1. BIOCIDAL SURFACE-FLOOR DISINFECTANT

2. Killall Properties  General Properties  Killall is approved by ministry of Health (of Republic of Turkey).  Killall was developed by cooperation of Arbisan-Üntaş and Quality is guaranteed and distributed by Untaş Comp (belongs to Ege University).  Killall is high level disinfectant  Why Killall?  Superior antimicrobial activity that does no present at competitors: 1:100 diluted Killall is effective against very broad range microorganisms including M. Tuberculosis and biofilms at 5 min.  Microorganisms proliferate in biofilm forms at surfaces and biofilms are found all the departments of the hospitals.  Microbial biofilms are so dangerous that is responsible for 65-80% of hospital acquired (nosocomial) infections  One concantrated product for disinfection of both floors and surfaces.  50 buckets (10L) of disinfectant can be prepared by diluting 5L of Killall for disinfection of floors.  500 units of disinfectant spray can be prepared with 5L of Killall for disinfection of surfaces.  Environmentally friendly: Does not contain silver and any other heavy metals. Decomposes to carbondioxide, oxygen and water.  Killall is not oxidative and not corrosive on the contrary of other peroxide (50%) containing products.  Does not harm metal and glass surfaces when diluted to the usage concentration. Very different usage fields Public locations (Hospitals, schools, otels, dormitories, streets, parks, buses…) Personal locations (Toilets, walls (disinfection and allergy prevention)…) Commercial locations and engineering systems (Food depots, farms, vantilating systems…) 2

3. Usage 3 Surface Disinfection (1:100 dilution) 10 ml of Killall is diluted to 1L in a spray box, 500 units of disinfectant spray can be prepared with 5L of Killall. Floor Disinfection (1:100 dilution) 100ml of Killall is added into a 10L of bucket with using the dosing pump 4 times. 50 buckets of disinfectant can be prepared by diluting 5L of Killall. Killall should not be mixed with bleach.

4. Antimicrobial Activity Tests Antimicrobial activity of Killall against microorganisms below was proved by the laboratories accredited by Ministry of health of Republic of Turkey.  1:100 dilution (Disinfection effect; Advised for general surface-floor cleaning)  Pseudomonas aeruginosa and its biofilm.  MRSA- Methicillin Resistant Staphylococcus aureus and its biofilm.  VRE- Vancomycin-resistant Enterococcus  Escherichia coli  Staphylococcus aureus  Enterococcus faecalis  Mycobacterium tuberculosis  Candida albicans  1:50 dilution (Sporicidal effect; Advised for operation room cleaning)  All the microorganisms above plus Bacillus subtilis spore 4

5. Biofilms 5 References Hung C-S, Henderson JP. Emerging concepts of biofilms in infectious diseases. Missouri medicine. 2008;106(4):292–296. Høiby N, Bjarnsholt T, Givskov M, Molin S, Ciofu O. Antibiotic resistance of bacterial biofilms. International journal of antimicrobial agents. 2010;35(4):322–332 Smith K, Hunter IS. Efficacy of common hospital biocides with biofilms of multi-drug resistant clinical isolates. Journal of medical microbiology. 2008;57(8):966–973 Bacteria usually attach surfaces in biofilm forms. Other disinfectants kill bacteria only at the surface of biofilms so that inner of the biofilms continue to threat our lives. According to National Institute of Health (of America) and scientific articles, biofilms are responsible for 65-80% of hospital acquired infections. (see references). Killall showed antimicrobial activity against P. aeruginosa and MRSA biofilms when diluted 100 times at 5 min. Anti-biofilm effect of competitor products are present when diluted 5-8 times at 10-60 min.

6. Comparision with competitor products: Hydrogen Peroxide + Silver  Killall was activated with citric acid.  1kg Killall contains 250g of citric acid. Hydrogen peroxide+silver formulations contains <0.5g silver per kg.  Superior Antimicrobial Effect  Because of its special formulation, Killall is effective against catalase containing (hydrogen peroxide resistant) microorganisms.  High amount of citric acid provides acidic conditions when Killall is diluted 100 times. Hydrogen peroxide is much more antimicrobial at acidic conditions.  Hydrogen peroxide+silver formulations contains very low silver content which falls almost zero when diluted 100 times.  At 50 times dilution, Killall is sporicidal while hydrogen peroxide+silver formulations are not.  Environment and User Friend  Citric acid is not a heavy metal like silver. Thus, Killall decomposes completely to carbondioxide, oxygene and water. 6  50% hydrogen peroxide is oxidative and has the risk of ignition of materials such as paper, board. Thus, oxidative chemicals have “oxidizing” risk symbol. Killall contains 25% hydrogen peroxide which is not oxidative while hydrogen peroxide+silver formulations are oxidative.

