雙語(yǔ)文章|美國(guó)口腔頜面外科醫(yī)師學(xué)會(huì)發(fā)布新冠疫情期間次氯酸消毒使用指導(dǎo)

冠狀病毒在全球范圍內(nèi)的流行已經(jīng)對(duì)醫(yī)療保健和經(jīng)濟(jì)造成了的大規(guī)模破壞。目前尚無(wú)有效的抗病毒藥物或批準(zhǔn)的疫苗，這意味著必須采取有效的消毒預(yù)防措施來(lái)應(yīng)對(duì)COVID-19。特別是口腔頜面外科醫(yī)師在為患者提供所需護(hù)理時(shí)具有高風(fēng)險(xiǎn)，隨著世界各地有越來(lái)越多口腔頜面外科診所開(kāi)辦，有必要降低患者和醫(yī)生之間傳播COVID-19的風(fēng)險(xiǎn)。

　　醫(yī)院外科醫(yī)生需要一種廉價(jià)、易得、無(wú)毒、實(shí)用性強(qiáng)并且可以對(duì)COVID-19病毒（新型冠狀病毒）進(jìn)行有效消殺的消毒劑，次氯酸成為不二選擇。因此，美國(guó)口腔頜面外科醫(yī)師學(xué)會(huì)的專家撰寫了一份次氯酸的介紹和相關(guān)應(yīng)用，發(fā)表在《J Oral Maxillofac Surg》雜志上，以指導(dǎo)次氯酸的正確使用。現(xiàn)由電解水技術(shù)頻道工作人員翻譯如下：

　　The surgeon needs to have an inexpensive, available, nontoxic, and practical disinfectant that is effective in sanitizing against the COVID-19 (Coronavirus Disease 2019) virus. The purpose of this article was to review the evidence for using hypochlorous acid in the office setting on a daily basis. The method used to assemble recommendations was a review of the literature including evidence for this solution when used in different locations and industries other than the oral maxillofacial clinic facility. The results indicate that this material can be used with a high predictability for disinfecting against the COVID-19 (Coronavirus Disease 2019) virus.

　　摘要

　　醫(yī)院外科醫(yī)生需要一種廉價(jià)、易得、無(wú)毒、實(shí)用性強(qiáng)并且可以對(duì)COVID-19病毒（新型冠狀病毒）進(jìn)行有效消殺的消毒劑。本文主要綜述了在醫(yī)療辦公環(huán)境中使用次氯酸消毒的案例，通過(guò)文獻(xiàn)綜述的方法，收集次氯酸溶液在不同地點(diǎn)和行業(yè)（口腔頜面診所及設(shè)施除外）中使用的案例以此得到次氯酸溶液使用意見(jiàn)。結(jié)果表明，次氯酸溶液在針對(duì)COVID-19病毒的消毒中具有很高的可行性。

　　COVID-19 Virus Structure and Mechanism of Infection

　　Coronavirus Disease 2019 (COVID-19) is a novel virus. It causes severe acute respiratory syndrome. Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) is the agent responsible for a surface-tosurface communicable disease that had infected approximately 4.7 million persons as of May 17, 2020.1 Health care providers need options to limit and control the spread of the virus between themselves and patients.

　　COVID-19病毒的結(jié)構(gòu)和感染機(jī)理

　　COVID-19是一種新型的冠狀病毒，它會(huì)導(dǎo)致嚴(yán)重的急性呼吸道綜合癥。例如，嚴(yán)重急性呼吸系統(tǒng)綜合癥冠狀病毒2（SARSCoV-2）是一種可接觸傳播的傳染病病原體，截至2020年5月17日，已有大約470萬(wàn)人感染了該病毒1。因此，醫(yī)護(hù)人員需要采取多種措施來(lái)限制和控制病毒在他們和病人之間傳播。

　　COVID-19 is an enveloped, positive-sense, single stranded RNA virus approximately 60 to 140 nm in diameter. The virus’s Spike glycoprotein S1 firmly binds to the angiotensin converting enzyme 2 (ACE2) receptor, which allows entry into the host cell.2-4 COVID-19 infection creates a cytokine storm, severe pneumonia, multiple-organ failure, and acute cardiac injury.5,6

