Efficacy and Safety of Liquid Chemical Germicides Applied for All-levels

Disinfection (Sterilization), Pre-sterilizing Treatment.

Published in Disinfection Practice magazine, 1, 2003
V. M. Bakhir, V.I.Vtorenko, B.I.Leonov, S.A.Panicheva, V.I.Prilutsky, N.Y.Shomovskaya
The Russian Scientific & Research Institute for Medical Engineering (VNIIIMT MZ RF)
Nowadays a range of disinfectants is essentially increased. There are over four hundred biocidal agents for
pre-sterilizing treatment, sanitation and all-levels disinfection used in Russia. However, appreciating results
of mans fight against microbes it is easy to see that the odds are not in mans favor. An amount of cultures
of pathogens resistant to liquid chemical germicides is increased. Recurrent planned replacements of one
biocidal agent to another do not solve a problem of nosocomial infection control, but only keep wavering
balance that could be upset by an accidental factor.
Official program documents that determined the strategy for nosocomial infection control and the way of
disinfection business development are based on analysis results of statistical data from application one or
another biocidal agent and reflect offers of chemicals market practically exerting nothing influence on it.
Absence of united scientific conception of fight against microbes based upon fundamental laws of biology,
modern progress in physics, chemistry and other sciences does not live any hope for some considerable
progress in sanitary epidemiological protection of population at least at present time.
It can be corroborate by following examples. In conception of preventive measures on nosocomial infection
control [1] approved by First Deputy Surgeon General of Russian Federation that the most perspective class
of liquid chemical germicides for different surfaces disinfection in clinics and hospitals are cationic surfactants
quarternary ammonium compounds and some other organic substances. It is claimed there that
substances may be used in presence of patients because these substances are not dangerous. Besides
cationic surfactants it is also recommended to use aldehydes and alcohols for disinfection and presterilization.
However, three years later it was stressed in the report [2] that all disinfectants disparity to modern
requirements for biocidal efficacy and hygienic safety. Cationic surfactants are stable at good detergent
power at the same time are inactive or have low-activity to such unsusceptible forms of pathogens as
mycobacteria Tuberculosis, funguses, spores and bacillus. One of cationic surfactants disadvantage is fast
and frequent adaptation of microbes to their effect. Liquid concentrated cationic surfactants possess
resorptive and irritating influence on skin and eyes mucous membrane and frequently act as allergens. A
high level of toxicity and sorptive power of aldehydes prevents from a wide recommendation of its use for
surface treatment, linens, and food utensils treatment.
A high toxicity of glutaral aldehyde is well known [3]. That is why its application has been forbidden in
England since May, 2002 [4]. However, disinfectants based on it are still advertised and on sale in Russia.
Ideal (perspective) disinfectants should posses high bactericidal activity, long shelf life, be ready for use
without any preliminary activation and utilized after use without negative effect to the environment. Long
storing of stable chemicals is available, but their utilization requires equivalent spending of another agent
or energy. Therefore, combination of stability and easy utilization is impossible.
As for the demand to exclude the preliminary activation stage before usage of ideal liquid chemical
germicide, it ought to take into consideration that all variety of biocidal agents are belong to few classes of
chemicals well-known for tens of years. So appearance of new class of chemicals, which will meet the
requirement, is unlikely. Modern tendency in developing new disinfectants is in search for activation means
of known disinfectants, and not the creation of new ones. For example, up till recently, 6% hydrogen
peroxide had been used for purposes of sterilization and high-level disinfection. Now the technology of
sterilization/high-level disinfection with hydrogen peroxide plasma is created to decrease its corrosion

