INFECTION PREVENTION AND CONTROL
In vivo, hypertonic saline nasal irrigation and gargle in patients with upper respiratory infections (URI) caused by coronavirus significantly reduced the duration and severity of the URI.
Inhaling approach In addition to nasal irrigation with hypertonic saline solutions, the inhaling approach has been studied extensively. The most important practical advantages of this method are its simplicity, and very low probability of adverse events, as observed in a meta-analysis study where safety data was reviewed in 24 trials: 13 trials (1,363 neonates, 703 treated with hypertonic saline) reported no adverse event, and 11 (2,360 infants, 1,265 treated with hypertonic saline) reported at least one adverse event, most of which were mild and resolved spontaneously. For more than the last decade HOCl
has played an increasingly important role in wound care. For antisepsis and wound decontamination, HOCl solutions are applied topically. Applications are often repeated during the day in the early stages of wound management, and are adjunctive to debridement and other procedures aimed at adherent soil and biofilm removal. HOCl-soaked wound dressings are relied upon for continued delivery of antimicrobial and healing enhancement benefits over time. Hypochlorous acid exhibits anti- inflammatory and immunomodulatory properties based on multiple laboratory analyses. These properties appear to correlate with potential therapeutic benefits of topically applied HOCl for a variety of skin disorders. There exist numerous examples of how the use of HOCl has outperformed many conventional (e.g. antibiotic) treatment schemes in both its efficiency and long-term patient acceptance. For example, Bongiovanni et al provided a comprehensive review of use of HOCl in the treatment of more than 1,000 venous leg ulcers (VLU). His summary speaks for itself: “Perhaps the greatest advance in VLU care is the addition of HCA [hypochlorous acid, HOCl] to the treatment armamentarium. These aqueous solutions of hypochlorous acid, even in trace amounts, will kill most pathogens within 30 seconds of exposure. Additional actions of HCA include reduction of mast cell degranulation, and active capillary dilation.
A virus envelope of membrane proteins being destroyed by HOCl molecules.
“The latter effect is of great importance in the diabetic VLU patient, since one of the paradoxes in diabetes is the reduction of capillary perfusion via arteriovenous shunting at the microcirculatory level.”
The ‘ideal disinfectant’ Block and Rowan in 2020 reviewed surgeons’ needs for disinfection in the face of the coronavirus pandemic, and concluded that ‘HOCl comprises many of the desired effects of the ideal disinfectant: it is easy to use, is inexpensive, has a good safety profile, and can be used to disinfect large areas quickly and with a broad range of bactericidal and virucidal effects’. There are no reports of adverse
reactions to topical applications by these methods based on the US EPA’s Toxicology Database DSSTox, or the US CDC Toxic Substances and Disease Registry, nor at either the Development and Reproductive Toxicology Database, or the European Bioinformatics Institute of EMBL.
oji active air – what is it, and why is it good? oji active air changes the indoor climate from potentially dangerous – with pathogens in the air and on surfaces – to a safer one, by maintaining a certain concentration of HOCl molecules in the building’s air. The air, and all surfaces exposed to it, are maintained free from pathogens. People cannot get infected in this building any more. Indoors, pathogen-carrying aerosol particles are recognised as important infection carriers like those in the current coronavirus pandemic. This infection route is often underestimated, yet represents the infection route that has been least systematically countered to date. Current indoor safety measures (e.g., distancing, masks, filters) provide only limited protection. Inhalation of hypochlorous acid (HOCl)-containing aerosols was recently shown in several studies to be safe and effective in prevention, and even in reduction of symptoms, of already infected individuals.
A controlled environment For our tests, we aerosolised bacterial suspensions into a controlled office space. The HOCl concentration was held at constant concentration with a software- controlled injection system (aerosolis device; oji Europe GmbH, Nauen, Germany) and a special HOCl gas sensor unit (Dräger AG, Lübeck, Germany). We confirmed the disinfecting power of the used HOCl in suspensions, and demonstrated the high efficacy of vaporized HOCl to deactivate airborne pathogens at safe and non- irritant levels (Microbiology Lab of Henkel, Düsseldorf, Germany). Incorporating this air disinfection
technology into building ventilation systems could make a valuable contribution to future infection prevention and control. It may take facility management to a new level of providing environmental safety.
What is the technology? oji active air is a system that produces HOCl in situ (i.e. at the customer location) from water and salt. Subsequently, the HOCl molecules are separated from any remaining other minerals and water, and fed into the building’s ventilation system. Within the HVAC system’s return air duct a sensor monitors the HOCl concentration in the air. oji active air is a fully automated system that always maintains a healthy concentration of HOCl molecules in the building; it is a ‘dry’ disinfection method. In contrast, ‘classic’ nebulisation is a ‘wet’
process. Aqueous solutions of disinfectants spray water droplets with high intensity and large volumes into the room atmosphere. The droplet diameter varies from around 300-1,000 µm. Such large droplets cannot hover for long in the atmosphere, and sink into and cover all surfaces. This includes penetrating electronic hardware – either through passive vent openings, or active suction caused by device ventilators. Nebulisation of mineralised water or aqueous disinfectant solutions have thus been identified as a hazard to electronics, including medical devices in hospitals and private homes. Dry aerosolisation of aqueous solutions
October 2022 Health Estate Journal 97
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