ADJUNCTIVE DEBRIDEMENT WITH HYPOCHLOROUS ACID LEADS TO A HEALING TRAJECTORY OF COMPLEX WOUNDS IN CHILDREN

Ferne T. Elsass, MSN, RN, CPN, CWON; Clinical Practice and Education Specialist of Wound and Ostomy, Children’s Hospital of The King’s Daughters, Norfolk, VA 23507

Hypochlorous Acid (HOCl) as a Promising Respiratory Antiseptic

Michael Winter ¹ , Dirk Boecker ² and Wilfried Posch ^3,*

1 Team Winter Kompetenztraining, 1030 Vienna, Austria; 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。

2 TOTO Consulting LLC, Campbell, CA 95080, USA; 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。

3 Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, Schöpfstrasse 41/R311,6020 Innsbruck, Austria

*Correspondence: 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。; Tel.: +43-512-9003-70706

Abstract

The COVID-19 pandemic has inflicted unprecedented pressure on communities and health-care systems around the world. An outstandingly broad and intensive investigation of possible therapeutic interventions is currently taking place to prevent similar future threats to the global population. Investigating the related mechanisms of action is often complex and time consuming. Moreover, research on biochemical interactions of new drugs involves a considerable amount of effort, consequently bearing inherent financial and operational risks for pharmaceutical companies. An interesting approach to counteract colonization and infection is the concept of antiseptic treatment in vivo. Antiseptics are cost-effective and globally accessible, due to their ease of production, transportation and handling. A broad spectrum of active agents with different properties is readily available. One of these substances is hypochlorous acid (HOCl), which is also a naturally occurring biocidal agent and as such part of the innate immune system. Its successful history of medical use in wound treatment, combined with low cytotoxicity and documented efficacy against various pathogens, suggests that HOCl might be an effective agent for treating the respiratory mucosa. This could potentially enable therapeutic inhalation for combating bacterial infections and viral pathogens such as human respiratory syncytial, influenza, and SARS-CoV-2 viruses, which will be discussed in the present article.

Keywords: HOCl; respiratory infection; antiseptic; antimicrobial treatment; RSV; influenza; COVID-19; SARS-CoV-2

Comparison of Skin Antiseptic Agents and the Role of 0.01% Hypochlorous Acid

Ann Q. Tran, MD ; Nicole Topilow, MD; Andrew Rong, MD; Patrice J. Persad, PhD; Michael C. Lee; James H. Lee; Apostolos G. Anagnostopoulos, MD; and Wendy W. Lee, MD, MS

Abstract

Background: Hypochlorous acid (HA) has both anti-microbial and wound-healing properties with a growing role for utilization in pre-procedural care on the face. 

Objectives: The authors sought to compare the antiseptic property of 0.01% HA solution, 5% povidone iodine (PI), 4% chlorhexidine gluconate (CHG), and 70% isopropyl alcohol (IPA) antiseptic on facial skin. 

Methods: This was a prospective single-center clinical trial.

Results: A total of 21 participants were recruited. Bacterial growth was seen in CHG (10%), IPA (71%), PI (81%), and HA (95%) of specimens (P < 0.001). CHG had less growth compared with HA (P = <0.001), IPA (P = <0.001), and PI (P = <0.001). No difference in bacterial growth was noted between HA and IPA (P = 0.063) or HA and PI (P = 0.25). Significant differences in mono-microbial and poly-microbial growth were seen between HA and IPA (P = 0.046) and HA and CHG (P = <0.001). Staphylococcus epidermidis grew less frequently in CHG (10%), followed by IPA (29%), PI (71%), and HA (71%). Staphylococcus capitis grew less frequently in CHG (0%), followed by PI (14%), HA (24%), and IPA (29%). 

Conclusions: CHG reduced the bacterial growth compared with HA, PI, and IPA. However, HA, PI, and IPA had insignificant differences in bactericidal effects. Our study provides a supporting role of HA to be considered as an antiseptic.

