Retrospective Review of Antibiotic Needs of Orthopedic Surgical Wounds Irrigated with HOCl

ABSTRACT Background: Surgical Site Infection (SSI) rates for post-op Open Reduction Internal Fixation (ORIF) tibia/fibula fractures range from 13-88%. Post-op infection has been associated with a heavy cost burden ($ amounts?) and are affiliated with hospital readmission penalties, infection control issues, and a complicated and extended patient recovery. Because of this, surgeons and hospital administrators alike are constantly evaluating ways to decrease post-op infection, and related costs, and associated risks. This includes selection of antimicrobial wash, methods of antimicrobial irrigation, and even whether to possibly soak hardware prior to implantation. To date, the effects of hypochlorous acid (HOCl) solution as a surgical irrigation tool for ORIF cases have not been thoroughly investigated in the United States. Methods: Retrospective data was collected from a random selection of post ORIF tib/fib patients over a 3-year period for analysis. During this 3-year period, hypochlorous acid (HOCl) was consistently used during the surgical procedures for both wound irrigation and hardware soaks. Areas of focus included hospital admissions, surgical prep and procedures, and post operative care. Various data points were obtained, including co-morbidities, medications administered, and healing progression. While patients were prepped, the various hardware was soaked in hypochlorous acid (HOCl) solution. During the surgical procedure, the wound was first irrigated with HOCl, followed by hardware implantation, and then the wound pocket was rinsed again with HOCl before primary closure of the incision. Results: Data analysis showed that incorporating hypochlorous acid (HOCl) solution into standard surgical protocols demonstrated an SSI rate of 0-6.6% and a timeline of healed incision site at an average of 11 days. Conclusion: Adding hypochlorous acid (HOCl) solution to the surgical regimen for traumatic orthopedic wounds may help decrease SSI rates hardware revisions, and healing times, although further studies are recommended.