Reducing Bioburden and Disrupting Hard to Remove Microbial Colonies with The Use of Pure Hypochlorous Acid (pHA)* to Reduce Bioburden in Pressure Ulcer Reconstruction: A Retrospective Review

Introduction: The Presence of bacterial colonies that are adherent to the tissue surface are recognized as deterrents to wound healing.  Pressure injury which results in ulceration is often chronic and difficult to heal primarily and may present unique challenges for surgical reconstruction due to the microbial burden. Evidence shows that pure Hypochlorous Acid (HOCl) based cleanser*, is able to remove bacteria, associated slime like materials, and necrotic tissue that are all usually associated with problem wounds.   Methods:We present a retrospective review of a series of 18 surgical reconstructive procedures for pressure ulceration over a 2-year period using Hypochlorous Acid (HOCl) based cleanser to help reduce the bacterial burden prior to closure. Over the 2- year period 46 patients presented with 62 pressure ulcers, with some patients presenting with multiple ulcers. Eighteen patients showed evidence of acute infection and or significant bioburden and underwent cleansing with pure Hypochlorous Acid to help reduce the risk of post operative infection. Cleansing was performed either as NPWTi-d** with HOCL as the instillation fluid or HOCL was utilized in the operating room as a 10 min soak gauze onto the wound bed.Results:Eighteen patients received HOCL cleansing.  16 of these received NPWTi-d*8 and 2 received HOCL as a 10 min soak in the operating room.  One patient underwent debridement only without surgical closure because of poor nutritional status (X2).  One patient underwent surgical closure but was soon transferred to hospice with no additional follow up.   The 16 patients that received NPWTi-d* underwent staged reconstruction 3-7 days following HOCL NPWT-id. There were no intraoperative complications and no postoperative infections. The 2 patients that underwent HOCL soak intraoperative for 10 min also had no postoperative infections and no dehiscence.Discussion: Pure pHA HOCl is a useful adjunct to address bioburden in pressure ulcer surgery which contaminated wounds and or those with evidence of acute infection.  Additionally, the use of HOCL appears to be quite compatible with the use of biological matrices used to promote wound healing such as human dermal matrix and amniotic materials that are often used in pressure ulcer surgery.References: