key: cord-0896420-35p4yecy authors: Mitsuboshi, Satoru; Yamaguchi, Ryo; Uchida, Hiroyuki; Kamoshida, Satoshi; Hashi, Hideki title: Inappropriate sales of hypochlorous acid solution in Japan: An online investigation date: 2020-10-08 journal: Infection control and hospital epidemiology DOI: 10.1017/ice.2020.1248 sha: df700029df45254a66185d15d0074591b2a66d13 doc_id: 896420 cord_uid: 35p4yecy nan Standardization, Japanese Industrial Standards, the European Committee for Standardization, the American Society for Testing and Materials, or the Association of Official Analytical Chemists. In total, 97 companies were investigated. Our research revealed that many companies provided inappropriate product information, recommended inappropriate use, and engaged in inappropriate advertising practices. To our knowledge, this is the first report to clarify the inappropriate sale of HAS products. Three concerns regarding efficacy, safety, and hype were raised by these results. First, the efficacy of many HAS products could not be assessed using standard indicators. For example, 30% of products had no label information on concentration, and 50% of products had no label information on pH or expiration date. In addition, most products did not describe the removal of dirt before the use of the disinfectant and the correct amount to use. Previous reports suggest that the presence of dirt, such as organic matter, and the use of an insufficient amount decrease the effectiveness of chlorine-based disinfectants and that their effectiveness may decrease at 2-4 weeks after the container has been opened. 7, 8 Moreover, it was unclear whether any of the products had undergone standard tests performed by public institutions to determine their safety and efficacy. 9 HAS products may be useful for preventing the transmission of SARS-CoV-2 when they are used at the appropriate concentration and in the appropriate manner. However, these products may not have been effective for such an application. Second, these products may cause adverse events. More than 90% of the products were recommended to be used by spraying, and~50% of them were recommended to be used by direct application onto the hands or by fogging of indoor spaces. Chlorine gas has a risk of adverse respiratory system events. 3 Children, the elderly, and individuals with comorbidities, all of whom have low toxicity tolerance, may be at particularly high risk of adverse events from exposure to chlorine gas resulting from inappropriate use of HAS. 3, 4 Indeed, some adverse events caused by HAS have been reported in Japan, possibly reflecting its inappropriate use. 10 Third, 33% of products were advertised using the word "disinfection." The use of the word "disinfection" is allowed only for medications registered under the Pharmaceutical and Medical Device Act in Japan. No HAS products are registered as medications in Japan, and thus such advertisements may be illegal. Moreover, 20% of the products were advertised for use in healthcare facilities. The reference to healthcare facilities may give people false reassurance concerning the effectiveness of the products and may be a strategy to boost sales. HAS may be inappropriately used in healthcare facilities that lack disinfectant specialists, such as nursing homes, clinics, and dental clinics. Further strategies for the proper use of disinfectants in these facilities may be needed. Our research has some limitations. Only those companies listing products on the Amazon website were studied; thus, these results need to be confirmed by further research. However, many people use the Amazon website because of its prominence. In addition, because we investigated only those products that contained HAS, other products that were inappropriately advertised were not included in our investigation. In conclusion, to protect patients and the general public from health hazards associated with the inappropriate use of HAS, it may be necessary to develop and implement appropriate regulations and to conduct awareness campaigns for both healthcare providers and the general public. Interim infection prevention and control recommendations for healthcare personnel during the coronavirus disease 2019 (COVID-19) pandemic Cleaning and disinfection of environmental surfaces in the context of COVID-19. World Health Organization website Chlorine gas inhalation: human clinical evidence of toxicity and experience in animal models The clinical toxicology of sodium hypochlorite Cleaning and disinfectant chemical exposures and temporal associations with COVID-19-National Poison Data System Facilities in Japan cautioned against hypochlorous acid misting to fight COVID-19. The Mainichi website Acidic electrolyzed water potently inactivates SARS-CoV-2 depending on the amount of free available chlorine contacting with the virus A systematic review of chlorine-based surface disinfection efficacy to inform recommendations for low-resource outbreak settings Development and assessment of disinfectant efficacy test methods for regulatory purposes Accident information data bank system Acknowledgments. We thank the members of the Infectious Disease Association for Teaching and Education in Nippon (IDATEN) and the IDATENpharm for their highly insightful advice on this work.Financial support. No financial support was provided relevant to this article. All authors report no conflicts of interest relevant to this article.