Considerations regarding the use of chlorine-based solutions in healthcare facilities and the home environment
Environmental sanitation is just one of several methods recommended for reducing the transmission of germs among patients and medical staff. Sanitation and disinfection, along with other infection control measures such as hand hygiene and isolation precautions, are important ways to help stop the spread of pathogens. This article primarily focuses on infection prevention and control practices in areas where chlorine-based solutions are primarily used for disinfection, but are not standardized and may vary significantly in terms of solution concentration.
Table of Contents
- Why is chlorine used as a disinfectant?
- Validation of chlorine-based products
- Considerations for chlorine use in healthcare settings
- Chlorine use in the home environment
- Warnings regarding domestic use of chlorine
Why is chlorine used as a disinfectant?
Chlorine-based solutions are oxidative chemicals and have broad-spectrum activity against a wide variety of microorganisms, from viruses to protozoa. They have been widely used as disinfectants and antiseptics since the 19th century. Studies have recently been published on the historical use of these compounds for environmental and healthcare infection control in the context of preventing the spread of the Ebola virus. (Source)
During Ebola outbreaks, 0.5% chlorine-based solutions (which would generally be equivalent to a 1:10 dilution of household bleach) were used to disinfect environmental surfaces, while a 0.05% solution was used for hand hygiene. Non-governmental organizations routinely provided hospitals and drinking water supply programs with sodium dichloroisocyanurate (NaDCC) to be used for preparing disinfectant solutions, as well as other chlorine-based products for use in the disinfection process. There were also some projects in Africa that involved the electrolytic creation of sodium hypochlorite from brine solutions (primarily for disinfecting drinking water, e.g., CDC Safe Water, UNICEF Safe Water). (Source)
Chlorine-based (sodium hypochlorite) solutions are produced in different concentrations in different parts of the world, and the strength of the solution can range between 2% and 12% NaOCl. Because there is such great variation in the concentration of products available in some countries, it is strongly recommended that the concentration of the chlorine product be assessed before use. (Source)
Validation of chlorine-based products
If there is any doubt about a product, it is recommended to determine the chlorine concentration through chemical analysis (e.g., DPD color-changing test kits, amperometric titration for residual chlorine, commercially available test strips, or test sticks). Reagent-grade water will also be needed to make 1:100 and 1:1000 dilutions of the prepared solution to perform the tests.
Considerations regarding chlorine use
There are no published studies that have tested the efficacy of chlorine-based products against ebolaviruses. However, chlorine solutions are known to be effective against a wide range of viruses. (Source)
Wet contact time is the amount of time that a surface being disinfected must remain wet with the disinfectant. The wet contact time for chlorine varies between 2 and 10 minutes, depending on the microbe/virus. For wet contact times longer than 10 minutes, it may be necessary to reapply a chlorine solution or another acceptable disinfectant. When treating surfaces potentially contaminated with ebolaviruses and other bloodborne pathogens, a 10-minute wet contact time with a 0.5% to 0.6% chlorine solution should be allowed.
Chlorine-based solutions and other disinfectants are inactivated by the presence of organic matter (blood, other proteinaceous matter, dirt), heavy metal ions, low temperature, or ultraviolet irradiation. Both the WHO and other international bodies recommend cleaning with detergent and water before applying the disinfectant. This will help prevent the inactivation of the disinfectant by organic matter.
Chlorinated products should not be used for routine hand hygiene, as they will eventually damage the skin. Soap and water or alcohol-based hand sanitizers are preferred. Hand sanitizers offer multiple benefits compared to the use of water and soap in terms of skin tolerance, compliance, and, especially when combined with the use of gloves, overall effectiveness against a wide variety of healthcare-associated pathogens. However, if hands are visibly soiled, use soap and water, not hand sanitizers.
Solutions with strong or weak hypochlorous acid can be prepared from many different types of available products. To be effective in infection control, solutions with a concentration containing either 0.5%–0.6% or 0.05%–0.06% available chlorine are required, depending on the intended use. Household bleach is different from either Ca(OCl)2 (e.g., HTH, chlorinated lime) or locally prepared "bleach" products commonly found in supermarkets. It is very important to understand which product is being used to make a solution, as the amount of dilution required for a product to be effective varies. (Source)
Other important considerations
Chlorine-based solutions must be prepared daily, as they are light-sensitive.
Most chlorine-based products require the removal of organic soil prior to use; specifically, cleaning before disinfection.
The disinfection step requires a wet contact time (the amount of time the disinfectant must remain on the surface to be effective).
The smell of chlorine does not necessarily indicate an adequate concentration of the solution, as the smell can be detected even at extremely low concentrations, as is the case with some chlorine swimming pool tablets.
Klintensiv Tip: Warning! Chlorine solutions are corrosive and can pit metal and damage the skin.
