk” patient environments.

  1. Acute Care, the patient environment is the area inside the curtain, including all items and equipment used in his/her care, as well as the bathroom that the patient uses.
  2. Intensive Care Units (ICUs), the patient environment is the room or bed space and items and equipment inside the room or bed space.
  3. Nursery/Neonatal setting, the patient environment is the bassinet and equipment outside the bassinet that is used for the infant.
  4. Ambulatory Care, the patient environment is the immediate vicinity of the examination or treatment table or chair and waiting areas.
  5. Long-term care, the resident environment includes their individual environment (e.g., bed space, bathroom) and personal mobility devices (e.g., wheelchair, walker).

Terminal Room cleaning is performed by the Environmental Services Staff. The cleaning includes emptying trash and removing any loose items, changing bed linen, wiping the mattress with a disinfectant, washing walls with detergent, cleaning bathroom sink and toilet with a disinfectant, wiping all bed rails, tables, light switches, door handles, telephone, call buttons, privacy curtain and other “high touch” items with a disinfectant then mop the floor with a detergent cleaner and disinfectant. Once the Environmental Staff completes the terminal room cleaning, the Environmental Service Supervisor inspects the room. The Supervisor will look for any visible dirt, blood, secretions, etc. They will also use a bio-luminescence meter to measure bacterial contamination. If the Environmental Service Supervisor rejects a room, the entire room is re-clean and disinfected.


In the US the average time from patient discharge to another patient occupying the same room is 27 minutes. The work required (as noted above) by the Environmental Service Staff to terminally clean the discharged patient room in the 27-minute timeframe is almost impossible. This creates extreme pressure and stress on the Environmental Service Staff resulting in poor cleaning and very high job turnover. Other factors contributing to poor cleaning and high turnover is the use of toxic and corrosive detergents and disinfectants. To improve cleaning performance, stronger and more toxic chemicals are required. However, these chemicals slow down cleaning time. The Staff must be more careful in handling these chemicals, adding a rinse step and allow time for the room to dry and “air out”.

Using stronger and more toxic cleaning and disinfecting chemicals does not always provide the level of disinfecting required by hospital guidelines. The over prescribed use of antibiotics have created “super-bugs”. These “super-bugs” can develop a resistance to disinfectants. There are sixteen hospital identified “super-bugs”. A few of these are MRSA (methicillan resistant staphylococcus aureaus), C. diff (clostridium difficle), VRE (vancomycin resistant enterococci) and acinetobactor baumannii.

To reduce the human factor in terminal room cleaning and eliminate the chemical resistance of “super-bugs” new technologies have been developed and are currently marketed. One new technology is called VHP (vaporize hydrogen peroxide). VHP meets and exceeds hospital guidelines for environmental surface disinfection.  The guideline for hospital cleaning was developed by HICPAC (Hospital Infection Control Procedures Advisory Committee). This committee is Infection Control doctors and researchers within the medical community specializing in Non-Critical Environmental surface disinfection. The level of surface disinfection for terminal room cleaning is called 6-log reduction. 6-log cleanliness is basically a sterile surface. VHP provides 6-log surface cleanliness but requires 4 hours to clean, disinfect and “air out” the room. In addition the Vaporized Hydrogen Peroxide equipment cost more than $200,000 and requires a company representative located full-time at the hospital to operate the equipment.

Another new technology for terminal room cleaning is UV-C light. UV light has been used for surface disinfection for many years. Used properly UV-C can provide a 6-log level of disinfection. However, UV-C is difficult to use because the light must be directed at an exact angle to the surface, the light requires a long contact time and the light must be checked regularly to insure the proper wavelength. A properly cleaned and disinfected room using UV-C equipment takes more than 90 minutes.

These technologies and others meet the HICPAC cleaning guidelines for terminal room cleaning but they do not come close to the time requirements for most hospitals. Electrolyzed Water is the only new technology that can provide 6-log disinfection within the 27-minute time requirement. In addition electrolyzed water is non-toxic, requires no chemical storage, mixing, dries faster and does not require Staff to wear protective clothing. Electrolyzed water can eliminate the pressure and stress of the Environmental Service Staff reducing turnover. It has no odor or chemical residue that can cause patient sensitivities.