　　COVID-19是一種有包膜的單股正鏈RNA病毒，直徑在60至140 nm之間。該病毒的刺突糖蛋白S1可以與血管緊張素轉(zhuǎn)換酶2（ACE2）受體緊密結(jié)合，從而可以進(jìn)入宿主細(xì)胞2-4。COVID-19感染會(huì)引起細(xì)胞因子風(fēng)暴、嚴(yán)重肺炎、多器官衰竭和急性心臟損傷5,6。

　　譯者注：細(xì)胞因子風(fēng)暴"(cytokine storm)，即病毒感染機(jī)體后機(jī)體產(chǎn)生了過(guò)多的細(xì)胞因子，造成過(guò)度反應(yīng)。

　　Transmission occurs through touch or aerosol spreading of the virus. A common pathway of spreading this virus is through respiratory aerosols from an infected person.7 During speech, humans emit thousands of oral fluid droplets per second that can remain airborne for 8 to 14 minutes.8 COVID-19 is detectable for up to 3 hours in surface aerosols, for up to 4 hours on copper, for up to 24 hours on cardboard, and for up to 2 to 3 days on plastic and stainless steel.9,10 There is a need to disinfect surfaces potentially exposed to COVID-19 to prevent transmission.

　　COVID-19可以通過(guò)直接接觸或氣溶膠進(jìn)行傳播，感染者呼吸道產(chǎn)生的氣溶膠是這種病毒的常見(jiàn)傳播途徑7。研究表明，人類在講話過(guò)程中，每秒會(huì)釋放成千上萬(wàn)的口腔液滴，這些液滴可以在空氣中停留8至14分鐘8，為病毒的傳播提供了有效的途徑。還應(yīng)注意的是，COVID-19可在氣溶膠中存在長(zhǎng)達(dá)3個(gè)小時(shí)，在銅板上存在長(zhǎng)達(dá)4個(gè)小時(shí)，在紙板上存在長(zhǎng)達(dá)24個(gè)小時(shí)，在塑料和不銹鋼上存在長(zhǎng)達(dá)2到3天9,10。因此，需要對(duì)可能附著COVID-19的物體表面進(jìn)行消毒，以防止病毒傳播。

　　Use of Disinfectants

　　Currently, the US Environmental Protection Agency has recommended numerous disinfectants against COVID-19 including hypochlorous acid (HOCl).11 This article focuses on HOCl.

　　消毒劑的使用

　　目前，美國(guó)環(huán)境保護(hù)署已經(jīng)推薦多種針對(duì)COVID-19的消毒劑，其中就包括次氯酸（HClO）11。接下來(lái)，本文重點(diǎn)討論的消毒劑是HClO。

　　Recommendations for Office Use

　　Importance of aerosol size to disinfection and application

　　Individuals working in the dental and medical field using surgical and high-speed handpieces are at risk from aerosolization. Aerosols are defined as particles less than 50 mm in diameter. Particles of this size are small enough to stay airborne for an extended period before they settle on environmental surfaces or enter the respiratory tract.41,42 Additionally, a true aerosol or droplet nuclei may be present in the air of the operatory for up to 30 minutes after a procedure.41

　　醫(yī)療辦公環(huán)境使用建議

　　氣溶膠大小對(duì)消毒和應(yīng)用的重要性

　　氣溶膠一般定義為直徑小于50 mm的顆粒。這種微粒尺寸足夠小，在沉降到環(huán)境表面或進(jìn)入呼吸道之前，可以在空氣中停留較長(zhǎng)的時(shí)間41,42。牙科和醫(yī)學(xué)領(lǐng)域中工作的人員在使用高速外科手持器械時(shí)，手術(shù)過(guò)程中因高速產(chǎn)生的氣溶膠或液滴核在手術(shù)后可以在空氣中存在長(zhǎng)達(dá)30分鐘，這種有可能攜帶病菌的氣溶膠使得醫(yī)護(hù)人員存在受感染的風(fēng)險(xiǎn)41。

　　Particles are classified based on size: Coarse particles measure 2.5 to 10 mm; fine particles, 0.1 mm to less than 2.5 mm; and ultrafine particles, less than 0.1 mm. The nose typically filters air particles larger than 10 mm. If a particle is smaller than 10 mm, it can enter the respiratory system. If smaller than 2.5 mm, it can enter the alveoli. A particle smaller than 0.1 mm, or an ultrafine particle, such as the COVID-19 virus, can enter the bloodstream or target the lungs.

