Infection control in hospitals is the key strategy for prevention of nosocomial infections by breaking down the transmission rout of infection from the source to susceptible patient by using of suitable disinfectants. Chlorine Dioxide Gas and Chlorine Gas are promising alternative to other chlorine-releasing disinfectants. Sixty-five samples were collected from clinical and environmental sources of Babylon Hospital for Pediatric and Gynecology and Al-Hilla General Teaching Hospital through a period from September 2018 to March 2019. An antibacterial efficacy test of ClO₂ and Cl₂ was performed against Streptococcus pneumoniae, Klebsiella pneumoniae, Enterobacter aerogenes, methicillin resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa, Escherichia coli, Bacillus sp. and Staphylococcus epidermidis. The results indicated that both of ClO₂ and Cl₂ revealed a remarkable antibacterial potency against all of tested bacteria but ClO₂ was more active compared with Cl₂. This antibacterial activity was a variable with the concentration and the type of bacteria.

• Ahmad, S., Hamda Kh., Uzma Sh., Shahnawaz R., Zeeshan R., Mohd Y. Kh., Ahsanullah Ansari, Zeba Siddiqui, Jalaluddin Mohammad Ashraf, Saleh M S Abdullah, Safia Habib, Moin Uddin (2017).Protein oxidation: an overview of metabolism of sulphur containing amino acid, cysteine. Frontiers in Bioscience, Scholar,9,71-87.
• Al-Sa’ady, A.T (2019). Detection of vancomycin resistance in multidrug-resistant Enterococcus faecalis isolated from burn infections. Drug Invention Today,11(11): 2984-2989.
• Al-Sa’ady, A.T (2019). Detection of vancomycin resistance in multidrug-resistant Enterococcus faecalis isolated from burn infections. Drug Invention Today,11(11): 2984-2989.
• Al-Sa’ady, A. T. A. & Naher, H. S.(2016). Study of etiologic multi-drug resistant bacteria of neonatal sepsis in Al-Hilla city. American Journal of BioMedicine,AJBM;4(11):513-533.
• Al-Sa’ady; A.T. & Naher; H. S. (2018).Study of the Routs of Etiologic Bacteria Causing Neonatal Infections in Al-Hilla City/ Iraq. Biochem. Cell. Arch. Vol. 18, No. 1, 577-586.
• ASHRAE, ANSI/ASHRAE Standard 62–2001(2001).Ventilation for acceptable indoor air quality, Atlanta: American Society of Heating, Refrigerating and Air-Conditioning Engineers, Inc.
• Aysa, N. H; Al-Maamori, Mohamed Hamza; Al-Maamori, Nehad Abdul Ameer(2015a).Studying The Mechanical Properties of Silicone Rubber-AlumComposites using in Manufacturing of Prosthetic Liners. Journal of Natural Sciences Research, Vol.5, No.15: 47-52.
• Aysa, N. H; Al-Maamori, Mohamed Hamza; Al-Maamori, Nehad Abdul Ameer(2015b).Effect of the Unmodified and Modified ZnO Nanoparticles on the Mechanical and Antibacterial Properties of Silicone Rubber Using in Medical Applications. Journal of Nanoscience and Nanoengineering, Vol. 1, No. 3: 119-124.
• Block, C.(2004).The effect of Perasafe and sodium dichloro-iso cyanurate (NaDCC) against spores of Clostridium difficile and Bacillus atrophaeus on stainless steel and polyvinyl chloride surfaces. J. of Hospital
• Boyce, J. M., N. L. Havill, J. A. Otter, L. C. McDonald, N. M. Adams, T. Cooper, A. Thompson, L. Wiggs, G. Killgore, A. Tauman, & J. Noble-Wang(2008).Impact of hydrogen peroxide vapor room decontamination on Clostridium difficile environmental contamination and transmission in a healthcare setting. Infect. Control Hosp. Epidemiol. 29723-729.
• Depuydt, P. Vogelaers, D.(2007).Nosocomial pneumonia outside the hospital: health-care associated pneumonia and nursing home pneumonia. Tijdschrift voor Geneeskunde (Belgium) (in Dutch). 63 (5): 174–181.
