Reduction in bacterial load using hypochlorous acid hygiene solution on ocular skin

David W Stroman, Keri Mintun, Arthur B Epstein, Crystal M Brimer, Chirag R Patel, James D Branch, Kathryn Najafi-Tagol, David W Stroman, Keri Mintun, Arthur B Epstein, Crystal M Brimer, Chirag R Patel, James D Branch, Kathryn Najafi-Tagol

Abstract

Purpose: To examine the magnitude of bacterial load reduction on the surface of the periocular skin 20 minutes after application of a saline hygiene solution containing 0.01% pure hypochlorous acid (HOCl).

Methods: Microbiological specimens were collected immediately prior to applying the hygiene solution and again 20 minutes later. Total microbial colonies were counted and each unique colony morphology was processed to identify the bacterial species and to determine the susceptibility profile to 15 selected antibiotics.

Results: Specimens were analyzed from the skin samples of 71 eyes from 36 patients. Prior to treatment, 194 unique bacterial isolates belonging to 33 different species were recovered. Twenty minutes after treatment, 138 unique bacterial isolates belonging to 26 different species were identified. Staphylococci accounted for 61% of all strains recovered and Staphylococcus epidermidis strains comprised 60% of the staphylococcal strains. No substantial differences in the distribution of Gram-positive, Gram-negative, or anaerobic species were noted before and after treatment. The quantitative data demonstrated a >99% reduction in the staphylococcal load on the surface of the skin 20 minutes following application of the hygiene solution. The total S. epidermidis colony-forming units were reduced by 99.5%. The HOCl hygiene solution removed staphylococcal isolates that were resistant to multiple antibiotics equally well as those isolates that were susceptible to antibiotics.

Conclusion: The application of a saline hygiene solution preserved with pure HOCl acid reduced the bacterial load significantly without altering the diversity of bacterial species remaining on the skin under the lower eyelid.

Keywords: Corynebacterium; Propionibacterium acnes; Staphylococcus aureus; Staphylococcus epidermidis; blepharitis; microbiome.

Conflict of interest statement

Disclosure David W Stroman, Keri Mintun, and Kathryn Najafi-Tagol are employees of NovaBay Pharmaceuticals. Arthur B Epstein and James D Branch are consultants for NovaBay Pharmaceuticals. Crystal M Brimer and Chirag R Patel have no conflicts to disclose in this work.

Figures

Figure 1
Figure 1
Bacterial diversity on the skin below the eyelid before treatment and 20 minutes after treatment with 0.01% hypochlorous acid hygiene solution.
Figure 2
Figure 2
The CFU reduction in the staphylococci load 20 minutes following treatment with 0.01% hypochlorous acid hygiene solution. Abbreviation: CFU, colony-forming units.