　　顆粒根據(jù)尺寸可以分成三類：尺寸在2.5~10 mm之間為粗顆粒；尺寸在0.1~2.5 mm之間為細(xì)顆粒；尺寸小于0.1 mm為超細(xì)顆粒。對(duì)于人體來(lái)說(shuō)，空氣中大于10 mm的顆粒會(huì)被鼻子過(guò)濾，而小于10 mm的顆粒能進(jìn)入呼吸系統(tǒng)，尺寸小于2.5 mm的顆粒可以進(jìn)入肺泡，小于0.1 mm的顆粒或超細(xì)顆粒（例如COVID-19病毒）則可以進(jìn)入血液或肺部。

　　Sotiriou et al42 showed that the concentrations of small particles (<0.5 mm) generated during dental drilling procedures were much higher than the concentrations of larger particles (>1 mm). Ultrasonic and sonic transmission during nonsurgical procedures had the highest incidence of particle transmission, followed by air polishing, air-water syringe, and high-speed handpiece aerosolization.43 One study found that ultrasonic instrumentation can transmit 100,000 microbes/ ft3 with aerosolization of up to 6 ft and, if improper air current is present, microbes can last anywhere

　　from 35 minutes to 17 hours.44

　　Sotiriou等人42的研究表明，在牙齒鉆孔過(guò)程中產(chǎn)生小顆粒（<0.5 mm）的濃度遠(yuǎn)高于大顆粒（> 1 mm）的濃度。在非手術(shù)過(guò)程中，超聲波和聲波傳播引起的顆粒傳播量最高，其次是空氣拋光、空氣-水注射器和高速機(jī)頭霧化43。一項(xiàng)研究發(fā)現(xiàn)，超聲儀器可通過(guò)長(zhǎng)達(dá)6英尺的氣溶膠傳播微生物（100000微生物/英尺），如果存在不適當(dāng)?shù)臍饬?，微生物可以在任何地方存?5分鐘至17小時(shí)44。

　　MOUTH RINSE 漱口

　　If HOCl is used as a mouth rinse, one must assume that a portion of the rinse will be swallowed. The systemic and gastrointestinal effects of ingesting HOCl, from the perspective of its use in mouthwash, was evaluated in an animal study.45 Seventeen mice were given free access to HOCl water as drinking water. No abnormal findings were observed in terms of visual inspections of the oral cavity, histopathologic tests, or measurements of surface enamel roughness, showing no systemic effect.

　　如果將HClO用作漱口水，則必須假定一部分漱口水會(huì)被吞咽。因此，從漱口水的使用角度出發(fā)，通過(guò)動(dòng)物實(shí)驗(yàn)評(píng)估了攝入HClO對(duì)全身和胃腸道的影響45。實(shí)驗(yàn)中，17只小鼠可以自由飲用HClO水，實(shí)驗(yàn)一段時(shí)間后，在口腔的視覺(jué)檢查、組織病理學(xué)檢查或表面釉質(zhì)粗糙度的測(cè)量方面均未觀察到異常，也未有系統(tǒng)性的影響。

　　OTHER CLINICAL APPLICATIONS 其他臨床消毒應(yīng)用

　　Ophthalmology 眼科

　　HOCl is used in the treatment of blepharitis by reducing the bacterial load on the surface of the periocular skin. Twenty minutes after application of a saline hygiene solution containing HOCl at 100 ppm, a greater than 99% reduction in the staphylococcal load was achieved.46

　　HClO可以通過(guò)減少眼周皮膚表面的細(xì)菌負(fù)荷而用于瞼緣炎的治療。在眼周圍使用含100ppm HClO的生理鹽水作用20分鐘后，葡萄球菌負(fù)荷降低了99％以上46。

　　Biofilm 生物膜

　　HOCl may be effective for cleaning biofilmcontaminated implant surfaces. HOCl significantly lowered the lipopolysaccharide concentration of Porphyromonas gingivalis when compared with sodium hypochlorite and chlorhexidine and was well tolerated by the oral tissues.47 HOCl significantly reduced bacteria on toothbrushes; it was effective as a mouthwash and for toothbrush disinfection.48

