Electrolytic Chloroxidizer

Electrolytic chloroxidizer, otherwise known as Amuchina, is a chlorine-based solution with a 17% sodium chloride component and 0.057% sodium hypochlorite. ExSept® is the 5 or 10% dilution of Amuchina. It is said to be effective against all spectrums of pathogens including Gram-positive, Gramnegative bacteria, viruses and spores. Amuchina is similar in molecular size and structure to water, and because it does not present with an electrical charge, the undissociated hypochlorous acid may easily cross the microbial cell membrane. Its intracellular targets are enzymes containing sulfhydril groups involved in aerobic and anaerobic pathways. The action of hypochlorous acid on these enzymes consists in irreversible oxidation of the thio-group, thus abolishing enzymatic action and resulting in the destruction of the bacteria (ExSept unpublished manuscript).

Amuchina is reported to be non-toxic, non-irritating [46, 47]. Roveda et al. [48] conducted a controlled randomized study on 48 patients comparing the antiseptic properties of Amuchina (ExSept 10%) to 10% povidone-iodine. Both antiseptics produced an immediate reaction in bacterial load during a single application, however, the absolute values were more significant with ExSept (p < 0.05). Jones and Mulberry [49] repeated the study with 24 female

Table 1. Exit site infections

Exit site infections

Group (n) Chlorhexidine

ExSept®

Total

p-Value

Negative culture

59

52

111

0.553

Clinical signs and positive culture

3

5

8

Clinical signs

2

0

2

Total

64

57

121

volunteers, 12 per group. The bacterial flora of the skin and abdomen were studied. Both products produced an immediate large reduction of bacteria at the abdominal area but Amuchina appeared more effective than povidone-iodine at the axillar area (p < 0.05). Cruz et al. [50] conducted a similar study comparing skin surface bacterial counts of three groups of 9 voluntary patients and found no difference between products (p < 0.05). No side effects occurred suggesting Amuchina was well-tolerated. In 1989, a Canadian clinical trials group lead by Churchill et al. [51] conducted a multi-center trial comparing the Y-set, which used Amuchina 50% as the in-line disinfectant and compared it to the standard peritoneal dialysis systems. There was a 61% risk reduction with Amuchina, however accidental infusions into the peritoneal cavity related to patient error caused moderate to severe abdominal pain for patients. DeVecchi et al. [52] used Amuchina as an in-line disinfectant in some Y-systems to prevent exogenous peritonitis. The results were inconclusive because the researchers suggested that glucose in solution, in combination with organic compounds like peritoneal dialysate, could reduce the bactericidal effect of the product. Therefore, it could not be determined as to what the clinical role of Amuchina was with the Y-set. In the study by Astle and Jensen [4], the standard 0.5% chlorhexidine with 70% alcohol (n = 64) was compared to ExSept 10% (n = 57) as a skin and hub disinfectant in 111 hemodialysis CVCs, 10 (8.26%) patients developed exit site infections: 5 from each group (table 1). Two episodes of bacteremia occurred in the study: one per group (table 2). 91.7% of the patients developed skin colonization: 56 patients in the cholorhexidine group and 55 in the ExSept group (table 3). Of the 10 patients who had exit site infections all were colonized. The microorganism primarily responsible for colonizing the skin was coagulase-negative Staphylococcus. In conclusion, ExSept 10% was comparable to chlorhexidine 0.5% with 70% alcohol for the incidence of catheter-related infections. However, ExSept is less costly and has less catheter-associated damage such as catheter cracking (tables 1-3).

Table 2. Bacteremic episodes

Culture results

Group (n)

Total

Chlorhexidine

ExSept®

Positive

1

1

2

Negative

61

56

117

Possible

2

0

2

Total

64

57

121

Table 3.

Skin colonization of exit sites

Colonization

Group (n)

Total

p-Value

>15 cfu

56 55

111

0.069

<15 cfu

8 2

10

Total

64 57

121

cfu = colony forming units.

Infection is a well-documented complication associated with CVCs for hemodialysis. It is imperative that strict aseptic technique is adhered to and all strategies employed in an effort to reduce or prevent infections associated with these catheters. Preventative care will also ensure the added benefit of reduced costs of hospitalizations. It is a primary concern that health care providers continue to study and search for methods to protect the patients from preventable infections.

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