activity and increase its biocidal activity [6]. Thus, liquid chemical germicides activation is directed to
development of conditions under which minimal concentration of active ingredients provides a high biocidal
effect at minimal corrosion, destructive activity and toxicity. Exposure time, concentration, temperature are
the most important characteristics of disinfection process and are major parameters of any practical
methodic.
Addition of activators, synergists, using an extra physical influence, i.e. creating conditions converting active
ingredients into metastable state at the moment of disinfection, is one of main directions for the disinfection
efficacy improvement in Russia [2].
Let us consider the processes accompanying application of stable organic solution for room disinfections
treatment on the example of compounds having membrane-attacking mechanism of pathogens. Cationic
surfactants, phenols, iodophors and some others are related to mentioned compounds.
Due to complexity and multi-functionality of microorganisms membrane specific interaction between
membranes biopolymers and abovementioned chemicals is hardly studied at all.
Cytoplasmic membrane is extremely vitally important structure of any cells including microbes. Organic
compounds are part of it and have many reactive groups that cause a high sensitiveness of membrane to
damaging factors of different nature. It is known that high concentration of membrane-attacking agents
destroy biopolymers of membrane, resulting in damaging lysis of microbes cell. The same chemicals in
small doses affect membrane functions change osmotic pressure, permeability, transport processes of
molecules and ions through membrane, inhibit metabolic processes, bio-oxidation and cell divisions.
Cationic surfactants (quarternary ammonium compounds) are concentrated at membrane and bind with
phosphatidic groups of its lipids; anionic surfactants such as alkaline detergents, alkyl- and arylsulfones,
iodophors react with membrane lipids. Phenols and alcohols dissolve lipids fragments of membrane.
After disinfection treatment is completed, the moist surfaces get dry, so organic compounds are
concentrated in a volume of porous material and turn into superfine and invisible to the eye film. Then it
evaporates by sublimation with less intensity than under evaporation during wet treatment. Formed aerosol
frequently has no smell that creates illusions of its harmlessness. One should take into account that in
accordance with known physical laws each liter of the air in the room contains about some milliards of
molecules of matter vaporized with natural course or due to sublimation even if its concentration could be
hardly measured and does not exceed hundreds or thousands parts from maximum permissible
concentration (MPC). During breathing as well as through the skin and mucous membrane such molecules
penetrate to human organism (patients or medical staff) and each one of it keeps realizing its main function
suppression of vital function of cells, but this time in a human body. Stability of liquid chemical germicides
creates their accumulation in organism followed by migration through digestive cycle.
Colonies of microorganisms form resistance to dry inefficient disinfectant and start using it as a nutrient
medium. Processes as described above have recently become an object of attention; so it is in a stage of
study now [7, 8].
It is quite evident that the development of new liquid chemical germicides which allow bacteria to develop
resistance in a short period of time, creates conditions for improvement of mutability mechanism of
pathogens and initiates appearance of new isolates of microorganisms. It is particularly dangerous because
systematical investigations are seldom carried out in hospitals, therefore it is impossible in the most cases
to determine during what time after beginning of use new disinfectant, microorganisms form resistance and
adaptive reactions.
Today by efficacy of disinfectants is implied its spectrum of biocidal activity. Efficacy also relates to exposure
time required for disinfection. However, taking a broad view on the subject we should say that disinfectant
iseffective only in the case it has a broad spectrum of biocidal activity and does not stimulate
microorganisms adaptation during a long-term use. In other words, effective disinfectant must be used for
years with certainty that microorganisms could not form adaptation to it for principal reasons.

Different means and technologies of disinfection that meet requirements mentioned above are known and
widely used. For instance, these are penetration of electromagnetic radiation (X-rays, gamma rays),
ultraviolet irradiation, treatment by ionized plasma, and, in conclusion, thermal methods of microorganisms
destruction. Case of cold high-level disinfection/sterilization by liquid, it is caused by metastable state of
dissolved disinfectant.
Let us consider a mechanism of antibacterial defense created by nature and functions in internal
environment of life organisms from unicellular organisms up to human over million of years and without
any fail.
It is proved [9] that leading role in bactericidal effect of neutrophils belongs to hypochlorous acid (HClO)
made by phagocytes. Under respiratory burst about 28% of oxygen used by neutrophils is spent for
formation of HClO. HClO is generated from hydrogen peroxide and chloride-ions in neutrophils. Catalyst of
this reaction is myeloperoxidase (MPO):
H2O2 + Cl

[Cat (P)]

HClO + OH [9, 10].

Hypochlorous acid dissociates in aqueous media with formation of hypochlorite-anion and hydrogen-ion:
HClO

ClO + +.

Concentrations of HClO and hypochlorite-anions ClO are almost equal at neutral pH. A decrease in pH shifts
reaction balance towards to HClO, and an increase of pH raises concentration of hypochlorite-anions.
A formation of H2O2 and HClO in a short time (fractions of a second) in a little volume of aqueous media
(parts of microliter, in a volume of active zone of phagocytosis) inevitably must be followed by reactions
of spontaneous decomposition and interaction of reaction products with formation of active particles similar
to once formed by radiolysis or electrolysis of water.
Spontaneous decomposition of hydrogen peroxide in aqueous media is followed by formation of highly active
biocides (in parenthesis appropriate reactions are presented):
HO2 hydroperoxide-anion (H2O2 + OH
22 peroxide-anion (OH + HO2

HO2 + H2O);

O22 + H2O);

2 superoxide-anion (O22 + H2O2

O2 + OH + OH );

2 hydrogen peroxide radical (O + H2O2

HO2 hydrogen super-oxide (O2 + H2O

H2O + HO2 );

HO2 + OH ).

