Practice Innovations
Wound care is a significant source of antibiotic prescriptions and thus an important field for implementation of antimicrobial stewardship. Research has found 16.4% of total antibiotic prescriptions can be attributed to wounds. In 2016, 270.2 million antibiotic prescriptions were written in the US, enough for 5 out of 6 adults to receive antibiotic coverage. Biofilm normally creates a protective casing to wound microbes that shields them from antimicrobials and antibiotics. After disrupting biofilm a therapeutic window exists where antimicrobials, such as hypochlorous acid, are more effective.
Methods:
At an academic health system’s community hospital division in the Midwest a Wound Hygiene Protocol was implemented incorporating hypochlorous acid* treatment as a standard of care for all wound types and patient presentations to proactively treat common barriers to wound healing including limiting the re-formation of biofilm and addressing pro-inflammatory bioburden. Topical and systemic antibiotic prescriptions including total antibiotic days prescribed per month per provider, as well as the form and type of antibiotics prescribed were reviewed for a one month time period. Comparisons between providers that incorporated hypochlorous acid as a standard of care and intermittent usage were analyzed.
Results:
A total of 219 patients were treated at the wound centers under review with 3 providers assessed. Two providers utilized hypochlorous acid within their practice intermittently, and 1 provider utilized as a standard of care as part of wound hygiene protocol. Outcomes evaluated included total topical and systemic antibiotic prescriptions during a 1 month assessment period, number of antibiotic days, and variability in prescribing practices.
Discussion:
Hypochlorous acid is an ideal agent to incorporate into a wound hygiene protocol for decontamination of the wound and periwound following cleansing. It has favorable effects on fibroblast and keratinocyte migration compared to other antimicrobial cleansers making it a preferable to limit bioburden while avoiding cytotoxicity. Wound hygiene is a protocol of care that incorporates evidenced-based wound bed preparation and biofilm based wound management to routinely, regularly, and proactively address common barriers to healing. Wound hygiene protocols that incorporate hypochlorous acid support antimicrobial stewardship without compromising healing, and have potential to limit antibiotic usage in complex patients with hard-to-heal wounds.
Trademarked Items: Puracyn Plus, Rialto, CA
References: 1. Murphy C, Atkin L, Swanson T, Tachi M, Tan YK, Vega de Ceniga M, Weir D, Wolcott R. International consensus document. Defying hard-to-heal wounds with an early antibiolm intervention strategy: wound hygiene. J Wound Care 2020; 29(Suppl 3b):S1–28.
2. Wolcott RD, Rumbaugh KP, James G, et al. Biofilm maturity studies indicate sharp debridement opens a time- dependent therapeutic window. J Wound Care. 2010;19(8):320-328. doi:10.12968/jowc.2010.19.8.77709
3. Sakarya S, Gunay N, Karakulak M, Ozturk B, Ertugrul B. Hypochlorous Acid: an ideal wound care agent with powerful microbicidal, antibiofilm, and wound healing potency. Wounds. 2014;26(12):342-350.
4. CDC. Antibiotic Use in the United States, 2018 Update: Progress and Opportunities. Atlanta, GA:
US Department of Health and Human Services, CDC; 2019.