EXPERT RECOMMENDATIONS FOR THE USE OF HOCL

ABSTRACT

Wound complications such as infection continue to inflict enormous financial and patient quality-of-life burdens. The traditional practice of using antiseptics and antibiotics to prevent and/or treat infections has been questioned with increasing concerns about the cytoxitity of antiseptics and proliferation of antibiotic resistant bacteria. Solutions of sodium hypochlorite (NaOCl), commonly known as Dakin’s solution, have been used in wound care for 100 years. In the last 15 years, more advanced hypochlorous acid (HOCl) solutions, based on electrochemistry, have emerged as safe and viable wound-cleansing agents and infection treatment adjunct therapies. After developing a literature-based summary of available evidence, a consensus panel of wound care researchers and practitioners met to review the evidence for 1) the antimicrobial effectiveness of HOCl based on in vitro studies, 2) the safety of HOCl solutions, and 3) the effectiveness of HOCl acid in treating different types of infected wounds in various settings and to develop recommendations for its use and application to prevent wound infection and treat infected wounds in the context of accepted wound care algorithms. Each participant gave a short presentation; this was followed by a moderated roundtable discussion with consensus-making regarding conclusions. Based on in vitro studies, the antimicrobial activity of HOCl appears to be comparable to other antiseptics but without cytotoxicity; there is more clinical evidence about its safety and effectiveness. With regard to the resolution of infection and improvement in wound healing by adjunct HOCl use, strong evidence was found for use in diabetic foot wounds; moderate evidence for use in septic surgical wounds; low evidence for venous leg ulcers, wounds of mixed etiology, or chronic wounds; and no evidence for burn wounds. The panel recommended HOCl should be used in addition to tissue management, infection, moisture imbalance, edge of the wound (the TIME algorithm) and aggressive debridement. The panel also recommended intralesional use of HOCl or other methods that ensure the wound is covered with the solution for 15 minutes after debridement.
More controlled clinical studies are needed to determine the safety and efficacy of HOCl in wound types with limited outcomes data and to evaluate outcomes of various application methods.

 
KEYWORDS: hypochlorous acid, review, anti-infective agents, wound, cleansing
INDEX: Armstrong D, Bohn G, Glat P, Kavros S, Kirsner R, Snyder R, Tettelbach W. Expert recommendations for the use of hypochlorous acid solution: science and clinical application. Ostomy Wound Manage. 2015;61(5 suppl): 4S–18S.

 

DAVID G. ARMSTRONG, DPM, MD, PHD, has disclosed he has received honorarium for participating in an Innovacyn scientific advisory board.
GREGORY BOHN, MD, FACS, ABPM/UHM, FACHM has disclosed he has received speaker honoraria and served as a consultant or paid advisory board member for Innovacyn. Dr. Bohn is also a member of the Speakers’ Bureau for Steadmed Poster Support.
PAUL GLAT, MD, FACS, has disclosed he has received speaker honoraria and served as a consultant or paid advisory board member for Innovacyn. Dr. Glat is also a member of the Speakers’ Bureau for Integra LifeSciences and Smith and Nephew.
STEVEN J. KAVROS, DPM, FACCWS, CWS, is the Medical Director of Innovacyn, Inc.
ROBERT KIRSNER, MD, PHD, has disclosed he has received speaker honoraria and served as a consultant or paid advisory board member for Innovacyn. Dr. Kirsner is a scientific advisor for Innovacyn, Mölnlycke, Kerecis, and Cardinal Healthcare. Dr. Kirsner is also a consultant for Kerecis.
ROBERT SNYDER, DPM, MSC, CWS, has disclosed he has received speaker honoraria and served as a consultant or paid advisory board member for Innovacyn. Dr. Snyder is also a consultant for Macrocure, MiMedx, and Acelity.
WILLIAM TETTELBACH, MD, FACP, CWS, has disclosed he has received speaker  honoraria and served as a consultant or paid advisory board member for Innovacyn. He is a member of the speakers’ bureau for Spiracur and MiMedx.

See http://www.puracynplus.com/the-benefits-of-puracyn/

Tags: antimicrobial, cleansing, HOCL, woundcare