1
At the same time it is possible the formation of extremely reactive singlet oxygen 12 : (ClO + H2O2
2+
H2O + Cl ). Participation of molecular oxygen ion-radical 2 in reactions of phagocytosis is determined
experimentally [10,11]. One of the described above could be the way of its formation.

Formation of free radicals lO , l , is possible in aqueous media in presence of l and lO

HClO + ClO

ClO + Cl + O .

By modern theory of catalytic processes, a formation of interim activated complex with myeloperoxidase as
a catalyst seems also to be most possivle. A dissociation of this complex is followed by formation of ,
and medium acidification:
HClO + ClO

[HClO

Cat ()

ClO ]

2l + 2O + +

Active hypochlorite radical lO can participate in reactions of atomic oxygen (O ) and hydroxyl radical (O
) formation:
lO + lO +

l + 2O + .

Followed by formation of chlorine radicals:

OH + Cl

Cl + OH .

Formed radicals and atomic oxygen take part in microbes destruction, oxidizing biopolymers, for example,
by the following:
RH2 + OH

RH2 + Cl
RH2 + O

RH + H2O;

RH + HCl;
RH + OH .

A metastable mixture of compounds formed during phagocytosis is a very effective mean for microbes
destruction due to many spontaneous realized possibilities of changing (irreversible damage) of essential
functions of microorganisms biopolymers at a level of electron transmission. Metastable particles with different
values of electrochemical potential possess universal spectrum of action, i.e. they are able to damage all large
systematic groups of microorganisms (bacteria, mycobacteria, viruses, funguses, spores) and without damaging
of human tissues and other multicellular system organisms.
That can be explained by texture and living activities of cells of that living organisms. Cells of multicellular
organisms during their life process, for example, in oxygenases reactions of cytochrome P-450, during
phagocytosis under microbes adhesion and cidal action produce a range of highly efficient oxidants. These cells
have a strong chemical system of antioxidant protection with preventing a toxic effect of such compounds on
vitally important cellular structures. Antioxidant properties of somatic cells are related to a presence of a strong
three-layered lipoproteins shell that contains diene conjugates (=) possessing electron-donor properties and
sulfhydric groups (SH). Microorganisms do not have strong mechanisms of antioxidant protection due to absence
of mentioned chemical groups.
All somatic cells of living organisms are heterotrophs: their trophism depends on availability of nutritive materials
in extracellular medium glucose, amino acids, fatty acids. Though biological well-being of any somatic cell is
up to place it keeps in a process of dispensing of trophic functions of all elements of multicellular system (cell is
supported by cell).
Trophic functions of multicellular organisms cells are obeyed to interchangeability law. If a trophism of single
cell is disturbed, then this disturbance can be corrected by neurotrophic regulation, functions of adjoining cells,
reparative processes, nutritive function of blood and so on.
All microbes cells are autotrophs, so their nutrition depends on their own activity, in other words if enzymatic
processes in microbes cell are depressed, it dies since there is no compensatory mechanism. Microbial cell gets
all its trophic functions by enzymatic reactions only. An interaction between microbial cells in their habitat is not
a compensatory one, that is to say susceptibility of microbe is in its autonomy.
Maximum use of fundamental difference between living organisms of micro- and macro-biological life is an
ideological basis of electrochemical activated biocidal solutions [12].
As physicochemical process electrochemical activation is an electrophysical and electrochemical influence on
water that contains ions and molecules of dissolved substances in it. It takes place under conditions of minimal

