V.M.Melnikova, G.P.Belikov, N.V.Loktionova, V.M.Bakhir, O.I.Sukhova
The Priorov Central Institute of Traumatology and Orthopedics of MZ RF, Moscow Medical and Stomatological University of MZ RF, VNIIIMT MZ RF
Electrochemically activated solutions
It was shown that in a surgical unit where nosocomial infection is one of the most serious problems, application of electrochemically activated solutions produced in STEL-10N-120-01 devices is very timely. Such solutions are used not only for disinfection, but also for prevention of wounds’ contamination and their treatment.
Nosocomial infection (NI) is a serious medical, social and ecological challenge. Most commonly, sources of NI in surgical hospitals are patients with septic complications and wound infection. Selection of up-to-date disinfectants and antiseptics efficiently combating opportunistic pathogens is an urgent issue, which requires immediate attention. Such disinfectants and antiseptics include electrochemically activated solutions [Belikov et al., 1997; Melnikova et al., 1997; Rovinskaya, 1997].
By the example of the work carried out in the Priorov Central Institute of Traumatology and Orthopedics, the article presents the results of many-year study and application of electrochemically activated (ECA) solutions produced in STEL devices for instrument disinfection and sterilization.
Materials and methods
The products of common salt electrochemical activation in STEL devices are neutral anolyte and alkaline catholyte. Anolyte demonstrates a high antibacterial, virucidal, anti-fungal and sporicidal activity, and catholyte has detergent qualities [Bakhir, 1999; Melnikova, 1999].
In 1996, NPO EKRAN provided the Institute with two new-generation STEL-10N-120-01 devices (model 80-01), which today are installed in a specially established Central Disinfection and Sterilization Department.
Three-year operation of these devices [Loktionova et al., 1997] indicates that the requirements of a 500-bed multi-field institute (CITO) for routine and overall indoor cleaning, equipment disinfection, instrument, dressing material, laboratory and table glassware decontamination are fully met with neutral (ANK) anolyte produced in the new devices. Calculations show that the daily need is up to 2000 liters of ANK. The Institute has used no other disinfectants in recent years. CITO’s microbiological laboratory regularly checks ANK antibacterial efficiency in respect of nosocomial microorganism strains vegetating in the Institute units.
V.M.Bakhir’s colleagues report that one STEL-10N-120-01 device (model 80-01) working 6 hours a day guarantees economic benefit of 200,000-250,000 rubles (US $ 8,000-12,000) a year (as compared to previously used disinfectants, even to chloramine).
Application of ANK produced by STEL-10N-120-01 devices installed in the Central Disinfection and Sterilization Unit has a number of advantages: the Institute’s departments are constantly supplied with adequate quantity of disinfectant solution; the solution’s consumption and the need for it in clinical units are under control, as well as the regularity and appropriateness of its use, and thanks to that, quality of routine and overall cleaning of the units rises, which is demonstrated by better results of sanitary-bacteriological washing sample analysis; besides, anolyte application is cost-effective, convenient and continuously supplied. The most NI vulnerable units requiring permanent bacteriological control are surgery unit, resuscitation and intensive care unit and septic complications’ unit. Comparison of bacteriological control results for the periods of 1992-9З and 1997-98 demonstrates considerable progress.
One of the major challenges in combating NI is treatment of patients with inflammatory septic complications and wound infections. Since microorganism poly-resistance to even new antibiotics has dramatically increased in recent years, some specialists would consider this phenomenon an ecological disaster. Today, search for new chemotherapeutical preparations for prevention and treatment of infections is badly needed. In this context ECA solutions attract special attention. Sodium hypochlorite produced by EDO-4 devices designed in the Institute for Physical and Chemical Medicine of the Russian Health Ministry is successfully applied in a number of medical institutions and CITO [Malginov et al., 1999] in cases of bacteremia, sepsis, local wound treatment and as a detoxifying agent. Sodium hypochlorite produced in EDO devices is approved by the Pharmacological Committee both for local and intravenous use. Anolyte and catholyte produced in STEL devices have no such approval, and they have been mostly tested by volunteers, members of research and engineering team and their relatives in cases of various infectious diseases; the results are favorable. In the Priorov Central Institute of Traumatology and Orthopedics of the Russian Ministry of Health [Loktionova, Kaveshnikov, 1993], a possibility of using neutral anolyte and catholyte produced in STEL devices for prevention and treatment of wound infection in cases of cut and gunshot wounds was studied in experimentation on animals. The results are very promising. Chance of microorganism adaptation to activated anolyte was suggested [Panicheva, 1998] to be negligible. Also, neutral anolyte was reported [Bazhenov, Khadzhibayev, 1997] to increase microorganisms’ antibiotic sensitivity. These findings are certainly worth attention and further research. In oral surgery [Tarasenko et al., 1999], septic wounds are successfully washed with neutral anolyte. Bacteriological checks demonstrated that the number of microorganisms was by 2-3 orders lower than in case of routinely used methods (hydrogen peroxide and other antiseptics). No microorganism adaptation to anolyte was observed.
Long-term comprehensive study and development of methods of applying in various types of surgical units (traumatological and orthopedic, dental and so on) electrochemically activated solutions produced by STEL devices, particularly of the new generation, is a perspective trend in NI combating, and the solutions can be used not only as disinfectants, but also as chemotherapeutical means to prevent and treat wound infections, as well as to treat hands [Zarezayev et al., 1994], especially in cases of emergency.
At present, all necessary measures are taken to obtain approval for carrying out extensive clinical tests of electrochemically activated solutions produced by STEL devices in a number of medical institutions.
Published in the Bulletin of Vinnitsa State Medical University, 2000; 2:327-328