Identifying and eradicating biofilm (with HOCL)

Steps to eliminate an age-old hazard from the health care environment

June 6, 2018

John Scherberger, FAHE, CHESP

Biofilms serve as protective coatings for microbes to shield them from unfavorable environments.

Biofilms are complex colonies of microorganisms that serve as protective coatings for microbes to shield them from unfavorable environments such as heat, ultraviolet light, cold, disinfectant chemicals and antibacterial drugs used in health care.

The components of biofilm greatly heighten bacteria’s resistance to antibiotics, thus enhancing the longevity and potential harm caused by bacteria.

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It often appears as slime and discoloring that can be seen in sink and floor drains, buildup around leaking faucets and faucet sprayers, unused toilets and floor mop sinks, hoppers found in soiled utility rooms in hospitals and janitors’ closets in commercial buildings. But biofilm is not always easily seen because it is found in many out-of-the-way locations such as air handlers, air conditioning evaporation trays, water cooling towers, and water coolers, features and fountains.

When biofilm is seen and (most often) not seen, bacteria are present and must be treated and approached with caution and concern.

Biofilm and health

Biofilm has existed as long as bacteria have been on the planet. But it wasn’t until the early 1970s that scientists began to understand the major impact biofilm had on human health; and scientists only began to understand the complexity of biofilms in the 1980s and 1990s.

It is not just an annoyance or another nuisance to be casually addressed by environmental services (ES) or facilities departments. It is an ever-present threat to health and the environment.

RESOURCES

• Certified Healthcare Environmental Services Professional
• Certified Healthcare Environmental Services Technician

• Certified Surgical Cleaning Technician

For instance, recent studies and investigations have shown that biofilm has been a major contributing factor in harm caused by improper or incomplete processing of medical devices and implants such as catheters, prosthetic joints and heart valves. Despite standardized processes thought to be effective at sterilizing medical instruments, biofilm is so pervasive and robust that numerous serious patient outcomes have resulted.

Failure to properly reprocess medical instruments to eradicate and remove biofilm during reprocessing of instruments like endoscopes prior to surgical procedures has resulted in infections such as carbapenem-resistant Enterobacteriaceae (CRE) being transferred to patients. As a result, the Centers for Disease Control and Prevention (CDC) established new procedures to ensure biofilm eradication is addressed when endoscopes are processed.

A hospital must be addressed in a universal manner because one area can have an impact upon another — even on other floors or nonintegrated departments. Too often, ES departments are not called upon to address issues found in nonclinical areas of hospitals.

For example, one area not typically addressed by the ES department in its constant pursuit of hygienic patient environments is food service facilities and locations. Biofilm is not only a constant concern as a source of food spoilage, but also food contact and preparation surface contact because, once food contact surfaces become contaminated with biofilm, it is much more difficult to eradicate the exopolysaccharides and bacterial cells of the bacteria.

Eradication and removal

Bacteria communicate and collaborate via chemical interactions for survival. To eradicate and remove bacteria and biofilm from the health care environment, a multidisciplinary and multimodal approach is essential. No one department can succeed and no one department has all the answers.

Biofilm is dangerous to immunocompromised patients. Therefore, removal and eradication must be concentrated and strategically approached.

Multidisciplinary teams must identify potential sites for targeting, which may include hot and cold water supply lines, idle faucets, drains, bathrooms, floors, moist/damp areas, soiled utility rooms, soiled laundry shafts, ice machine drains and dispensing chutes, water fountains, boiler rooms, air vents and many other areas.

Health facilities professionals who are responsible for the hospital environment must recognize that biofilm is not always seen by casual visual inspection and presents a real danger. These disciplines must also recognize that appropriate personal protective equipment (PPE) always should be used when addressing the removal of biofilm as the nature/virulence of a biofilm always must be considered suspect.

Facilities professionals tasked with locating, eradicating and removing biofilm also should be trained and educated regarding why they should look for it, what to look for and how to eradicate and remove biofilm once located.

Often, those responsible for carrying out biofilm removal are just told to “do it” or “get it done” without any specific directions or knowledge. Left to one’s own inventiveness or lack thereof, results are often minimal or even disastrous.

For example, thinking that pouring bleach or a bleach solution down a drain or on a surface will terminate the issue is shortsighted. Biofilm is produced to protect bacteria from harsh environments and disinfectants such as bleach, and antibiotics fall into the definition of a harsh environment.

ES professionals also should recognize that bleach does not clean; rather it is an oxidizer and disinfectant. Hypochlorous acid (HOCl) is an Environmental Protection Agency (EPA)-registered, hospital-grade disinfectant that is as effective as bleach (if not more) in the biofilm-abolition process and is much safer for the environment, metals, staff and PPE. The odor is not noxious and thus safer for all concerned, particularly if removing biofilm from a closed and fresh-air-deprived environment.

Additionally, hospitals are subject to EPA regulations regarding discharge of residual chlorine into wastewater. If an incorrect solution is applied, the possibility exists of exceeding the maximum residual chlorine level into the waste stream.

HOCl is considered a safe alternative to bleach for its disinfecting ability and is safer for personnel to use. However, ES professionals must have a complete understanding of both bleach and HOCl reactivity. With both solutions, there is still the potential for danger if ammonia is present. Both solutions, when mixed with ammonia, are hazardous. Neither HOCl nor sodium hypochlorite should ever be introduced directly into any drain without first flushing the drain with clean water. If ammonia in any form is present, doing so may result in chloramine gas being released, which may cause respiratory distress or death.

