The Effectiveness of Hypochlorous Acid Solution on Healing of Infected Diabetic Foot Ulcers

Abstract

Introduction: Wound cleansing remains a corner stone in the management of diabetic foot ulcer. Hydrogen Peroxide (H₂O₂) and Povidone Iodine are topical antimicrobial agents but known to be toxic to cells involved in the wound healing cascade. The biggest challenge for the physicians and nurses is searching for a safe, non-cytotoxic and effective wound cleansing as Hypochlorous acid (HOCL). This study aimed to compare the efficacy of HOCL versus H₂O₂ followed by Povidine Iodine as a wound care agent in treating infected diabetic foot ulcers. Patients and methods: Design: used a randomized clinical trial design to compare the efficacy of HOCL versus H2O2 followed by Povidine Iodine as a wound care agent in treating infected diabetic foot ulcers. Setting: This study was carried out in outpatient plastic and vascular surgery clinic at Assiut university Hospital. Subjects: A random selection was performed on 60 patients with infected diabetic foot ulcers divided equally to control and study group. Methods: HOCL was used for the study group, as irrigate the wound with HOCL in a concentration; sterile Nacl 0.9% to HOCL 50.5% at ratio 8:2 and leave for 5 minutes, before covered the wound with sterile dressing. While H₂O₂ followed by Povidine Iodine used for the control group and the results were compared. Bacterial cultures were obtained before start washing, after five days thin each five days to the end of the study for the two groups. Results: HOCL was able to be effective against Candida, Proteus, Klebsella, Psudomonas, and Methicillin resistant staphylococcus aureus (MARSA) compare to H2O2 and Povidine iodine. There is a statistically significant difference between using HOCL and H2O2 and Povidine iodine as a washing therapy in reducing bacterial count, wound pain, odor, discharge and improve wound healing in diabetic foot ulcer. Conclusion: Hypochlorous acid is a potent antimicrobial cleanser against a wide range of microorganisms. Hypochlorous Acid is safe, low cost, painless, easy to perform, and improve wound healing or rapidly prepared diabetic foot ulcer for skin flap or graft. Recommendation: The study recommended use of HOCL as a virtuous diabetic wound care cleanser. Further research is needed on a larger scale to validate the effectiveness of Hypochlorous acid as a wound care agent in septic diabetic foot ulcers.

Keywords: Hypochlorous Acid, Hydrogen Peroxide, Infected diabetic foot ulcer, Povidine Iodine.