HOCl in the Hospital Setting
The HOCl Trust for Hygiene and Safer Water has no commercial interests in the promotion of the use of HOCl, and has no commercial ties with any of the companies or brands referenced in this document.
A Comprehensive Look at the Use of Hypochlorous Acid for the Hospital Setting During Covid-19 Outbreak
Who is the HOCl Trust?
The HOCl Trust for Hygiene and Safer Water comprises three volunteer Trustees dedicated to informing and educating about Hypochlorous Acid (HOCl). We are a charity and not a commercial entity. During the Covid-19 outbreak, our focus has been on providing free supplies of HOCl to frontline key workers ‘on the ground’ with guidance on how to use it to protect themselves, their patients and their families and co-workers from infection. Our wider effort has been to attempt to encourage the government via various contacts such as Hon. Richard Arthur, to implement a programme of fogging in hospitals and to encourage the use of HOCl as keyworkers’ PPE.
What is Hypochlorous Acid?
Hypochlorous Acid (HOCl) is part of the immune system, made by our white blood cells to kill pathogens when invading the body1. HOCl is safe and non-toxic, it is used in a variety of applications from open abdominal wound cleaning2 to gargling for sore throats3,4, nasal irrigation5 from the food industry6 and agriculture7 to sterilising baby equipment8, no rinsing is required, it can be touched and even drinking it causes no harm9, 10.
How is HOCl made?
There are several ways of making HOCl outside of the body. Many commercial manufacturers use electrolysis of saline solution (such as our founder’s original product, ‘Sterliox’). We have determined a method of making HOCl chemically which is far more cost effective, stable and easier to transport (Salvox – see Unilever presentation pdf attached). We then determined that NaDCC is HOCl on dissolution – an easy and readily available form of free available chlorine which is stable and produces HOCl at the perfect pH when dissolved in water to the correct concentration (see PURTABS brochure pdf attached, and Angiene SDS pdf attached).
HOCl in the NHS
- The W.H.O. have HOCl in the form of Chlorine: ‘NaDCC’ listed on their Disease Commodity Package for Novel Coronavirus as critical PPE for health care facilities.
- NaDCC (sodium dichloroisocyanurate otherwise known as troclosene sodium12) when dissolved in water is free available chlorine in the form of Hypochlorous Acid (HOCl).
- NaDCC is available to the NHS in tablet form in the NHS Supply chain catalogue 14
There are several brands and suppliers on the list – main ingredient must be sodium dochloroisocyanurate or trocolosene sodium, additional ingredients may be adipic acid and sodium carbonate, but these do not inhibit the manufacture of HOCl on dissolution
- NaDCC tablets are made available by NHS’ Dedicated PPE Supply Channel for Covid-19 all NHS Trusts as ‘Chlorine releasing tablets’17 HOWEVER all products on the list as ‘General Purpose Detergent’ contain detergents which prevent the product from being made up as safe HOCl
- Staff have been told they aren’t allowed to use the NaDCC we are donating to them, as it is not alcohol-based, or it is not the product they have trained their staff to use and they don’t have the time to retrain their staff and therefore are not using the supplies they have registered for.
The added detergent means that the NaDCC cannot be used to its full potential as HOCl, that is:
- used to decontaminate PPE during the donning and doffing stage (all reusable PPE could be easily decontaminated with HOCl, and even single use PPE could be decontaminated where there is a shortage, although due to the ‘flimsy’ nature of this type of single use PPE it could be impractical, but a simple fog or spray down whilst in sue will prolong the life of the PPE)
- used topically on hands, sprayed on the face, as a gargle or used as a nasal rinse if concern of contamination with Covid-19 is suspected and carried as PPE
- fogged or misted safely around people in tunnels or dedicated fogging spaces on entrances/exits into and out of hospitals
An increasing number of organisations globally are using HOCl for fogging to combat Covid-19 in a variety of settings from hospitals to dental surgeries, care homes and for fogging of entrances to public transport and places of work, even the fire departments in the US are using it to fog their fire engines. It is safe for fogging in the presence of people18.
HOCl is widely recognised to deal swiftly with viruses, for example, when fogged, only 20ppm can kill norovirus in up to 10 mins. 200ppm kills norovirus in up to a minute19.
With greater understanding of the chemistry NHS supply chain has access to, it can be quick and easy to move away from the detergent-contaminated product to the NaDCC without detergents will make a safe, cost-effective, superior, efficient biocide for managing healthcare facilities.
The NHS Supply Chain, with this knowledge, has a duty to urgently:
- Shift to the detergent-free NaDCC products from suppliers
- Upgrade NaDCC to ‘Essential PPE for frontline staff’
- Launch an NHS-wide information-based campaign to educate staff about the properties of HOCl and how to make it easily with the NaDCC they have made available to them through the supply channel
- Break away from the restrictive protocol of using fogging in hospitals only when the hospital is considered to be the original source of infection during this outbreak and implement fogging at doffing stations at the very least, but ideally at hospital entrances and exits to minimise any viral contamination on the person of anyone going into or out of a hospital
- Announce to all frontline keyworkers that if they are given/donated or provided with chlorine disinfectant tablets or granules they can and should use them as directed on the package, to make up 1000ppm, in place of alcohol-based rubs where these are unavailable or in short supply
With access to their own hand-held HOCl sprays, frontline staff could frequently decontaminate themselves with 500-1000ppm, without harming themselves, their colleagues or their patients. If hospitals had supply of NaDCC to hand that wasn’t contaminated with detergents, fogging in hospitals could be widely implemented quickly and cost-effectively, rapidly reducing the risk to life of both staff and patients, and reducing the risk of taking the virus home with them to their families.
Two articles which highlight the benefits of HOCl for the NHS and in the battle against Covid-19 note:
Hypochlorous Acid in the Fight Against COVID-19, Alan G. Kabat, OD, FAAO
Why the NHS and Private Clinics Should Look Further than Alcohol-Based Sanitisers
Video Playlists of interest:
How to make HOCl
500ppm AFC: 1 x 1.7g NaDCC tablet to 2 litres water.
1000ppm AFC: 2 x 1.7g NaDCC tablets to 2 litres water.
2000ppm AFC: 4 x 1.7g NaDCC tablets to 2 litres of tap water.
- this study shows how gargling with salt water works to generate HOCl in the cells http://www.elvisstudy.com/nasal-irrigation-and-gargling.html
- gargling directly with HOCl works also https://www.alliedacademies.org/articles/comparison-of-the-preventive-effects-of-slightly-acidic-hocl-mouthwash-and-chx-mouthwash-for-oral-diseases.pdf
- https://www.boots.com/vital-baby-aquaint-sanitising-water-500ml-10199504 / https://www.vitalbaby.com/aquaint-sanitising-water-packs/
- https://www.who.int/emergencies/what-we-do/prevention-readiness/disease-commodity-packages/dcp-ncov.pdf?ua=1 (also attached)
- https://www.who.int/water_sanitation_health/dwq/chemicals/sodiumdichloroisocyanuratesum_2nadd.pdf (also attached)