　　HClO可有效清潔受生物膜污染的植入物表面。與次氯酸鈉和洗必泰相比，HClO顯著降低了牙齦卟啉單胞菌的脂多糖濃度，并且口腔組織有很好耐受性47。此外，HClO可顯著減少牙刷上的細(xì)菌，因此HClO可作為漱口水和牙刷的有效消毒劑48。

　　Wound Care 傷口護(hù)理

　　In a clinical study on intraperitoneal wound care, patients underwent lavage of the peritoneal cavity with 100ppm HOCl and washing of the wound with 200 ppm.49 No adverse effects were observed. HOCl has been shown to be an effective agent in reducing wound bacterial counts in open wounds.50 In irrigation solution in an ultrasonic system, HOCl lowered the bacterial counts by 4 to 6 logs. By the time of definitive closure, the bacterial counts were back up to 105 for the saline solution– irrigated control wounds but remained at 102 or lower for the HOCl-irrigated wounds. Postoperative closure failure occurred in more than 80% of patients in the saline solution group versus 25% of those in the HOCl group.

　　在一項(xiàng)腹膜內(nèi)傷口護(hù)理的臨床研究中，患者用100ppm的HClO沖洗腹腔，并用200 ppm的HClO清洗傷口，在傷口處理過(guò)程中患者沒(méi)有觀察到不良反應(yīng)49。目前，研究已經(jīng)證明HClO是減少開(kāi)放傷口中細(xì)菌的有效試劑50，例如，在超聲波處理系統(tǒng)的沖洗溶液中，HClO可以將細(xì)菌數(shù)降低4至6個(gè)對(duì)數(shù)單位。在傷口完全閉合時(shí)，用鹽水沖洗處理的傷口中細(xì)菌數(shù)恢復(fù)到105，而HClO沖洗處理的傷口細(xì)菌數(shù)則在102及以下。同時(shí)，用鹽水處理的患者80％以上出現(xiàn)傷口術(shù)后閉合失?。欢鳫ClO處理組中，只有25％的患者出現(xiàn)傷口術(shù)后閉合失敗。

　　Hand Sanitizing 手衛(wèi)生

　　Hand antiseptics are alcohol based or non–alcohol based containing antibiotic compounds.51 Chlorinebased sanitizers, at a concentration of 50 to 100 ppm, are effective against bacteria and viruses.52 HOCl specifically used for hand sanitizers is effective at 100- to 200-ppm strengths.53,54

　　手部消毒劑是含酒精或不含酒精的抗菌化合物51。濃度為50至100 ppm的氯系消毒劑可有效抵抗細(xì)菌和病毒52，專門用于洗手液的HClO在100~200 ppm的濃度就可以有效殺菌53,54。

　　Surface Application 物表消毒

　　A study looked at disinfecting outpatient surgical centers using HOCl.55 After cleaning, the rooms in the HOCl cleaning and disinfection study arm had significantly lower bacterial counts than

　　the rooms that underwent standard cleaning and disinfection.

　　一項(xiàng)著眼于使用HClO對(duì)門診手術(shù)中心進(jìn)行消毒的研究表明55，HClO清洗和消毒后，研究室的細(xì)菌數(shù)明顯少于進(jìn)行標(biāo)準(zhǔn)清洗和消毒的房間。

　　HOCl Applied by Spray or Fogger 噴霧或霧化方法使用HClO

　　A fogger takes a solution and creates a small aerosol mist, ideally less than 20μm in size, to disinfect an area. HOCl fogs are highly effective in the microbial disinfection of surfaces. The fogging process can alter the physical and chemical properties of the disinfectant. It was found that fogging reduced the AFC concentration by approximately 70% and increased the pH by approximately 1.3, making the solution slightly more basic; it is speculated that the loss of chlorine resulted from evaporation of chlorine gas.56,57 Because the changes in the properties of hypochlorous fogs are predictable, pre-fogging adjustment of the concentration and pH of the solution makes it possible to control the concentration levels to the desirable range to inactivate pathogens after fogging. When the appropriate concentrations are used, a study found 3 to 5 log10 reductions in both the infectivity and RNA titers of all tested viruses on both vertical and horizontal surfaces, suggesting that fogging is an effective approach to reduce viruses on surfaces.40,58

