Dakin's Solution Research Articles

Multiple Modality Treatment Regimen in an Aggressive Resistant Fungal Hand Infection: A Case Report

Cutaneous fungal infections are a rare but significant complication associated with immunocompromised states. Lesions allowed to progress to disseminated fungemia are associated with a near 80% mortality rate. Treatment guidelines aimed at local control are vague, centering on wide local excision with systemic antifungal medications. We present the case of a 3-year-old female who, while receiving induction chemotherapy, developed a progressive Aspergillus flavus infection. Involvement included the distal palm and common and proper neurovascular bundles to two fingers. Initial treatments with serial debridement and topical Dakin's solution were unsuccessful in eliminating this fungal infection. A novel treatment using topical voriconazole mixed with Aquaphor® (Beiersdorf AG; Hamburg, Germany) was compounded in the hospital pharmacy to maintain a moist wound healing environment followed by the use of the Vacuum Assisted Closure (VAC®, Kinetic Concepts, San Antonio, TX). Significant improvement was noted within 4days with this new dressing regimen. Topical voriconazole therapy followed by VAC allowed progressive healing and eventual closure with a split thickness skin graft. The wound was then durably closed, allowing critical chemotherapy to resume. No evidence of systemic fungemia developed, and her clinical recovery preceded laboratory evidence of immune system recovery. Fungal skin infections can be a threat to both life and limb in immunocompromised patients. The armamentarium available to combat this rare but difficult problem is imperfect. In certain infections not responsive to other therapies, the therapeutic regimen described herein should be considered if wide local excision carries significant functional morbidity.

The Use of Dakin's Solution in Chronic Wounds

Cornwell, Patricia; Arnold-Long, Mary; Barss, Stephanie Bernahl; Varnado, Myra F. Author Information

Using antimicrobial solution for irrigation in appendicitis to lower surgical site infection rates

Background The use of antimicrobial solutions for irrigation in appendicitis is controversial. Numerous antiseptic and antibiotic solutions have been suggested for use as an intraoperative irrigant. We sought to determine whether there was a difference in postoperative surgical site infections (SSIs) comparing normal saline (.9%), antiseptic solution (Dakin's, .25%), and an antibiotic solution (imipenem 1 mg/mL). Methods We performed a retrospective study of adult appendectomies from January 1997 through November 2007 at a single institution The data were evaluated by multivariate logistic regression analysis and chi-square test. The incidences of postoperative overall SSI, wound infection, and abdominal abscess were compared. Results A total of 1,063 cases were identified. Saline (n = 661) had an SSI rate of 9.8% (65/661), a wound infection rate of 7.3% (48/661), and an abdominal abscess rate of 4.2% (28/661). Dakin's (n = 208) had an SSI rate of 20.7% (43/208), a wound infection rate of 15.9% (33/208), and an abdominal abscess rate of 9.1% (19/208). Imipenem (n = 194) irrigation had an SSI rate of .5% (1/194), a wound infection rate of .5% (1/194), and an abdominal abscess rate of .5% (1/194). Conclusions These results suggest that abdominal irrigation with an antibiotic solution (imipenem 1 mg/mL) is superior to both normal saline and Dakin's solution.

Abstract No. 257: Safety and Efficacy of Dakin's Solution for Irrigation of Pancreatic Fluid Collections in 83 Patients

Abstract No. 257: Safety and Efficacy of Dakin's Solution for Irrigation of Pancreatic Fluid Collections in 83 Patients

A critical evaluation of a flow‐cell based on a liquid core waveguide for chemiluminescence measurements

Liquid-core waveguides (LCWs), devices that constrain the emitted radiation minimizing losses during the transport, are an alternative to maximize the amount of detected radiation in luminescence. In this work, the performance of a LCW flow-cell was critically evaluated for chemiluminescence measurements, by using as model the oxidation of luminol by hydrogen peroxide or hypochlorite. An analytical procedure for hypochlorite determination was also developed, with linear response in the range 0.2-3.8 mg/L (2.7-51 micromol/L), a detection limit estimated as 8 microg/L (0.64 micromol/L) at the 99.7% confidence level and luminol consumption of 50 microg/determination. The coefficients of variation were 3.3% and 1.6% for 0.4 and 1.9 mg/L ClO(-), respectively, with a sampling rate of 164 determinations/h. The procedure was applied to the analysis of Dakin's solution samples, yielding results in agreement with those obtained by iodometric titration at the 95% confidence level.

