VOYENNO-MEDITSINSKIY ZHURNAL (Journal of Military Medicine) 9¢ 99 pp.56-58
Mikhailov S.N., Honored Doctor of the Russian Federation, Colonel of Medical Military Service
Mistryukov V.V., Colonel of Medical Military Service
IN TODAY’S health care, a burning issue is prevention of nosocomial infections affecting 20-30% of patients depending on the type of medical facility department and accounting system [4, 6, 7].
In conditions when the range of microorganisms constantly changes as does their level of resistance to disinfectant and sterilizing agents, prevention of postoperative complications is directly linked with effective disinfection of surgical instruments and equipment, with microbial decontamination of environmental and air objects. Microbial species prevalence is associated with the type of surgery. Abdominal surgery favors anaerobes, trauma and orthopedic surgery – Staphylococcus Aureus and staphylococcal pyoderma, ENT manipulations mostly evoke anaerobes though recently hemophilic bacteria have become more prominent. Tonsillar infections tend to be poly-microbial. The same trend is observed in thoracic surgery.
Opportunistic pathogenic bacteria, such as Pseudomonas, Klebsiella, Proteus and Enterobacter are increasingly noticeable. Close to 40% of Pseudomonas species are found in culture obtained from hand washing sinks and from oxygen apparatus humidifiers.
Microbial decontamination becomes the most serious challenge to practical health care despite the abundance of disinfectants and sterilizing chemicals (halogens, surfactants, peracetic and formic acid derivatives, new combinations of chlorine-containing substances). Due to inadequate financing and high cost of the above agents, medical facilities still use traditional solutions of bleaching powder, chloramine and so on. Sporicidal action of their 5-10% solution is toxic for man.
Since 1992, our surgical unit has been using sodium hypochlorite obtained by electrolysis of common salt aqueous solution with no electrode product separation. It possesses a wide antimicrobial scope of action in 0.25-0.5% concentration (ELMA-1 device). Another type of synthesis of electrochemical aqueous solutions in diaphragm-type devices with separated electrode products - STEL-МТ-2-60, STEL-10-250 developed in the Moscow-based Scientific Production Association EKRAN appears absolutely unique. Electrochemically synthesized activated (ECA) solutions anolyte and catholyte have been included into the List of Home and Imported Disinfectants, approved for use in 1999. On the basis of diaphragm-type flow-through electrochemical modulars (FEM) having no analogues in the world, there occurs unipolar (anode and cathode) treatment of water-saline solutions with mineralization within the limits of 0.01-3 g/l. Electron-acceptor solution structure is formed at the anode, and electron-donor one – at the cathode. FEM provides water treatment in electrode chambers with electric field of 10,000,000 V/cm voltage. The liquid is converted into thermodynamic state of relaxation, normally lasting for 48-72 hours. Reactive capacity of anolyte results not only from trivial stable electrolysis products, but also from superactive compounds: hydrogen peroxide, hypochlorous, chlorous, chloric and perchloric acids, peroxocarbonates, chlorine oxides, hydroxyl radicals etc. The presence of these compounds is evident due to abnormally high anolyte ORP value at a low (0.03%) concentration. High biocidal activity, unique combination of detergent and antimicrobial properties, the widest scope of antibacterial effect, good compatibility of ECA solutions with human body tissues makes it possible to trace all types of microbial decontamination (disinfection, sterilization, antiseptics and chemotherapy).
A new step in the disinfection practice of the surgical unit has become the use of anolyte produced in STEL-МТ-2-60. The device operates in 6 regimes synthesizing ECA solutions of 30 to 350 mg/l active chlorine compounds’ (ACC) concentration. Meta-stable structure of these solutions stimulates bio-anti-oxidant activity, helps stabilize cell membranes, strengthen non-specific immunity, increase body resistance to the action of radiation factors, toxins and xenobiotics; enhances biologic oxidation, general anabolism; accelerates reparative and physiological processes.