• Dodek, P., S. Keenan, D. Cook, D. Heyland, M. Jacka, L. Hand, J. Muscedere, D. Foster, N. Mehta, R. Hall, & C. Brun-Buisson.(2004).Evidence-based clinical practice guideline for the prevention of ventilator-associated pneumonia. Ann. Intern. Med. 141:305-313.
• Eleraky, N. Z., Potgieter, L. N. & Kennedy, M. A.(2002).Virucidal efficacy of four new disinfectants. J Am Anim Hosp Assoc. 38, 231–234.
• Gilberto, R. & Eloisa, T. (2015). Sodium Hypochlorite (NaClO): Ruffini Method for the Treatment of Topic Infectious Diseases of the Skin, Mucous Membranes and Systemic Diseases. The Battle Against Microbial Pathogens: Basic Science, Technological Advances and Educational Programs (A. Méndez-Vilas, Ed.).
• Gray, N.F. (2014). “Chemistry of Chlorine Dioxide” in “ Microbiology of Waterborne Diseases,Second Edition”.
• Horan, T.C, Gaynes, R.P. Mayhall, C.G, editor. (2004).Hospital epidemiology and infection control. 3. Philadelphia: Lippincott Williams & Wilkins Surveillance of nosocomial infections.1659–702.
• International Program on Chemical Safety (IPCS).(2002) Chlorine dioxide (gas). Geneva: World Health Organization, International Programme on Chemical Safety (Concise International Chemical Assessment.
• Jaiswal, Swati; Mishra, Prashant (2018).Antimicrobial and antibiofilm activity of curcumin-silver nanoparticles with improved stability and selective toxicity to bacteria over mammalian cells. Medical Microbiology and Immunology, 207(1):pp 39–53.
• Kollef, M. H. (2004). Prevention of hospital-associated pneumonia and ventilator-associated pneumonia. Crit. Care Med. 32:1396-1405.
• Körtvélyesi, Z. (2004). Analytical Methods for the Measurement of Chlorine Dioxide and Related oxychlorine species in Aqueous Solution. PhD, A thesis. Miami University, Oxford, Ohio.
• Kramer, A., Schwebke, I. & Kampf, G.(2006).How long do nosocomial pathogens persist on inanimate surfaces? A systematic review. BMC Infect. Dis. 6130.
• Leung, M & Chan, A.H.S. (2006).Control and management of hospital indoor air quality. Med Sci Monit, 12(3): SR17-23.
• Manan, S. S., Jianu, O. A., & Rosen, M. A. (2019). Investigation of Heat Extraction Methods from Cuprous Chloride for Improving the Efficiency of the Thermochemical Copper-Chlorine Cycle. European Journal of Sustainable Development Research, 3(1), em0075.
• Morino,H.; T. Fukuda, T. Miura & Shibata, T. (2011).Effect of low-concentration chlorine dioxide gas against bacteria and viruses on a glass surface in wet environments. Letters in Applied Microbiology, 53, 628–634.
• National water biosecurity manual : poultry production.(2009).English, Book, Illustrated edition. Canberra, A.C.T.] : DAFF.ID 44879460
• Nieuwenhoven,V. C. A., E. Buskens, D. C. Bergmans, F. H. van Tiel, G. Ramsay, & M. J. Bonten(2004). Oral decontamination is cost-saving in the prevention of ventilator-associated pneumonia in intensive care units. Crit. Care Med. 32:126-130.
• Ogata, N.(2007). Denaturation of Protein by Chlorine Dioxide:  Oxidative Modification of Tryptophan and Tyrosine Residues. Biochemistry, 46 (16), pp. 4898–4911. DOI: 10.1021/bi061827u.
• Ogata, Norio and Shibata, Takashi (2008)Protective effect of low-concentration chlorine dioxide gas against influenza A virus infection. journal of General Virology. 89: 60–67.
• Otter1, J. A. & French, G. L.(2009). Survival of Nosocomial Bacteria and Spores on Surfaces and Inactivation by Hydrogen Peroxide Vapor. J Clin Microbiol.;47(1): 205–207.
• Patwardhan, R.B, Dhakephalkar, P.K, Niphadkar, K.B, Chopade, B.A.(2008). A study on nosocomial pathogens in ICU with special reference to multiresistant Acinetobacter baumannii harbouring multiple plasmids. Indian J Med Res.,128:178–87.
