(EBP-010) Clinical Review: Chemical Wound Debridement with 0.50% Sodium Hypochlorite Solution

SHAWN AMERSI, APRN CNP-C MSN WCS-C EDS-C – MEDICAL PROVIDER, ADULT & GERIATRICS ACUTE & CHRONIC HEALTH, Pro Healthcare Clinic; Martha Snyder, APRN FNP-C MSN WCS-C EDS-C – CLINICAL TEAM LEAD, SKIN & WOUND CARE, RHEMA HEALTHCARE

Introduction:

Microorganisms are the primary contributors to biofilm formation and subsequent infection. Wounds covered with necrotic or non-viable tissue require debridement to expose healthy connective tissue, reduce critical colonization, and to promote wound healing. However, there are circumstances in which sharp or ultrasonic wound debridement method is not appropriate. In these cases, the wound still requires timely and effective intervention to prevent deterioration and support the healing process.

 NaOCl solution has a long history of use as an endodontic irrigant, dating back to 1936, when it was first adopted for its potent germicidal properties and its ability to dissolve the soft tissues of the dental pulp. During root canal preparation, NaOCl solutions ranging from 2.5% to 6.0% are used to achieve effective chemical–mechanical debridement of the canal. Because sodium hypochlorite contains approximately 5% free chlorine, it breaks down proteins into amino groups through chloramination reactions. Its strong alkalinity, with a pH of around 12.

Methods:

The five selected patients with full thickness wound were identified in the controlled treatment group. Wound size (Length x Width x Depth) and percentage of viable and non-viable tissue was measured at baseline and during the weekly assessments. Pain, characteristics of the wound base, and periwound skin erythema, edema, and maceration were assessed. Calcium Alginate sheet moistened with 0.50% of NaOCl solution was applied to three (5) selected full thickness wounds which were in inflammatory phase of wound healing. An ABD pad was applied to all wounds as a secondary dressing and wound dressings were changed once every 24 to 48 hours. 

Results:

All five (5) patients demonstrated a positive clinical response to the 0.50% sodium hypochlorite solution, evidenced by loosening of non-viable tissue, absence of wound odor, and lack of pain, burning, or pruritus, along with the development of a healthy, granular wound bed.

Discussion:

As McCullough et al. highlighted, contemporary wound care has shifted the paradigm from merely preventing infection to actively creating an optimal environment for tissue repair. While some have expressed concerns that antiseptics may be excessively cytotoxic and potentially hinder healing and certain guidelines even discourage the use of agents such as NaOCl solution. This perspective overlooks the nuanced nature of wound management. Wound care is complex, and no single approach is universally superior. When used appropriately and tailored to the patient’s specific clinical context, each agent offers distinct therapeutic advantages that can support, rather than impede, the healing process.