References

    1. Grice EA, Segre JA. The skin microbiome. Nat Rev Microbiol. 2011;9(4):244–253.
    1. Dougherty JM, McCulley JP. Comparative bacteriology of chronic blepharitis. Br J Ophthalmol. 1984;68(8):524–528.
    1. American Academy of Ophthalmology . Cornea/External Disease Panel. Preferred Practice Pattern® Guidelines. Blepharitis. San Francisco: American Academy of Ophthalmology; 2013. [Accessed January 20, 2017]. Available from: .
    1. Nichols KK, Foulks GN, Bron AJ, et al. The international workshop on meibomian gland dysfunction: executive summary. Invest Ophthalmol Vis Sci. 2011;52(4):1922–1929.
    1. Nelson JD, Shimazaki J, Benitez-del-Castillo JM, et al. The international workshop on meibomian gland dysfunction: report of the definition and classification subcommittee. Invest Ophthalmol Vis Sci. 2011;52(4):1930–1937.
    1. Baudouin C, Messmer EM, Aragona P, et al. Revisiting the vicious circle of dry eye disease: a focus on the pathophysiology of meibomian gland dysfunction. Br J Ophthalmol. 2016;100(3):300–306.
    1. Lemp MA, Crews LA, Bron AJ, Foulks GN, Sullivan BD. Distribution of aqueous-deficient and evaporative dry eye in a clinic-based patient cohort: a retrospective study. Cornea. 2012;31(5):472–478.
    1. Wick JY. Treating blepharitis: annoying condition for patients, vocabulary builder for pharmacists. Pharmacy Times. Feb 20, 2012. [Accessed June 15, 2016]. Available from: .
    1. Schaumberg DA, Sullivan DA, Buring JE, Dana MR. Prevalence of dry eye syndrome among US women. Am J Ophthalmol. 2003;136(2):318–326.
    1. Lee SH, Oh DH, Jung JY, Kim JC, Jeon CO. Comparative ocular microbial communities in humans with and without blepharitis. Invest Ophthalmol Vis Sci. 2012;53(9):5585–5593.
    1. Lina G, Boutite F, Tristan A, Bes M, Etienne J, Vandenesch F. Bacterial competition for human nasal cavity colonization: role of Staphylococcal agr alleles. Appl Environ Microbiol. 2003;69(1):18–23.
    1. Groden LR, Murphy B, Rodnite J, Genvert GI. Lid flora in blepharitis. Cornea. 1991;10(1):50–53.
    1. Suzuki T, Sano Y, Sasaki O, Kinoshita S. Ocular surface inflammation induced by Propionibacterium acnes. Cornea. 2002;21(8):812–817.
    1. Hurst JK. What really happens in the neutrophil phagosome? Free Radic Biol Med. 2012;53(3):508–520.
    1. Kumar V, Abbas AK, Fausto N. Acute and chronic inflammation Robbins and Cotran Pathologic Basis of Disease. 7th ed. Philadelphia: Elsevier; 2005. pp. 29–73.
    1. Wang L, Bassiri M, Najafi R, et al. Hypochlorous acid as a potential wound care agent: part I. Stabilized hypochlorous acid: a component of the inorganic armamentarium of innate immunity. J Burns Wounds. 2007;6:e5.
    1. Avenova® with Neutrox® [package insert] Emeryville, CA: NovaBay Pharmaceuticals, Inc; 2014.
    1. Schiffman RM, Christianson MD, Jacobsen G, Hirsch JD, Reis BL. Reliability and validity of the Ocular Surface Disease Index. Arch Ophthalmol. 2000;118(5):615–621.
    1. Shin H, Price K, Albert L, Dodick J, Park L, Dominguez-Bello MG. Changes in the eye microbiota associated with contact lens wearing. mBio. 2016;7(2):e00198.
    1. Bezza Benkaouha I, Le Brun C, Pisella PJ, Chandenier J, Lanotte P. Bacterial flora in blepharitis. J Fr Ophtalmol. 2015;38(8):723–728. French [with English abstract]
    1. Otto M. Staphylococcus epidermidis – the ‘accidental’ pathogen. Nat Rev Microbiol. 2009;7(8):555–567.
    1. Flanagan JL, Khandekar N, Zhu H, et al. Glycerol monolaurate inhibits lipase production by clinical ocular isolates without affecting bacterial cell viability. Invest Ophthalmol Vis Sci. 2016;57(2):544–550.
    1. Veldman P, Colby K. Current evidence for topical azithromycin 1% ophthalmic solution in the treatment of blepharitis and blepharitis-associated ocular dryness. Int Ophthalmol Clin. 2011;51(4):43–52.
    1. Foulks GN, Borchman D, Yappert M, Kim SH, McKay JW. Topical azithromycin therapy for meibomian gland dysfunction: clinical response and lipid alterations. Cornea. 2010;29(7):781–788.
    1. Scott IU, Flynn HW, Jr, Feuer W. Endophthalmitis after secondary intraocular lens implantation. A case-report study. Ophthalmology. 1995;102(12):1925–1931.
    1. Miño de Kaspar H, Shriver EM, Nguyen EV, et al. Risk factors for antibiotic-resistant conjunctival bacterial flora in patients undergoing intraocular surgery. Graefes Arch Clin Exp Ophthalmol. 2003;241(9):730–733.
    1. Peral A, Alonso J, García-García C, Niño-Rueda C, Calvo Del Bosque P. Importance of lid hygiene before ocular surgery: qualitative and quantitative analysis of eyelid and conjunctiva microbiota. Eye Contact Lens. 2016;42(6):366–370.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere