Abstract

This study presents a case series conducted at a private hospital in Mexico City, where healthcare personnel were exposed to SARS-CoV-2 without adequate protective measures. As a voluntary prophylactic measure, and given the high mortality from COVID-19 at that time, a protocol was implemented consisting of nebulization with a super-oxidized solution (Microdacyn) for 15 minutes, three times daily for 7 days. The objective was to evaluate the safety of this preventive treatment. Specific measurements were obtained in each participant to demonstrate the safety of the procedure. Of eleven initial subjects, eight completed the protocol; one was excluded due to pre-existing cardiac arrhythmia and two were withdrawn for other reasons (one subject had a positive SARS-CoV-2 PCR test, with adequate oxygen saturation and no complications, and another withdrew consent). The mean age of participants was 33.2 years, with three women and five men. The protocol was initiated on the fourth day after exposure. At baseline and at the end of the protocol, SARS-CoV-2 PCR testing, IgG and IgM antibodies, chest radiographs, general blood tests, and spirometry were performed. Positive IgG was found in two subjects who reported symptoms consistent with COVID-19 months earlier. No serious or clinically significant adverse events were reported during treatment; no changes were observed in vital parameters (heart rate, respiratory rate, oxygen saturation), and there were no hospital admissions or deaths. At the end of the protocol, all patients were negative for SARS-CoV-2 by PCR, spirometry did not differ from baseline, and the remaining laboratory and imaging studies showed no significant changes. These results suggest that nebulization with a super-oxidized solution is safe as a prophylactic treatment in individuals at high risk of exposure to SARS-CoV-2, which could serve as a precedent for the management of this and other types of respiratory infections.

Keywords

  • SARS-CoV-2
  • ultrasonic nebulization
  • super-oxidized solution
  • prophylaxis
  • healthcare personnel
  • spi

References

  1. [1] Xie Y, Choi T, Al-Aly Z. Postacute Sequelae of SARS-CoV-2 Infection in the Pre-Delta, Delta, and Omicron Eras. New England Journal of Medicine. 2024;391(6):515-525. doi:10.1056/NEJMOA2403211
  2. [2] Toledo Salinas C del C, de la Torre Rosas A, López Ridaura R, Dyer Leal DD, Cortés Alcalá R, y col. PLAN DE GESTIÓN A LARGO PLAZO PARA EL CONTROL DE LA COVID-19. Accessed December 8, 2025. https://coronavirus.gob.mx/wp-content/uploads/2023/06/2023.06.08-Plan-LP-COVID.pdf
  3. [3] COVID-19 Tablero México - CONACYT - CentroGeo - GeoInt - DataLab. Accessed June 19, 2020. https://coronavirus.gob.mx/datos/#DOView
  4. [4] Berlin DA, Gulick RM, Martinez FJ. Severe Covid-19. New England Journal of Medicine. 2020;383(25):2451-2460. doi:10.1056/NEJMCP2009575
  5. [5] Chen Y, Liu Q, Guo D. Emerging coronaviruses: Genome structure, replication, and pathogenesis. Journal of Medical Virology. Preprint posted online 2020. doi:10.1002/jmv.25681
  6. [6] Yeo LY, Friend JR, McIntosh MP, Meeusen EN, Morton DA. Ultrasonic nebulization platforms for pulmonary drug delivery. Expert Opinion on Drug Delivery.Taylor & Francis. 2010;7(6):663-679. doi:10.1517/17425247.2010.485608
  7. [7] Karolewicz B, Nartowski K, Pluta J, Gorniak A. Physicochemical characterization and dissolution studies of acyclovir solid dispersions with Pluronic F127 prepared by the kneading method. Acta Pharmaceutica. 2016;66(1):119-128. doi:10.1515/acph-2016-0008
  8. [8] Mcdonnell G, Russell AD. Antiseptics and disinfectants: Activity, action, and resistance. Clinical Microbiology Reviews.American Society for Microbiology. 1999;12(1):147-179. doi:10.1128/cmr.12.1.147
  9. [9] Ortega-Peña S, Hidalgo-González C, Robson MC, Krötzsch E. In vitro microbicidal, anti‐biofilm and cytotoxic effects of different commercial antiseptics. International Wound Journal. 2016;14(3):470. doi:10.1111/IWJ.12625
  10. [10] Del Rosso JQ, Bhatia N. Status Report on Topical Hypochlorous Acid: Clinical Relevance of Specific Formulations, Potential Modes of Action, and Study Outcomes. The Journal of Clinical and Aesthetic Dermatology. 2018;11(11):36.
