sodium-hypochlorite and Diarrhea

Household water treatment using sodium hypochlorite (NaOCl) has been recognized as a cost-effective means of reducing the heavy burden of diarrhea and other waterborne diseases, especially among populations without access to improved water supplies. Sodium dichloroisocyanurate (NaDCC), which is widely used in emergencies, is an alternative source of chlorine that may present certain advantages over NaOCl for household-based interventions in development settings. We summarize the basic chemistry and possible benefits of NaDCC, and review the available literature concerning its safety and regulatory treatment and microbiological effectiveness. We review the evidence concerning NaDCC in field studies, including microbiological performance and health outcomes. Finally, we examine studies and data to compare NaDCC with NaOCl in terms of compliance, acceptability, affordability and sustainability, and suggest areas for further research.

Topics: Developing Countries; Diarrhea; Disinfectants; Humans; Sodium Hypochlorite; Triazines; Water Microbiology; Water Purification; Water Supply

Household water treatment has been advocated as a means of decreasing the burden of diarrheal diseases among young children in areas where piped and treated water is not available. However, its effect size, the target population that benefit from the intervention, and its acceptability especially in rural population is yet to be determined. The objective of the study was to assess the effectiveness of household water chlorination in reducing incidence of diarrhea among children under-five years of age.. A cluster randomized community trial was conducted in 36 rural neighborhoods of Eastern Ethiopia. Households with at least one child under-five years of age were included in the study. The study compared diarrhea incidence among children who received sodium hypochlorite (liquid bleach) for household water treatment and children who did not receive the water treatment. Generalized Estimation Equation model was used to compute adjusted incidence rate ratio and the corresponding 95% confidence interval.. In this study, the incidence of diarrhea was 4.5 episodes/100 person week observations in the intervention arm compared to 10.4 episodes/100 person week observations in the control arm. A statistically significant reduction in incidence of diarrhea was observed in the intervention group compared to the control (Adjusted IRR = 0.42, 95% CI 0.36-0.48).. Expanding access to household water chlorination can help to substantially reduce child morbidity and achieve millennium development goal until reliable access to safe water is achieved.. ClinicalTrials.gov NCT01376440.

Topics: Child, Preschool; Diarrhea; Drinking Water; Ethiopia; Family Characteristics; Halogenation; Humans; Incidence; Infant; Logistic Models; Sodium Hypochlorite; Water Purification

A randomized controlled trial of four interventions was conducted using tubewells (n=2,486), liquid sodium hypochlorite ('Clorin') distributed with an improved water vessel (n=2,305), hygiene promotion (n=1,877), and a combination of the three (n=2,040) to create an evidence-base for water policy in Afghanistan. A fifth group served as a control (n=2,377). Interventions were randomized across 32 villages in Wardak province. Outcomes were measured through two household surveys separated by one year and twice-weekly household surveillance conducted over 16 months. The households receiving all three interventions showed reduction in diarrhoea compared with the control group, through both longitudinal surveillance data (IRR [95% CI]=0.61 [0.47-0.81]) and cross-sectional survey data (AOR [95% CI]=0.53 [0.30-0.93]). This reduction was significant when all household members were included, but did not reach significance when only children under five were considered. These results suggest multi-barrier methods are necessary where there are many opportunities for water contamination. Surveillance data suggested a greater impact of interventions on reducing diarrhoeal diseases than data from the surveys. Higher economic status as measured through household assets was associated with lower rates of diarrhoea and greater intervention uptake, excepting Clorin. Use of soap was also associated with lower prevalence of diarrhoea.