After years of working in hospitals with Environmental Service and Infection Control Professionals, the most important cleaning solution proved to be electrolyzed alkaline water. Alkaline water’s cleaning performance is due to its alkalinity and very negative ORP (oxidation-reduction potential). The more negative the solution the greater cleaning power and faster drying properties. Electrolyzed Alkaline Water’s negative ORP has a very short shelf life. It is usually less than 1 hour in an open container exposed to air.  The key for electrolyzed water technology’s acceptance in hospitals is making the Environmental Service Staff job easier, safer and less pressure. As a result, electrolyzed water must be a direct replacement to detergents and work in their cleaning process. For example, the Environmental Service Staff at the start of their shift fill an open container with a detergent solution and add 8 to 10 micro-fiber mop heads. One mop head per room is used to mop walls and floors. As the staff changes mop heads and agitates the solution, the ORP of ordinary electrolyzed alkaline water is quickly lost. However, a patent-pending product enhancement (enhanced alkaline water) preserves the negative ORP and actually continues the electrolysis process maintaining the alkaline water above pH11. The product will keep the alkaline water’s pH and ORP for at least 1 day. Enhanced alkaline water can be used into the mop head containers, spray bottles or other applicators. The product will maintain negative ORP with the addition of dyes, surfactants or other cleaning aids.

Once surfaces are cleaned with alkaline water, the surface has a negative charge. At this point, the electrolyzed acidic water disinfectant can be applied with an electrostatic spray device. This device will put a 5 to 10 mil coating on every surface within the room. Electrostatic sprayers can reach every side of a surface even if the sprayer is not pointed directly at the surface. Electrostatic spraying of a patient room takes less than 3 minutes. This technique enables the Environmental Surface Staff to take more time cleaning with the alkaline water and still finish under the 27-minute time requirement.

Electrolyzed Water technology and application equipment can reduce a hospital’s overall chemical costs, cut Environmental Service labor requirements and reduce the hospital liability insurance premiums. This is proven technology that has been used in Japanese hospitals for more than 20 years. In Japan electrolyzed water technology has reduce healthcare acquired infections to less than 2%.

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EPA approves HOCL as high level disinfectant

August 28, 2013

The U.S. Environmental Protection Agency (the “EPA”) approved an HOCL disinfecting solution, marketed under two brand names. This new EPA-approved label incorporates kill claims for certain high risk pathogens that pose a significant risk in healthcare facilities and pathogens that present significant problems in produce, livestock and food processing facilities that are inspected by the U.S. Department of Agriculture (the “USDA”).

The new kill claims that relate to healthcare facilities include Klebsiella pneumonia carbapenemase (KPC) and New Delhi Metallo-Beta Lactamase (NDM), Clostridium difficile spores (C. diff), Mycobacterium bovis (Tuberculosis), Vancomycin Resistant Enterococcus (VRE) and Human Immunodeficiency Virus (HIV).

KPC and NDM, the two most common types of carbapenem-resistant Enterobacteriaceae (CRE), were recently cited in a Centers for Disease Control and Prevention (the “CDC”) Health Advisory, due to each bacteria’s high level of drug resistance, the mortality rate for humans that become infected with the bacteria and the increase in cases involving each bacteria (see the CDC Health Advisory at C. diff is also a major problem for healthcare facilities due to its resistance to multiple antibiotics and, in its spore form, its resistance to routine disinfection products.

Both CRE and C. diff are hospital-acquired infections (HAIs) that most commonly occur in healthcare settings in patients who are receiving treatment for other conditions and who are taking long courses of certain antibiotics. The rates of infection for both CRE and C. diff increase in direct proportion to the length of a patient’s stay at a healthcare facility. Since CRE bacteria and C. diff are highly resistant to multiple drugs, preventing the spread of those bacteria has become a focal point requiring healthcare providers to establish new disinfecting protocols that incorporate the use of effective disinfectants such as HOCL.

The new kill claims related to USDA inspected produce, livestock and food processing facilities (fruits and vegetables, meat and poultry, and dairy and egg farms and processing facilities) inspected by the USDA include Listeria and E. coli. Both Listeria and E. coli continue to be prevalent pathogens causing food poisoning in humans. The amended EPA-approved label related to Listeria and E. coli permits HOCL to be applied on surfaces without requiring a rinse and also permits HOCL to be applied as a sanitizer. When used as a sanitizer, HOCL can be diluted to a lower concentration. Both the no rinse and sanitizer permitted uses are very important in agriculture, livestock and food processing facilities where larger volumes of disinfecting and sanitizing solution are required to cover the surface area.

