Beating Biofilm with Hypochlorous Acid Instillation with Negative Pressure Wound Therapy

Biofilm and the bacterial burden have been recognized as impediments to wound progression. The use of negative pressure wound therapy with instillation and dwell time (NPWTi-d) has gained wide adoption and interest due in part to the increasing complexity of wounds and patient conditions.  NPWTi-d has been shown to reduce bacterial burden, however, it’s effect on biofilm is uncertain. 1  Perhaps alternatives to N1ormal Saline offer benefit, specifically if bioburden can be addressed.
Robson describes two components to biofilm:  Polysaccharides and proteins.  Polysaccharides which are long chains of simple sugars (monosaccharides) can be broken down by most liquids and may be the mechanism by which HOCL works. 2
We present 2 extreme cases of HOCL beating biofilm where orthopedic hardware is infected and exposed, but unable to be removed.  Wound bed preparation was performed with NPWTi-d using HOCL for instillation.  Closure was performed in both cases, without recurrent infection. In both cases limb salvage was accomplished.
While the updated consensus panel for NPWT with instillation (2019) recommended Normal Saline as the solution of choice3, we believe there may be a role for HOCL to assist with wound bed preparation in complex wounds, particularly to assist with reduction of biofilm.  More studies are recommended to look at the ideal solution for NPWTi-d, and specifically their effect on biofilm.

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References (if applicable): REFERENCES
1. Kim PJ, Attinger CE, Steinberg JS et al. The impact of negative-pressure wound therapy with instillation compared with standard negative-pressure wound therapy: a retrospective, historical, cohort, controlled study. Plast Reconstr Surg 2014;133:709-716.
2. Robson MC, History of hypochlorous acid and its mechanism of action. Supplement to Wounds 2019; S46-48.
3. Kim PJ, Attinger CE, Cjstantine, T. et al. Negative pressure wound therapy with instillation: International consensus guidelines update. Int Wound J. 2019;1-13.