Topics: Afghanistan; Diarrhea; Health Education; Humans; Hygiene; Sodium Hypochlorite; Water Microbiology; Water Purification; Water Supply

To evaluate the effectiveness of point of use water treatment with flocculent-disinfectant on reducing diarrhoea and the additional benefit of promoting hand washing with soap.. The study was conducted in squatter settlements of Karachi, Pakistan, where diarrhoea is a leading cause of childhood death. Interventions were randomly assigned to 47 neighbourhoods. Households in 10 neighbourhoods received diluted bleach and a water vessel; nine neighbourhoods received soap and were encouraged to wash hands; nine neighbourhoods received flocculent-disinfectant water treatment and a water vessel; 10 neighbourhoods received disinfectant-disinfectant water treatment and soap and were encouraged to wash hands; and nine neighbourhoods were followed as controls. Field workers visited households at least once a week from April to December 2003 to promote use of the interventions and to collect data on diarrhoea.. Study participants in control neighbourhoods had diarrhoea on 5.2% of days. Compared to controls, participants living in intervention neighbourhoods had a lower prevalence of diarrhoea: 55% (95% CI 17%, 80%) lower in bleach and water vessel neighbourhoods, 51% (95% CI 12%, 76%) lower in hand washing promotion with soap neighbourhoods, 64% lower (95% CI 29%, 90%) in disinfectant-disinfectant neighbourhoods, and 55% (95% CI 18%, 80%) lower in disinfectant-disinfectant plus hand washing with soap neighbourhoods.. With an intense community-based intervention and supplies provided free of cost, each of the home-based interventions significantly reduced diarrhoea. There was no benefit by combining hand washing promotion with water treatment.

Topics: Adolescent; Breast Feeding; Child; Child, Preschool; Diarrhea; Disinfectants; Female; Hand Disinfection; Humans; Infant; Male; Pakistan; Patient Acceptance of Health Care; Prevalence; Soaps; Socioeconomic Factors; Sodium Hypochlorite; Treatment Outcome; Water Purification; Water Supply

Safe water systems (SWSs) have been shown to reduce diarrhea and death. We examined the cost-effectiveness of SWS for HIV-affected households using health outcomes and costs from a randomized controlled trial in Tororo, Uganda. SWS was part of a home-based health care package that included rapid diarrhea diagnosis and treatment of 196 households with relatively good water and sanitation coverage. SWS use averted 37 diarrhea episodes and 310 diarrhea-days, representing 0.155 disability-adjusted life year (DALY) gained per 100 person-years, but did not alter mortality. Net program costs were 5.21 dollars/episode averted, 0.62 dollars/diarrhea-day averted, and 1,252 dollars/DALY gained. If mortality reduction had equaled another SWS trial in Kenya, the cost would have been 11 dollars/DALY gained. The high SWS cost per DALY gained was probably caused by a lack of mortality benefit in a trial designed to rapidly treat diarrhea. SWS is an effective intervention whose cost-effectiveness is sensitive to diarrhea-related mortality, diarrhea incidence, and effective clinical management.

Topics: Cost-Benefit Analysis; Diarrhea; Family Characteristics; HIV Infections; Humans; Patient Education as Topic; Quality-Adjusted Life Years; Rural Health Services; Sodium Hypochlorite; Treatment Outcome; Uganda; Water Purification

To compare the effect on prevalence of diarrhoea and mortality of household based treatment of drinking water with flocculant-disinfectant, sodium hypochlorite, and standard practices in areas with turbid water source in Africa.. Cluster randomised controlled trial over 20 weeks.. Family compounds, each containing several houses, in rural western Kenya.. 6650 people in 605 family compounds.. Water treatment: flocculant-disinfectant, sodium hypochlorite, and usual practice (control).. Prevalence of diarrhoea and all cause mortality. Escherichia coli concentration, free residual chlorine concentration, and turbidity in household drinking water as surrogates for effectiveness of water treatment.. In children < 2 years old, compared with those in the control compounds, the absolute difference in prevalence of diarrhoea was -25% in the flocculant-disinfectant arm (95% confidence interval -40 to -5) and -17% in the sodium hypochlorite arm (-34 to 4). In all age groups compared with control, the absolute difference in prevalence was -19% in the flocculant-disinfectant arm (-34 to -2) and -26% in the sodium hypochlorite arm (-39 to -9). There were significantly fewer deaths in the intervention compounds than in the control compounds (relative risk of death 0.58, P = 0.036). Fourteen per cent of water samples from control compounds had E coli concentrations < 1 CFU/100 ml compared with 82% in flocculant-disinfectant and 78% in sodium hypochlorite compounds. The mean turbidity of drinking water was 8 nephelometric turbidity units (NTU) in flocculant-disinfectant households, compared with 55 NTU in the two other compounds (P < 0.001).. In areas of turbid water, flocculant-disinfectant was associated with a significant reduction in diarrhoea among children < 2 years. This health benefit, combined with a significant reduction in turbidity, suggests that the flocculant-disinfectant is well suited to areas with highly contaminated and turbid water.

