Research & Evidence on Hypochlorous Acid
Temporary abdominal closure combined with an irrigating system utilizing hypochlorous acid solution to decrease abdominal mucopurulence.
HOCl acid has also been described as a wound cleanser. It has been shown to significantly reduce bioburden in peripheral open wounds, thereby assisting in their closure. However, intra-abdominal placement of HOCl has never been described to treat the open septic abdomen. The combination of the ABNPWT device system and the VAC Veraflo device allows for delivery of a set amount of irrigation in a timed manner. This combination in a patient with a septic abdomen proved pivotal in the resolution of the gross mucopurulence visualized in the abdomen.
Matthews MR, Quan AN, Weir AS, et al. Temporary abdominal closure combined with an irrigating system utilizing hypochlorous acid solution to decrease abdominal mucopurulence. *Eplasty*. 2018;18:e12.
The use of hypochlorous acid lavage to treat infected cavity wounds.
One day after administration of the hypochlorous acid, the fever began to subside, suggesting that this solution was able to adequately destroy the infecting microorganisms. The patient rated his pain during this procedure as 2/10. The infection had cleared within 2 weeks, and a swab culture found no microbial growth. The wound volume was reduced by more than 90% after 5 weeks, and final wound closure was achieved after 6 weeks.
Wongkietkachorn, A., Surakunprapha, P., Wittayapairoch, J., Wongkietkachorn, N., & Wongkietkachorn, S. (2020). The use of hypochlorous acid lavage to treat infected cavity wounds. Plastic and Reconstructive Surgery Global Open, 8(1).
0.01% hypochlorous acid as an alternative skin antiseptic: An in vitro comparison
In vitro studies of 0.01% HOCl were observed to have equal or more efficacious antiseptic properties compared with isopropyl alcohol (IPA), chlorhexidine gluconate (CHG), and povidone-iodine (PVP-I).
Anagnostopoulos, A. G., Rong, A., Miller, D., Tran, A. Q., Head, T., Lee, M. C., & Lee, W. W. (2018). 0.01% hypochlorous acid as an alternative skin antiseptic: an in vitro comparison. Dermatologic surgery, 44(12), 1489-1493.
Expert Recommendations for the Use of Hypochlorous Solution: Science and Clinical Application
In vitro studies demonstrate HOCl is effective against all human bacterial, viral, and fungal pathogens.
Armstrong, D. G., Bohn, G., Glat, P., Kavros, S. J., Kirsner, R., Snyder, R., & Tettelbach, W. (2015). Expert Recommendations for the Use of Hypochlorous Solution: Science and Clinical Application. Ostomy/Wound Management, 61 (5), S2-S19.
The role of hypochlorous acid in the management of eye infections: a case series
Experiences from clinical practice suggest that hypochlorous acid (HOCl) used as adjuvant treatment can shorten the time to clinical resolution of blepharitis, particularly in relation to the ophthalmic complications that often occur with a blepharitis diagnosis. In addition, in clinical practice, HOCl adjuvant treatment also resulted in a viable option for the management of ophthalmic disorders other than blepharitis.
Bertone, C., Mollicone, A., Russo, S., Sasso, P., Fasciani, R., Riccardi, C., ... & ALI working group. (2022). The role of hypochlorous acid in the management of eye infections: a case series. Drugs in Context, 11.
Dry eye patients report improvement in symptoms with hypochlorous acid use over 30 days.
On average, subjects reported a 10-point decrease in OSDI score on Day 14 (from 37 to 27) and a further improvement of 5 points on Day 30 (22). A similar response was seen with the EIQ, where subjects showed a 20.5-point decrease over 30 days (from 39 to 18.5). Corneal and conjunctival staining was also reduced over 30 days (from grade 4 to 3 and grade 3 to 1, respectively). Demodex counts were reduced by nearly half over the study period.
Kern, J. R., & Fahmy, A. M. (2019). Dry eye patients report improvement in symptoms with hypochlorous acid use over 30 days. Investigative Ophthalmology & Visual Science, 60(9), 6740-6740
Treatment of bacterial and viral conjunctivitis with topical ultrapure stable hypochlorous acid (HOCl): a clinical evaluation and treatment response in 79 cases.
A new treatment method for infective eye conditions is proposed which does not rely on the use of topical antibiotics. HOCl, when applied at 80mg/l pH5.4, is profoundly effective and well tolerated in cases of bacterial or viral conjunctivitis.
Adamson, P. S., Roos, H., & von Holdt, J. (2015). Treatment of bacterial and viral conjunctivitis with topical ultrapure stable hypochlorous acid (HOCl): a clinical evaluation and treatment response in 79 cases. Investigative Ophthalmology & Visual Science, 56(7), 280-280.