How bleach kills germs

August 27, 2013

Bleach has been killing germs for more than 200 years but it was only since 2008 that U.S. scientists figured out how the cleaner does its dirty work.

It seems that hypochlorous acid, the active ingredient in bleach, attacks proteins in bacteria, causing them to clump up much like an egg that has been boiled, a team at the University of Michigan reported in the journal Cell on Thursday.

The discovery, which may better explain how humans fight off infections, came quite by accident.

“As so often happens in science, we did not set out to address this question,” Ursula Jakob, who led the team, said in a statement.

The researchers had been studying a bacterial protein called heat shock protein 33, which is a kind of molecular chaperon that becomes active when cells are in distress, for example from the high temperature of a fever.

In this case, the source of the distress was hypochlorous acid or hypochlorite.

Jakob’s team figured out that bleach and high temperatures have very similar effects on proteins.

When they exposed the bacteria to bleach, the heat shock protein became active in an attempt to protect other proteins in the bacteria from losing their chemical structure, forming clumps that would eventually die off.

“Many of the proteins that hypochlorite attacks are essential for bacterial growth, so inactivating those proteins likely kills the bacteria,” Marianne Ilbert, a postdoctoral fellow in Jakob’s lab, said in a statement.

The researchers said the human immune system produces hypochlorous acid in response to infection but the substance does not kill only the bacterial invaders. It kills human cells too, which may explain how tissue is destroyed in chronic inflammation.

“Hypochlorous acid is an important part of host defense,” Jakob said. “It’s not just something we use on our countertops.”

This post has been posted in 2008. Mentioned Journal article available upon request.

Onsite Generation Of Environmentally Friendly CIP Cleaners And Sanitizers

July 28, 2013

Clean-in-place (CIP) is an important part of many food and beverage processes. The need for thorough cleaning and safe production is paramount, but efficiency is also important to ensure operational costs are minimized and plant run time maximized. In today’s markets, there is an increasing need for more frequent product changeover to meet changing and varied consumer demands. This presents increased production challenges and the time to changeover between products becomes an important criterion for operational efficiency.


An international beverage company faced the challenge of producing an increasing number of difficult-to-clean products (pungent flavors, solid material and increased spoilage potential) at its bottling plants. This was combined with an increasing need to run smaller production runs, requiring more frequent product changeovers which had a significant negative impact on available production time. A keen social ethic to provide sustainable production along with drivers for flexible production and reduced costs led the business to review its CIP processes.


The increased use of more pungent product lines with different flavors and additives across the customer’s sites made equipment more difficult to clean from an organoleptic and microbiological standpoint. Frequent product changes meant a solution was required that would improve the process efficacy, lead to better operational efficiency as well as reduce environmental impact — save energy and water, reduce potentially harmful waste streams and improve conditions and safety for plant personnel.


Electrolyzed cleaning and sanitizing fluids have been shown to maintain or improve cleaning and sanitizing effectiveness within the CIP process. The first step in this project was to go through a rigorous validation process, including microbiological and organoleptic testing, with the customer to prove it safe and effective.

The technology produces a cleaning and/or sanitizing agent through the electrolysis of a solution of sodium chloride or sodium carbonate. The system produces Hypochlorous acid (HOCl), a weak acid but powerful and natural sanitizer also produced by the human body to fight infection. HOCl sanitizes rapidly without the need for heating and, as it is produced from readily available natural materials, offers a highly sustainable sanitation and cleaning solution. The technology uniquely generates fluids at the required concentration with no mixing or dilution required. Without the need to add dilution water, Electrolyzed Water provides superior cleaning and sanitizing as every drop of the solution has been electrolyzed.

Superior cleaning and sanitizing without the need for heating offers reduced cleaning times and increased plant running times. For the beverage company, this is especially critical during seasonal production peaks where maximizing production times is critical to the business. Electrolyzed Water delivers drastically reduced bottle-to-bottle downtime for a traditional full CIP cycle. Typically the time savings is over 50 percent and in many cases, this saves hours per CIP. For product changeover CIP processes, the typical time for Electrolyzed Water is 15 minutes or less — a significant savings compared with the previous technology which took around one hour. This supports the beverage company’s ‘just in time’ production approach, which requires smaller batch runs and more frequent product changeovers.

