Hypochlorous Acid Solution* for Wound Bed Preparation in the Surgical and Nonsurgical Patient

The use of hypochlorous acid (HOCL) in the preparation of the wound bed has become an increasingly well-accepted practice.  Several guidelines have indicated that HOCL cleansers have the ability to mechanically remove necrotic debris and microbial matter from the wound bed. 1.2 Though most patients with wounds in acute settings are transient, some do reside in acute care facilities for several days. 

In our facility, both transient and longer-term patients are treated with HOCL in preparation for surgical closure and sometimes as the primary treatment in those patients who are not surgical candidates and or decline surgical closure.  Pressure ulcer surgery has a particularly high risk of complications.3   

Some patients are not surgical candidates and or decline surgical closure.  We use HOCL in two ways that have been clinically effective in our hands.   

An emergent process is the use of HOCL with the instillation technology with dwell time that is associated with the use of Negative Pressure Wound Therapy (NPWTi-d).4 We have presented such work elsewhere with promising results, and for surgical closure, this is our preferred use of HOCL.   

However, some wounds are not suitable for NPWT and for those, we use gauze soaked with HOCl solution.  Moistened gauze is often described as a more traditional method and its simplicity supports its continued use. In this paper we highlight cases where wounds in the acute care setting have benefitted from HOCL with and without NPWT.  Cleansing with HOCL in anticipation of surgical closure or preparation for discharge can help boost the confidence that these wounds are able to proceed to healing.  

Additionally, the simplicity of moistened gauze may expedite discharge in those patients where NPWT is declined and or contraindicated. While more studies are recommended to look at the ideal solution for both NPWTi-d and moistened gauze, the role of HOCl for wound cleansing may offer distinct benefits that may help the surgical and non-surgical patient which also may assist with a timelier discharge from the acute setting.