Reduction in bacterial load using hypochlorous acid hygiene solution on ocular skin
The application of a saline hygiene solution preserved with pure HOCl acid reduced the bacterial load significantly without altering the diversity of bacterial species remaining on the skin under the lower eyelid.
Stroman, D. W., Mintun, K., Epstein, A. B., Brimer, C. M., Patel, C. R., Branch, J. D., & Najafi-Tagol, K. (2017). Reduction in bacterial load using hypochlorous acid hygiene solution on ocular skin. Clinical Ophthalmology, 707-714.
Influence of acidic pH on wound healing in vivo: A novel perspective for wound treatment
Acidification of the wound by acidic buffers was found to be an effective strategy to improve wound healing. A significant improvement in wound healing parameters was observed as early as 2 days post-treatment with acidic buffers compared to controls, with faster rate of epithelialization, wound closure and higher levels of collagen at day 7. pH is shown to play a role in mediating the rate of wound healing, with acidic buffers formulated at pH 4 observed to stimulate faster recovery of wounded tissues than pH 6 buffers. Our study shows the importance of maintaining an acidic wound microenvironment at pH 4, which could be a potential therapeutic strategy for wound management.
Sim, P., Strudwick, X. L., Song, Y., Cowin, A. J., & Garg, S. (2022). Influence of acidic pH on wound healing in vivo: a novel perspective for wound treatment. International Journal of Molecular Sciences, 23(21), 13655.
The Use of Hypochlorous Acid in the Healing of a Diabetic Foot Ulcer
In these case study presentations, HOCl appears to be effective as a potent DFU antiseptic agent with anti-inflammatory and debridement properties. It is inexpensive, easy to use, safe, reduces odour and pain, as well as exudate. It is also not painful to apply, assisting in an elevated level of patient compliance.
Roos, H. (2022). The Use of Hypochlorous Acid in the Healing of a Diabetic Foot Ulcer. *Clinical Science*, *8*(4), 53-56.
The Use of Hypochlorous Acid in An Infected Burn Wound – A Case Study
Care of patients with burns is complex, could be lengthy and could be complicated by infection, especially if the prevailing bacteria are present as biofilms. This complication can be anticipated and treated with the use of HOCl, an effective agent against planktonic and biofilm bacteria. Furthermore, its effect on the modulation of inflammation ultimately yields improved outcomes. The patient in this case study, despite the formation of biofilm and inflammation, responded well to the local application of and daily dressing with HOCl and gauze. The results suggest that treatment of wounds with HOCl should be investigated for all burn cases where the wounds are not following the normal wound healing trajectory according to the wound healing phases.
Roos, H., Kana, B., & Naude, L. (2021). The use of hypochlorous acid in an infected burn wound–a case study. Wound Healing Southern Africa, 14(1), 21-24.
The Immediate and Delayed Post-Debridement Effects on Tissue Bacterial Wound Counts of Hypochlorous Acid Versus Saline Irrigation in Chronic Wounds
Hypochlorous acid irrigation with ultrasound debridement reduced bacterial growth in chronic open wounds more efficiently than saline alone. Postoperative wound closure outcomes suggest a remarkable reduction in wound complications after wound debridement using hypochlorous acid irrigation with ultrasound versus saline alone.
Hiebert, J. M., & Robson, M. C. (2016). The immediate and delayed post-debridement effects on tissue bacterial wound counts of hypochlorous acid versus saline irrigation in chronic wounds. Eplasty, 16.
Effect of Stabilized Hypochlorous Acid on Re-epithelialization and Bacterial Bioburden in Acute Wounds: A Randomized Controlled Trial in Healthy Volunteers
This study demonstrates immediate and durable antimicrobial action and beneficial effect on acute wound healing after irrigation and treatment with a stabilized hypochlorous acid formulation.
Burian, E. A., Sabah, L., Kirketerp-Møller, K., Gundersen, G., & Ågren, M. S. (2022). Effect of stabilized hypochlorous acid on re-epithelialization and bacterial bioburden in acute wounds: a randomized controlled trial in healthy volunteers. *Acta Dermato-Venereologica*, *102*, adv00727-adv00727.
Hypochlorous acid as a potential wound care agent: Part II. Stabilized hypochlorous acid: its role in decreasing tissue bacterial bioburden and overcoming the inhibition of infection on wound healing
This stabilized form of hypochlorous acid (NVC-101) could have potential application as an antimicrobial wound irrigation and treatment solution if its effective pH range can be maintained in the clinical situation. NVC-101 solution was equally effective at pH 3.5 or 4.0 and more efficient soon after its application. As opposed to other antimicrobials investigated in this animal model, NVC-101 controls the tissue bacterial bioburden without inhibiting the wound healing process.
