Improving Wound Outcomes using Negative Pressure Wound Therapy with Hypochlorous Acid Instillation

Improving Wound Outcomes using Negative Pressure Wound Therapy with Hypochlorous Acid Instillation Michael D. Kalos, DNP, RN, CWOCNRegions Hospital14123 Jardin Ave N Hugo, MN 55038Kalos_consulting@yahoo.comConflicts of Interest: URGOSpring, 2021Abstract

PURPOSE: To determine if hypochlorous acid (HOCL) solution utilized in Negative Pressure Wound Therapy with Instillation and a dwell time (NPWTi-d ) improves wound management with effective cleansing of acute or chronic complex wounds. DESIGN: Prospective case study.

SUBJECTS AND SETTING: A 454-bed metropolitan Level I Trauma Center in the Midwestern United States. Based on monthly service statistics the inpatient wound consult services provided on average care to 430 individuals presenting with traumatic, surgical and/or pressure related injuries. Subjects were 18 years old or older and agreed to use HOCL based cleanser. The information covers January to December 2020.

METHODS: Implemented an evidence-based practice using approved cleansing solution for the wounds. Care focused using instillation with HOCl. NPWTi-d with HOCl was implemented in 3 cases detailed in a poster presentation. Therapy consisted of instilled HOCL with 10 -80ml of solution with dwell times of 5-10 minutes followed by 1.5-3 hours of continuous NPWT (-50mmHg to -125mmHg). Access to HOCl was provided by the consult service and required a supply chain ensuring adequate product availability.

RESULTS: During this time an average 430 referrals a month were made to the wound services. Patients presenting with wounds needing NPWTi-d utilized HOCl successfully with no complications. Using NPWTi-d and HOCl, demonstrated a return to healthy and stable tissue base as evidenced by the 3 cases presented. Wounds remained moist and non-malodorous. Therapy was continued inpatient and discontinued at discharge. Time in an acute care hospital is finite. This limits longitudinal assessment and gauging of wound resolution. Long Term Care Hospitals, Home Care Agencies and Rehabilitative Centers are limited to allow continuation of NPWTi-d which is an identified area of potential improvement in patient care.

CONCLUSION: Healing is complex process for the human body. Wounds require hydration, nutrition, microclimate, protection, and pH balanced cleansing solutions. The use of NPWTi-d and HOCl promoted healing through debris removal and thwarted bacteria colonization.