Disruption and eradication

Biofilm in the health care environment — as opposed to being present on implants or other implements introduced into a body — must be disrupted through mechanical or physical action.

Once a multidisciplinary and multimodal team has been identified and trained, how the process is implemented is vital. The following actions may be used or adapted by ES professionals:

• If possible, determine the type or identity of the biofilm to be removed to know the best process to implement.
• Discuss what chemical/disinfectant is to be used and how it is to be applied.
• The decision to manually scrub with a brush and a bucket of cleaner/disinfectant is usually one of the first to be considered and dismissed. But, just as in medicine, the guiding principle for removal and eradication of biofilm should be to use the most appropriate and efficient method without disrupting or causing harm to surrounding areas.
• Scrubbing or high-pressure spraying is most often the choice, but must be appropriate to the environment and conditions personnel may encounter. Methods and chemicals will be dictated by accessibility, electrical considerations, the patient care environment and restricted areas such as pharmacies, intensive care units or research labs.
• Steam is also one of the most useful multimodal interventions that can be used in combating biofilm. Two types of steam generators are normally available for health care ES: low-pressure/high temperature electric powered, usually with a self-contained steam chamber that uses manual effort in combination with mechanical action (brushes or microfiber cloths) designed for small spaces; and high-pressure/high-temperature generators that are fully electric or a combination of electric/gas units connected to water supply sources via hoses. These units rely on high-pressure water nozzles to disrupt and remove biofilm. The high temperature of both types of generators dislocates and kills the cells, and the manual or mechanical pressure physically removes the biofilm and most biofilm molecules from surfaces. Again, the environment in which the biofilm is located must be considered.
• The physical removal of the biofilm must be followed by removing any remaining contaminated water from floor, metal or other surfaces lest any bacteria remaining be allowed to repopulate the contact surfaces.
• The previous step should be followed by a clean-water rinse followed by an application of a properly diluted solution of a germicidal agent such as HOCl.

Proper and appropriate PPE must be used and documented. Implementation of the buddy system — especially in closed and potentially dangerous environments — must be followed.

ES professionals must use safe and effective cleaners and disinfectants for cleaning and disinfecting brushes, wipers, buckets, scrapers, mops, steam generators, wet vacuum cleaners and attachments, and clothing/footwear that may have been contaminated. Proper hand washing after completion of the assigned tasks must be followed as well.

Training required

Proper processing of clinical and aesthetic surfaces (cleaning and disinfecting with proper tools that trap and remove bacteria and unseen biofilm) is an essential step toward the goal of a healthy, hygienic patient care environment. Biofilm will never be completely eradicated from the health care environment, but every reasonable effort to prevent its presence and proliferation must be taken.

Formal training of ES and facilities staff regarding the virulence and ubiquitous nature of biofilm must be a priority.

The Association for the Healthcare Environment’s Certified Healthcare Environmental Services Professional, Certified Healthcare Environmental Services Technician and Certified Surgical Cleaning Technician programs are excellent first steps in addressing the importance of proper processes and techniques to address biofilm.

John Scherberger, FAHE, CHESP, is president and founder of Healthcare Risk Mitigation, Spartanburg, S.C. He can be contacted via email at jfscherberger@me.com.

HOCL as an antimicrobial

Topical antimicrobials are frequently used in conjunction with treatment and surgery to prevent and reduce the likelihood of infection. Hypochlorous acid (HOCl) is naturally occurring and its benefits has been well documented. The use and safety of HOCl as an antimicrobial in healthcare settings is supported by available evidence.

In the human body, cells produce hypochlorous acid – which helps destroy bacteria – thus making HOCl a naturally occurring chemical. Hypochlorous acid (HOCl) is a weak acid consisting of reactive oxidizing molecules that include hypochlorous acid and peroxide. This evolutionary response of white blood cells has allowed them to combine hydrogen peroxide and an enzyme known as myeloperoxidase to produce HOCl which safely and effectively eradicates any known pathogen in nature.  HOCl has enabled our biology (i) to eradicate every pathogen by dissociating into different oxidative molecules each with a distinct mode of action and capability to eradicate pathogens (ii) while remaining safe to mammalian cells through the entire biological process and (iii) not promoting the emergence of newly resistant bacteria.

HOCl is a potent antimicrobial capable of eradicating bacteria including antibiotic-resistant strains, viruses, fungi, and spores. For more than 25 years the technology has been used worldwide primarily for the mechanical cleansing and debridement of wounds. “Chlorine-containing biocides are widely used for the decontamination of surfaces, usually in the form of hypochlorite (ClO−), being inexpensive to produce and having proven antimicrobial activity”. Applications of aqueous solutions containing approximately 30-2500 ppm (.003% to 0.25%) HOCl are in a variety of areas including (but not limited to) wound care⁴, as antimicrobial agents⁵, as anti-allergen agents⁶, dental care⁷ and there are also significant applications in water treatments⁸, food sanitization⁹, and hard surface disinfection¹⁰, oil drilling¹¹ and cosmetics¹²

Mode of Action

When water and sodium hypochlorite interact, they produce Na+ and OCl− in an equilibrium with hypochlorous acid (HOCl). Th pH affects the predominance of HOCl or OCl− in solution. As [insert citation paper] states that chlorine exists primarily as hypochlorous acid between pH 4 and 7, as opposed to hypochlorite being the most prevalent above pH 9.

