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

Abstract

Abstract Background Currently, the issue of sanitation and hygiene in health facilities is a significant global concern, particularly in resource limited setting. It is worth noting that sodium hypochlorite continues to be predominantly utilized as a disinfectant in health facilities across sub-Saharan African countries. However, the commercial availability of low-quality products and inherent chemical instability has posed a hurdle to the disinfectant in the control of microorganisms. This may lead to the transmission of healthcare-associated infections (HAIs), and spread of antimicrobial resistance. Hence, this study aims to determine the quality and surface cleaning efficacy of sodium hypochlorite products used in the in Health Facilities of Jimma Town, Oromia Regional State, Ethiopia.Methods Twenty seven samples, comprising six brands, were collected according to the method described by a joint WHO/FAO guideline from all health facilities in Jimma town from September 1 to October 31, 2021. The physicochemical quality of sodium hypochlorite was assessed using World health organization (WHO) and Food and Agriculture Organization (FAO) guidelines; while physicochemical quality and surface cleaning efficacy of the brands were determined using the US Pharmacopeia and EPA standard methods, respectively. Microsoft Excel 2013, and SPSS version 21.0 (IBM Corporation, Armonk, NY, USA) were used for statistical analysis. Graphs, tables, and numerical summary measures presented the findings. The Pearson correlation test determined the correlations between chlorine content and pH/storage period. The efficacy of the highest and lowest quality brands was analyzed using the independent-samples T-test. The differences were deemed statistically significant at the probability level of p < 0.05.Results , About 83.33%, of sodium hypochlorite brands used at healthcare facilities in Jimma Town failed to meet the US Pharmacopeia standard for chlorine content. The SH 01 brand exhibited the highest chlorine content, measuring at 4.64% ± 0.09%. On the other hand, the absence of chlorine was confirmed in the SH 04 brand, with a mere 0.12% ± 0.02% chlorine content. It is noteworthy that approximately 83.3% of the brands evaluated 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: Nearly five of sixth brands of sodium hypochlorite were of poor quality. The brand with the lowest chlorine content was ineffective in controlling multidrug-resistant pathogens. The log reduction of P. aeruginosa and S. aureus was high in brand containing high chlorine content. Health care providers and regulatory bodies should increase the regular inspections and quality testing of sodium hypochlorite product to improve its quality and surface cleaning efficacy.