　　噴霧器能將溶液制成小的霧狀噴霧對(duì)某一區(qū)域進(jìn)行消毒，理想情況下，噴霧液滴的大小應(yīng)小于20μm，HClO噴霧對(duì)物體表面的微生物消毒效果非常顯著。霧化過(guò)程會(huì)改變消毒劑的物理和化學(xué)性質(zhì)，結(jié)果表明，霧化會(huì)使AFC濃度降低約70％，pH值升高約1.3，溶液的堿性略微提高，這種霧化造成的氯損失是由含氯溶液蒸發(fā)引起的。由于次氯酸霧的性質(zhì)變化是可以預(yù)測(cè)的，因此在霧化前調(diào)節(jié)溶液的濃度和pH值可以將濃度控制在理想的范圍內(nèi)，霧化后的HClO能有效滅活病原體。一項(xiàng)研究發(fā)現(xiàn)，當(dāng)使用適當(dāng)濃度的HClO時(shí)，所有被測(cè)病毒在垂直和水平表面上的傳染性和RNA滴度均降低了3至5個(gè)對(duì)數(shù)單位，這表明霧化是物體表面消毒的有效方法40,58。

　　HOCl solutions appear to be virucidal based on concentrations above 50 ppm. HOCl was evaluated against a low-pathogenic avian influenza virus (AIV), H7N1.59 The HOCl solutions contained 50-, 100-, and 200-ppm chlorine at pH 6. Spraying with HOCl decreased the AIV titer to an undetectable level (<2.5 log10TCID50/mL) within 5 seconds, with the exception of the 50-ppm solution harvested after spraying at a distance of 30 cm. When HOCl solutions were sprayed directly onto sheets containing the virus for 10 seconds, the solutions of 100 and 200 ppm inactivated AIV immediately. The 50-ppm solution required at least 3 minutes of contact time. These data suggest that HOCl can be used in spray form to inactivate AIV.59,60 When the aerosol was not sprayed directly onto an inoculated surface, a lower amount of solution had a chance to come into contact with the AIV. It required at least 10 minutes of contact to be effective.61

　　如果濃度高于50 ppm，HClO溶液具有一定的殺病毒作用。利用低致病性禽流感病毒（AIV）H7N1對(duì)HClO的殺病毒性進(jìn)行了評(píng)估59，使用三種具有不同AFC濃度的HClO溶液進(jìn)行測(cè)試，有效氯濃度分別為50、100和200 ppm（pH值均為6）。除了50 ppm的HClO溶液外，在30 cm處噴灑HClO溶液后，可在5秒內(nèi)將AIV滴度降至不可檢測(cè)的水平（<2.5 log10TCID50/mL）59,60。將HClO溶液直接噴到含有病毒的薄片上10秒鐘，100和200 ppm的HClO溶液立即使AIV失活，而50 ppm的HClO溶液至少需要3分鐘的接觸時(shí)間才能使AIV失活。以上結(jié)果表明HClO可以通過(guò)噴霧的形式使AIV失活。另外，如果沒(méi)有將噴霧直接噴灑到AIV接種表面上，只有少量的溶液與AIV接觸時(shí)，則至少需要10分鐘的才能使AIV失活61。

　　The ability of a sprayer to make smaller particles may help a solution’s molecules to be suspended in the air for a longer period because of their low settling velocity rate. This may increase the solution’s chance of coming into contact with pathogens and inactivating them. Thus, the fogger used should have an aerosol

　　size less than 20 mm.62

　　噴霧器產(chǎn)生較小顆粒的能力會(huì)降低HClO溶液的沉降速度，從而有助于溶液中的HClO分子在空氣中懸浮更長(zhǎng)的時(shí)間，這會(huì)增加HClO與病原體接觸并使它們滅活的機(jī)會(huì)。同樣需要注意的是，使用噴霧器產(chǎn)生的氣溶膠尺寸應(yīng)小于20μm62。

　　Discussion 討論

　　The coronavirus pandemic has caused both a massive health care and economic disruption across the world. The current unavailability of an effective antiviral drug or approved vaccine means that the implementation of effective preventive measures is necessary to counteract COVID-19. Oral-maxillofacial surgeons are high-risk providers providing needed care to patients. As more OMS and surgical offices open during reopening in the United States and elsewhere in the world, the need to reduce the risk of transmission of COVID-19 between patients and providers is necessary. It is widely believed that with proper screening and discretion, along with adequate personal protective equipment, there is a low probability of becoming infected. The goal of this article is to provide information regarding disinfection in the clinical office setting using HOCl, a relatively inexpensive, nontoxic, noncorrosive, and well studied compound.