Hypochlorous acid is the active component responsible for bacterial disruption by chlorine-releasing agents (CRAs). It is understood that the OCl− ion has little effect compared to undissolved HOCl.

Hypochlorous acid indiscreetly targets bacteria by chemically linking (or attaching) chlorine atoms to  nucleotide bases that disrupt the function of bacterial DNA, impede metabolic pathways in which cells use enzymes to oxidize nutrients, and release energy, and other membrane-associated activities. At certain concentrations, HOCl eradicates spores and viruses. As a sporicide, HOCl causes the spore coat to detach from the cortex, where further degradation occurs.[e1] According to Springthorpe, “CRAs also possess virucidal activity”. HOCl is an effective virucidal when fogging a confined space. Park et al describes how  “Exposing virus-contaminated carriers of ceramic tile (porous) and stainless steel (nonporous) to 20 to 200 ppm of HOCl solution resulted in ≥99.9% (≥3 log₁₀) reductions of both infectivity and RNA titers of tested viruses within 10 min of exposure time. HOCl fogged in a confined space reduced the infectivity and RNA titers of NV, murine NV, and MS2 on these carriers by at least 99.9% (3 log₁₀), regardless of carrier location and orientation. We conclude that HOCl solution as a liquid or fog is likely to be effective in disinfecting common settings to reduce NV exposures and thereby control virus spread via fomites”

Toxicity

Toxicity, flammability and compatibility of materials should be considered in selecting an appropriate disinfectant. For environmental decontamination applications within habitable spaces, clearly certain biocides are too toxic (e.g., phenolics and glutaraldehyde) or flammable (e.g., alcohols) or have the potential to leave unwanted residues on surfaces (e.g., iodophors). Hypochlorous is not flammable and not known to release harsh chemicals. Hypochlorous acid should not be mixed with ammonia-based products, as chloramines can be released.

EPA Approved Marketing Claims

The Environmental Protection Agency approved marketing claims in 2017 for Lysol’s Daily Cleanser (owned by Reckitt Benckiser), a hypochlorous acid product with the following ingredients, water (99.813%), salt (0.17%), Hypochlorous acid (0.017%). Lysol’s approved marketing claims exhibit it’s product to be gentle with no harsh vapors, safe for babies and pets, and suitable for medical applications.

1. Suitable (for use) as a (peroxide alternative)
2. Breaks Down to Saline Solution
3. (Breathe Easy:) (Fragrance Free) (No Harsh Fumes) (No Harsh Chemicals)
4. Leaves no harsh (chemical) residue
5. No harsh (chemical(s)) (residue) (left) (behind)
6. A (gentle) (mild) way to clean
7. No rinsing (necessary) (required)
8. For use in (newborn) nurseries
9. For use in neonatal nurseries
10. No harm after pet contact with product
11. Fragrance Free, won’t irritate your dog’s nose
12. No harsh fumes to irritate (pet) (dog) noses
13. (Gentle) (Mild) (enough) to use on any washable hard, non-porous surface

Acute Oral Toxicity

A 2-year study by the National Toxicology Program was initiated to determine the potential toxicity and carcinogenicity associated with extended, direct exposure to chlorinated water or indirect chemical exposure through the formation of by-products. This study is cited for its completeness. Water containing 0, 70, 140, or 275 ppm chlorine (based on available atomic chlorine) was given to both female and male rats and mice. Further, water containing 50, 100, or 200 ppm chloramine was administered to rats and mice of both sexes for 2 years as well. The study noted that survival among treated rats and mice was similar to controls. The Environmental Protection Agency used NTP study to develop an oral Reference Dose (RfD) for chlorine. In the EPA’s Rfd report, they clarify that “the term “free chlorine” (free available chlorine, free residual chlorine) refers to the concentrations of elemental chlorine, hypochlorous acid and hypochlorite ion that collectively occur in water.” A No Observed Adverse Effect Level (NOAEL) was identified by the EPA, which states “the NOAEL of 275 ppm (13.6 or 14.4 mg/kg-day for male and female rats, respectively)”. Another hypochlorous acid study was performed that exposed rats to 14 mg/kg-day for up to 12 months (Abdel-Rahman et al. 1984). A NOAEL of 14 mg/kg-day was identified for this study. No mortality was observed. Only minor systemic toxicity was found.

[Insert: HOCl is less that acute toxicity amount]

NTP, 1992. Chlorinated and Chloraminated Water, NTP TR 392

https://www.ncbi.nlm.nih.gov/pubmed/12637967

Respiratory and Inhalation Effects

A 2-year chlorine gas inhalation study with rats showed no evidence of carcinogenicity (CIIT 1993; Wolf et al. 1995).

According to the Environmental Protection Agency an Inhalation Reference concentration (RfC) for chlorite is not recommended at this time.

Pool chlorination has been associated with a risk of developing asthma. However results of pool chlorination causing respiratory symptoms or other health effects are not consistent. Font-Ribera et al suggests that swimming did not increase the risk of asthma or allergic symptoms in British children. However swimming was associated with increased lung function and lower risk of asthma symptoms, especially among children with preexisting respiratory conditions. Goodman et al conducted a meta-analysis that noted that asthma and swimming could only be confirmed in a study of only non-competitive swimmers. The study mentions that it’s too early to draw conclusions between swimming and asthma, since the association isn’t confirmed among non-competitive swimmers. The study also notes, “Asthmatics may be more likely to select swimming because of their condition”.

