Harran Üniversitesi Tıp Fakültesi Dergisi

1304-9623 1309-4025

Harran University

10.35440/hutfd.1627450

Infectious Diseases

Bulaşıcı Hastalıklar

The Effect of Fogging with Hypochlorous Solution on The Rate of Healthcare-Associated Infections

Hipokloröz Çözelti ile Sislemenin Sağlık Hizmeti İlişkili Enfeksiyon Hızı Üzerine Etkisi

https://orcid.org/0000-0002-6264-1685

Çelik Ekinci

Semiha

University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology

03 26 2025

22 1 109 114 01 26 2025 02 27 2025

2004

Journal of Harran University Medical Faculty

Background: The prevention of healthcare-associated infections hinges on the meticulous cleaning and disinfection of patient care areas, forming the cornerstone of standard precautions. Hypochlorous solution, in contrast to other disinfectants, is a unique and effective agent due to its sterile, safe, and highly efficacious nature. This is attributed to its synthesis through the electrolysis of pure water and sodium hypochloride. In this study, we sought to assess the effectiveness of fogging hypochlorous solution in curbing the ongoing Acinetobacter outbreak in our hospital.Materials and Methods: The application of a hypochlorous solution by fogging was conducted in one intensive care unit with 10 beds, while this method was not employed in the other intensive care unit with 9 beds. Fogging was conducted on all surfaces five times a day for one month while patients were undergoing treatment in their beds. In addition to fogging, routine cleaning, disinfection and hand hygiene practices were maintained. Culture results and HAI rates for both intensive care units were recorded for the one-month period preceding fogging and the one-month period during which fogging was performed.Results: The prevalence of growths among patients decreased from 36.4% to 29% in the non-fogging ICU, while a similar decline was observed in the fogging ICU, from 54.5% to 28.1%. While the culture positivity rate in the ICU without fogging increased from 15 to 19 in the second period, this number decreased from 17 to 13 in the ICU with fogging. While the rate of healthcare-associated infection (HAI) increased from 4.5 to 12.9 in the non-fogging ICU, the rate of HAI decreased from 18.2 to 3.1 in the fogging ICU.Conclusions: It was therefore concluded that fogging with hypochlorous solution may be associated with a decrease in culture positivity and SHIE rate, and that it does not cause any adverse effects on patients, healthcare personnel or medical instruments. However, in order to reach a definitive conc-lusion on the subject, it was evaluated that our results need to be supported by prospectively desig-ned studies in which the before and after periods are standardised.

Amaç: Sağlık Hizmeti İlişkili Enfeksiyonları önlemek için, hasta bakım alanlarının temizlenmesi ve dezenfekte edilmesi standart önlemlerin en önemli parçasıdır. Kullanılan tüm dezenfektanların aksine, hipokloröz çözelti, sodium hipoklorür ile saf suyun elektrolizi ile oluşturulduğu için güvenilir, etkin ve sterilizandır. Bu çalışmamızda hastanemizde devam eden Acinetobacter salgınının engellenmesinde hipokloröz çözeltinin sisleme ile uygulanmasının etkinliğini ölçmeyi amaçladık.Materyal ve metod: Hipokloröz çözelti ile sisleme 10 yataklı bir yoğun bakım ünitesinde uygulanırken, 9 yataklı diğer yoğun bakım ünitesinde uygulanamadı. Sisleme bir ay boyunca, günde 5 kez, hastalar yataklarında tedavi almakta iken, tüm yüzeylere uygulandı. Sislemeye ek olarak rutin temizlik-dezenfeksiyon ve el hijyeni uygulamalarına devam edildi. Her iki yoğun bakım ünitesinin sisleme önce-si bir aylık dönemde ve sisleme süresince bir aylık dönemde olan kültür sonuçları ve SHİE hızları kay-dedildi.Bulgular: Sisleme uygulanmayan YBÜ’de üreme saptanan hasta sayısı %36,4’ten, %29’a düşerken, sisle-me uygulanan YBÜ’de %54,5’ten %28,1’e gerilemiştir. Sisleme yapılmayan YBÜ’de 15 kültür pozitifliği, ikinci dönemde 19’a yükselirken; sisleme uygulanan YBÜ’de bu sayı 17’den 13’e gerilemiştir. Sisleme uygulanmayan YBÜ’de SHİE hızı 4,5’tan 12,9’a çıkarken, sisleme uygulanan YBÜ’de SHİE hızı 18,2’den 3,1’e gerilemiştir.Sonuç: Hipokloröz çözelti ile sislemenin, kültür pozitifliğinde ve SHİE hızında azalma ile ilişkili olabile-ceği, hastalar, sağlık personeli ve tıbbi aletler açısından herhangi bir olumsuz duruma yol açmadığı sonucuna varılmıştır. Lakin konu hakkında kesin kanaate varmak için öncesi ve sonrası dönemin stan-dardize edilmiş olduğu prospektif dizayn edilmiş çalışmalarla sonuçlarımızın desteklenmesine ihtiyaç olduğu değerlendirilmiştir.Anahtar Kelimeler: Hipokloröz Asit, Sisleme, Dezenfektan, Çapraz Kontaminasyon, Sağlık Hizmeti İlişkili Enfeksiyon Hızı

