Acetic Acid or Dakin’s Solution in Wound Care: Am I Doing This Right?

How and when do you use two common topical antiseptics, acetic acid and Dakin’s solution? We help clear up the confusion. 

Acetic Acid or Dakin’s Solution in Wound Care: Am I Doing This Right?

 

In wound care, we now recognize that antibiotics – and their overuse –  contribute to bacterial resistance. With so many antibiotics losing their effectiveness, clinicians have turned to antiseptics that are bactericidal (kill bacteria) or bacteriostatic (inhibit bacteria growth) to cleanse and treat infected wounds.

At WCEI®, we receive a lot of questions about two popular antiseptics:  acetic acid and Dakin’s solution (sodium hypochlorite).  Both boast a broad range of effectiveness. Neither is new or cutting-edge. The early Egyptians treated wounds with acetic acid.  World War I clinicians successfully used sodium hypochlorite to avoid amputations due to infection. Yet, despite these long histories, we find that today’s clinicians are confused about how to use them. When should we choose these treatments and how do we use them to prepare and dress the wound?

Acetic Acid (Vinegar Solution)

Acetic acid has shown effectiveness against many Gram-positive and Gram-negative organisms, especially Pseudomonas aeruginosa. Though acetic acid does not kill bacteria, it does create an acidic environment unfavorable for bacterial growth. As an important additional benefit, evidence suggests that lowering a wound’s pH can also accelerate wound healing.

To treat Pseudomonas in chronic wounds, use a solution of acetic acid 0.5% – 1.0% and apply to the wound via irrigation or sterile, soaked gauze three times per day (TID) for a limited duration.  In vivo studies have shown that we can use acetic acid  in wounds safely for short periods (4-7 days) to control bacterial levels without compromising the healing process.

Dakin’s Solution

Dakin’s solution is a dilute hypochlorite (bleach) solution that shows effectiveness against Gram-positive bacteria such as strep and staph, as well as a broad spectrum of anaerobic organisms and fungi. It kills the microorganisms, but also harms healthy cells in all concentrations. Considering this cytotoxicity, use on infected wounds only, and no longer than 14 days.

You’ll typically use Dakin’s at ¼ strength, which is 0.125% (full strength is .50%). It can be sprayed on the wound, poured as a wound irrigant, or used in a wet compress. Apply to the wound twice per day (BID) for best results.

Though Dakin’s is probably the best-known sodium hypochlorite antimicrobial product, it is not the only one. Hypochlorites exist in other forms, including non-cytotoxic products such as Anasept® cleansers.

Can I Make My Own Solutions?

It’s tempting to try to mix your own acetic acid or sodium hypochlorite solutions, especially in the home health setting. After all, a simple internet search will produce plenty of recipes using household vinegar or bleach. But remember, this is a form of compounding and is not within the scope of practice for nurses and therapists. Bottom line: don’t make it yourself, purchase acetic acid and Dakin’s solutions from the pharmacy.

Tell Us About Your Weapons Against Infected Wounds

How do you alleviate your patients’ pain and symptoms from infection? What types of topical treatments have you used, and what made the biggest difference? We would love to hear about your experiences. Please share your thoughts and ideas below.

 

Wound Care Education Institute® provides online and onsite courses in Skin, WoundDiabetic and Ostomy Management. Eligible clinicians may sit for the prestigious WCC®, DWC® and OMS national board certification exams through the National Alliance of Wound Care and Ostomy®(NAWCO®). For details, see wcei.net.

DISCLAIMER: All clinical recommendations are intended to assist with determining the appropriate wound therapy for the patient. Responsibility for final decisions and actions related to care of specific patients shall remain the obligation of the institution, its staff, and the patients’ attending physicians. Nothing in this information shall be deemed to constitute the providing of medical care or the diagnosis of any medical condition. Individuals should contact their healthcare providers for medical-related information.

 

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