Jiang-Hua Li et al mentions that chlorination is the most popular method for disinfecting swimming pool water; however, although pathogens are being killed, many toxic compounds, called disinfection by-products (DBPs), are formed. The study, with a rat model concluded that direct irritation of the DBPs to the respiratory tract, eyes and skin because these organs were in direct contacted with the DBPs, the eyes and skin might be the organs that require greater attention for permanent damage, the liver is most likely the most possible target organ of DBPs. Also that training intensity, training frequency and water choking may be the primary factors for lung damage induced by swimming, instead of chlorination.

“Nevertheless, disinfection of swimming-pool water with chlorine is an example of how a very strong oxidant such as HOCl can be tolerated by humans if the concentration is accordingly low. As a result of feeding chlorine gas into the pool water, HOCl is formed (see equation 1) and maintained at a very low concentration equivalent to 0.5 to 1.5 mg Cl2/liter (7.1 to 21.2 μM).”

With enough free chlorine and adequate ventilation to blow away the breakdown products that gas off the pool, the chlorine will break down the ammonia products until nitrogen is all that is left, which gases off the pool.

Nitrogen trichloride is the cause of most of that “swimming pool” smell. It can be highly irritating and is the cause of the lung, eye and throat irritation people experience in poorly ventilated indoor pools.

Ae Dermal Toxicity

Chlorine:

Few animal studies addressed no- or mild-effect levels at exposure times of 10 min to 8 h. No gross or microscopic lung changes occurred in rabbits following a 30-min exposure at 50 ppm (Barrow and Smith 1975). The highest 30-min values resulting in no deaths (LC0) for the rat and rabbit were 547 ppm (Zwart and Woutersen 1988) and 200 ppm (Barrow and Smith 1975), respectively. The 60-min concentrations resulting in no deaths in the rat and mouse were 322 (Zwart and Woutersen 1988) and 150 ppm (O’Neil 1991), respectively. No deaths, but moderate to severe lesions of the respiratory tract and peribronchiolitis, occurred in rats following a 6- h exposure at 9.1 ppm (Jiang et al. 1983).

Thirty-minute LC50 values ranged from 137 ppm in the mouse (Back et al. 1972) to 700 ppm in the rat (Zwart and Woutersen 1988). The 60-min LC50 and LC01 values for the rat were 455 ppm and 288 ppm (Zwart and Woutersen 1988).

Reproductive & Developmental Effects

Chlorine administered in the drinking water or by gavage to rats or mice did not cause reproductive or developmental problems (Druckrey 1968; Abdel-Rahman 1982; Meier et al. 1985; Carlton et al. 1986).

Manufacturing

HOCL can be synthesized through electrolysis of a dilute brine solution:

In the electrolysis process, a brine solution (NaCl + H2O) provides the chloride ion (Cl-) that is reduced (by electricity) to form chlorine gas. This process is done in water, so the chlorine gas produced chemically reacts with water present to produce hypochlorous acid (HOCl), hydrogen ion (H+) and chloride ion (Cl-). The reaction is as follows:

2Cl-      Cl2                                 (electrolysis)
Cl2  +  H2O     HOCl  +  H+  +  Cl-            (hydrolysis)

This process utilizes an electrochemical chambered cell or group of cells that have electric current passed through the aqueous NaCl solution.
OCl-   +   H+       HOCl                       (lowering  pH)

To be continued……

Your HOCL caregiver,

Michel van Schaik,  info@aquaox.net

For more information visit www.aquaox.com

Air Purification in Inhabited Rooms by Spraying or Atomizing Hypochlorites (HOCL).

Author(s) : MASTERMAN, A. T.

Journal article : Journal of Industrial Hygiene and Toxicology 1938 Vol.20 pp.278-88

Abstract : A sodium hypochlorite solution containing sodium chloride was atomized and the rate of progress of the vapour followed by means of a series of Bunsen burners placed at increasing distances from the atomizer. The yellow sodium flame indicated when the vapour reached the burner and also how long it persisted in the neighbourhood. The rates of travel varied in different experiments, but in one experiment quoted, in which the sprayer was worked at 4 1b. per sq. inch air pressure and in which a hypochlorite solution containing 0.05 per cent. available chlorine was used, the spray travelled 20 feet in under two minutes and persisted for over 20 minutes. Experiments were carried out by exposing Petri dishes containing nutrient agar at different parts of a room or factory in which numbers of people were working, and measuring the degree of air purification that occurred following a single spraying by the decrease in the number of colonies developing. In different experiments it was found that the plate count 1-5 hours after spraying might show a reduction of 90 per. cent. on the .initial count. The proportion of active chlorine needed was not determined precisely, though in one experiment a concentration of 0.14 mgm. of active chlorine per cu. ft. appeared to yield satisfactory results. Assuming that the chlorine was in the form of hypochlorous acid gas, this would represent a concentration by volume of one part in six millions. No discomfort was caused to any of the occupants of the room or factories. G. S. Wilson.