hipokloröz asit sisleme dezenfektan çapraz kontaminasyon sağlık hizmeti ilişkili enfeksiyon hızı

hypochlorous acid fogging disinfectant cross contamination healthcare associated infection rate

1. Sönmez A, Öztürk ŞB, Abacıgil F. Sağlık Hizmeti İlişkili Enfeksiyon Epidemiyolojisi ve Sürveyansı. Hemşirelik Bilimi Dergisi. 2021;4(1):41-45

2. Balakrishnan VS. WHO's first global infection prevention and control report. The Lancet. Infectious diseases. 2022;22(8):1122.

3. Boyce JM, Pittet D. Healthcare Infection Control Practices Advi-sory Committee, & HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Guideline for Hand Hygiene in Health-Care Settings. Rec-ommendations of the Healthcare Infection Control Practices Ad-visory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Society for Healthcare Epidemiology of Ameri-ca/Association for Professionals in Infection Control/Infectious Diseases Society of America. MMWR. Recommendations and re-ports: Morbidity and mortality weekly report. Recommendations and reports. 2002;51(RR-16):1–CE4.

4. cdc.gov [homepage on the Internet]. Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008. Rutala WA, We-ber DJ and the Healthcare Infection Control Practices Advisory Committee (HICPAC). [Update: June 2024, cited 30 January 2025]. Available from: https://www.cdc.gov/infection-control/hcp/disinfection-and-sterilization/index.html

5. cdc.gov [homepage on the Internet]. 2007 Guideline for Isola-tion Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings. Siegel JD, Rhinehart E, Jackson M, Chiarello L; the Healthcare Infection Control Practices Advisory Commit-tee. [Update: September 2024, cited 30 January 2025]. Availab-le from: https://www.cdc.gov/infection-control/hcp/isolation-precautions/index.html

6. Ono T, Yamashita K, Murayama T, Sato T. Microbicidal effect of weak acid hypochlorous solution on various microorganisms. Bi-ocontrol science. 2012;17(3):129–133.

7. Miyaoka Y, Yamaguchi M, Kadota C, Hasan MA, Kabir MH, Shoham D, et al. Rapid in vitro virucidal activity of slightly acidic hypo-chlorous acid water toward aerosolized coronavirus in simulated human-dispersed droplets. Virus research. 2022;311:198701.