  11. [11] Fukuzaki S. Mechanisms of actions of sodium hypochlorite in cleaning and disinfection processes. Biocontrol Science. Preprint posted online 2006. doi:10.4265/bio.11.147
  12. [12] Landa-Solis C, González-Espinosa D, Guzmán-Soriano B, et al. MicrocynTM: A novel super-oxidized water with neutral pH and disinfectant activity. Journal of Hospital Infection. 2005;61(4):291-299. doi:10.1016/j.jhin.2005.04.021
  13. [13] Boecker D, Zhang Z, Breves R, Herth F, Kramer A, Bulitta C. Antimicrobial efficacy, mode of action and in vivo use of hypochlorous acid (HOCl) for prevention or therapeutic support of infections. GMS Hyg Infect Control. 2023;18:Doc07. doi:10.3205/DGKH000433
  14. [14] Rutala WA, Weber DJ. New Disinfection and Sterilization Methods. Vol 7.
  15. [15] Hatanaka N, Yasugi M, Sato T, Mukamoto M, Yamasaki S. Hypochlorous acid solution is a potent antiviral agent against SARS-CoV-2. 1496 | J Appl Microbiol. 2022;132:1496. doi:10.1111/jam.15284
  16. [16] Urushidani M, Kawayoshi A, Kotaki T, Saeki K, Mori Y, Kameoka M. Inactivation of SARS-CoV-2 and influenza A virus by dry fogging hypochlorous acid solution and hydrogen peroxide solution. PLoS One. 2022;17(4):e0261802. doi:10.1371/JOURNAL.PONE.0261802
  17. [17] Kubo M, Eda R, Maehana S, et al. Virucidal efficacy of hypochlorous acid water for aqueous phase and atomization against SARS-CoV-2. J Water Health. 2024;22(3):601-611. doi:10.2166/WH.2024.348
  18. [18] Severing AL, Rembe JD, Koester V, Stuermer EK. Safety and efficacy profiles of different commercial sodium hypochlorite/hypochlorous acid solutions (NaClO/HClO): Antimicrobial efficacy, cytotoxic impact and physicochemical parameters in vitro. Journal of Antimicrobial Chemotherapy. 2019;74(2):365-372. doi:10.1093/JAC/DKY432
  19. [19] Benedusi M, Tamburini E, Sicurella M, et al. The Lesson Learned from the COVID-19 Pandemic: Can an Active Chemical Be Effective, Safe, Harmless-for-Humans and Low-Cost at a Time? Evidence on Aerosolized Hypochlorous Acid. International Journal of Environmental Research and Public Health. 2022;19(20). doi:10.3390/IJERPH192013163
  20. [20] Lewandowski RB, Stȩpińska M, Osuchowski Ł, et al. The HOCl dry fog-is it safe for human cells? PLoS ONE. 2024;19(5 May). doi:10.1371/JOURNAL.PONE.0304602
  21. [21] Bayraktar G, Yılmaz Göler AM, Aksu B, Öztürk Özener H. Efficacy of hypochlorous acid as an alternative oral antimicrobial agent on human gingival fibroblasts, Aggregatibacter actinomycetemcomitans, and Candida albicans biofilms in vitro. Biofouling. 2023;39(9-10):980-989. doi:10.1080/08927014.2023.2288071
  22. [22] Souza MA, Steier L, Vanin GN, et al. Antimicrobial action, cytotoxicity and erosive potential of hypochlorous acid obtained from an electrolytic device compared with sodium hypochlorite. Clinical Oral Investigations. 2024;28(5). doi:10.1007/S00784-024-05675-6
  23. [23] Rebollar González RC, Torres-López E. Super-Oxidized Solution Nebulization for the Symptomatic Treatment of Airway Infections Including COVID-19 Cases Report. International Journal of Innovative Research in Medical Science (IJIRMS). 2020;05(08):299-308. doi:https://doi.org/10.23958/ijirms/vol05-i08/922
  24. [24] Gutiérrez-García R, DE LA CERDA-ÁNGELES JC, Cabrera-Licona A, Delgado-Enciso I, Mervitch-Sigal N, Paz-Michel BA. Nasopharyngeal and oropharyngeal rinses with neutral electrolyzed water prevents COVID-19 in front-line health professionals: A randomized, open-label, controlled trial in a general hospital in Mexico City. Biomedical Reports. 2022;16(2). doi:10.3892/BR.2021.1494
