sodium-hypochlorite and Wounds-and-Injuries

Dead tissue, in the form of slough and necrosis, can, if present in a wound, delay healing and promote infection. Debridement describes any method by which such materials are removed and, as a consequence, the potential to achieve wound healing enhanced. In this article, the first of two, the author discusses the history of debridement, cell death, the nature of necrotic tissue and a variety of debridement techniques. All methods of debridement have associated risks and benefits and while this article examines its clinical application there are also legal and professional issues to consider particularly in relation to conservative sharp debridement. These issues will be addressed in the second article.

Topics: Anti-Infective Agents, Local; Apoptosis; Bandages; Borates; Debridement; Humans; Hydrogen Peroxide; Necrosis; Povidone-Iodine; Risk Factors; Sodium Hypochlorite; Treatment Outcome; Wound Healing; Wounds and Injuries

Patients with skin injuries account for 15% of accident and emergency (A&E) admissions (Leaman, 1991). Although there is evidence to suggest that wound cleansing is not always necessary (Thomlinson, 1987), no diagnostic test exists to allow healthcare practitioners to identify whether the bacterial load in the wound is capable of causing infection (Chrisholm, 1992). For this reason, all wounds in A&E should undergo some form of cleansing to decrease the bacterial inoculum in the wound to levels that can be managed by host defences (Chrisholm, 1992). Heyworth (1997) postulates that successful management of the contaminated wound must remove contaminants while inflicting minimal injury to tissue. This article reviews the research on the preparation and cleansing of superficial lacerations. Wound closure and indications for oral antibiotics will not be discussed.

Topics: Anti-Infective Agents, Local; Chlorhexidine; Disinfection; Humans; Povidone-Iodine; Sodium Hypochlorite; Therapeutic Irrigation; Wounds and Injuries

We conducted a randomized controlled trial comparing EUSOL (Edinburgh University Solution of Lime) and sugar as dressing agents in the treatment of traumatic wounds. Patients in both groups were matched for age and gender. We found EUSOL did better than sugar in terms of contraction of size of wound, presence of discharge, floor area covered with slough, formation of healthy granulation and early possibility of wound coverage.

Topics: Adolescent; Adult; Anti-Infective Agents; Bandages; Borates; Carbohydrates; Female; Humans; Male; Middle Aged; Sodium Hypochlorite; Treatment Outcome; Wound Healing; Wounds and Injuries; Young Adult

Microbial bioburden in both acute and chronic wounds is an important factor in wound healing. Consequently, the reduction of bioburden to host-manageable levels, as well as the elimination of certain virulent forms of wound pathogens (regardless of their number), has become a goal of the wound care professional. A prospective, controlled clinical study using accepted sampling methods was conducted to compare the use of an antimicrobial wound cleanser (0.057% sodium hypochlorite in an isotonic saline solution) to normal saline on the reduction of bioburden and wound size. During the 2-month study, 100% of the wounds cleansed with the antimicrobial wound cleanser (n = 9) demonstrated aerobic bioburden reduction from baseline in a range from 1 to 4 logs per wound, while 56% of the wounds cleansed with normal saline (n = 9) showed an increase in aerobic bioburden levels. The proportion of wounds exhibiting a reduction in wound size was higher in the antimicrobial wound cleanser group than in the saline group. Further research to increase understanding of the relationship between wound bioburden, healing, and cleansing agents is needed.

Topics: Adult; Aged; Aged, 80 and over; Colony Count, Microbial; Disinfectants; Female; Humans; Male; Middle Aged; Skin Ulcer; Soaps; Sodium Chloride; Sodium Hypochlorite; Wound Healing; Wounds and Injuries

The morbidity and mortality of soldiers injured during the First World War stemmed in large part from infections of battle wounds. Preventing and treating such infections was a major challenge for the medical corps. Alexis Carrel, a French-American surgeon, advocated irrigating open wounds with a hypochlorite solution (the Carrel-Dakin solution) to prevent the growth of bacteria contaminating them. His method of treatment was complicated and time consuming and was not well followed by surgeons who doubted the necessity of such an exacting protocol. In 1917, Carrel wrote a letter to an American colonel overseeing U.S. medical personnel soliciting his support in training American medical personnel in the proper use of the Carrel-Dakin solution. This letter was the stimulus for recalling here the opposition encountered by both Carrel and Joseph Lister, his predecessor in the aseptic-antiseptic treatment of open wounds, and for noting the conflicting views of contemporary surgeons over surgical sepsis.