8. Saglik.gov.tr [internet sayfası]. SALGIN ŞÜPHESİ DURUMUNDA SALGIN VARLIĞINA KARAR VERME VE SÜREÇTEKİ ÖNEMLİ İLKE VE ESASLAR. TC. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü. [gün-celleme: Nisan 2023, alıntılama tarihi: 30 January 2025]. Erişim: https://hsgm.saglik.gov.tr/depo/Yayinlarimiz/Rehberler/hsgm-salgin-karari-verme-rehberi.pdf

9. Morita C, Nishida T, Ito K. Biological toxicity of acid electrolyzed functional water: effect of oral administration on mouse diges-tive tract and changes in body weight. Archives of oral biology. 2011;56(4):359–366.

10. Stroman DW, Mintun K, Epstein AB, Brimer CM, Patel CR, Branch JD, et al. Reduction in bacterial load using hypochlorous acid hygiene solution on ocular skin. Clinical ophthalmology (Auck-land, N.Z.). 2017;11:707–714.

11. Chen CJ, Chen CC, Ding SJ. Effectiveness of Hypochlorous Acid to Reduce the Biofilms on Titanium Alloy Surfaces in Vitro. Interna-tional journal of molecular sciences. 2016;17(7):1161.

12. Kubota A, Goda T, Tsuru T, Yonekura T, Yagi M, Kawahara H, et al. Efficacy and safety of strong acid electrolyzed water for perito-neal lavage to prevent surgical site infection in patients with perforated appendicitis. Surgery today. 2015;45(7):876–879.

13. Ji C, Guo W, Amir H. Experience of diagnosis and treatment of hard-to-heal wounds infected with Acinetobacter baumannii: a case study. Journal of wound care. 2024;33(4):278–285.

14. Hao XX, Li BM, Zhang Q, Lin BZh, Ge LP, Wang CY, et al. Disinfec-tion effectiveness of slightly acidic electrolysed water in swine barns. Journal of applied microbiology. 2013;115(3):703–710.

15. Hakim H, Thammakarn C, Suguro A, Ishida Y, Nakajima K, Kitazawa M, et al. Aerosol Disinfection Capacity of Slightly Acidic Hypo-chlorous Acid Water Towards Newcastle Disease Virus in the Air: An In Vivo Experiment. Avian diseases. 2015;59(4):486–491.

16. Block MS, Rowan BG. Hypochlorous Acid: A Review. Journal of oral and maxillofacial surgery: official journal of the American As-sociation of Oral and Maxillofacial Surgeons. 2020;78(9):1461–1466.

17. Palau M, Muñoz E, Lujan E, Larrosa N, Gomis X, Márquez E, et al. In Vitro and In Vivo Antimicrobial Activity of Hypochlorous Acid against Drug-Resistant and Biofilm-Producing Strains. Microbiolo-gy spectrum. 2022;10(5):e0236522.

18. Overholt B, Reynolds K, Wheeler D. 1151. A Safer, More Effec-tive Method for Cleaning and Disinfecting GI Endoscopic Proce-dure Rooms. Open Forum Infectious Diseases. 2018;5 Suppl 1: S346.

19. Sartelli M, Coccolini F, Catena F, Pagani L. Global Infection Pre-vention and Management in Healthcare. Volume 3: Sepsis and infections in surgery. [first published: 18 November 2024, cited 30 January 2025]. Available from: https://infectionsinsurgery.org/wp-content/uploads/2024/11/volume-3-published-18- november-1.pdf.

20. Feng KC, Ghai A, Liu H, Salerno A, Miller C, Liu J, et al. Efficacy of hypochlorous acid (HOCl) fog in sanitizing surfaces against Enter-ococcus faecalis. American journal of infection control. 2022;50(12):1311–1315.

21. Nasiłowska B, Włodarski M, Kaliszewski M, Bogdanowicz Z, Krzowski Ł, Kopczyński K, et al. Decontamination Effect of Hypo-chlorous Acid Dry Mist on Selected Bacteria, Viruses, Spores, and Fungi as Well as on Components of Electronic Systems. Interna-tional journal of molecular sciences. 2024;25(13):7198.