  25. [25] Wölfel R, Corman VM, Guggemos W, et al. Virological assessment of hospitalized patients with COVID-2019. Nature. Published online 2020. doi:10.1038/s41586-020-2196-x
  26. [26] Zou L, Ruan F, Huang M, et al. SARS-CoV-2 viral load in upper respiratory specimens of infected patients. New England Journal of Medicine. Preprint posted online 2020. doi:10.1056/NEJMc2001737
  27. [27] Greenhalgh T, Koh GCH, Car J. Covid-19: A remote assessment in primary care. The BMJ. 2020;368:1-5. doi:10.1136/bmj.m1182
  28. [28] COVID-19 Tablero México - CONAHCYT - CentroGeo - GeoInt - DataLab. 25/6/2023. Accessed December 8, 2025. https://datos.covid-19.conacyt.mx/#DOView. Accessed Jan, 2021
  29. [29] Sanders JM, Monogue ML, Jodlowski TZ, Cutrell JB. Pharmacologic Treatments for Coronavirus Disease 2019 (COVID-19): A Review. JAMA - Journal of the American Medical Association.American Medical Association. Preprint posted online 2020. doi:10.1001/jama.2020.6019
  30. [30] Types of COVID-19 Treatment | COVID-19 | CDC. Accessed December 9, 2025. https://www.cdc.gov/covid/treatment/index.html
  31. [31] Bhimraj A, Morgan RL, Hirsch Shumaker A, et al. Infectious Diseases Society of America Guidelines on the Treatment and Management of Patients With COVID-19 (September 2022) Clinical Infectious Diseases ® 2024;78(7):e250-e349. Published online 2022. doi:10.1093/cid/ciac724
  32. [32] To KKW, Tsang OTY, Leung WS, et al. Temporal profiles of viral load in posterior oropharyngeal saliva samples and serum antibody responses during infection by SARS-CoV-2: an observational cohort study. The Lancet Infectious Diseases. Published online 2020. doi:10.1016/S1473-3099(20)30196-1
  33. [33] Johansson MA, Quandelacy TM, Kada S, et al. SARS-CoV-2 Transmission from People Without COVID-19 Symptoms. JAMA network open. 2021;4(1). doi:10.1001/JAMANETWORKOPEN.2020.35057
  34. [34] Kim HJ, Lee JG, Kang JW, et al. Effects of a low concentration hypochlorous Acid nasal irrigation solution on bacteria, fungi, and virus. The Laryngoscope. 2008;118(10):1862-1867. doi:10.1097/MLG.0B013E31817F4D34
  35. [35] Aras A, Karaman E, Yıldırım S, Yılmaz Ö, Kızıltan R, Karaman K. Intraperitoneal infusion of neutral-pH superoxidized solution in rats: Evaluation of toxicity and complications on peritoneal surface and liver. Medical Science Monitor. 2017;23:960-965. doi:10.12659/MSM.899453
  36. [36] Murashevych B, Maslak H, Girenko D, Abraimova O, Netronina O, Shvets V. The effect of hypochlorous acid inhalation on the activity of antioxidant system enzymes in rats of different ages. Free radical research. 2024;58(8-9):441-457. doi:10.1080/10715762.2024.2386688
  37. [37] Ohno H, Higashidate M, Yokosuka T. Mediastinal irrigation with superoxidized water after open-heart surgery: The safety and pitfalls of cardiovascular surgical application. Surg Today. 2000;30(11):1055-1056. doi:10.1007/s005950070035
  38. [38] Nissen N, Balachandran P, Chennai AH, et al. early Diagnosis and surgical Treatment for necrotizing Fasciitis: a Multicenter study. 2017;4(5). doi:10.3389/fsurg.2017.00005
  39. [39] Bongiovanni CM. Effects of Hypochlorous Acid Solutions on Venous Leg Ulcers (VLU): Experience With 1249 VLUs in 897 Patients. Journal of the American College of Clinical Wound Specialists. 2014;6(3):32-37. doi:10.1016/j.jccw.2016.01.001
  40. [40] Bennett MS. Lower extremity management in patients with diabetes. Journal Of The American Pharmaceutical Association (Washington,DC: 1996). 2000;40(5 Suppl 1):S40-S41.