Preparing chlorine-based solutions for infection control
When preparing chlorine-based solutions, keep in mind that there is no single simple dilution that can be used to reach the optimal working concentration. How much dilution is required depends on the type of product available. The following guidance can be used when preparing chlorine solutions.
Before use, consult the safety data sheet of the specific product used and check the section for appropriate personal protective equipment to avoid chlorine exposure.
Prepare a 0.05% chlorine solution by adding one tablespoon of HTH granules to 20 liters of clean water and stirring for 10 seconds. Prepare a 0.5% hypochlorite solution by adding 10 heaping tablespoons of HTH granules to 20 liters of clean water. After mixing, wait 30 minutes to allow all Ca(OCl)2 granules to dissolve. (Source)
Alternatively, the following methods can be used to prepare chlorine solutions from either sodium hypochlorite (liquid) or calcium hypochlorite.
Chlorine use in the home environment
The first thing to remember is that the hypochlorous acid we use for cleaning is normally at a concentration between 5 and 6 percent. No other presentation should be used than those recommended for cleaning, and we must also take all safety measures for its use, including the use of face masks, gloves, and goggles.
Disinfectant properties of chlorine
Chlorine has high disinfectant properties that normally eliminate 99% of bacteria and viruses, including the entire Coronavirus family, while additionally eliminating other potentially harmful pathogens such as E. coli, Norovirus, Shigella, Salmonella, cold viruses, among others. This is why hypochlorous acid is ideal for cleaning walls and bathroom fixtures, kitchen countertops, and any surface. (Source)
Eliminating mold
Normally we want our homes to be clean, but we don't pay attention to the presence of mold in areas like bathrooms and kitchens. Mold can cause serious health problems, such as skin irritation, nasal congestion, and throat and eye irritation. Chlorine is a good product for cleaning mold from our bathrooms and kitchens.
Bleaching clothes
Our white clothes can look like new when we wash them if we add a small amount of chlorine-based bleach to our regular soap. Care must be taken with the quantity, as an excess can damage our clothes; it should also not be used with colored clothes.
Disinfecting dishes
We usually don't pay attention to the maintenance of our dishwasher, but it is very efficient and quick to spray some chlorine-based disinfectant inside the equipment once a week and start a cycle with the equipment empty; you will notice the difference. Do not mix with any dishwasher detergent.
Warnings regarding domestic use of chlorine
There are times when it is not advisable to use hypochlorous acid in any of its presentations.
Wooden floors and furniture
Although there is much talk about the benefits of cleaning and disinfecting wooden floors with chlorine products, we do not recommend using chlorine on wooden floors and furniture for any reason; chlorine can irreparably damage the protective layer of the wood and remove its natural shine. There are many specialized wood care products on the market that can provide better results without damaging your floors or furniture.
Klintensiv Tip: For floors, it is recommended to use only products specially designed for this purpose. An example is the Klintensiv floor solution, a formula specially designed to ensure efficient and easy cleaning of ceramic, marble, granite, stone, porcelain, and linoleum surfaces, with an intense fragrance effect.
Displays and electronic equipment
Another common mistake we make is cleaning the screens of electronic equipment with cloths or wipes that contain chlorine. In any concentration, chlorine will damage screens, especially if they are touchscreens. It is advisable to clean the display of any electronic equipment according to the manufacturer's instructions.
Carpets
Using chlorine or cloths impregnated with chlorine to remove any stain from a carpet can discolor the carpet material by damaging it. It is also important to be careful when cleaning plastic furniture or dark plastic furniture, as chlorine can discolor the material.
Precautions in chlorine use
Under no circumstances should we mix chlorine with any other cleaning product, as chemical reactions occur that can be extremely dangerous to health. Another important aspect is not to mix chlorine with hot water, as it generates hydrochloric gas, which is life-threatening. (Source)
When using chlorine, we must wear the proper protective equipment for personal safety; the use of gloves as well as protective masks is required.
We should not use chlorine in enclosed places or places with little ventilation; this is of the utmost importance because chlorine gases are harmful to personal health.
Chlorine, regardless of the form in which it is used (liquid or chlorine swimming pool tablets), must not be ingested, so high safety measures are recommended for storage at home.
Conclusion
Chlorine is an extremely useful substance in the healthcare environment due to its disinfectant properties. Additionally, a wide range of household cleaning products contain chlorine. Its effectiveness has been proven over time both for removing pathogens and for cleaning dirt and stains in the home. However, caution is required when using products based on hypochlorous acid because the adverse effects of this substance can be harmful to humans and animals.
Sources:
https://www.elainescleaningsolutions.com/cleaning-with-chlorine/
https://www.cdc.gov/vhf/ebola/clinicians/non-us-healthcare-settings/chlorine-use.html