Continuous production of Electrolyzed Water in large volumes meet the needs of the company’s large facilities. Current systems are fully automated and operators only need to check the salt levels within the system on a weekly basis. Important parameters including fluid concentration are continually monitored and alarms if they fall below acceptable values, shutting down the system to ensure that the Electrolyzed Water produced is within specifications without requiring monitoring by the plant personnel.

Traditional CIP technology uses concentrated chemicals shipped to site which are often applied at elevated temperatures.  Electrolyzed Water is produced on site in volumes to match site demands at any particular time, eliminating waste production and reducing water consumption. Cleaning and sanitizing at ambient temperature reduces the energy consumed for the process and, using just salt and water to create the fluids, both the cleaner and sanitizer are inherently safe and produce a safer, easy-to-handle waste water stream.

For this large beverage company, HOCl has proven to offer superior cleaning and microbiological performance with annual savings of between $50,000 and $120,000 in chemical costs along with an associated $20-50,000 saving in costs for wastewater treatment. The reduced changeover time between products equates to savings between $100,000 and $1 million, depending on the plant production schedule and value assigned to increased plant production line availability.

The on-demand production of cleaning/sanitizing fluid to match the plant’s needs and the improvements in the cleaning process reduce water consumption related to the cleaning and sanitizing processes by an estimated 20-40 percent per year. The use of ambient solutions further reduces maintenance costs associated with the thermal stresses from hot CIP processes. Electrolyzed Water minimizes the impact on the environment with a reduced carbon footprint, reduced water usage and a safe, sustainable production methodology.

Electrolyzed Water systems have delivered significant improvements to plant working conditions. The automation of the system provides a much simpler CIP process. The inherent safety of the fluids, coupled with the ambient temperature application also significantly reduces risks to safety of personnel, who no longer need to be concerned about chemical vapors, risk of caustic burns or hot machinery surfaces during CIP cycles. The value of personnel safety is sometimes difficult to evaluate in monetary terms but is surely one of the most important benefits of the system.

Electrolyzed Water eradicates hospital water bugs

June 28, 2013

Researchers at Trinity College Dublin (TCD) have developed a new system that eradicates bacterial contamination in hospital water tanks, distribution systems and taps.

They say the new system is highly effective and inexpensive, and could be used throughout the hospital service.

Water contamination was linked to the deaths recently of three babies in a Belfast maternity hospital from pseudomonas infection.

According to the researchers funded by the the Health Research Board and Dublin Dental University Hospital, hospital wash basin taps and output water are reservoirs of bacteria that can lead to serious consequences for patients.

Prof David Coleman of TCD, principal investigator with the project, said hospital water systems and washbasin taps are frequently contaminated with biofilm containing bacteria including Pseudomonas aeruginosa.

He said at the start of the study, the team measured the amount of bacteria in hot and cold water from the Dental Hospital’s clinic washbasin taps. The predominant bacteria identified were pseudomonas and related species.

The researchers cleaned and disinfected the water system at the hospital and then developed and installed a novel automated water disinfectant system to eradicate miocrobioal contamination on an ongoing basis.

The new system involved treating the water with Hypochlorous Acid (HOCL), an environmentally-friendly disinfectant. Electronic probes constantly monitor the levels of disinfectant in the water and adjust the levels via automated pumps when contamination is found.

The disinfectant is generated by electrochemical activation of a dilute solution using an onsite generator.

Following monitoring over 54 weeks, it was was found that the system virtually eliminated bacteria from taps.

The researchers said their results showed that by systematically destroying bacteria in a hospital’s water distribution network and in the in the supply water, they have devised a consistently effective and safe means of ensuring that hospital water and washbasin taps are no longer reservoirs of contamination that can lead to patient infection.

The HRB/TCD researchers claim their system costs much less than current less efficient water treatment systems and their technology could be adopted in the health service to improve patient safety and reduce running costs.

They have stressed that their new disinfectant system is not harmful for human contact. They are planning to assess the effectiveness of the new system further in a larger hospital as part of their project.

The research is published in the Journal of Hospital Infection.