Browse > Article
http://dx.doi.org/10.5668/JEHS.2020.46.5.495

Characteristics of Humidifier Disinfectant-like Products Containing NaDCC (sodium dichloroisocyanurate) and Their Use in Hospitals  

Jo, Eun-Kyung (Korean Society of Environmental Health)
Han, Kyunghee (Department of Preventive Medicine, Gachon University College of Medicine)
Ju, Min Jae (Department of Preventive Medicine, Gachon University College of Medicine)
Yang, Wonho (Department of Occupational Health, Daegu Catholic University)
Cho, Yoon-Hyeong (Department of Preventive Medicine, Gachon University College of Medicine)
Publication Information
Journal of Environmental Health Sciences / v.46, no.5, 2020 , pp. 495-503 More about this Journal
Abstract
Objective: This study aimed to compare the characteristics of humidifier disinfectant-like products (HD-like products) and humidifier disinfectant products (HD products) and introduce actual cases of the usage of HD-like products in hospitals based on an on-site investigation. Methods: The characteristics, chemical components, and usage of HD-like products (Hichlor or Biospot) and HD products (N-with) containing NaDCC (sodium dichloroisocyanurate) were compared. In the process of conducting the on-site investigation, four hospitals were identified as previously using HD-like products. Each on-site investigation to identify the use of HD-like products was composed of four parts: 1) hospital infection control guidelines, 2) manual for humidifiers in patient's rooms, 3) interviews with nursing staff, infection managers, and purchase managers, 4) searching on the product purchase system. Results: Although HD-like products (Hichlor and Biospot) and HD products (N-with) were sold for different usage purposes, they were all white-colored and coin-shaped foaming tablets with the same chemical component, NaDCC. The manual for using HD-like products and HD products was similar (inserting the tablet in a humidifier container with water). Among the four hospitals, one had used Hichlor in the same manner as HD (N-with) by inserting a tablet in 1L of water in a filled humidifier container and Biospot as a kind of detergent for humidifier container cleaning. Another two hospitals had used Biospot and/or Aniosyme as a kind of detergent for humidifier container cleaning. The other hospital had used unknown product in the same manner as N-with, so we thus assumed it was either an HD products (N-with) or HD-like products (Hichlor, Biospot). Conclusion: This study raises the possibility of the development of adverse health effects similar to exposure to an HD-products when exposed to an HD-like products and the possibility of further use in other medical institutions or multi-use facilities. Therefore, an expansion of the investigation is needed in order to confirm whether there have been similar cases in the past.
Keywords
Humidifier disinfectant; humidifier disinfectant-like product; N-with; NaDCC (sodium dichloroisocyanurate); Hichlor; Biospot; on-site investigation; hospital;
Citations & Related Records
Times Cited By KSCI : 4  (Citation Analysis)
연도 인용수 순위
1 Tablan OC, Anderson LJ, Besser R, Bridges C, & Hajjeh R. Guidelines for Preventing Health-careassociated Pneumonia, 2003: Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR (Morbidity and Mortality Weekly Report), 26, 53(RR-3); 2004. 1-36.
2 Infection Control Office in Hospital A. Infection control guideline of Hospital A - Revised in 2010-; 2010.
3 Korea Occupational Safety & Health Agency. An Evaluation of Respiratory Effect of Disinfectant (NaDCC).
4 ICRC. Emergency Relief Items Catalogue 2002. Chlorine, NaDCC. Water and Sanitation; 2002. 379-381.
5 Ministry of Environment. COVID-19 guidelines and precautions for preventing misuse of sterilizing products ('20.7.13): http://ecolife.me.go.kr/ecolife/bbs/notice/show/2897 [accessed 8 September 2020].
6 Han KH, Jo EK, Seo YJ, Kwak JH, Yang WH, Kim Pan-Gyi, Choi YH. Investigation of Exposure Status to Humidifier Disinfectant in Hospitals: An On-site Investigation of 23 Hospitals. J Environ Health Sci. 2020; 46(4): 433-443.   DOI
7 Special Investigation Commission on Humidifier Disinfectants & 4-16 Sewol Ferry Disasters. [a prress release] Results on the Use of Humidifier Disinfectants in Hosptials. Available: http://socialdisasterscommission.go.kr/news/report/Read.jsp?ntt_id=3773 [accessed 29 June 2020].
8 Medical Company A. Clinical data of Hichlor from hospital A.
9 Infection Control Office in Hospital C. An official letter of cooperation for infection control guidelines in Hospital C; 2006.
10 National Institute of Environmental Research. Final Report on NaDCC Inhalation Toxicity Study. 2019.
11 Hammond BG, Barbee SJ, Inoue T, Ishida N, Levinskas GJ et al. A review of toxicology studies on cyanurate and its chlorinated derivatives. Environ Health Perspect. 1986; 69: 287-292.   DOI
12 Park SM, Jeong IS, Chang CH, & Lee YS. Colony Counts by Different Disinfecting Processes and Operating Time for Humidifiers in an Intensive Care Unit. J Korean Biol Nurs Sci. 2009; 11(1): 92-98.
13 Korea Environmental Industry & Technology Institute. Humidifier disinfectant application and reception status (based on '20.8.07). https://www.healthrelief.or.kr/home/content/stats01/view.do [accessed 07 August 2020].
14 Han KH, Yoon JG, Jo EK, Ryu HS, Yang WH, & Choi YH. Case Studies of Exposures to Humidifier Disinfectant in Hospitals: Focusing on the Exposure Assessment of the Fourth Round of Applicants. J Environ Health Sci. 2019; 45(4): 358-369.
15 Lee SM. A comparative study of microorganism concentration in humidifier's water tanks and vibrators, depend on user's operating habit at the scene of hospital ward and administrative offices in universities. [dissertation]. [Seoul]: Hansung University. 2013.
16 Infection Control Office in Hospital B. infection control guidelines and cooperation actions in Hospital B of 2005-2011; 2005-2011.
17 Mandell GL, Bennett JE, & Dolin, R. Mandell's Principles and Practices of Infection Diseases, 6th Ed. Churchill Livingstone; 2004.
18 Korean Society for Nosocomial Infection Control (KOSNIC). Nosocomial Infection Control; 2006.
19 Department of Health and Human Services (DHHS) and Center for Disease Control and Prevention (CDC). Guidelines for Environmental Infection Control in Health-Care Facilities Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). Available: https://www.cdc.gov/mmwr//PDF/rr/rr5210.pdf [accessed 07 August 2020].