Comment: Soluble chlorine disinfectants vital for Ebola containment

Alec Barton of GV Health discusses the vital role that soluble chlorine disinfectants are now playing in the fight against Ebola

In this article, Alec Barton of GV Health discusses some of the issues that healthcare professionals and public health officials dealing with the Ebola crisis are facing and the vital role that soluble chlorine disinfectants are now playing

The current Ebola outbreak is highlighting the importance of chlorine disinfectants for public health and patient safety use.

There are huge challenges for public health officials and medical practitioners in containing the outbreak, as well as providing protection for the population in areas where the outbreak is occurring

Soluble chlorine disinfectants are now playing a vital role in helping prevent the spread of Ebola in the ongoing crisis in West Africa.

Good public health and patient safety practices are essential, mboth for preventing the spread of Ebola Virus Disease (EVD), and during the management and treatment of patients infected with it.

It is widely understood that those treating and caring for victims are themselves at very great risk, but until very recently it was not as widely known that that this must include those involved in the removal and disposal of the deceased bodies of victims.

There are huge challenges for public health officials and medical practitioners in containing the outbreak, as well as providing protection for the population in areas where the outbreak is occurring. Secondary infections also pose a very high risk.

The current Ebola outbreak is mainly concentrated in areas where there are often very limited existing medical facilities and where those that do exist are of a poor standard. Public health services and the general levels of hygiene in many affected areas are often rudimentary, and governments lack both the resources and sufficiently-trained staff to address the challenges.

Among some communities currently affected by EDV, knowledge and understanding of hygiene and the ways in which infectious diseases are spread is highly limited. Moreover, it is rapidly becoming clear that deep-rooted social and cultural practices, in particular those relating to death and burial, are significantly increasing the risk of the spread of Ebola. Morbid as it may be, the corpses of those who have succumbed to EVD remain highly infectious and require extremely careful handing, isolation, disinfection and disposal.

The remoteness of many communities also presents challenges. These areas are more difficult to reach for public health officials and medical practitioners. Delivering equipment and disinfectants can itself be challenging in remote and inhospitable terrain.

EVD greatly lowers the resistance of sufferers to other infectious diseases. Particularly in more remote areas of West Africa, infections such as TB and C.difficile are prevalent among the population. As a result, a high proportion of those who succumb to Ebola in the current crisis are also carrying a secondary infection. This leads to complications and increased risk for both patients and healthcare practitioners.

As the outbreak has progressed, soluble chlorine has become the principal form of disinfectant. It is now used both by government health teams and by all major charities working in the field wherever possible

Against this challenging background, public health officials and medical practitioners fighting the Ebola outbreak have been turning to chlorine-based disinfectants as a key tool to improve hygiene in healthcare facilities as well as public health and hygiene. They are also key to protecting those living in affected areas and all those directly involved in the treatment and care of EVD sufferers.

In the early days of the current outbreak, liquid chlorine was the principal type of disinfectant used. There are even reported cases of diluted domestic bleach being used in Ebola clinics. However, as the outbreak has progressed, soluble chlorine has become the principal form of disinfectant. It is now used both by government health teams and by all major charities working in the field wherever possible.

Soluble chlorine disinfectants offer a number of advantages over liquid chlorine. Key among these are ease of portability and storage, coupled with much lower risk of spillage and injury to those involved in transporting, handling and storing the disinfectant. Moreover, soluble chlorine does not degrade, retaining its full effectiveness over much longer time periods and in a much wider range of environments compared to liquid forms of chlorine.

These advantages also translate into lower costs when compared to liquid disinfectants. This is vital during the current Ebola outbreak where resources are limited. In many developed countries, soluble chlorine tablets and granules have almost completely taken over from liquid forms of chlorine disinfectant for public health and healthcare uses.

Soluble chlorine disinfectants are available from a number of suppliers. However, there are major differences between the formulations and presentations. Factors such as the range of different tablet weights, available NaDCC and granular structure affect their ease of use. This has now been recognised as a major factor in locations where skills and training are limited.

From a medical perspective the exact formulation affects the range of pathogens that a disinfectant is effective against, the speed of virus kill, the effective temperature range, and the dilution rate which determines the area that can be effectively disinfected with a given quantity.

Only the latest generation of soluble chlorine disinfectants, developed within the past 2-3 years, offer healthcare workers and public health officials with the full range of benefits needed for the fight against Ebola. They are:

  • Temperature tolerant: remaining fully effective across a very wide temperature range which is vitally important in tropical settings
  • Effective against major secondary risk pathogens such as c-difficile and TB: these are both frequently encountered due to the high levels of bloody diarrhoea and coughing encountered in EVD
  • Remains effective in the presence of high organic matter: prevalent in remote locations where facilities are limited

Only the latest generation of soluble chlorine disinfectants, developed within the past 2-3 years, offer healthcare workers and public health officials with the full range of benefits needed for the fight against Ebola

When selecting a supplier it is important to ensure that their products are fully tested to the appropriate European or US EPA standards. The European Standards for the evaluation of virucidal activity of chemical disinfectants and antiseptics used in human medicine (EN14476) require that disinfectants should inactivate all viruses in one minute at a dose of 500 ppm (clean conditions) or 1000 ppm (dirty conditions).

At the time of writing the World Health Organization has confirmed that more than 3,000 individuals are known to have died in West Africa as a result of contracting Ebola. Public health officials agree, however, that the real death toll is likely to be many times higher.

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