Quality and Surface Cleaning Efficacy of Sodium Hypochlorite Products Used in Health Facilities of Jimma Town, Oromia Regional State, Ethiopia

Abstract

Background: The broader use of sodium hypochlorite in microorganisms control has been challenged by the commercial availability of low-quality products. The problem is more prominent in developing countries where disinfectant regulations are less stringent. Thus, this study aims to determine the quality and surface cleaning efficacy of sodium hypochlorite products used in health facilities of Jimma Town, Oromia Regional State, Ethiopia. Methods and Materials: A survey-based study was conducted in Jimma town from September 1 to October 31, 2021. Twenty-seven samples were collected randomly from all health facilities based on a joint WHO/FAO guidelines. The samples were categorized into six brands. The chief executive officers of the healthcare facility were informed that the samples are intended only for research purpose. The physicochemical quality and surface cleaning efficacy of the brands were determined using the US Pharmacopeia and EPA standard methods, respectively. Result: Only one brand (SH 01) out of six had the storage instructions, 'keep in a cool, dry area away from direct sunshine and heat.' Instead of bleaching the red litmus paper, the SH 04 brand turned it blue. Most of the brands differed from the label's claimed contents by a significant percentage (59.6 on average, P = 0.0001). The SH 01 brand had the highest chlorine content (4.64% ± 0.09%), while the SH 05 brand had the lowest (1.09% ± 0.09%). The absence of chlorine was confirmed in the SH 04 brand (0.12% ± 0.02%). Five of the six brands were of poor quality. Low chlorine content was shown to have a weak relationship with pH (r = 0.43, P = 0.025), as well as storage period (r = -0.398, P = 0.040). The mean log reductions (LRs) in P. aeruginosa (LR SH 01 = 4.13, LR SH 05 =3.17, and p = 0.008) and S. aureus (LR SH 01 = 4.26, LR SH 05 =3.47, and p = 0.009) varied significantly across the SH 01 and SH 05 brands. Conclusion and Recommendations: Five of the six brands evaluated were of poor quality. The lowest quality brand was ineffectual at controlling microorganisms. Hence, treating healthcare- associated infections with antibiotics becomes significantly more challenging. Regular manufacturer inspections and a large-scale quality and efficacy evaluation of sodium hypochlorite products are recommended