7. Comparision with competitor products: Sodium Hypochlorite 7  Sodium hypochlorite is active ingredient of bleach and disrupts cell membrane.  Sodium hypochlorite has bad chlorine odor.  There are several products containing 5% sodium hypochlorite, which are effective against several microorganisms except biofilm and spores when diluted 100-400 times.  It has been proved that 1000 times diluted Killall is effective against MRSA at 5 min.  Sodium hypochlorite should be used at very high conentrations in order to kill biofilm bacteria: It can kill biofilm when diluted 8.3 times at 10 min (see ref.). This dilution means that 1L bleach should completely be poured into a 10L bucket of water.  Killall kills biofilm bacteria when diluted 100 times at 5 min. Reference Mataraci E, Gerceker A. Evaluation of the Minimum Bactericidal Concentrations of Various Disinfectants against Pseudomonas aeruginosa in Biofilm Cultures. Ankem. 2011;25(4):209–214.

8. Comparision with competitor products: Quaternary Ammonium Compounds 8  Quaternary ammonium compounds are (+) charged and disrupt (-) charged cell membranes.  There are several products containing one or several of benzalkonium chloride, didecyl dimethyl ammonium chloride and cetrimide active ingredients.  Quaternary ammonium compounds are low level disinfectants and don’t kill many microorganisms.  Cetrimide doesn’t kill P. Aeruginosa bacteria. Thus, cetrimide containing agar (cetrimide agar) is used for selectively isolate P. Aeruginosa bacteria.  100-400 times dilutable quaternary ammonium compound containing products are effective at 10-30 min. against several microorganisms except biofilm and spores.  It has been proved that 1000 times diluted Killall is effective against MRSA at 5 min.  Exposure of cell charge of biofilm and spores is very low. Therefore, very high concentrations of quaternary ammonium compounds are required in order to kill biofilm and spores. For example, 10% benzalkonium chloride containing concentrated disinfectants could not kill all of biofilm bacteria when diluted 10 times (1%) at 24h of contact time.  Killall kills biofilm bacteria when diluted 100 times at 5 min.  Mycobacterium tuberculosis bacterium has a special cell membrane which gives resistance to benzalkonium chloride. Thus, most of benzalkonium chloride containing products don’t have tuberculosidal activity.  Killall is effective against Mycobacterium tuberculosis bacteria at 100 times dilution and 5 min. of contact time. The required contact time for this action is 30 min. at many of surgical instruments disinfectants.

9. Reference Smith K, Hunter IS. Efficacy of common hospital biocides with biofilms of multi-drug resistant clinical isolates. Journal of medical microbiology. 2008;57(8):966–973 Benzalkonium Chloride vs Biofilms 1% concentration of benzalkonium chloride is ineffective (80% alive) against P. Aeruginosa biyofilm on stainless steel. Contact conditions: 24h, 37 o C 9

10. Summary PropertiesKillall Benzalkonium Chloride (10%) Hydrogen Peroxide + Silver (50%) Sodium Hypochloride (5%) Simple Disinfection 5 min. at 100 times dilution Disinfection in 15-30 min. at 100 times dilution Disinfection in 5-15 min. at 100 times dilution Killing of Biofilm Bacteria 5 min. at 100 times dilution Not effective at 10 times dilution Effective at 3% concentration (16 times dilution) Effective at 8.3 times dilution and 10 min. of contact time Sporicidal Activity Effective at 50 times dilution Doesn’t have sporicidal effect Sporicidal at 5% concentration (10 times dilution) Some formulations are sporicidal at 50 times dilution Dilution with tap water CompatibleDecreases activity Compatible Compatibility with Detergents Could be diluted with detergent solutions (not containing bleach) Incompatible with anionic surfactants which are the main ingredients of most of detergents Tap water decreases activity Compatible with detergents Cleaning Propery HighNo such propertyModerateHigh Environmental and personal risks Decomposes into carbondioxide, oxygene and water. Doesn’t have oxidizing risk Much more slower degradation. Toxic to nature Heavy metal (silver) remains in the nature. Has oxidizing property Emits toxic chlorine gas Odor of diluted solution Odorless Chlorine odor at 100 times dilution. It should be diluted 8.3 times to kill biofilm bacteria

11. BIOCIDAL SURFACE-FLOOR DISINFECTANT