The White Powder You Should Bring on Every Deployment
Powdered High Strength Calcium Hypochlorite (Ca(ClO)₂) is essential for a medic to keep in the team house or aid station in an austere environment. It can easily be bought, transported and reconstituted for many purposes…
Instrument Disinfection:
Autoclaving instruments with high pressure steam is the industry standard for sterilization. This is why the SF Medical TACSET includes the infamous portable pressure sterilizer more commonly known to the rest of the team as the lobster pot. If you find yourself in a situation without the lobster pot there are some other techniques for high level disinfection which will get your surgical instruments cleaner than just wiping them on your pants. These techniques include using dry heat, boiling, microwave, UV exposure and chemical dips.
To use Calcium Hypochlorite for “sterilization” of surgical instruments be sure to grossly decontaminate with a wire or stiff bristle brush first. Then mix 75g of 70% strength Ca(ClO)₂ into a liter bottle to make a household 5.25% strength bleach solution. Contact time is 5-10mins. Once you have scrubbed in and made yourself as sterile as possible, remove the instruments drom the bleach bath and irrigate with sterile irrigation fluid before use. This solution contains approx 52,500ppm Hypochlorite.
One of the weaker solutions described below can also be used as long as contact time is increased. Soaking any longer than recommended will damage the instruments as it is a powerful oxidizer. Do not store in a metal container or in a container with a metal cap.
Water Purification:
5 drops of this 5.25% solution can be used to purify a liter of suspect water in order to remove bacteria and viruses to make safe for drinking. This will not kill Giardia or Cryptosporidium cysts. Those must be filtered or purified in another manner. This also will not remove other pollutants such as chemicals or heavy metals.
Surface disinfectant:
To make a strong disinfecting solution for surfaces exposed to bodily fluids such as patient litters and other non-sterile equipment, mix 100mLs of the 5.25% solution with 900mL of clean water. This will make a 5250ppm or 0.525% solution. Another way to get this strength is to use 7g of the concentrated powder in a liter of water.
Wound Clensing:
The JTS CPG on Invasive Fungal Infections recommends a 1/20th strength (Full strength is traditionally a .5%) solution of 0.025% Dakins solution that is used directly on wounds to kill pathogens. This has been especially usefully when contaminated dirt and soil is blasted into a wound inoculating it with invasive fungal species such as Aspergillis.
Irrigation with Dakins solution should only be done temporarily. If left on for 4-7 days straight while waiting for delayed primary closure we have seen muscle tissue become indurated and hard after marinating for these longer periods of time without serial washout and debridement. To make 0.025% Dakins solution mix 5mL of the household 5.25% in a liter bottle with a teaspoon of baking soda.
In order to test any of these concentrations, test strips can be purchased in bulk for different levels of chlorine.
Be sure to clearly label each bottle with the strength and date made. They should last more than a few months at the lower concentrations but are easy enough to make a new batch when needed.
Math:
When calculating remember that 1mg/liter is equivalent to 1ppm and that the amount of active ingredient varies and should be read from the bottle. Most commonly high test calcium Hypochlorite is found with 70% available chlorine.
Make Household 5.25% Bleach:5.25%=.0525
1,000,000×.0525=52,500ppm
5.25% solution=52,500ppm
75g × 70%=52.5g Ca(ClO)₂ in 1L H₂O
52.5g=52,500mg
1mg/liter=1ppm
Available chlorine in 1L=52,500ppm
Surface Disinfectant:52,500ppm÷10=5,250ppm=0.525%
0.025% Dakins Solution:
.525%÷20=.02625%~0.025%
1000mL÷5mL=200
5mL of 5.25%=52,500ppm
5mL of 5.25%+995mL H₂O=0.02625%
0.02625%~0.025%
Further Reading:
JSOM Article: Field Sterilization in the Austere and Operational Environment A Literature Review of Recommendations
Will JS, Alderman SM, Sawyer RC. 16(2). 36 – 43. (Journal Article)
Click to access 2016236Will.pdf
US Army Public Health Center: Using and Preparing High Strength Chlorine
https://phc.amedd.army.mil/PHC%2520Resource%2520Library/TIP_No_13-034-1114_Prepare_Measure_High_Chlorine_Solutions.pdf&ved=2ahUKEwjPg_jM97faAhXIwFkKHXQ9D6MQFjABegQICBAB&usg=AOvVaw3sqohjTgpg83PmUqJl6VWe
Joint Trauma System Clinical Practice Guideline on Invasive Fungal Infections:
Joint Trauma System
As the DoD Center of Excellence for MHS trauma care delivery, JTS directly assists each Combatant Command in trauma system planning, treatment, management, and improvement of casualty outcomes to include battle injuries, disease non-battle injuries and all-hazard settings through evidence-driven performance improvement.
Prolonged Field Care and Joint Trauma System Clinical Practice Guideline on Acute Wound Management:
Click to access wound_mgmnt_pfc_24jul2017.pdf
US CDC: Disinfection with Chlorine:
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Ohio State University Medical Center PDF -How to Make Dakins Solution accessed from:
https://www.itstactical.com/wp-content/uploads/2012/01/Dakins_Solution.pdf&ved=2ahUKEwiVl8fx-cbaAhWJc98KHebHCF4QFjAKegQICBAB&usg=AOvVaw1d25RBwQEvK83Xd6z7L48i
Washington State Department of Health Water Purification:
Water Purification
The treatments described below work only to remove bacteria or viruses from water. If you suspect the water is unsafe because of chemicals, oils, poisonous substances, sewage or other contaminants, do not drink the water. Don’t drink water that is dark colored, has an odor or contains solid materials.
Calcium Hypochlorite Solution Calculator:
https://www.publichealthontario.ca/en/ServicesAndTools/Tools/Pages/Dilution-Calculator.aspx
CDC Pool Disinfection and Testing:
Water Treatment and Testing
Chlorine and pH, your disinfection team, are the first defense against germs that can make swimmers sick. As a residential pool or hot tub/spa owner, it is your responsibility to regularly check the chlorine concentration and pH of the pool or hot tub/spa water to help protect yourself and your family and friends from swimming-related illnesses.
Question: When the only source of calcium hypochlorite is commercially prepared swimming pool shock (unstabilized, powdered form) or 3″ tablets (stabilized, compressed tablet form), which form is preferred and are there any issues presented by commonly used stabilizers (e.g., cyanuric acid)?
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