Scientific data show that by saturating gauze with hypochlorous acid-based cleanser, a perfect delivery system is achieved, both for soaking and packing wounds. How much to soak into gauze for effectiveness?

Introduction: It is well known that pH controlled, mildly acidic pure Hypochlorous Acid (pHA) based cleansers produce visibly clean wounds, that also can be shown to have lower bioburden as measured by punch biopsies. However, preclinical data shows that the best effects of germ removal are seen when the cleanser is allowed to remain in contact with the contaminated wound for 5-10 minutes. Thus, the means to deliver such exposure times is critical.  Fortunately, one of the lowest priced disposable wound gauzes, is resistant to degradation by the pHA solution, allowing its use as a desirable delivery mechanism for the cleanser. We report chemical measurements of the hypochlorous acid over time when used to soak medical grade gauze.Methods:Square gauze, 10 X 10 cm size, was soaked with 15 ml of pHA based cleanser containing 300 ppm of hypochlorous acid (HOCl)*. A polyurethane foam was similarly used for such soaking as a potential, more expensive alternative to gauze, but one that may be preferred as a more advanced material than gauze. The HOCl level in the dressings was measured over time.Results:The polyurethane foam exposure to pHA led to rapid degradation of the HOCl over the 20 minutes time measured. The HOCl level fell to zero within four minutes, with >90% degradation occurring in one minute. In contrast, utilizing saturated gauze, there was no observable degradation of the antimicrobial preservative in the cleanser, HOCl, over time, up to  the experimental time of 20 minutes.Discussion: The best way to achieve the cleansing is to maintain contact with the wound with a cleansing product that does not degrade within the delivery system/soaking dressing used. Based on this data, the most basic wound care product, sterile gauze, provides an ideal delivery mechanism of the cleanser. This has been observed in clinical practice, but now there is scientific proof that this is a sound way to retain the original property of the cleanser for the desired period at the wound interface. Conversely, polyurethane foams of the type tested were too reactive with the cleanser and would not be appropriate for soaking.References:Armstrong DG, Bohn G, Glat P, Kavros SJ, Kirsner R, Snyder R, Tettelbach W.Armstrong DG, et al. Expert Recommendations for the Use of Hypochlorous Solution: Science and Clinical Application. Ostomy Wound Management 2015 May;61(5): S2-S19. https://pubmed.ncbi.nlm.nih.gov/28692424/ Dissemond J. Wound Cleansing: benefits of hypochlorous acid. Journal of Wound Care Published Online:5 Oct 2020https://www.karger.com/Article/ Abstract/481545 Robson MC. Advancing the science of wound bed preparation for chronic wounds. Ostomy Wound Manag. 2012;58(12):2–3. https://www.o-wm.com/ article/pearls-practice-advancing-science-wound-bed-preparation-chronic- wounds Sakarya S, Gunay N, Karakulak M, Ozturk B, Ertugrul B. Hypochlorous acid: an ideal wound care agent with powe rful microbicidal, antibiofilm, and wound healing potency. Wounds 2014;26(12):342–350. https://pubmed.ncbi.nlm.nih. gov/25785777/