Topics: Disinfectants; Disinfection; History, 20th Century; Humans; Sodium Hypochlorite; World War I; Wounds and Injuries

Minimum bactericidal concentrations (MBCs) of seven biocides for 42 methicillin-resistant Staphylococcus aureus (MRSA) isolates at 5, 30, or 180 min, for hand scrubs or soaks, isolated in 2003 in Japan were determined. The MBC values of glutaraldehyde, povidone iodine, and ethanol were lower than the user concentrations in all exposure times. However, at 5 min exposure of sodium hypochlorite, benzalkonium chloride, alkyldiaminoethylglycine hydrochloride, and chlorhexidine digluconate some strains showed higher MBC values than the user concentrations. These results indicated the possibility that MRSA survived under proper user concentration conditions and exposure time.

Topics: Benzalkonium Compounds; Chlorhexidine; Disinfectants; Ethanol; Female; Glutaral; Hand; Hand Disinfection; Humans; Male; Methicillin Resistance; Microbial Sensitivity Tests; Mucous Membrane; Phylogeny; Povidone-Iodine; Sodium Hypochlorite; Staphylococcus aureus; Time Factors; Urine; Wounds and Injuries

To determine toxicity indexes of commercially available skin, wound, and skin/wound cleansers on in vitro fibroblasts and keratinocytes.. Seventeen cleansers and 3 liquid bath soaps were evaluated for cytotoxic effect on human infant dermal fibroblasts and epidermal keratinocytes. Both skin cell types were exposed to serial 10-fold dilutions of each cleanser until treated cell viability was comparable to untreated controls.. The experimental design allowed calculation of relative toxicity indexes ranging from 0 to 100,000. Shur-Clens, SAF-Clens, and saline were found to be the least toxic to fibroblasts (toxicity index 0); Dial Antibacterial Soap and Ivory Liqui-Gel were the most toxic (toxicity index 100,000). Biolex, Shur-Clens, and Techni-Care were the least toxic to keratinocytes (toxicity index 0); hydrogen peroxide, modified Dakin's solution, and povidone (10%) were found to be the most toxic (toxicity index 100,000).. Successful cutaneous tissue repair depends on the viability of the principal cell types involved (fibroblasts and keratinocytes). Toxicity indexes provide helpful guidelines for subsequent in vivo evaluations and clinical applications. The study findings also suggest that judicious use of these supposedly innocuous agents should be considered in a clinical setting.

Topics: Acetic Acid; Anti-Infective Agents, Local; Benzethonium; Boric Acids; Cell Culture Techniques; Cell Survival; Cells, Cultured; Drug Combinations; Drug Evaluation, Preclinical; Fibroblasts; Humans; Hydrogen Peroxide; Infant; Keratinocytes; Povidone-Iodine; Skin Care; Soaps; Sodium Bicarbonate; Sodium Chloride; Sodium Hypochlorite; Toxicity Tests; Wound Healing; Wounds and Injuries

Early irrigation and surgical debridement of high-energy wounds and open fractures effectively prevents infection. Rapid wound care has been maximized by the United States military's "forward surgical teams." However, the volume of sterile irrigant required to treat multiple patients with multiple wounds presents a significant logistical burden. Using ground-derived field water could eliminate this burden.. We collected 100 water samples from five sources. An initial bacterial count (CFU/mL) was determined before treatment. 5% sodium hypochlorite was then added to each sample to derive a concentration of 0.025%. After treatment, a final bacterial colony count was performed.. We found no bacterial growth in 99/100 samples. One post-treatment sample grew a single colony of a Bacillus species not present in the pretreatment culture and was determined to be an air contaminant.. Our field-expedient modification of Dakin's solution could substitute for sterile irrigation fluid when it is neither available nor logistically feasible.