Record Number : 19382701336

Descriptor(s) : chlorine, factories, feet, occupational health, purification, sodium chloride, sodium hypochlorite, spraying

Identifier(s) : NaCl

 

EXPERT RECOMMENDATIONS FOR THE USE OF HOCL

ABSTRACT

Wound complications such as infection continue to inflict enormous financial and patient quality-of-life burdens. The traditional practice of using antiseptics and antibiotics to prevent and/or treat infections has been questioned with increasing concerns about the cytoxitity of antiseptics and proliferation of antibiotic resistant bacteria. Solutions of sodium hypochlorite (NaOCl), commonly known as Dakin’s solution, have been used in wound care for 100 years. In the last 15 years, more advanced hypochlorous acid (HOCl) solutions, based on electrochemistry, have emerged as safe and viable wound-cleansing agents and infection treatment adjunct therapies. After developing a literature-based summary of available evidence, a consensus panel of wound care researchers and practitioners met to review the evidence for 1) the antimicrobial effectiveness of HOCl based on in vitro studies, 2) the safety of HOCl solutions, and 3) the effectiveness of HOCl acid in treating different types of infected wounds in various settings and to develop recommendations for its use and application to prevent wound infection and treat infected wounds in the context of accepted wound care algorithms. Each participant gave a short presentation; this was followed by a moderated roundtable discussion with consensus-making regarding conclusions. Based on in vitro studies, the antimicrobial activity of HOCl appears to be comparable to other antiseptics but without cytotoxicity; there is more clinical evidence about its safety and effectiveness. With regard to the resolution of infection and improvement in wound healing by adjunct HOCl use, strong evidence was found for use in diabetic foot wounds; moderate evidence for use in septic surgical wounds; low evidence for venous leg ulcers, wounds of mixed etiology, or chronic wounds; and no evidence for burn wounds. The panel recommended HOCl should be used in addition to tissue management, infection, moisture imbalance, edge of the wound (the TIME algorithm) and aggressive debridement. The panel also recommended intralesional use of HOCl or other methods that ensure the wound is covered with the solution for 15 minutes after debridement.
More controlled clinical studies are needed to determine the safety and efficacy of HOCl in wound types with limited outcomes data and to evaluate outcomes of various application methods.

 
KEYWORDS: hypochlorous acid, review, anti-infective agents, wound, cleansing
INDEX: Armstrong D, Bohn G, Glat P, Kavros S, Kirsner R, Snyder R, Tettelbach W. Expert recommendations for the use of hypochlorous acid solution: science and clinical application. Ostomy Wound Manage. 2015;61(5 suppl): 4S–18S.

 

DAVID G. ARMSTRONG, DPM, MD, PHD, has disclosed he has received honorarium for participating in an Innovacyn scientific advisory board.
GREGORY BOHN, MD, FACS, ABPM/UHM, FACHM has disclosed he has received speaker honoraria and served as a consultant or paid advisory board member for Innovacyn. Dr. Bohn is also a member of the Speakers’ Bureau for Steadmed Poster Support.
PAUL GLAT, MD, FACS, has disclosed he has received speaker honoraria and served as a consultant or paid advisory board member for Innovacyn. Dr. Glat is also a member of the Speakers’ Bureau for Integra LifeSciences and Smith and Nephew.
STEVEN J. KAVROS, DPM, FACCWS, CWS, is the Medical Director of Innovacyn, Inc.
ROBERT KIRSNER, MD, PHD, has disclosed he has received speaker honoraria and served as a consultant or paid advisory board member for Innovacyn. Dr. Kirsner is a scientific advisor for Innovacyn, Mölnlycke, Kerecis, and Cardinal Healthcare. Dr. Kirsner is also a consultant for Kerecis.
ROBERT SNYDER, DPM, MSC, CWS, has disclosed he has received speaker honoraria and served as a consultant or paid advisory board member for Innovacyn. Dr. Snyder is also a consultant for Macrocure, MiMedx, and Acelity.
WILLIAM TETTELBACH, MD, FACP, CWS, has disclosed he has received speaker  honoraria and served as a consultant or paid advisory board member for Innovacyn. He is a member of the speakers’ bureau for Spiracur and MiMedx.

See http://www.puracynplus.com/the-benefits-of-puracyn/

HOCL & NaOH SHOULD HAVE EVERYONE’S INTEREST

Some of the truths about to be stated may be hard to admit.  Nevertheless, let our blunt approach be a wake-up call that empowers you to make real conversion to HOCL & NaOH SOLUTIONS.

The characteristics of HOCL & NaOH should be of interest to Environmental Services (EVS)and Infection Preventionists (IP), but few are joining the knowledge parade or paying serious attention.

The good news is that other actively-engaged professionals are now recognizing that HOCL & NaOH are ready-to-use, low-cost SOLUTIONS that render healthcare facilities really safe and hygienic.  And, these SOLUTIONS are safe when discharged into the environment.

Over the years, EVS and IP resistance has centered around 1) wanting to avoid being first, and 2) wanting to speak to “someone in a local hospital” rather than accept that a number of nationally-recognized hospitals have made successful HOCL & NaOH conversion.

HARD TO BELIEVE

EVS & IP are reluctant to drop using their chemical distributor in spite of their awareness that on-site generated HOCL & NaOH SOLUTIONS are less expensive and more-effective cleaners and disinfectants.

Insisting that only EPA registered disinfectants can be used, EVS & IP fail to grasp that the HOCL SOLUTION generated is an EPA registered hospital-grade disinfectant … while the Aquaox on-site generator itself is not.