• Rahim, B. Peyman, M. Davood, N. Hamid, R.K. (2011).An epidemiological study of nosocomial infections in the patients admitted in the intensive care unit of Urmia Imam Reza Hospital: An etiological investigation. Ann Biol Res., 2:172–8.
• Rasamiravaka, T., Quentin L., Pierre D.,& Mondher E. J.(2015).The Formation of Biofilms by Pseudomonas aeruginosa: A Review of the Natural and Synthetic Compounds Interfering with Control Mechanisms. BioMed Research International.Volume 2015, ID 759348, 17 pages. http://dx.doi.org/10.1155/2015/759348.
• Sadeghi, K.; Gopinath, K.; Phuntheera, K.; Sarinthip, Th.; Sher, B. Kh.; Jongchul S.(2020). A polymeric chlorine dioxide self-releasing sheet to prolong postharvest life of cherry tomatoes. Postharvest Biology and Technology; Volume 161, March 2020, 111040. https://doi.org/10.1016/j.postharvbio.2019.111040.
• Sanekata, T., Fukuda, T., Miura, T., Morino, H., Lee, C., Mae-da, K., Araki, K. Otake, T.et al.(2010).Evaluation of the antiviral activity of chlorine dioxide and sodium hypochlo-rite against feline calicivirus, human influenza virus,measles virus, canine distemper virus, human herpesvirus,human adenovirus, canine adenovirus canine parvovi-rus.Biocontrol Sci,15, 45–49.
• Seifi, K., Kazemian, H., Heidari, H., Rezagholizadeh, F., Saee, Y., Shirvani, F., & Shirvani, Houri, H. (2016).Evaluation of Biofilm Formation Among Klebsiella pneumoniae Isolates and Molecular Characterization by ERIC-PCR. Jundishapur J Microbiol.; 9(1): e30682. doi: [10.5812/jjm.30682.
• Sun, X1., Bai, J., Ference, C., Wang, Z., Zhang, Y., Narciso, J., Zhou, K.(2014).Antimicrobial activity of controlled-release chlorine dioxide gas on fresh blueberries. J Food Prot.;77(7):1127-32. doi: 10.4315/0362-028X.JFP-13-554.
• Van Laer, A.F., Verdyck, R., Jansens, H. and Coenen. E.(2008). Disinfectants containing chlorine: an occupational hazard? Infection control and hospital epidemiology.29(5):474.
• Vuotto, C, Longo, F, Pascolini, C, Donelli, G, Balice, M.P, Libori, M.F, Tiracchia, V., Salvia, A., Varaldo, P.E.(2017).Biofilm formation and antibiotic resistance in Klebsiella pneumoniae urinary strains. J Appl Microbiol.123(4):1003-1018. doi: 10.1111/jam.13533.
• Warren, D. K., S. J. Shukla, M. A. Olsen, M. H. Kollef, C. S. Hollenbeak, M. J. Cox, M. M. Cohen, & V. J. Fraser(2003).Outcome and attributable cost of ventilator-associated pneumonia among intensive care unit patients in a suburban medical center. Crit. Care Med. 31:1312-1317.
• Weaver-Meyers,P.L., Stolt,W.A. & Kowa leski, B.(2000).Controlling mould on library materials with chlorine dioxide: An eight-year case study. Abbey newsletter. 24:4.
• WHO/FWC/WSH/16.49(2016). Chlorine Dioxide, Chlorite and Chlorate in Drinking-water. Background document for development of WHO Guidelines for Drinking-water Quality.
• Windf, C. (2011). The Toxicology of Chlorine. Environmental Research. 85(2): 105-114.
• Young, R.O. (2016).Chlorine Dioxide (CLO2) as a Non Toxic Antimicrobial Agent for Virus, Bacteria and Yeast (Candid albicans). International Journal of Vaccines and Vaccination.2(6):00052.
• Zhang, Z., McCann, C., Stout, J.E., Piesczynski, S., Hawks, R., Vidic, R. and Yu, V.L. (2007).Safety and efficacy of chlorine dioxide for Legionella control in a hospital water system. Infection Control and Hospital Epidemiology. 28(8):1009-1012.

This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.