The Cleaning and Disinfecting of Hemodialysis Equipment Using Electrolyzed Strong Acid Aqueous Solution

Abstract

In general, sodium hypochlorite, formalin, and Dialox (Teijin Gambro Medical, Ltd., Tokyo, Japan [main ingredients: H2O2, CH3CHOOOH, CH3COOH, H2O]) are used to clean and disinfect hemodialysis pipelines. In this study, the suitability of electrolyzed strong acid aqueous solution (ESAAS), which has attracted considerable interest in Japan because of its strong disinfecting properties, was examined. The crossover method was used to investigate the effectiveness of ESAAS in disinfecting the dialysis pipelines in comparison to that of sodium hypochlorite (200 ppm) used alternately with 1% acetic acid. The number of bacteria and the concentration of endotoxin (Et) were measured over an approximately 3 year period, starting in September 1994. Until then, 200 ppm sodium hypochlorite had been used alternately with 1% acetic acid, and the contamination of the pipeline had been marked. However, after switching to the ESAAS disinfection method, the dialysis pipelines very rapidly became cleaner. Therefore, the decision to develop an automated ESAAS cleaning system for long-term use was made. During the development period, the original disinfectants (200 ppm sodium hypochlorite used alternately with 1% acetic acid) were used as a stopgap. After confirmation of its performance and safety, the automated ESAAS cleaning system was introduced. To find out whether the decrease in bacteria secondarily caused a decrease in the Et concentration or whether the ESAAS directly inactivated the Et, an in vitro experiment was carried out. Highly concentrated Et, which had been left in the reverse osmosis (RO) drainage pipeline, was used as a sample to investigate the effects of ESAAS on Et at various concentrations and temperatures and on the recovery test. The results showed that ESAAS directly inactivated Et. This paper reports the results of the crossover test. The results of parallel tests carried out over an approximately 4 year period have already been reported. No significant problems occurred in the dialysis. The automated ESAAS cleaning system that was developed proved to be more economical than the conventional disinfecting method.

Microbiological quality of water and dialysate in a haemodialysis unit in Ponta Grossa-PR, Brazil

“…The haemodialysis unit studied here has a routine monthly disinfection of the water distribution system, utilizing sodium hypochlorite at 500 ppm for 10 min, for the purpose of preventing increased numbers of bacteria and impeding the formation of biofilms (Tanaka et al 1999).…”

“…Among the outbreaks of infections by Gram-negative bacteria reported in haemodialysis units, inadequate disinfection of the water-treatment system and distribution has been mentioned as a possible source of such outbreaks (Pisani et al 2000;Arvanitidou et al 2003;Magalhães et al 2003). The haemodialysis unit studied here has a routine monthly disinfection of the water distribution system, utilizing sodium hypochlorite at 500 ppm for 10 min, for the purpose of preventing increased numbers of bacteria and impeding the formation of biofilms (Tanaka et al 1999).…”

Electrolyzed Strong Acid Aqueous Solution Irrigation Promotes Wound Healing in a Burn Wound Model

“…It is known that almost all germs will perish within 10 s in such a solution. It is important to note that the solution loses both its electrolytic potential and its germicidal action when it comes into contact with multicellular organic matter and reverts to ordinary water with no added function (1)(2)(3)(4)(5)(6).…”

Effect of electrolyzed strong acid water on peritoneal irrigation of experimental perforated peritonitis

“…Its strong microbicidal activity inhibits the growth of not only a wide spectrum of bacteria including methicillinresistant Staphylococcus aureus, 2−4,17 but also viruses including human immunodefi ciency virus and hepatitis B virus; 6−8 moreover, it directly inactivates endotoxin. 18 In addition to its strong microbicidal activity, ESAW has the following advantages over various chemical disinfection agents: it is minimally invasive to tissue because of its extremely low cytotoxicity, 19 it is ecological because its breakdown produces only saline and traces of chloride gas, and last but not least, it is economical because the source is just tap water and salt. Therefore, ESAW has been increasingly used as a disinfectant for medical instruments, such as hemodialysis equipment 18 and endoscopes, 20 and for hand disinfection, 21 and its efficacy and feasibility have also been increasingly recognized in Japan.…”