heat release in the area of dimensional charge at the electrode surface (anode or cathode) of electrochemical
system at nonequilibrium charge transfer through the interface electrode electrolyte by electrons [13, 14].
As a result of electrochemical activation water converts into metastable (activated) condition showing increased
reactivity in different physical-chemical processes during some tens hours. Electrochemical activation allows
directly change a composition of dissolved gases, acid-base and redox characteristics of water within the bigger
scale then under the equivalent chemical regulation. Chemical reagents (oxidants or reducing agents) in
metastable condition can be generated from water and dissolved substances. It is used in processes of water
purification and disinfection as well as for water or diluted electrolyte solution transformation into ecologically
friendly biocidal (disinfecting/sterilizing solution), cleaning, extractive and other functionally useful solutions.
Flow through electrolytic modular (FEM) is used for electrochemical transformation of water and dissolved
substances. A distinctive feature of FEM is in combination of properties of ideal displacement reactor and ideal
mixing reactor in one element as well as high technical and economic characteristics at processing of fresh water
and low-mineralized solutions.
Anolytes A, AN, ANK are types of electrochemically solutions generated by STEL-devices. They are different
from each other by physicochemical properties and biocidal activity due to different technological processes used
for their generation. At present time anolyte ANK generated by STEL devices is the most perfect solution by its
functional and technological properties among other electrochemically activated solutions. There are following
stages of ANK generation: cathode treatment of pre-mixed brine, during which pH value rises and electrolyte is
saturated with dissolved hydrogen; removing hydrogen and hydroxides of heavy metals formed by cations and
hydroxide anions; generation of hydro- peroxide and oxygen- chlorine- released type oxidants by anode treatment.
Some reactions of anolyte ANK generating process are presented below.
Reactions of the first stage:
2H2O + 2Na+ + 2e

2NaOH + H2 (sodium hydroxide formation);

2H2O + 2e
H2 + 2OH (formation of free anions of hydroxyl at current density over 500 /m2; reaction rate
raises when concentration of sodium chloride decrease);
2 + 2 + 2

2 + - (formation of peroxide anion by dissolved in water oxygen);

2 + 22 + 2

22 + 2 (formation of hydrogen peroxide by dissolved in water oxygen).

Reactions of the last stage of anolyte ANK generation:

2Cl - 2e

Cl2

(formation of molecular chlorine which immediately reacts with components of near-electrode

medium):
Cl2 + H2O

HClO + HCl;

HCl + NaOH
2H2O - 4e

NaCl + H2O;
4H+ + O2 (formation of oxygen and ions of oxony);

OH + Cl - 2e
Cl + 2OH - 2e

HClO (direct synthesis of hypochlorous acid);

ClO + H2O (direct synthesis of hypochlorite anion);

3OH - 2e
HO2 - e

HO2 + H2O (formation of peroxide anion); HO2- "e HO2 (formation of hydrogen superoxide);
HO2 (formation of hydroxyl radical);

Cl + 4 OH - 5 e

ClO2 + 2H2O (formation of chlorine dioxide);

O2 + 2 OH - 3 e

O3 + H2O (ozone formation);

H2O - 2e

2 H+ + O (atomic oxygen formation).

Besides, in a volume of anolyte ANK during processes of relaxation reactions proceed; as a result of it other
biocide substances are generated, in particular, singlet molecular oxygen (12), molecular anion-radical of ozone
(O3 ), hypochlorite-radical (ClO ), atomic chlorine (Cl ), chlorite-anion (lO2 ) and others. A comparison of
bactericidal substances being in phagocytosis and contained in anolyte ANK practically recognizes their clear
identity.
Environmentally friendly electrochemically-activated anolyte ANK has life time that is necessary for procedure
of disinfection. After its use it spontaneously degrades without formation of toxic xenobiotics and does not require
any neutralization before discharging to sewerage. Anolyte ANK is activated during a period of relaxation, i.e.
the time during which spontaneous change of its physicochemical characteristics, catalytic and biocatalytic
activity takes place. The spontaneous change of these parameters is evidence of dissipation of excess internal
energy due to dissipative processes.
A mixture of metastable active agents eliminates microbes ability for adaptation to bactericidal effect of anolyte
ANK. A small total concentration of active oxygen and chlorine compounds guarantees for absolute safety for
man and environment under long-term use of anolyte.
A chemical potential of molecules and ions in anolyte ANK is much higher than in hypochlorite solutions. A low
mineralization of anolyte ANK and its hydration ability helps penetration through cell membrane, creates
conditions for intensive osmotic and electroosmotic oxidants transfer into intracellular media. The osmotic
transfer of oxidants through shells and membranes of microbes cells is more intensive than through membranes
of somatic cells due to inherent difference in osmotic gradient of these types of cells. Electrically charged cluster
structures formed by dissolved gas molecules in water and electron-active components of medium promote highspeed electroosmotic carry of oxidants into bacterial cell, because this clusters produce strong local electric fields
with high heterogeneity in zones of contact with biopolymers.
Activated anolyte ANK produced by STEL-devices kills microorganisms of bacterial, viral and fungous etiology
(Staphylococcus aureus, Pseudumonas aeruginosa, Escherichia coli, hepatitis B virus, poliomyelitis virus, HIV,
adenovirus, pathogens of tuberculosis, salmonellosis, dermatomycosis and others). By its efficacy anolyte greatly
exceeds chloramines, sodium hypochlorite and overwhelming majority of other disinfectants and sterilizing
agents.
A sum of active oxygen and chlorine compounds in anolyte ANK (total oxidant content) is within 100 to 500
mg/l, that is dozens times less than in most solutions of currently used disinfectants. Anolyte ANK does not cause
coagulation of protein that protects microorganisms and, due to its loosened structure, easily penetrate into
pinholes of living and lifeless matter.
Anolyte ANK is generated by STEL-devices from dilute solution of sodium chloride in drinking water. Total
mineralization of initial solution for anolyte ANK eneration is within 1,5 to 5,0 g/l. That prevents from anolyte
active ingredients accumulation in porous materials after it used and dried up.