Effect of Dakin's Solution on Components of a Dermal Equivalent

The use of Dakin's solution on open wounds remains controversial in clinical practice. Here we investigated the effect of Dakin's solution on collagen degradation and fibroblast migration using a dermal equivalent. Acid solubilized or neutralized collagen was combined with four dilutions of Dakin's solution (0.5%, 0.25%, 0.125%, 0.0125%), with and without serum, at room temperature and 37 degrees C. Collagen degradation was examined at 0, 1, and 24 h using 8% SDS-page gels. Cell migration was determined using dermal equivalents where fibroblasts were incorporated into 3D collagen gels and exposed to Dakin's solution with and without serum. The cells were assessed for viability and cell migration at 24 and 48 h. Dakin's at 0.0125% resulted in little or no collagen degradation compared with a higher concentration of 0.5%, where collagen was either partially or completely degraded. Likewise, cell migration was completely inhibited at higher concentrations, while fibroblasts in a 3D matrix at 0.0125% were still able to migrate at 24 and 48 h, albeit in fewer numbers compared with controls. Serum had a protective effect for both collagen degradation and cell migration when added together with the Dakin's solutions. A time and temperature dependent effect was also noted, with longer contact and higher temperatures being more detrimental. Collagen degradation and fibroblast migration is affected by the concentration of Dakin's solution, the presence or absence of serum, time exposure and temperature. Use of Dakin's solution in clinical settings should take these findings into consideration in clinical practice.

Cytotoxic Effect of Sodium Hypochlorite 0.5% (NaOCl) on Ocular Melanoma Cells In Vitro

Purpose: Excision with or without adjuvant cryotherapy or brachytherapy is the treatment of choice in conjunctival melanoma. Adjuvant rinsing with alcohol or sodium hypochlorite peroperatively (Dakin's solution) is used in some centers to prevent seeding of melanoma cells. The purpose of this research is to compare the cytotoxicity of sodium hypochlorite (NaOCl) with other potential cytotoxic solutions in the treatment of conjunctival melanoma. Methods: Three uveal melanoma cell lines (OCM8, Mel285, and Mel270) and one conjunctival melanoma cell line (CM2005.1) were tested in a proliferation test (CellTiter 96 AQueous One Solution Cell Proliferation Assay, Promega, Madison, WI). The 96-well plates were coated with melanoma cells and treated with sodium hypochlorite 0.5%, sodium bicarbonate (1.4% and 8.4%), ethanol 99%, or sodium chlorite during 3, 5, or 15 minutes. Each solution was tested in several dilutions. Results: In all cell lines, no surviving cells were observed after treatment of 3 minutes with sodium hypochlorite. Ethanol 99% had a similar effect. A reduction of 70% of viable cells could be reached using sodium bicarbonate 1.4% or 8.4%. Water reduced the amount of viable cells by 40%. Conclusions: Sodium hypochlorite is cytotoxic for melanocytic cells in vitro. Its use may reduce local seeding of tumor cells and may decrease metastasis after extirpation of an extended ocular tumour. Further in vivo evaluation of sodium hypochlorite is required.

A Toxicity Index of Skin and Wound Cleansers Used on In Vitro Fibroblasts and Keratinocytes

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.

Influence of different auxiliary agents of biomechanical preparation in the filling of "artificially prepared" lateral canals

The purpose of the present study was to evaluate the influence of some auxiliary agents of biomechanical preparation of the root canal on the filling of artificial lateral canals in extracted human teeth. A total of eighty single-rooted teeth were employed, which were submitted to preparation of three artificial lateral canals in one of the proximal aspects at the cervical, middle and apical thirds, besides one in the buccal aspect. The main canals were prepared by Profile 0.4 rotary instruments through the crown-down technique and irrigated with the irrigants investigated, as follows: Group A - 1% sodium hypochlorite and final irrigation with trisodium EDTA for 5 minutes; Group B - Endogel (2% chlorhexidine gel); Group C - Endo PTC and Dakin's solution and final irrigation with Tergentol- Furacin; and Group D - File Eze. The root canals were obturated by the Tagger's hybrid technique and then radiographed for assessment of the penetration rate of the filling materials in the lateral canals. Analysis of the results demonstrated no statistically significant difference (p<0.05) between the irrigants both to each other and as regards the location (thirds and aspects) of the artificial lateral canals.

How to Prevent Errors – Safety Issues with Patient-Controlled Analgesia (Part 2); Potential for Confusing Dakin's Solution with Sterile Water

These medication errors have occurred in health care facilities at least once. They will happen again—perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them in your inservice training programs. Your assistance is required to continue this feature. The reports described here were received through the USP Medication Errors Reporting Program (MERP), which is presented in cooperation with the Institute for Safe Medication Practices. If you have encountered medication errors and would like to report them, you may call USP toll-free, 24 hours a day, at 800-233-7767 (800-23-ERROR). Any reports published by ISMP will be anonymous. Comments are also invited; the writers’ names will be published if desired. ISMP may be contacted at the address shown below. Errors, close calls, or hazardous conditions may be reported through the ISMP ( www.ismp.org ) or USP ( www.usp.org ) Web sites or communicated directly to ISMP by calling 800-FAIL SAFE or via E-mail at ismpinfo@ismp.org . ISMP guarantees the confidentiality and security of the information received and respects reporters’ wishes as to the level of detail included in publications.

