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Hypochlorous acid (HOCl), a naturally occurring wound cleanser

Hypochlorous acid (HOCl), a naturally occurring reactive oxygen species (ROS), has shown to be an effective wound cleanser. Human neutrophils produce HOCl as part of the defense mechanism against bacteria.

HOCl exerts its antimicrobial effect via oxidative burst. has been found to be non-cytotoxic in in vitro and in vivo studies. HOCl does not cause irritation to tissues, such as the eyes or the skin. Though it is effective in killing bacteria, HOCl is much safer for fibroblasts and keratinocytes in the wound compared to traditional wound cleansers (i.e., hydrogen peroxide, povidone-iodine, chlorhexidine gluconate).

HOCl has a pKa of 7.5, mimicking the normal pH of healthy, human skin. HOCl has almost twice the oxidation reduction potential (ORP) compared to hypochlorite at equivalent concentrations. When compared to hypochlorite and hydrogen peroxide, HOCl has a much lower comparative minimum bactericidal concentration. HOCl can kill bacteria commonly found in wounds (i.e., E. coli, P. aeruginosa and S. aureus) at a significantly lower concentration than hypochlorite and hydrogen peroxide. HOCl also has a much higher relative therapeutic index than hypochlorite and hydrogen peroxide. It has the best balance between effectively killing bacteria without harming healthy wound cells (e.g., fibroblasts).

Once HOCl makes contact with a wound, it rapidly biodegrades (within 30 seconds), rendering it safe as a wound cleanser. In vitro studies have found that HOCl can effectively kill 99.999% of common bacteria and spores found in wounds in 15 seconds.

References

1. Faust E, Chinofsky A, Black J. Gaps in practice: Wound irrigation versus wound cleansing. Presented at the Fall SAWC. Las Vegas, NV 2022.

2. International Wound Infection Institute (IWII) Wound Infection in Clinical Practice. Wounds International. 2022.

3. John W Keyloun, Jeffrey W Shupp. Wounds, supplement. October 2019.

4. Robson M. The scientific bases for the use of hypochlorous acid to avoid pitfalls. Wounds, supplement. October 2017.

5. Wang L, et al. J Burns Wounds. 2007;6:e5.

6. Bohn GA, Champion S, Eldridge K. Can the use of hypochlorous acid change your dressing selection? Poster Presentation: Symposium for Advanced Wound Care. 2013. Orlando, Florida

7. Nerandzic MM, Rackaityte E, Jury LA, et al. Novel strategies for enhanced removal of persistent Bacillusanthracis surro-gates and Clostridium difficile spores from skin. PLoS One. 2013;8(7):e68706. DOI: 10.1371/journal.pone.0068706

8. Nair HKR et al. International Consensus Document: Use of wound antiseptics in practice. Wounds International. 2023.

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