Aquaox Infection Control Systems include two EPA registered disinfectants.  Rather than accepting HOCL efficacy data and combined label claims, IP looks for off-label microorganisms (not found on chemical labels, either).  So, what is enabling big companies to continue providing chemicals unsound for humans, facilities and the environment?

ORGANIZATIONAL DYSFUNCTION

Failure to share, cooperate and collaborate leads to the dysfunction of departments and disciplines responsible for ensuring hygienic equipment and outcomes.

Until EVS leaders take responsibility to become more educated and aware of issues historically outside their wheelhouse, they cannot be effective centers of influence in their hospitals.

Support for using HOCL and NaOH solutions must come from the board of directors and facility manager.

The most effective approach is TOP-DOWN directive from the Board and/or C-level executive(s) that the EVS (contract cleaners) use only on-site generated HOCL & NaOH SOLUTIONS and that their company is subject to dismissal should they bring on property any unapproved (specialty) chemicals or attempt to push other disinfection methods.

When top management is truly ready to make a change for the better – they can have improvements in hygiene cleanliness and really effective discharge-room outcomes that result in reduced infection rates and bring higher patient satisfaction ratings.

Lip service does not bring back lives lost due to failure to reduce HAI rates.

The real fear ought to be what happens when not making the conversion.

Again, let our blunt approach be a wake-up call that empowers you to make a clean conversion with HOCL & NaOH SOLUTIONS.

Aquaox’ years of onsite experience validates that disinfectants do not effectively remove debris. Keeping surfaces clean requires effective, periodical cleaning using a detergent. Then, spray disinfectant and let air-dry.

For more information, contact Michel van Schaik at 800.790.7520. info@aquaox.net/info@greenspeed.biz

EPA approves HOCL as high level disinfectant

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 http://www.bt.cdc.gov/HAN/han00341.asp). 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.

EPA Regulations with regard to Onsite production, Usage, Storage and Transport of Onsite produced Hypochlorous Acid (HOCL).

M. van Schaik

Introduction

There is a lot of confusion whether Electrolyzed Water is allowed to be used as a disinfectant or sanitizer. EPA, FDA, USDA and local authorities have approved or allowed usage of Electrolyzed Water in many applications. Having said so, a few applications need more data about the efficacy of Electrolyzed Water and methods how disinfection or sanitation is guaranteed. Other applications may have a limitation on the HOCL concentration.  The following article explain what is and what is not allowed by the US Environment Protection Agency.

EPA Regulation with regard to Onsite PRODUCTION of pesticides with AQUAOX Devices

Under Section 3 of the Pesticide Regulations under the Federal Insecticide Fungicide and Rodenticide Act, as amended (FIFRA), the EPA regulates pesticides, which are registered and sold in interstate commerce to control various forms of vermin.

Under these regulations (Subpart Z –Devices Part 152.500  ‘Requirement for devices”) Pesticide Devices are not required to be registered, but must have an approved label which meet the Section 3 Regulations, Part 162.10, and have a registered establishment in which they are produced. Under Section 7 of the FIFRA each owner of a pesticide device must produce to the EPA enforcement program a report of products produced each and every year and to whom they are sold in a standard report form.

Devices which everyone has heard about are electrically generated, ozonators for use in treating drinking water, chlorinators which derive Free Available Chlorine from the electrolysis of water and sale, copper/silver cathodes which by electrically activity cause release of silver and cupper ions into drinking water in hotels and hospitals, invisible noise mechanisms which mediate insects and rodents in small areas.  In each case the device is unique and based upon the data which the device originator has in hand or can reference to EPA has a product which is efficacious and safe when used as directed.

Devices are subject to labelling and misbranding requirements under FIFRA section 2(p) and 2(q); registration and reporting requirements under FIFRA section 7; recording keeping requirements under FIFRA section 8; inspection requirements under FIFRA section 9; import and expert restrictions under FIFRA section 17; and child resistant packaging requirements imposed pursuant to FIFRA section 25 (c)(3).

AQUAOX devices hava an EPA establishment number and we report pursuant to Section 7 of the Act.  Basically our device, using electric current 230 volt, produces Hypochlorous Acid (HOCL) on demand on site, which kills bacteria, mold, mildew, viruses and surface filling algae.  The device uses sodium chloride (table salt) in a liquid format in water and an electric charge to generate on demand HOCL-solution. HOCL (200ppm Free Available Chlorine) does the killing of the life forms.  When the electric has been turned off the device produces no HOCL-solution and has no residual in it.  Our device meets all the Section 3 labelling requirements and we pay close attention to all the FIFRA requirements so as to be fully compliant No product is produced from our device for storage or later use per regulations.

Electrolyzed water is approved under 21 CFR 173.315 for direct contact with processed foods. Electrolyzed water is approved for several indirect food contract applications under 21 CFR 172.892, 21 CFR 175.105, 21 CFR 176.170 and 21 CFR 177.2800. It is an approved sanitizer that meets 21 CFR 178.1010. The EPA has also given approval (40 CFR 180.1054) for washing raw foods that are to be consumed without processing.

40 CFR 180.940. HOCL when used as ingredient in an antimicrobial pesticide formulation may be applied to: Food-contact surfaces in public eating places, dairy-processing equipment, and food-processing equipment and utensils. When ready for use, the end-use concentration of all Hypochlorous Acid chemicals in the solution is not to exceed 200 ppm determined as Free Available Chlorine

AQUAOX device does not require a hazardous use permit whereas chlorine in bottles must be permitted for filling, transportation or storage.