Topics: Adolescent; Adult; Aged; Cluster Analysis; Diarrhea; Disinfectants; Female; Flocculation; Humans; Infant; Infant, Newborn; Kenya; Male; Middle Aged; Prevalence; Rural Health; Sodium Hypochlorite; Water Purification; Water Supply

Diarrhea is frequent among persons infected with human immunodeficiency virus (HIV) but few interventions are available for people in Africa. We conducted a randomized controlled trial of a home-based, safe water intervention on the incidence and severity of diarrhea among persons with HIV living in rural Uganda. Between April 2001 and November 2002, households of 509 persons with HIV and 1,521 HIV-negative household members received a closed-mouth plastic container, a dilute chlorine solution, and hygiene education (safe water system [SWS]) or simply hygiene education alone. After five months, HIV-positive participants received daily cotrimoxazole prophylaxis (160 mg of trimethoprim and 800 mg of sulfamethoxazole) and were followed for an additional 1.5 years. Persons with HIV using SWS had 25% fewer diarrhea episodes (adjusted incidence rate ratio [IRR] = 0.75, 95% confidence interval [CI] = 0.59-0.94, P = 0.015), 33% fewer days with diarrhea (IRR = 0.67, 95% CI = 0.48-0.94, P = 0.021), and less visible blood or mucus in stools (28% versus 39%; P < 0.0001). The SWS was equally effective with or without cotrimoxazole prophylaxis (P = 0.73 for interaction), and together they reduced diarrhea episodes by 67% (IRR = 0.33, 95% CI = 0.24-0.46, P < 0.0001), days with diarrhea by 54% (IRR = 0.46, 95% CI = 0.32-0.66, P < 0.0001), and days of work or school lost due to diarrhea by 47% (IRR = 0.53, 95% CI = 0.34-0.83, P < 0.0056). A home-based safe water system reduced diarrhea frequency and severity among persons with HIV living in Africa and large scale implementation should be considered.

Topics: Adolescent; Adult; AIDS-Related Opportunistic Infections; Anti-Infective Agents; Child; Child, Preschool; Diarrhea; Disinfectants; Female; HIV; HIV Infections; Housing; Humans; Incidence; Infant; Infant, Newborn; Male; Middle Aged; Rural Population; Severity of Illness Index; Sodium Hypochlorite; Trimethoprim, Sulfamethoxazole Drug Combination; Uganda; Water Purification; Water Supply

Implementation of a hospital-wide program of terminal cleaning of patient rooms revolving around hydrogen peroxide vapor (HPV) technology and evaluation of its impact on endemic nosocomial Clostridium difficile-associated diarrhea (CDAD) have not been previously reported.. This was a retrospective quasiexperimental study involving a 900-bed community hospital. During the preintervention period (January 2007-November 2008), rooms vacated by patients with CDAD or on contact precautions for other targeted pathogens underwent 1 or more rounds of cleaning with bleach. During the intervention period (January-December 2009), targeted newly evacuated rooms underwent "enhanced cleaning" consisting of use of bleach followed by HPV decontamination utilizing a priority scale based on the pathogen and room location. Rooms vacated by patients with CDAD but for which HPV decontamination was not possible the same day underwent 4 rounds of cleaning with bleach instead.. During the intervention period, 1,123 HPV decontamination rounds were performed involving 96.7% of hospital rooms. Of 334 rooms vacated by patients with CDAD (May-December 2009), 180 (54%) underwent HPV decontamination. The rate of nosocomial CDAD rate dropped significantly from 0.88 cases/1,000 patient-days to 0.55 cases/1,000 patient-days (rate ratio, 0.63; 95% confidence interval: 0.50-0.79, P < .0001).. A hospital-wide program of enhanced terminal cleaning of targeted patient rooms revolving around HPV technology was practical and was associated with a significant reduction in CDAD rates.