The Potential Use of Hypochlorous Acid and a Smart Prefabricated Sanitising Chamber to Reduce Occupation-Related COVID-19 Exposure

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Hypochlorous Acid as a Potential Wound Care Agent Part I. Stabilized Hypochlorous Acid: A Component of the Inorganic Armamentarium of Innate Immunity

Wang L, PhD, ^a Bassiri M, PhD, ^a Najafi R, PhD, ^a Najafi K, MD, ^b Yang J, BS, ^a Khosrovi B, PhD, ^a Hwong W, BS, ^a Barati E, BS, ^a Belisle B, PhD, ^a Celeri C, MS^a , and Robson MC, MD ^c

^aNovaBay Pharmaceuticals, Inc, Emeryville, CA; ^bEye Institute San Rafael, CA; and ^c Institute for  Tissue Regeneration, Repair and Rehabilitation, Bay Pines, FL.

Objective: Hypochlorous acid (HOCl), a major inorganic bactericidal compound of innate immunity, is effective against a broad range of microorganisms. Owing to its chemical nature, HOCl has never been used as a pharmaceutical drug for treating infection. In this article, we describe the chemical production, stabilization, and biological activity of a pharmaceutically useful formulation of HOCl. Methods: Stabilized HOCl is in the form of a physiologically balanced solution in 0.9% saline at a pH range of 3.5 to 4.0. Chlorine species distribution in solution is a function of pH. In aqueous solution, HOCl is the predominant species at the pH range of 3 to 6. At pH values less than 3.5, the solution exists as a mixture of chlorine in aqueous phase, chlorine gas, trichloride (Cl− 3 ), and HOCl. At pH greater than 5.5, sodium hypochlorite (NaOCl) starts to form and becomes the predominant species in the alkaline pH. To maintain HOCl solution in a stable form, maximize its antimicrobial activities, and minimize undesirable side products, the pH must be maintained at 3.5 to 5. Results: Using this stabilized form of HOCl, the potent antimicrobial activities of HOCl are demonstrated against a wide range of microorganisms. The in vitro cytotoxicity profile in L929 cells and the in vivo safety profile of HOCl in various animal models are described. Conclusion: On the basis of the antimicrobial activity and the lack of animal toxicity, it is predicted that stabilized HOCl has potential pharmaceutical applications in the control of soft tissue infection.

Irrigation Solutions in Wound Care and Breast Surgery: Evidence-Based Applications, Regulatory Considerations, and Future Directions

Stephanie M. Mueller ^1,2 , LaYow C. Yu ² , Michael Drake Pike ² , Hannah D. Shi ² and Dennis P. Orgill ^1,2,*

1 Division of Plastic and Reconstructive Surgery, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115, USA; 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。

2 Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA; 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。 (L.C.Y.); 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。 (M.D.P.); 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。 (H.D.S.)

* Correspondence: 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。

Abstract

Background: Irrigation is a key strategy in reducing bioburden, disrupting biofilms, and supporting wound healing. While saline is the standard for its safety and availability, antiseptic and antibiotic solutions are often used in clinical scenarios that require infection control. However, the rise in antibiotic stewardship and concerns regarding cytotoxicity are reshaping current practices. This review identifies recent trends, current controversies, and persistent gaps in knowledge that warrant further investigation and regulatory attention. Methods: A literature review identified irrigation solutions commonly used in plastic surgery; labeling and concentrations were obtained from Devices@FDA, Drugs@FDA, and DailyMed, and PubMed, Cochrane Central, and Embase were searched (January 2022–July 2025) for human studies on acute wounds, chronic wounds, and implant-based breast surgery. Results: In acute wounds, saline and potable tap water effectively prevent infection. In chronic wounds, such as diabetic foot ulcers and pressure injuries, antiseptic agents, including hypochlorous acid, sodium hypochlorite, polyhexanide, and citrate-based solutions, have shown promise in improving healing and reducing infection. In implant-based breast reconstruction and augmentation, data on antiseptics, such as chlorhexidine, and changes in FDA guidance for povidone–iodine and bacitracin have prompted a reevaluation of intraoperative irrigation practices. Conclusion: Despite widespread use, many antiseptics remain off-label, and high-quality clinical studies comparing efficacy and safety are lacking.

Keywords: wound irrigation; saline irrigation; antiseptic irrigation; surgical site infection/prevention and control; breast pocket irrigation; Povidone–Iodine (PVI); Polyhexamethylene Biguanide/polyhexanide (PHMB); Hypochlorous Acid (HOCl); Sodium Hypochlorite (NaOCl); Triple antibiotic solution (TAS)