Useful properties of anolyte ANK such as its efficacy, safety and economy are confirmed in full measure by many
hospitals. In some of them (for instance, in Moscow City Hospitals 15 and 52) anolyte ANK is practically
the only disinfectant in last few years. A position of anolyte in disinfectants structure of the hospitals exceeds 97
%, and its annual consumption is about 1000 tons per hospital [15, 16].
Different disinfectants had been used in the hospitals before application of anolyte ANK. Many of that
disinfectants corroded metals, dimnessed glass instruments, damaged synthetic materials, developed skin allergic
reactions and headache to medical personnel. More over, it was necessary to train medical personnel to prepare
of working solutions of each disinfectant and to provide them with personal protection (respirator, shoes, eye
protectors, rubber gloves, apron).
Hospitals were spending considerable amount of money for buying disinfectants, detergents, antiseptics, tanks
for their storage, special clothes and protection. It required periodical renewal of drains disabled because of
aggressive solutions discharge. Taking into account limited efficiency of disinfectants, particularly for
nosocomial infection control, and possibility of incorrect preparation of applied disinfectants, microbiological
laboratories of these hospitals had to make primary and secondary bacteriological control on disinfection quality
by taking 500 700 tests each month. It was spent a lot of test agents for control of parameters of prepared
disinfectants.
Application of anolyte ANK generated by STEL devices eliminated mentioned above negative aspects from using
traditional chemicals resulted in following beneficial effects: bacteriological contamination of treated objects was
considerably reduced, a number of negative test results decreased on about 85 95 %, which allowed to cut down
monthly bacteriological routine tests up to 200 300. Besides, secondary infecting rate by hepatitis B among
patients have been reduced from 0,45 0,50% to 0,06 to 0,08 % which shows an improvement in quality of
disinfection and nosocomial infection control.
Anolyte ANK is used in the following hospitals departments: surgery and purulent surgery departments,
therapeutic department, department of transfusiology, gynecology department, department of proctology,
pathology department, diagnostic centers, waiting rooms, rehabilitation centers, intensive care, traumatologic,
clinical-diagnostic laboratory, opthalmology, vascular surgery, cardio-surgical, cardiovascular departments,
neurology unit, operative, anesthetic departments, unit of endoscops, physiotherapy, dental departments,
department of functional diagnostics, of ultrasonic and X-Ray diagnostics, and also in central sterilization
department (Moscow City Hospital 15), in puerperal hospital with obstetric division, departments of pathology
of pregnant, of newborns, operative and maternity rooms.
STEL devices in hospitals are compact, easy in operation, ecologically safe and could be installed in any room.
They do not require special long training of medical personnel for work with. Their operation doesnt require any
special protective cloth. Amount of generated anolyte meets the required amount of departments and could be
increased by request from medical personnel in compliance with epidemiological situation. It is possible to
generate anolyte ANK with different concentration of oxidants [17]. Testing of oxidants concentration in anolyte
ANK is conducted by using test-strips for express analyses or by iodometric titration for more accuracy. Neutral
anolyte ANK is easy-to-use and readily used in hospitals. Contrary to other disinfectants, it can be applied as a
multifunctional solution for all-levels disinfection, as well as cleaning and sterilization simultaneously.
Resume. For effective sanitary-and-epidemiological protection of population, it is necessary to work out unified
scientific conception of fight against microbes based on fundamental laws of biology, current achievements in
physics, chemistry and another sciences that includes the following principals:
1. Besides data on antimicrobial activity and exposure time, an estimation on efficacy of liquid chemical
germicides must also include data concerned with microorganisms ability to develop a resistance to the given
disinfectant or sterilizing agent.