In case of doubt or for clarification AQUAOX LLC should be consulted. We are unable to anticipate all conditions under which the product may be used, and users are advised to carry out an assessment of workplace risk and carry out their own tests to determine Safety and Suitability for the process and conditions of use.

EPA regulation with regard to the USAGE and STORAGE of Neutral Electrolyzed Water generated on-site from an AQUAOX device

Under the FIFRA, EPA does not regulate water or sodium chloride (table salt) as a pesticide when used in an AQUAOX device that generates a pesticidal solution (HOCL).

The 0.2% HOCL-solution generated by the AQUAOX device is not regulated by the EPA as a pesticide as long as the solution itself is used on-site (i.e. where it is generated). If however, the solution is packaged, distributed or sold for use other than the site at which it was generated, then the product is subject to registration as a pesticide under FIFRA.

Accordingly, applying the solution on-site in e.g. 1 gallon containers would not be subject to registration, but distributing and selling the product for use other than at the site of generation would be subject to registration. Finally, the AQUAOX Device is considered to be a pesticide device and is subject to the requirements specified in 40 CFR 152.500.

As long as the HOCL-solution is applied on-site, no EPA requirements under FIFRA apply other than those specified above. EPA recommends, however, that the operator of pesticide devices provide labels for plastic containers with HOCL-solutions, so that workers and others will know what is in the containers and what precautions and directions should be followed handling and using the solution.

Thus, temporary storage of the HOCL-solution is allowed, as long as HOCL-solution is used on-site.

Finally, the operator of the AQUAOX device should check as to state and local regulatory requirements that may apply to the AQUAOX device and the generated solution.

EPA regulation with regard to TRANSPORT of Neutral Electrolyzed Water generated on-site from an AQUAOX device.

Under FIFRA, EPA does not provide a clear rule and this need to be further investigated. Most probably EPA will NOT permit transport as onsite produced HOCL-solutions are strictly intended to be used on-site.

AQUAOX’ interpretation of the FIFRA is that transport of HOCL-solution within the on-site location is permitted, as long as HOCL-solution is used on-site.  Thus, transport of HOCL-solution in e.g. 1 gallon container to another department, building or place within the operator’s organization, company and/or location is permitted, as long HOCL-solution is used within the operator’s organization, company and/or location.

Accordingly, storage in trucks should be permitted, as long HOCL is used within the operator’s organization, company and/or location. In AQUAOX’ opinion Onsite generated HOCL is permitted to be transported over the public road to another location to be used within the operator’s organization, company and/or location is. However, FIFRA is very unclear about this particularly kind of transport. Likewise the EPA, AQUAOX recommends to provide labels and a MSDS of HOCL on all containers or trucks filled with HOCL.

On top of this AQUAOX advices to have a FUNCTIONAL and WORKING AQUAOX device on each truck, to be used for onsite generation of HOCL, if a user is going to transport HOCL to a client for executing a service such as e.g. fogging a premises or spraying a surface.

EPA regulation on on-site generated pesticides BOTTLED, PACKAGED, STORAGED and DISTRIBUTED (SOLD).

If the onsite produced HOCL is bottled, packaged, stored, distributed and sold, the HOCL-solution is subject to registration as a pesticide. Thus, if HOCL is bottled, packed and sold as a liquid, the user of AQUAOX’ Device MUST register HOCL as a pesticide to obtain a registration number for HOCL.

The registration of the onsite generated HOCL MUST be in the operator’s name and the operator will be exclusively responsible for the produced pesticide.

Footnotes:

AQUAOX is NOT involved in bottling, packaging and distributing pesticides. AQUAOX manufactures, distribute and sell AQUAOX devices which are regulated by the EPA as onsite pesticide devices.

AQUAOX does not permit their distributors to register HOCL (onsite generated pesticide) as a pesticide.

AQUAOX does not advocate, nor promote users (owners/ final users of the AQUAOX Device) to register HOCL as pesticide. AQUAOX rejects all liability, if users do not comply with the FIFRA regulations for onsite pesticide devices. AQUAOX does not advocate or promote the usage of HOCL otherwise than used onsite.

For more information, visit www.aquaox.net

Anti-microbials, disinfectants, sanitizers and sterilants

Introduction

An antimicrobial is a substance that kills or inhibits the growth of microorganisms such as bacteria, fungi, or protozoans. Antimicrobials either kill microbes (microbicidal) or prevent the growth of microbes (microbistatic). The terminology often associated with antimicrobials can be confusing or misleading and in many cases there is an overlap in function. Another word for microorganism is germ. Consequently, an antimicrobial is the same as a germicidal agent. Disinfectants are antimicrobials (or germicidal agents) used on non-living objects. Sometimes, an antimicrobial is considered a sanitizer, sometimes a sanitizer depending the use concentration of the antimicrobial.

In order to clarify some key terms which are often used interchangeably, I have attempted to define the meaning of the products under discussion in their legal sense.

Microorganisms

Microorganismes are too small to be seen by the naked eye.Microorganisms are very diverse; they include bacteria, fungi, archaea, and protists; microscopic plants (called green algae); and animals such as plankton and the planarian. Some microbiologists also include viruses, but others consider these as non-living.