By now, over 20 technologies in medicine and 50 – in biotechnology have been developed . During this year, we have been producing neutral anolyte (AN) with active chlorine content of 0.025-0.03%, at current strength of 8-10 А and biocidal anolyte output of 40-45 l/h. The solution’s antimicrobial effect is equivalent to that of 10% sodium hypochlorite solution, and is more than twice that of 2% alkaline glutaric aldehyde solution; anolyte is non-toxic . The same AN concentration is sufficient to inactivate HIV as well as hepatitis virus, and that is of immense importance in surgical tools’ disinfection. AN’s distinctive feature is its ability to combine disinfection and pre-sterilization cleansing not only saving detergents and perhydrol, but also reducing by half treatment time. AN is also special because in the above concentration 20 minutes is sufficient to achieve sterilizing effect. This is 3-4 times quicker than when Cidex (alkaline glutaric aldehyde – one of the best sterilizing solutions) is used. When applying 2% aqueous glutaric aldehyde, sterilization effect ensues after 10 hours, in case of routinely used 6% hydrogen peroxide at 600 – 3 hours, at 180 – 6 hours. We made sure of AN sterilizing effect having treated 10 instruments by 5-fold holding in AN having 0.03% active chlorine concentration. With no anti-corrosive additives (0.1% and 0.05% catapol and sodium boron gluconate solutions) instruments become rusty. Anti-corrosive additives are compulsory in instrument disinfection and sterilization.
AN’s non-toxicity and effectiveness make it possible to use it as antiseptic for hands’ treatment . High biocidal effect of anolyte has been confirmed by control washing samples from surgeons’ and operational nurses’ hands (ACC 180-250 mg/l, 100% sterility of 15 samples-cultures collected from hands treated with AN for 3 minutes).
Using anolyte, it should be kept in mind that when ECA solutions lose their principal characteristic – relaxation, there appear hypochlorite solutions which little change with time and are stable, but which are four-times inferior to anolyte in their biocidal activity, though dozens of times exceed non-activated hypochlorite solutions in biocidal effect . Anomalous properties of anolyte and catholyte completely disappear when the solutions’ mineralization is over 5 g/l.
During 200 hours of operation STEL-МТ-2-60 produced 8 tons of anolyte. That has covered the cost of the device purchased in 1995. One liter of anolyte costs 240 rubles, of Cidex – US $ 4, of 1 kg of dry chloramine – 35,000 rubles. To prepare an equivalent volume (8000 l) of bactericidal 5% chloramine solution, 400 kg of dry matter or 1200 kg of dry iodopyron would be necessary for obtaining 1% solution, or 1400 l of perhydrol to prepare 6% hydrogen peroxide solution. Neutral anolyte is a fair alternative to costly disinfectants.
We have estimated the anolyte requirements to disinfect operating rooms of 350 m2 area. Given 70 ml per 1 m2 during routine cleaning (twice a day) and 300 ml per 1m2 during clear-out (once a week), about 1.6 tons of anolyte were prepared every month. Such device as STEL-МТ-2-60 producing 40-45 l/h satisfies annual requirements of the surgical unit (18-20 tons) of the military hospital in the town of Khlebnikovo being operated 1-2 times a day.
The hospital purchased a new STEL-10-250 device with 250-l/h capacity. Running for 2 hours a day it fully supplies the 400-bed hospital with disinfectant, the annual demand being 80-100 tons.
Application of ECA solutions in the surgical unit brought about positive results of routine checks of air and environment microbial contamination: postoperative wound sepsis dropped from 5.6% in 1993 to 0.6% in1996; quality of cleaning has improved.
Home-produced devices are compact and easy-to-handle; solution produced from water and salt is physiologically harmful, environmentally friendly, highly efficient and cheap. Practical possibility of producing in STEL devices electrochemically activated solutions suitable for disinfection, sterilization, hand and wound treatment makes them equal to universal mobile facilities capable of working in field conditions.
Electrochemically activated solutions represent a very promising trend in medical science development.