2. A creation of new effective and safe for human liquid chemical germicides must be based on fundamental
differences between micro- and macro-organisms, by copying or modeling protection mechanisms used by cells
of multicellular organisms.
3. The main criteria for safety of liquid chemical germicides must be defined whether active agents of given
biocide are xenobiotics. Consumer should be informed by a special label with information on xenobiotics
presence.
References
1. Pockrovsky V.I., ed., Conception of preventive measures on nosocomial infection control. The Ministry
of Health of Russian Federation, 1999.
2. Fedorova L.S., Basic directions of disinfectants efficacy increase. Materials of the All-Russian scientific
conference devoted to the centenary of birthday of Vashkov V.I. Issues of the day of disinfectology in
infectious and parasitic disease prevention . Moscow: ITAR-TASS, 2002. p. 26-30.
3. Bill Glass. Exposure to Glutaraldehyde Alone or in a Fume Mix: a Review of 26 cases. Journal of the
NZMRT, Volume 40, No 2, June, 1997, p.13-17.
4. Jon Richards. Withdrawl of Disinfectant Hit by Safety Fears. BBC News on Line: Health. January 22,
2002.
5. Shandala M.G. Methodological problems of present-day disinfectology. Materials of the All-Russian
scientific conference devoted to the centenary of birthday of Vashkov V.I. Issues of the day of
disinfectology in infectious and parasitic disease prevention . Moscow: ITAR-TASS, 2002. p. 9-16.
6. William A. Rutala. Chemical germicides in health care // International symposium, may 1994. Printed
in Canada. 1995. 312 p.
7. Patrick R. Murray, Ellen Jo Baron, Michael A. Pfaller, Fred C. Tenover, Robert H. Yolken. Manual of
clinical microbiology. Sixth edition. ASM PRESS. Washington, D.C. p. 227 - 245.
8. G. McDonnell, A.D. Russel. Antiseptics and Disinfectants: Activity, Action and Resistance. Clinical
Microbiology Reviews 12. p.147179
9. Lopatkin N.A., Lopuhin Y.M. Efferent methods in medicine (theoretical and experimental aspects of
extracorporal treatment modes). Moscow: Medicina, 1989. p. 352
10. Archakov A.I., Karusina I.I. Oxidation of foreign substances and problems of toxicology. Vestnik AMN
USSR, 1988, 1, p. 14 - 28.
11. Archakov .I. Microsomal oxidation. Moscow: Nauka, 1975. p. 327
12. Panicheva S.A. Medical and technical systems and technologies for synthesis of electrochemically
activated solutions. Moscow: VNIIIMT, 1998. p. 122.
13. Bachir V.M. Electrochemical activation. Moscow: VNIIIMT, 1992. part 2.
14. Bakhir V.M., Zadorozhny Y.G., Leonov B.I., Panicheva S.A., Prilutsky V.I. Electrochemical activation:
water treatment and production of effective solutions. Moscow: VNIIIMT, 2001.
15. Rovinskaya V.B., Suhova O.I. An experience of electrochemical activated solutions use in multifield
hospital. Proceeding of the First International Symposium Electrochemical activation in medicine,
agriculture and industry. Moscow: VNIIIMT, 1997, p.70- 72.
16. Bakhir V.M., Vtorenko V.I., Zadorozhny Y.G., Leonov B.I., Panicheva S.A., Prilutsky V.I. Some
aspects of getting and using electrochemically activated anolyte ANK. Proceeding of the Third

International Symposium Electrochemical activation in medicine, agriculture and industry. Moscow:

VNIIIMT, 2001, p. 3 - 25.
17. Recommendations on applying of the Neutral anolyte ANK produced by STEL-10N-120-01 for
disinfection, pre-sterilizing treatment and sterilization, approved by the Head of the RF State Committee
of Sanitary and Epidemic Control, 11-3/206-09 of the 17-th of June, 2002.