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Severing AL, Rembe JD, Koester V, Stuermer EK. Safety and efficacy profiles of different commercial sodium hypochlorite/hypochlorous acid solutions (NaClO/HClO): antimicrobial efficacy, cytotoxic impact and physicochemical parameters in vitro. J Antimicrob Chemother 2020; 74:365-372. [PMID: 30388236 DOI: 10.1093/jac/dky432] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 09/26/2018] [Indexed: 12/22/2022] Open
Abstract
Background Sodium hypochlorite (NaClO, SHC)/hypochlorous acid (HClO, HCA) wound irrigation solutions have experienced a renaissance in the prevention and treatment of low-level wound infections. They are attributed with lower cytotoxicity and have therefore gained increasing attention in daily clinical practice. Objectives To determine the cytotoxicity and antimicrobial efficacy of six NaClO/HClO wound irrigation solutions. Methods For cytotoxicity evaluation (based on DIN EN 10993-5), human keratinocytes (HaCaT) and human skin fibroblasts (BJ) were used. Staphylococcus aureus and Pseudomonas aeruginosa were used for antimicrobial efficacy evaluation (based on DIN EN 13727). Solutions were evaluated after 1, 5 and 15 min of exposure. Additionally, physicochemical properties (pH and oxidation-reduction potential values) were investigated. Results Efficacy and cytotoxicity varied significantly between solutions. Generally, increasing antimicrobial activity was associated with decreasing cell viability. Furthermore, a concentration- and time-dependent impact on pathogens and cells was observed: cytotoxic and antimicrobial activity increased with rising NaClO/HClO solution concentrations and extended exposure times. Based on these in vitro evaluations, the following ranking (lowest to highest microbicidal effect and cytotoxic impact) was found: Microdacyn60® (SHC/HCA-M) < Granudacyn® (SHC/HCA-G) < Veriforte™ (SHC/HCA-V) < KerraSol™ (SHC-K) < Lavanox® (SHC-L) ≪ ActiMaris®forte (SHC/SM-A). Conclusions The presented results indicate that microbicidal effects are almost always associated with certain negative side effects on cell proliferation. Efficacy and biocompatibility of NaClO/HClO solutions depend on their specific formulation and physicochemical properties. The investigations also underline the necessity for exact product- and application-specific efficacy profiles.
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Affiliation(s)
- Anna-Lena Severing
- Institute for Translational Wound Research, Centre for Biomedical Education and Research (ZBAF), Witten/Herdecke University, Witten, Germany
| | - Julian-Dario Rembe
- Institute for Translational Wound Research, Centre for Biomedical Education and Research (ZBAF), Witten/Herdecke University, Witten, Germany
| | - Verena Koester
- Institute for Translational Wound Research, Centre for Biomedical Education and Research (ZBAF), Witten/Herdecke University, Witten, Germany
| | - Ewa K Stuermer
- Institute for Translational Wound Research, Centre for Biomedical Education and Research (ZBAF), Witten/Herdecke University, Witten, Germany
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Banovic F, Olivry T, Bäumer W, Paps J, Stahl J, Rogers A, Jacob M. Diluted sodium hypochlorite (bleach) in dogs: antiseptic efficacy, local tolerability and in vitro effect on skin barrier function and inflammation. Vet Dermatol 2017; 29:6-e5. [PMID: 28906043 DOI: 10.1111/vde.12487] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Diluted sodium hypochlorite represents an inexpensive and widely available topical antiseptic, but there are no tolerability and efficacy data in veterinary dermatology. OBJECTIVES To determine the in vivo antibacterial effect and tolerability of topical diluted bleach application and to assess its in vitro effect on skin barrier lipids and anti-inflammatory properties on keratinocytes. METHODS Topical hypochlorite at 0.05% and tap water were applied to both sides of the thorax of four healthy dogs. The anti-inflammatory effect on canine keratinocytes was determined by real-time polymerase chain reaction; skin barrier integrity was assessed by evaluating stratum corneum lipid changes in canine stratified epidermal constructs. RESULTS The cell viability of primary keratinocytes treated with water and diluted hypochlorite at 0.005 and 0.01%, reduced the percentage of viable cells by 10%. The exposure of primary keratinocytes to 0.005% diluted hypochlorite significantly reduced the induction of inflammatory genes chemokine ligand-2 (CCL2; P = 0.015) and thymus and activation-regulated chemokine (TARC/CCL17, P = 0.032). There were no changes in skin lipid ceramide and nonceramide fractions in stratified epidermal constructs cultured for 17 days with 0.05% hypochlorite. Topical hypochlorite at 0.05% and tap water were well-tolerated without signs of skin irritation. Although a marked reduction in bacterial counts was seen within 20 min of diluted bleach application compared to the tap water control, this was only marginally significant (P = 0.06). CONCLUSIONS AND CLINICAL IMPORTANCE The results indicate that a topical diluted bleach solution, at either 0.05 or 0.005% hypochlorite concentrations, is a well-tolerated antiseptic that also exhibits anti-inflammatory properties.
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Affiliation(s)
- Frane Banovic
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, 2200 College Station Road, Athens, GA, 30602, USA.,Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC, 27607, USA
| | - Thierry Olivry
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC, 27607, USA
| | - Wolfgang Bäumer
- Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC, 27607, USA
| | - Judy Paps
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC, 27607, USA
| | - Jessica Stahl
- Department of Pharmacology, Toxicology and Pharmacy, University of Veterinary Medicine Hannover, D-30559, Hannover, Germany
| | - Ana Rogers
- Department of Population Health and Pathology, North Carolina State University, 1060 William Moore Drive, Raleigh, NC, 27607, USA
| | - Megan Jacob
- Department of Population Health and Pathology, North Carolina State University, 1060 William Moore Drive, Raleigh, NC, 27607, USA
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Gray D, Foster K, Cruz A, Kane G, Toomey M, Bay C, Kardos P, Ostovar GA. Universal decolonization with hypochlorous solution in a burn intensive care unit in a tertiary care community hospital. Am J Infect Control 2016; 44:1044-6. [PMID: 27079244 DOI: 10.1016/j.ajic.2016.02.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 01/28/2016] [Accepted: 02/01/2016] [Indexed: 12/01/2022]
Abstract
Infections are the leading cause of morbidity and mortality in burn patients. Patients colonized with methicillin-resistant Staphylococcus aureus (MRSA) are at higher risk of developing an invasive infection, and MRSA is endemic in many burn units. The typical decolonization regimen of mupirocin and chlorhexidine bathing is not optimal in burn patients because of chlorhexidine limitations on nonintact skin. We studied the impact of universal decolonization using mupirocin and hypochlorous acid bathing on health care-associated MRSA infections in a burn intensive care unit. We show a significant decrease in total MRSA infections.
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Affiliation(s)
- Dorinne Gray
- Department of Infection Prevention and Control, Maricopa Integrated Health System, Phoenix, AZ
| | - Kevin Foster
- The Arizona Burn Center, Maricopa Integrated Health System, Phoenix, AZ
| | - Abner Cruz
- Department of Infection Prevention and Control, Maricopa Integrated Health System, Phoenix, AZ
| | - Gail Kane
- Department of Infection Prevention and Control, Maricopa Integrated Health System, Phoenix, AZ
| | - Mike Toomey
- Department of Infection Prevention and Control, Maricopa Integrated Health System, Phoenix, AZ
| | - Curtis Bay
- Biostatistics, A.T. Still University, Mesa, AZ
| | - Patricia Kardos
- The Arizona Burn Center, Maricopa Integrated Health System, Phoenix, AZ
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