　　冠狀病毒在全球范圍內(nèi)的流行已經(jīng)對(duì)醫(yī)療保健和經(jīng)濟(jì)造成了的大規(guī)模破壞。目前尚無(wú)有效的抗病毒藥物或批準(zhǔn)的疫苗，這意味著必須采取有效的預(yù)防措施來(lái)應(yīng)對(duì)COVID-19。特別是口腔頜面外科醫(yī)師在為患者提供所需護(hù)理時(shí)具有高風(fēng)險(xiǎn)，隨著世界各地有越來(lái)越多口腔頜面外科診所開(kāi)辦，有必要降低患者和醫(yī)生之間傳播COVID-19的風(fēng)險(xiǎn)。人們普遍認(rèn)為，經(jīng)過(guò)適當(dāng)?shù)暮Y查和謹(jǐn)慎的處理，再加上適當(dāng)?shù)膫€(gè)人防護(hù)設(shè)備，就可以使得感染的可能性降低。本文的目的是提供有關(guān)在臨床中使用HClO（一種相對(duì)便宜、無(wú)毒、無(wú)腐蝕和研究充分的化合物）進(jìn)行消毒的事實(shí)。

　　HOCl has uses in many industries from farming and restaurants, regarding food, to health care applications, including chronic wound care and disinfection. 34,36,43,45,46,63 In addition to the use of HOCl as a liquid-based disinfectant, fogging with hypochlorous vapor has shown virucidal activity against numerous types of viruses and bacteria.40,56,57 This is of potential benefit to disinfect large spaces such as medical and dental offices where aerosols can be airborne for extended periods.42,44,64 In terms of particle size, oral-maxillofacial surgeons may be at a slightly lower risk than their dental counterparts because ultrasonic scaling and high-speed handpieces create smaller particles that remain airborne longer.42 However, aerosols are still created with surgical handpieces. Additionally, the COVID-19 virus can be present on some surfaces for days, and the disinfection of all surfaces of an operatory is important to reduce transmission.9,10

　　HClO已應(yīng)用于許多行業(yè)中，從農(nóng)業(yè)和餐飲業(yè)到食品業(yè)，再到醫(yī)療保健行業(yè)（包括慢性傷口護(hù)理和消毒）34,36,43,45,46,63。除了使用HClO作為液體消毒劑外，用霧化的HClO溶液也可以對(duì)多種類型病毒和細(xì)菌的活性進(jìn)行殺滅40,56,57。這對(duì)消毒較大的空間（例如醫(yī)療和牙科診所）具有一定的優(yōu)勢(shì)，因?yàn)樵谶@些空間中，氣溶膠可以長(zhǎng)時(shí)間在空氣中存在。另一方面，就顆粒大小而言，口腔頜面外科醫(yī)生的患病風(fēng)險(xiǎn)可能比其牙科同行略低，因?yàn)槌暡ㄏ囱篮透咚贆C(jī)頭會(huì)產(chǎn)生更小的顆粒，使得消毒劑可以在空氣中存在更長(zhǎng)的時(shí)間。但是，手術(shù)機(jī)頭仍會(huì)產(chǎn)生氣溶膠，這將有利于病毒的傳播。此外，COVID-19病毒可以在某些表面上存在數(shù)天，對(duì)醫(yī)護(hù)人員所在工作室進(jìn)行消毒對(duì)于減少病毒傳播十分重要9,10。

　　Many properties of HOCl contribute to why it may be the disinfectant of choice in the OMS setting. It can be made on-site inexpensively. A gallon of HOCl can be purchased from manufacturers but it is far more economical for an oral-maxillofacial surgeon to produce the solution on-site in the office.65 A variety of HOCl systems costing less than $275 are available on the market.66 By combining non-iodinated salt, water, and electricity,33 1 L of HOCl can be made in 8 minutes and the process can be repeated many times throughout the day. By comparison, a pack of common disinfecting wipes containing quaternary ammonium compounds costs between $4 and $15 for a pack containing 80 sheets. These wipes may only last a day or two depending the size of the office and area to clean. Shortages of these products can occur, making sourcing them difficult as well.67