  41. [41] Armstrong DG, Bohn G, Glat P, et al. Expert Recommendations for the Use of Hypochlorous Solution: Science and Clinical Application. Ostomy Wound Manage. 2015;61(5):S2-S19.
  42. [42] Bongiovanni CM. Effects of Hypochlorous Acid Solutions on Venous Leg Ulcers (VLU): Experience With 1249 VLUs in 897 Patients. Journal of the American College of Clinical Wound Specialists. 2014;6(3):32-37. doi:10.1016/j.jccw.2016.01.001
  43. [43] Hingorani A, Lamuraglia GM, Henke P, et al. The management of diabetic foot: A clinical practice guideline by the Society for Vascular Surgery in collaboration with the American Podiatric Medical Association and the Society for Vascular Medicine. Providence. Published online 2016. doi:10.1016/j.jvs.2015.10.003
  44. [44] Ball RL, Garg G, Vazquez JS, et al. Hypochlorous Acid Solution Is Safe for Intracavitary Lavage: Examination in a Rodent Model. Eplasty. 2021;21:e1.
  45. [45] Coetzee E, Whitelaw A, Kahn D, Rode H. The use of topical, un-buffered sodium hypochlorite in the management of burn wound infection. Burns: journal of the International Society for Burn Injuries. 2012;38(4):529-533. doi:10.1016/j.burns.2011.10.008
  46. [46] Parikh R, Bakhshi G, Naik M, Gaikwad B, Jadhav K, Tayade M. The Efficacy and Safety of Tetrachlorodecaoxide in Comparison with Super-oxidised Solution in Wound Healing. Archives of plastic surgery. 2016;43(5):395-401. doi:10.5999/APS.2016.43.5.395
  47. [47] Sellappan H, Alagoo D, Loo C, Vijian K, Sibin R, Chuah JA. Effect of peritoneal and wound lavage with super-oxidized solution on surgical-site infection after open appendicectomy in perforated appendicitis (PLaSSo): randomized clinical trial. BJS open. 2024;8(5). doi:10.1093/BJSOPEN/ZRAE121
  48. [48] Iacopi E, Abbruzzese L, Goretti C, Riitano N, Piaggesi A. The Use of a Novel Super-Oxidized Solution on Top of Standard Treatment in the Home Care Management of Postsurgical Lesions of the Diabetic Foot Reduces Reinfections and Shortens Healing Time. The international journal of lower extremity wounds. 2018;17(4):268-274. doi:10.1177/1534734618795593
  49. [49] González RR, Torres López E, García OM, et al. Eficacia del sistema de irrigación/aspiración continua con solución de superoxidación (SIACRE) para el tratamiento de pacientes con heridas abdominales infectadas complicadas, en comparación con el tratamiento convencional. Rev Hosp Jua Mex. 2010;77(4):239-244.
  50. [50] Singal R, Dhar S, Zaman M, Singh B, Singh V, Sethi S. Comparative Evaluation of Intra-Operative Peritoneal Lavage with Super Oxidized Solution and Normal Saline in Peritonitis Cases; Randomized Controlled Trial. Mædica. 2016;11(4):277.
  51. [51] Winter M, Boecker D, Posch W. Hypochlorous Acid (HOCl) as a Promising Respiratory Antiseptic. Viruses. 2025;17(9):1219. doi:10.3390/V17091219