Robson, M. C., Payne, W. G., Ko, F., Mentis, M., Donati, G., Shafii, S. M., ... & Bassiri, M. (2007). Hypochlorous acid as a potential wound care agent: part II. Stabilized hypochlorous acid: its role in decreasing tissue bacterial bioburden and overcoming the inhibition of infection on wound healing. Journal of burns and wounds, 6.
Hypochlorous acid: An ideal wound care agent with powerful microbicidal, antibiofilm, and wound healing potency
The stabilized HOCl solution had dose-dependent favorable effects on fibroblast and keratinocyte migration compared to povidone iodine and media alone. These features lead to a stabilized HOCl solution as an ideal wound care agent.
Sakarya, S., Gunay, N., Karakulak, M., Ozturk, B., & Ertugrul, B. (2014). Hypochlorous acid: an ideal wound care agent with powerful microbicidal, antibiofilm, and wound healing potency. Wounds, 26(12), 342-350.
Status report on topical hypochlorous acid: Clinical relevance of specific formulations, potential modes of action, and study outcomes
Topical formulations of stabilized, pH-neutral HOCl (e.g., solution, gel, spray) have been evaluated in several studies demonstrating both antimicrobial effects and therapeutic benefit in many cutaneous disorders, including seborrheic dermatitis, atopic dermatitis-associated pruritus, acne vulgaris, diabetic foot ulcers, and hypertrophic scars/keloids. Topical HOCl appears to be well tolerated and safe, without any major adverse events reported.
Del Rosso, J. Q., & Bhatia, N. (2018). Status report on topical hypochlorous acid: clinical relevance of specific formulations, potential modes of action, and study outcomes. The Journal of Clinical and Aesthetic Dermatology, 11(11), 36.
Testing the efficacy of topical antimicrobial treatments using a two and five species chronic wound biofilm model
HOCl gel shows promise as a new topical antimicrobial for wounds, especially due to its ability to inhibit P. aeruginosa.
Nedelea, A. G., Plant, R. L., Robins, L. I., & Maddocks, S. E. (2022). Testing the efficacy of topical antimicrobial treatments using a two and five species chronic wound biofilm model. Journal of Applied Microbiology, 132(1), 715-724.
Hypochlorous acid antiseptic washout improves patient comfort after intravitreal injection: A patient reported outcomes study
This study suggests that the use of HOCL 0.01% spray after Betadine® 5% for IVI prophylaxis will offer improved patient comfort as a rinse for Betadine®. The known spectrum of antiseptic coverage provided by HOCl 0.01% spray was equal to or better than Betadine®, and affects the majority of the pathogens commonly implicated in endophthalmitis. This research reports on the novel use of HOCL 0.01% as an ocular surface antiseptic.
Fam, A., Finger, P. T., Tomar, A. S., Garg, G., & Chin, K. J. (2020). Hypochlorous acid antiseptic washout improves patient comfort after intravitreal injection: A patient reported outcomes study. Indian Journal of Ophthalmology, 68(11), 2439.
Effect of stabilized hypochlorous acid on re-epithelialization and bacterial bioburden in acute wounds: A randomized controlled trial in healthy volunteers
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 group. This study demonstrates immediate and durable antimicrobial action and a beneficial effect on acute wound healing after irrigation and treatment with a stabilized hypochlorous acid formulation.
Burian, E. A., Sabah, L., Kirketerp-Møller, K., Gundersen, G., & Ågren, M. S. (2022). Effect of stabilized hypochlorous acid on re-epithelialization and bacterial bioburden in acute wounds: A randomized controlled trial in healthy volunteers. Acta Dermato-Venereologica, 102, adv00727-adv00727.
Hypochlorous acid gel technology — Its impact on post-procedure treatment and scar prevention
There have been many studies evaluating the beneficial effects of HOCL solution on wound healing; however, there is limited data reviewing the effect of HOCL scar gel. However, the scar gel has demonstrated benefits over silicone gel treatment. In a randomized, double-blind study including 44 adults with a linear or widespread HTS or keloid scars, comparing HOCL scar gel to treatment with silicone gel, favorable results for HOCL gel were demonstrated.
Gold, M. H., Andriessen, A., Dayan, S. H., Fabi, S. G., Lorenc, Z. P., & Henderson Berg, M. H. (2017). Hypochlorous acid gel technology—Its impact on postprocedure treatment and scar prevention. Journal of cosmetic dermatology, 16(2), 162-167.