Topics: Adult; Clostridium Infections; Cross Infection; Diarrhea; Disinfectants; Disinfection; Endemic Diseases; Hospitals, Community; Housekeeping, Hospital; Humans; Hydrogen Peroxide; Infection Control; Patients' Rooms; Retrospective Studies; Sodium Hypochlorite; Volatilization

Almost a billion persons lack access to improved drinking water, and diarrheal diseases cause an estimated 1.87 million deaths per year. Sodium dichloroisocyanurate (NaDCC) tablets are widely recommended for household water treatment to reduce diarrhea. Because NaDCC is directly added to untreated water sources, concerns have been raised about the potential health impact of disinfection by-products. This study investigated trihalomethane (THM) production in water from six sources used for drinking (0.6-888.5 nephelometric turbidity units) near Arusha, Tanzania. No sample collected at 1, 8, and 24 hours after NaDCC addition exceeded the World Health Organization guideline values for either individual or total THMs. Ceramic filtration, sand filtration, cloth filtration, and settling and decanting were not effective mitigation strategies to reduce THM formation. Chlorine residual and THM formation were not significantly different in NaDCC and sodium hypochlorite treatment. Household chlorination of turbid and non-turbid waters did not create THM concentrations that exceeded health risk guidelines.

Topics: Chlorine; Diarrhea; Disinfectants; Disinfection; Fresh Water; Halogenation; Sodium Hypochlorite; Tanzania; Triazines; Trihalomethanes; Water Microbiology; Water Pollutants, Chemical; Water Purification; Water Supply; World Health Organization

Topics: Centers for Disease Control and Prevention, U.S.; Colony Count, Microbial; Diarrhea; Disinfectants; Enterobacteriaceae Infections; Family Characteristics; Humans; Rural Health; Sodium Hypochlorite; United States; Water Microbiology; Water Purification

An increased rate of Clostridium difficile-associated diarrhea (CDAD) was noted in 2 intensive care units of a university-affiliated tertiary care facility. One unit instituted enhanced environmental cleaning with a hypochlorite solution in all rooms, whereas the other unit used hypochlorite solution only in rooms of patients with CDAD. The CDAD rates decreased in both units.

Topics: Clostridioides difficile; Cross Infection; Diarrhea; Disinfectants; Enterocolitis, Pseudomembranous; Humans; Intensive Care Units; Sodium Hypochlorite

Topics: Africa; Developing Countries; Diarrhea; Disinfectants; Disinfection; Humans; Sodium Hypochlorite; Water Purification; Water Supply

Giardia sp infection was believed responsible for chronic, intermittent diarrhea in a group of 14 Persian cats. Seven of the cats were shedding Giardia sp cysts, and 6 of these cats had diarrhea at the time of fecal examination. Conversely, only 1 of 6 clinically normal cats in the group was shedding Giardia sp cysts. Cysts were not detected in feces of 2 cats with diarrhea. Cats less than or equal to 3 years old were more likely to be found shedding cysts. The parasite apparently was eradicated from the cattery by a combination of cage disinfection (1% sodium hypochlorite solution) and oral furazolidone treatment (4 mg/kg of body weight, BID for 5 consecutive days). During treatment, clinical signs resolved, and all cats remained clinically normal 2 months after treatment.

Topics: Animals; Cat Diseases; Cats; Diarrhea; Disinfection; Furazolidone; Giardiasis; Metronidazole; Sodium Hypochlorite