Bacteria

Bacteria are unicellular microorganisms. Bacteria are either beneficial and protective to the immune systems or cause infectious diseases. Bacteria that causes infectious diseases are called pathogens.

Fungi

Fungi are eukaryotic organisms that includes microorganisms such as yeasts and molds, as well as the more familiar mushrooms.

Spores

In biology, a spore is a reproductive structure that is adapted for dispersal and surviving for extended periods of time in unfavorable conditions. Spores form part of the life cycles of many bacteria, plants, algae, fungi and some protozoans. Some pathogens transform from their normal or vegetative state to form spores and are difficult to eliminate since they can resist the effects that sanitizer or disinfectant exposures have on bacteria. Elimination of spores is carried out by specialized chemical agents or physical means, and require several hours for total microbial destruction.

Disinfectant

A disinfectant is a germicidal agent which is capable of destroying disease causing bacteria or pathogens, but not spores and not all viruses. From a technical and legal sense, a disinfectant must be capable of reducing the level of pathogenic bacteria by 99.999% during a time frame greater than 5 but less than 10 minutes. The main difference between a sanitizer and a disinfectant is that at a specified use dilution, the disinfectant must have a higher kill capability for pathogenic bacteria compared to that of a sanitizer.

Sanitizer

In general, to sanitize means to reduce the number of microorganisms to a safe level. One official and legal version states that a sanitizer must be capable of killing 99.999% known as a 5 log reduction, of a specific bacterial test population, and to do so within 30 seconds. A sanitizer may or may not necessarily destroy pathogenic or disease causing bacteria as is a criteria for a disinfectant. An alternate definition is that a hard surface sanitizer is a germicidal agent which is capable of killing 99.9% ( 3 log reduction), of the infectious organisms which may be present in a bacterial population, within 30 seconds.

Sterilants

Sterilants are specialized chemicals, such as glutaraldehyde or formaldehyde, which are capable of eliminating all forms of microbial life, including spores. The term sterilant conveys an absolute meaning; a substance can not be partially sterile.

Future developments of germicidal agents

The future effectiveness of antimicrobials is somewhat in doubt. Microorganisms, especially bacteria, are becoming resistant to more and more antimicrobial agents. Bacteria found in hospitals appear to be especially resilient, and are causing increasing difficulty for the sickest patients–those in the hospital. Currently, bacterial resistance is combated by the discovery of new drugs. However, microorganisms are becoming resistant more quickly than new drugs are being made available; thus, future research in antimicrobial therapy may focus on finding how to overcome resistance to antimicrobials, or how to treat infections with alternative antimicrobials.

Neutral Electrolyzed Water (NEW) also known as Anolyte is an activated aqueous solution of sodium chloride produced by passing a weak saline solution through an electrolytic cell and temporarily changing the properties of the salt water into a powerful oxidizing agent exhibiting antimicrobial properties. Neutral Electrolyzed Water (NEW) is produced near neutral 6.5 pH where the predominant antimicrobial agent is Hypochlorous Acid, the most efficient and efficacious specie of chlorine. Hypochlorous Acid kills microorganisms (bacteria, fungi, algae, spores and viruses).

The properties of NEW can be precisely controlled within Aquaox EC-Systems. NEW can be applied as liquid, mist/fog or spray. NEW is a colorless, aqueous solution with a slight chlorine or ozone odor. NEW is produced on site and intended to be used soon after being produced. NEW must be used within 30 days of production.

NEW is convenient, used for general disinfecting, for use on nursery surfaces, use on bathroom surfaces, use in athletic facilities, for use on athletic equipment and suitable for hospital use. NEW will not harm hard non-porous surfaces including titanium-coated medical grade stainless steel. NEW can be used neat or diluted with drinking water to reduce the free available chlorine.

Alkaline Water (AW) also known as Catholyte consist of Sodium Hydroxide (NAOH), commonly known as caustic soda, lye, or sodium hydrate. Sodium Hydroxide is a caustic compound which attacks organic matter. Caustic soda is available commercially in various white solid forms and as a solutions of various concentrations in water.
Sodium hydroxide provides fuctions of neutralisation of acids, hydrolysis, condensation. saponification and replacement of other groups in organic compounds of hydroxyl ions. Sodium Hydroxide removes waxes and oils from fibre to make the fibre more receptive to washing, bleaching and dying. Sodium hydroxide is also widely used in in making soaps and detergents. Sodium hydroxide is occasionally used in the home as an agent for unblocking drains. The chemical mechanism employed is the conversion of grease to a form of soap, and so forming a water soluble form to be dissolved by flushing; also decomposing complex molecules such as the protein of hair. Sodium hydroxide is frequently used as an industrial cleaning agent where it is often called “caustic”. It is added to water, heated, and then used to clean the process equipment, storage tanks, etc. It can dissolve grease, oils, fats and protein based deposits. The sodium hydroxide solution can also be added to surfactants. A sodium hydroxide soak solution is used as a powerful degreaser on stainless and glass bakeware. It is also a common ingredient in oven cleaners.

Alkaline Water (AW) is a less concentrated than commercial available Sodium Hydroxide solutions and has the same applications, although dosage is different. AW is a mild detergent and degreaser very useful for cleaning surfaces prior to sanitizing or disinfecting.

For more information, please contact aquaox@comcast.net or visit www.aquaox.net