Systemic harmful effects of ingestion of household bleaches

Factors that affect mortality in local patients who ingested common household cleansing products and required intubation

Introduction:

Ingestion of common household cleansing products resulting in a need for intubation is not uncommon in Hong Kong. The objective of this study was to determine the factors that affect the mortality in this group of patients.

Methods:

This was a retrospective cohort study conducted in the Hong Kong Poison Information Centre, encompassing data from all Accident and Emergency Departments in Hong Kong over the period of 1 January 2008 to 31 January 2019. This study was conducted by recruiting all patients who had ingested common household cleansing products and required intubation in the same hospital admission. The outcome was death. The study aimed to look at risk factors associated with mortality.

Results:

Seventy-seven patients were included in the final analysis. The median age was 53 years. The mortality rate was 21%. Univariate analysis (at p < 0.05) indicated that (1) older age, (2) ingestion to intubation time more than 12 h, (3) not admitted to intensive care unit, (4) complication of chest infection, (5) complication of fast atrial fibrillation, and (6) complication of acute kidney injury were factors associated with higher mortality rate. Among these, older age and development of acute kidney injury were statistically significant (p < 0.05) on multivariate analysis.

Conclusion:

Among patients who ingested household cleansing products and required intubation, older age and development of acute kidney injury were factors strongly associated with mortality.

Accidental Use of Sodium Hypochlorite Instead of Haemodialysis Solution: A Case Report

Haemodialysis that involves diffusion of solutes across a semi-permeable membrane allows excretion of harmful solutes and excess fluids. All dialysis machines are disinfected by chemical agents (e.g. sodium hypochlorite, formaldehyde, glutaraldehyde, peroxyacetic acid). Sodium hypochlorite (NaOCl), which is known as household bleach, is a whitening agent and used in medical treatment and disinfection of tap water. Herein, we present a 66-year-old female patient who was inadvertently connected to NaOCl solution infusion in a routine haemodialysis session. By the time the accident was noticed, approximately 200 ml of undiluted NaOCl cleaning solution (concentration 1.21-1.23 g/ml) had been added to the dialysis bath, soaking the membrane fibres. The patient was admitted to the hospital about 30 minutes after the exposure, and her Glasgow Coma Scale score was recorded as 5/15 (E1, V1, M3). In conclusion, more stringent standards should be enforced in the sterilization of haemodialysis machines and related equipments. Accidental contacts with disinfectants should be prevented in dialysis units.

A comparison of the sensitivity of four Staphylococcus aureus isolates to two chlorine-based disinfectants and an eco-friendly commercially available cleaning agent

The aim of this study was to determine the effect of household bleach, a sodium dichloroisocyanurate (NaDCC)-based disinfectant and an eco-friendly cleaning agent (EFCA) on four Staphylococcus aureus strains, including two isolated from community infections. The products were assessed using the suspension (EN 1276) and surface (EN 13697) tests, while biofilm activity was determined using the 96-well plate method. Bleach and NaDCC caused > 5 log reduction in viable counts within 5 min in suspension, whilst on surfaces the reduction was < 3 log. Bleach at 5000 ppm free available chlorine completely eradicated MSSA NCTC 13297 and PVL CA MSSA biofilms within 10 min, but not at 500 and 50 ppm, NaDCC was less effective against biofilms. The EFCA demonstrated no antimicrobial activity. It is of concern that at the recommended "use" dilution, bleach did not eradicate biofilms. Although increasing contact time and/or concentration should improve the activity, this may not be acceptable to the user.

Treatment of field water with sodium hypochlorite for surgical irrigation

BACKGROUND

Early irrigation and surgical debridement of high-energy wounds and open fractures effectively prevents infection. Rapid wound care has been maximized by the United States military's "forward surgical teams." However, the volume of sterile irrigant required to treat multiple patients with multiple wounds presents a significant logistical burden. Using ground-derived field water could eliminate this burden.

METHODS

We collected 100 water samples from five sources. An initial bacterial count (CFU/mL) was determined before treatment. 5% sodium hypochlorite was then added to each sample to derive a concentration of 0.025%. After treatment, a final bacterial colony count was performed.

RESULTS

We found no bacterial growth in 99/100 samples. One post-treatment sample grew a single colony of a Bacillus species not present in the pretreatment culture and was determined to be an air contaminant.

CONCLUSIONS

Our field-expedient modification of Dakin's solution could substitute for sterile irrigation fluid when it is neither available nor logistically feasible.