Time to rethink medical disinfection from a planetary health perspective

Disinfection products can have substantial environmental impacts which include associated manufacturing emissions, toxicity to marine life and potential adverse health outcomes. Despite this, disinfection is under-represented in sustainability approaches. Disinfection is a key part of healthcare provision and as such should be reflected in healthcare sustainability strategies. The adverse environmental effects of several common disinfectants are highlighted here. Sustainable alternatives should be considered. Hypochlorous acid (HOCl) is a potential alternative disinfectant that could be used in sustainability strategies, carrying a minimal toxicity profile compared to hypochlorite (bleach) and the unique ability to be made on site. Better clarity is needed regarding the environmental impact of disinfectants used in the healthcare setting and healthcare providers should move to seek sustainable alternatives such as hypochlorous acid

HOCl vs OCl−: clarification on chlorine-based disinfectants used within clinical settings

Disinfection is a mainstay of infection prevention, the importance of which was highlighted throughout the SARS-CoV-2 pandemic. There is frequent misuse of terminology surrounding chlorine solutions in the literature. This leads not only to confusion but has potentially dangerous outcomes, as inappropriate mixing of chlorine solutions with other disinfectants or cleaning solutions can lead to the release of chlorine gas. This article provides a resource for accurate terminology surrounding chlorine-based disinfection and clarifies some of the key inaccuracies, including the pH-dependent nature of chlorine species distribution of hypochlorous acid (HOCl) (neutral/acidic chlorine solution) and hypochlorite (OCl-) (alkaline chlorine solution). Misuse and misunderstanding of chlorine solutions and the terminology used can be harmful therefore this is an essential resource for those utilising chlorine as a disinfectant

Predicting Inadequate Weight Loss After Bariatric Surgery:Derivation and Validation of a Four Factor Model

Introduction: Weight loss following bariatric surgery is variable and predicting inadequate weight loss is required to help select patients for bariatric surgery. The aim of the present study was to determine variables associated with inadequate weight loss and to derive and validate a predictive model. Methods: All patients who underwent laparoscopic sleeve gastrectomy and Roux-en-Y gastrectomy (2008–2022) in a tertiary referral centre were followed up prospectively. Inadequate weight loss was defined as excess weight loss (EWL) &lt; 50% by 24 months. A top-down approach was performed using multivariate logistic regression and then internally validated using bootstrapping. Patients were categorised into risk groups. Results: A total of 280 patients (median age, 49 years; M:F, 69:211) were included (146 LSG; 134 LRYGB). At 24 months, the median total weight loss was 30.9% and 80.0% achieved EWL ≥ 50% by 24 months. Variables associated with inadequate weight loss were T2DM (OR 2.42; p = 0.042), age 51–60 (OR 1.93, p = 0.006), age &gt; 60 (OR 4.93, p &lt; 0.001), starting BMI &gt; 50 kg/m² (OR 1.93, p = 0.037) and pre-operative weight loss (OR 3.51; p = 0.036). The validation C-index was 0.75 (slope = 0.89). Low, medium and high-risk groups had a 4.9%, 16.7% and 44.6% risk of inadequate weight loss, respectively. Conclusions: Inadequate weight loss can be predicted using a four factor model which could help patients and clinicians in decision-making for bariatric surgery. Graphical Abstract: (Figure presented.)</p

HOCl vs OCl-: Clarification on chlorine based disinfectants used within clinical settings

Disinfection is a mainstay of infection prevention, the importance of which was highlighted throughout the SARS-CoV-2 pandemic. There is frequent misuse of terminology surrounding chlorine solutions in the literature. This leads not only to confusion but has potentially dangerous outcomes, as inappropriate mixing of chlorine solutions with other disinfectants or cleaning solutions can lead to release of chlorine gas. This article provides a resource for accurate terminology surrounding chlorine-based disinfection and clarifies some of the key inaccuracies including the pH dependent nature chlorine species distribution of hypochlorous acid (HOCl) (neutral/acidic chlorine solution) and hypochlorite (OCl-) (alkaline chlorine solution).Misuse and misunderstanding of chlorine solutions and the terminology used can be harmful therefore this is an essential resource for those utilising chlorine as a disinfectant