　　HClO的許多特性都表明它是口腔頜面外科診所優(yōu)良的消毒劑選擇。雖然從制造商處也可以購(gòu)買一定量的HClO溶液，但是對(duì)于口腔頜面外科醫(yī)生而言，在辦公室現(xiàn)場(chǎng)生產(chǎn)HClO溶液要經(jīng)濟(jì)得多65。市場(chǎng)上可以買到各種價(jià)格低于275美元的HClO裝置66，僅僅需要非碘鹽、水和電33，就可以在8分鐘內(nèi)制成1 L的HClO溶液，并且在一天內(nèi)可以多次制備HClO溶液。相比之下，一包有80張含季銨化合物的普通消毒濕巾的價(jià)則為4至15美元，并且根據(jù)牙科工作地點(diǎn)和需清潔區(qū)域的大小，這些濕巾只能使用一兩天，而且這些產(chǎn)品可能會(huì)出現(xiàn)供貨不足、難以采購(gòu)的現(xiàn)象67。

　　In addition to using HOCl in the form of wipes for disinfecting, using HOCl vapors through a fogging machine is an economical way to disinfect a large operating room or suite in which aerosols were produced during surgery. Foggers or misting machines are handheld machines and can be purchased for a reasonable cost.68 The aerosol mist ideally should be less than 20μm in size to maximally disinfect an area. It is important to note that the fogging process can alter the physical and chemical properties of the disinfectant, making it more dilute and basic. As mentioned before, the AFC concentration can be reduced by approximately 70% and the pH can increase by about 1.3.40 To make a vapor as effective as a solution containing 100 ppm of HOCl, the solution would need to be concentrated. The fine mist can be left in the empty surgical room without thought regarding harmful chemical effects; the surfaces are then wiped clean and dry after a few minutes and, for a more dilute solution, after 10 minutes.

　　HClO除了以濕巾形式的進(jìn)行消毒之外，通過(guò)霧化機(jī)產(chǎn)生HClO霧氣是對(duì)大型手術(shù)室或手術(shù)期間產(chǎn)生氣溶膠的房間進(jìn)行消毒的一種經(jīng)濟(jì)方法，霧化機(jī)或噴霧機(jī)一般是手持式的，并且購(gòu)買價(jià)格比較優(yōu)惠68。理想情況下，氣溶膠霧的尺寸應(yīng)小于20μm，這樣可以最大程度地消毒一個(gè)區(qū)域。值得注意的是，霧化過(guò)程會(huì)改變消毒劑的物理和化學(xué)性質(zhì)，使得溶液濃度降低且堿性增強(qiáng)。如前所述，霧化后HClO溶液的AFC濃度可降低約70％，pH值可提高約1.340。要使霧化后的HClO溶液與100 ppm的HClO溶液一樣有效，必須將溶液進(jìn)行濃縮。細(xì)霧可以在手術(shù)室的空氣中長(zhǎng)時(shí)間停留，并且無(wú)有害的化學(xué)作用，只需要在幾分鐘后，將其擦拭干凈。對(duì)于更稀的HClO溶液，則需在10分鐘后，將其擦拭干凈。

　　HOCl is one disinfectant that, when combined with adequate personal protective equipment, screening and social-distancing techniques, hand washing, and high-volume evacuation suction, may help reduce the transmission of COVID-19 in the outpatient OMS setting. It comprises many of the desired effects of the ideal disinfectant: It is easy to use, is inexpensive, has a good safety profile, and can be used to disinfect large areas quickly and with a broad range of bactericidal and virucidal effects.

　　當(dāng)HClO與適當(dāng)?shù)膫€(gè)人防護(hù)設(shè)備、篩查和社交疏導(dǎo)技術(shù)、洗手和大容量空氣處理裝置結(jié)合使用時(shí)，可以減少口腔頜面外科門診環(huán)境中COVID-19的傳播機(jī)會(huì)。HClO具有理想消毒劑的許多特性：易于使用，價(jià)格便宜，具有良好的安全性，可用于大面積區(qū)域快速消毒，并具有廣泛的殺菌作用。因此，HClO是一種十分有效且理想的消毒劑。