Hypochlorous acid (HOCl) is a new alternative to traditional solutions for surgical wound irrigation and managing complex, hard-to-heal wounds. Its unique mechanism of action, which includes both bactericidal and anti-inflammatory effects, makes it an effective solution for wound management. Studies have shown that using HOCl can result in faster healing times, reduced inflammation, and a lower risk of infection.

We all know evidence is king. So when it comes to a comparison of traditional approaches versus use of hypochlorous acid, let’s take a look at what clinical research has to say on the matter.

Sterile Saline vs. HOCl

In a 2022 published study, suction-blister models were used to raise and de-roof the skin in 20 healthy volunteers, individuals were randomly assigned a stabilized hypochlorous acid solution or sterile saline solution and the wounds were irrigated and treated on day 0, 2, and 4³.

Researchers found that the hypochlorous acid solution increased re-epithelialization on day 4 by 14% compared with the control solution (95% confidence interval (CI) 6.8–20%, p = 0.00051) and was not inferior (p < 0.0001) to the control solution on day 10 (0.3%, 95% CI –1.3–1.9%)³. Additionally, researchers found median bacterial counts were lower with stabilized hypochlorous acid compared with control and were further reduced after irrigation and treatment of both groups on day 4, but remained lower in the stabilized hypochlorous acid group compared with the control group³.

Figure 1. Course of treatment with stabilized hypochlorous acid (HOCl) or saline control (NaCl) on days 0 (before irrigation and application of HOCl/NaCl), 4, 10, and 17. Scale bar: 6 mm.

Source: Burian, E. A. et al. (2022)

In a 2016 study published in the National Library of Medicine, researchers compared the efficacy of hypochlorous acid and sterile saline as debridement solutions in chronic wound treatment⁴. Seventeen patients with chronic wounds were randomly selected for study, and divided into the hypochlorous acid irrigation or saline irrigation group. All patients who participated in the study provided pre- and postoperative tissue samples for qualitative and quantitative bacteriology.

Researchers concluded that while both solutions initially reduced the bacterial count present in the wounds, by the time of definitive closure, the saline-irrigated wounds had bacterial counts back up to 10⁴ whereas the HOCl–irrigated wounds remained at 10² or lower⁴. Upwards of 80% of the patients in the saline group had postoperative closure failure compared with 25% of patients in the hypochlorous acid group⁴.

Povidone Iodine vs. HOCl

With both anti-microbial properties and anti-inflammatory properties, hypochlorous acid presents an efficacious, multi-beneficial solution for both mechanical irrigation and debridement in wound management and surgical irrigation.

In a 2020 publishing, researchers used hypochlorous-acid to irrigate a horseshoe perianal abscess in an immunocompromised patient when a povidone iodine solution was deemed ineffective and painful for the patient⁵. The patient reported little discomfort with the initial HOCl-irrigation, and the day following the irrigation procedure the patient’s fever was noticeably reduced⁵. Researchers noted the patient’s infection cleared within 2 weeks, and a subsequent swab culture found no microbial growth present in the healed cavity⁵. In fact, the wound volume was reduced by more than 90% after 5 weeks, and final wound closure was achieved after 6 weeks⁵.

In contrast to this case, the study notes another patient with a horseshoe perianal abscess who received traditional irrigation with a diluted povidone iodine and wet-to-dry dressing faced similar problems, but the fever in this case did not subside, and the wound became even more complicated⁵.

And The Winner Is...

As we can see from these studies, HOCl solution has been found to be effective in improving wound healing in a variety of wound types, including chronic wounds¹⁻⁵. It has also been clinically proven to improve patient outcomes and increase comfortability in irrigation procedures⁵.

Hypochlorous acid is a relatively new alternative to standard saline solution for surgical wound irrigation and managing complex, hard-to-heal wounds. Its unique mechanism of action, which includes both bactericidal and anti-inflammatory effects, makes it an effective solution for wound management.

Ultimately, hypochlorous acid is an evidence-based alternative to standard saline solution that all doctors and nurses should consider using in their practice.

For more information about HOCl as a safe and effective solution for wound irrigation, contact us or learn more here.