Topics: Air Microbiology; Colony Count, Microbial; Debridement; Disinfectants; Drug Contamination; Drug Evaluation, Preclinical; Fresh Water; General Surgery; Humans; Infection Control; Military Medicine; Military Personnel; Sodium Hypochlorite; Solutions; Therapeutic Irrigation; Time Factors; United States; Warfare; Water Microbiology; Water Supply; Wound Infection; Wounds and Injuries

Topics: Aged; Anti-Infective Agents, Local; Drug Labeling; Drug Packaging; Female; Humans; Medication Errors; Patients' Rooms; Sodium Chloride; Sodium Hypochlorite; Solutions; Wounds and Injuries

To determine the effect of Hurricane Andrew on a pediatric emergency department.. A retrospective analysis of ED visits through the use of computerized records and chart review.. A children's hospital in South Florida.. All patients presenting to the ED during the control week and the two study weeks after the hurricane.. Census, diagnoses, admission rate, and patient geographic origin and age.. During week 1, there was an average daily increase of 40.7% in patient volume (P < .01) and a 3.3% decrease in the admission rate (P < .01). The increased census was due mainly to local patients, rather than those from the most devastated areas. More patients were seen with open wounds, gastroenteritis, and impetigo (all, P < .05); more were more than 18 years old (P < .05). By the second week, both census and admission rate returned to normal; cases of cellulitis (P < .05) and open wounds (P < .001) were increased. Although not statistically significant, a higher percentage of hydrocarbon and/or bleach ingestions was seen for both weeks.. Following a hurricane, personnel in a pediatric ED can expect to see an increased census, with more diagnoses of open wounds, gastroenteritis, and skin infections. They may also see hydrocarbon and bleach ingestions. Alerting parents to the potential for injury and accidental poisoning in their children after a hurricane may help prevent the reported morbidity.

Topics: Adolescent; Adult; Child; Child, Preschool; Emergency Service, Hospital; Florida; Humans; Hydrocarbons; Infant; Patient Admission; Retrospective Studies; Sodium Hypochlorite; Wounds and Injuries

Topics: Borates; Humans; Sodium Hypochlorite; Wounds and Injuries

Topics: Anti-Infective Agents; Borates; Dermatitis, Contact; Humans; Sodium Hypochlorite; Wounds and Injuries

Topics: Anti-Infective Agents; Borates; History, 20th Century; Humans; Sodium Hypochlorite; Warfare; Wounds and Injuries

Topics: Anti-Infective Agents; Attitude of Health Personnel; Borates; Community Health Nursing; Humans; Sodium Hypochlorite; South Africa; Wounds and Injuries

Topics: Anti-Infective Agents; Borates; Community Health Nursing; Humans; Sodium Hypochlorite; Ulcer; Wounds and Injuries

The efficiency of four commonly used antiseptics, chlorhexidine, povidone-iodine, cetrimide and sodium hypochlorite was compared in the disinfection of silicone-foam dressing used in the management of open granulating wounds. An in vitro model was first used to determine the minimum effective concentration of each antiseptic in killing a standard culture of Pseudomonas. The appropriate concentrations were then compared in comparative studies of clinical wounds. Chlorhexidine proved to be the most effective antiseptic, povidone-iodine and cetrimide were moderately successful, but sodium hypochlorite gave poor results. A subsidiary study looked at the problem of wound irritation by carry-over of the antiseptic. A rinse of the dressing after disinfection prevented irritation by chlorhexidine without compromising its antibacterial effect, but this procedure sometimes failed to prevent irritation when using the other antiseptic agents. It is concluded that chlorhexidine is the preferred cleansing agent in the management of silicone-foam dressings on both grounds of bacteriological efficiency and lack of wound irritation. It should be noted that Hibitane concentrate used in this work contains non-ionic detergent and a stabilizing agent. Pure preparations of chlorhexidine may not behave similarly.

Topics: Anti-Infective Agents, Local; Bandages; Cetrimonium; Cetrimonium Compounds; Chlorhexidine; Disinfection; Humans; Models, Biological; Povidone-Iodine; Pseudomonas aeruginosa; Silicones; Sodium Hypochlorite; Sterilization; Wounds and Injuries

Topics: Attitude; Bandages; Diffusion of Innovation; Humans; Sodium Hypochlorite; Wounds and Injuries

Topics: Adult; Ankle Injuries; Arm Injuries; Casts, Surgical; Debridement; Fibula; Forearm Injuries; Fractures, Bone; Humans; Hydrotherapy; Immersion; Leg Injuries; Male; Methods; Middle Aged; Sodium Hypochlorite; Tibial Fractures; Wounds and Injuries

Topics: Anti-Bacterial Agents; Antisepsis; Balsams; Debridement; Europe; Gloves, Surgical; Humans; Military Medicine; Operating Rooms; Resins, Plant; Sodium Hypochlorite; Steam; Sterilization; Surgical Wound Infection; United Kingdom; United States; Wounds and Injuries