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A Better Disinfectant for Low-Resourced Hospitals? A Multi-Period Cluster Randomised Trial Comparing Hypochlorous Acid with Sodium Hypochlorite in Nigerian Hospitals: The EWASH Trial

Environmental hygiene in hospitals is a major challenge worldwide. Low-resourced hospitals in African countries continue to rely on sodium hypochlorite (NaOCl) as major disinfectant. However, NaOCl has several limitations such as the need for daily dilution, irritation, and corrosion. Hypochlorous a...

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Autores principales: Gon, Giorgia, Dansero, Lucia, Aiken, Alexander M., Bottomley, Christian, Dancer, Stephanie J., Graham, Wendy J., Ike, Olivia C., Lewis, Michelle, Meakin, Nick, Okafor, Obiora, Uwaezuoke, Nkolika S., Okwor, Tochi Joy
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9146012/
https://www.ncbi.nlm.nih.gov/pubmed/35630355
http://dx.doi.org/10.3390/microorganisms10050910
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author Gon, Giorgia
Dansero, Lucia
Aiken, Alexander M.
Bottomley, Christian
Dancer, Stephanie J.
Graham, Wendy J.
Ike, Olivia C.
Lewis, Michelle
Meakin, Nick
Okafor, Obiora
Uwaezuoke, Nkolika S.
Okwor, Tochi Joy
author_facet Gon, Giorgia
Dansero, Lucia
Aiken, Alexander M.
Bottomley, Christian
Dancer, Stephanie J.
Graham, Wendy J.
Ike, Olivia C.
Lewis, Michelle
Meakin, Nick
Okafor, Obiora
Uwaezuoke, Nkolika S.
Okwor, Tochi Joy
author_sort Gon, Giorgia
collection PubMed
description Environmental hygiene in hospitals is a major challenge worldwide. Low-resourced hospitals in African countries continue to rely on sodium hypochlorite (NaOCl) as major disinfectant. However, NaOCl has several limitations such as the need for daily dilution, irritation, and corrosion. Hypochlorous acid (HOCl) is an innovative surface disinfectant produced by saline electrolysis with a much higher safety profile. We assessed non-inferiority of HOCl against standard NaOCl for surface disinfection in two hospitals in Abuja, Nigeria using a double-blind multi-period randomised cross-over study. Microbiological cleanliness [Aerobic Colony Counts (ACC)] was measured using dipslides. We aggregated data at the cluster-period level and fitted a linear regression. Microbiological cleanliness was high for both disinfectant (84.8% HOCl; 87.3% NaOCl). No evidence of a significant difference between the two products was found (RD = 2%, 90%CI: −5.1%–+0.4%; p-value = 0.163). We cannot rule out the possibility of HOCl being inferior by up to 5.1 percentage points and hence we did not strictly meet the non-inferiority margin we set ourselves. However, even a maximum difference of 5.1% in favour of sodium hypochlorite would not suggest there is a clinically relevant difference between the two products. We demonstrated that HOCl and NaOCl have a similar efficacy in achieving microbiological cleanliness, with HOCl acting at a lower concentration. With a better safety profile, and potential applicability across many healthcare uses, HOCl provides an attractive and potentially cost-efficient alternative to sodium hypochlorite in low resource settings.
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spelling pubmed-91460122022-05-29 A Better Disinfectant for Low-Resourced Hospitals? A Multi-Period Cluster Randomised Trial Comparing Hypochlorous Acid with Sodium Hypochlorite in Nigerian Hospitals: The EWASH Trial Gon, Giorgia Dansero, Lucia Aiken, Alexander M. Bottomley, Christian Dancer, Stephanie J. Graham, Wendy J. Ike, Olivia C. Lewis, Michelle Meakin, Nick Okafor, Obiora Uwaezuoke, Nkolika S. Okwor, Tochi Joy Microorganisms Article Environmental hygiene in hospitals is a major challenge worldwide. Low-resourced hospitals in African countries continue to rely on sodium hypochlorite (NaOCl) as major disinfectant. However, NaOCl has several limitations such as the need for daily dilution, irritation, and corrosion. Hypochlorous acid (HOCl) is an innovative surface disinfectant produced by saline electrolysis with a much higher safety profile. We assessed non-inferiority of HOCl against standard NaOCl for surface disinfection in two hospitals in Abuja, Nigeria using a double-blind multi-period randomised cross-over study. Microbiological cleanliness [Aerobic Colony Counts (ACC)] was measured using dipslides. We aggregated data at the cluster-period level and fitted a linear regression. Microbiological cleanliness was high for both disinfectant (84.8% HOCl; 87.3% NaOCl). No evidence of a significant difference between the two products was found (RD = 2%, 90%CI: −5.1%–+0.4%; p-value = 0.163). We cannot rule out the possibility of HOCl being inferior by up to 5.1 percentage points and hence we did not strictly meet the non-inferiority margin we set ourselves. However, even a maximum difference of 5.1% in favour of sodium hypochlorite would not suggest there is a clinically relevant difference between the two products. We demonstrated that HOCl and NaOCl have a similar efficacy in achieving microbiological cleanliness, with HOCl acting at a lower concentration. With a better safety profile, and potential applicability across many healthcare uses, HOCl provides an attractive and potentially cost-efficient alternative to sodium hypochlorite in low resource settings. MDPI 2022-04-26 /pmc/articles/PMC9146012/ /pubmed/35630355 http://dx.doi.org/10.3390/microorganisms10050910 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Gon, Giorgia
Dansero, Lucia
Aiken, Alexander M.
Bottomley, Christian
Dancer, Stephanie J.
Graham, Wendy J.
Ike, Olivia C.
Lewis, Michelle
Meakin, Nick
Okafor, Obiora
Uwaezuoke, Nkolika S.
Okwor, Tochi Joy
A Better Disinfectant for Low-Resourced Hospitals? A Multi-Period Cluster Randomised Trial Comparing Hypochlorous Acid with Sodium Hypochlorite in Nigerian Hospitals: The EWASH Trial
title A Better Disinfectant for Low-Resourced Hospitals? A Multi-Period Cluster Randomised Trial Comparing Hypochlorous Acid with Sodium Hypochlorite in Nigerian Hospitals: The EWASH Trial
title_full A Better Disinfectant for Low-Resourced Hospitals? A Multi-Period Cluster Randomised Trial Comparing Hypochlorous Acid with Sodium Hypochlorite in Nigerian Hospitals: The EWASH Trial
title_fullStr A Better Disinfectant for Low-Resourced Hospitals? A Multi-Period Cluster Randomised Trial Comparing Hypochlorous Acid with Sodium Hypochlorite in Nigerian Hospitals: The EWASH Trial
title_full_unstemmed A Better Disinfectant for Low-Resourced Hospitals? A Multi-Period Cluster Randomised Trial Comparing Hypochlorous Acid with Sodium Hypochlorite in Nigerian Hospitals: The EWASH Trial
title_short A Better Disinfectant for Low-Resourced Hospitals? A Multi-Period Cluster Randomised Trial Comparing Hypochlorous Acid with Sodium Hypochlorite in Nigerian Hospitals: The EWASH Trial
title_sort better disinfectant for low-resourced hospitals? a multi-period cluster randomised trial comparing hypochlorous acid with sodium hypochlorite in nigerian hospitals: the ewash trial
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9146012/
https://www.ncbi.nlm.nih.gov/pubmed/35630355
http://dx.doi.org/10.3390/microorganisms10050910
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