Treatment of field water with sodium hypochlorite for surgical irrigation.

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.

101. Chemoprophylaxis of filarial nematode infctions: natural exposure to avermectin-attenuated third-stage larvae does not engender protective immunity in a bovine model of onchocerciasis

Myiasis is defined as an infestation of the organs and/or tissues of human and other animals by fly maggots. Fly species that normally breed in meat or carrion (Diptera: Calliphoridae, Sarcophagidae) may become involved in cutaneous myiasis by colonizing preexisting wounds. Reports of human wound myiasis contracted in hospitals and nursing homes, especially when patients are chronically ill or bed-ridden, are not uncommon across North America and often result in cases of neglect and civil litigation. Based on a case history dealing with this latter situation and circumstances surrounding the treatment of maggot infestation, we designed an experiment to assess the effectiveness of wound cleansing solutions on maggot mortality. Treatments, consisting of four commonly used cleaning solutions (isopropyl alcohol, Dakin's solution, iodine, and hydrogen peroxide) and a control (deionized water), were applied to experimental units (n = 5), with each unit consisting of groups of actively feeding Lucilia sericata maggots (Diptera: Calliphoridae). Every 24 h, treatments were applied and mortality was assessed for the duration of the study (14 days). Total mean mortality increased over the duration of the experiment, with an initial large increase (10–25%) after the first treatment application, followed by a gradual increase over the remainder of the study. General differences among treatments indicated greatest mean total mortality for Dakin's solution (sodium hypochlorite) (46%), followed by isopropyl alcohol (42%), Betadine (37%), hydrogen peroxide (33%) and lowest mortality for the control (25%); however, no statistically significant differences were observed among treatments and no treatment resulted in 100% maggot mortality. Traditional wound cleansing solutions may not be sufficient for maggot infestations of pre-existing wounds and supplemental treatments may be necessary to effectively treat cases of wound myiasis.

Influence of Peroperative Lavage Solutions on Peritoneal Defence Mechanisms in vitro

To find out the in vitro reaction of mesothelial cells and polymorphonuclear leucocytes (PMN) to incubation with seven commonly-used lavage solutions. Experimental study. Laboratories, The Netherlands. Cultured human peritoneal mesothelial cells and isolated PMN. Incubation of cells with clinically used lavage solutions (sodium chloride, Hartmann's solution, povidone-iodine, Dakin's solution, taurolidine, chlorhexidine, and hydrogen peroxide). Activation of monolayers of mesothelial cells and PMN measured by release of oxygen free radicals (chemiluminescence) and interleukin (IL)-8 concentrations and toxic effects measured by morphology, release of lactate dehydrogenase, failure of the restriction of the passage of inulin, and incorporation of propidium iodide. All solutions activated and killed mesothelial cells and PMN to some extent; the more concentrated the solution the greater the effect on these cells. Lavage solutions both poison and stimulate mesothelial cells and neutrophils, and some solutions are more potent than others.

Nonselective debridement and antimicrobial cleansing of a venting ductal breast carcinoma

A woman with a moderately differentiated carcinoma that erupted through the skin and amputated her breast was treated with whirlpool, topical antimicrobials, radiation, and chemotherapy. The draining, necrotic, and septic wound was treated for 5 months with a whirlpool containing dilute povidone-iodine solution and intravenous chemotherapy. Wet bandages, necrotic tissue, and softened eschar were removed by whirlpool agitation or mechanically debrided. To start treatment the wound was dressed with Debrisan crystals and sterile gauze for 1 week. Afterwards, wet-to-dry dressings wetted with Dakin's solution were applied. Tissue ingrowth at the wound margin started after 2 weeks, with whirlpool treatments effecting a tissue-reddening hyperemia. Wound drainage ceased after 2 months, with granulation and revascularization resulting. Eleven months later the wound was closed, aseptic, and undergoing dry flaking. The patient was cancer free with a completely healed wound 2 years after treatment. In this case, nonspecific debridement using whirlpool and topical antimicrobials promoted healing of an open fungating wound from a breast carcinoma.

UPDATING PRESSURE ULCER CARE

Do not clean ulcer wounds with skin cleansers or antiseptic agents-e.g., povidone iodine, iodophor, sodium hypochlorite solution (Dakins solution), hydrogen peroxide, or acetic acid. Antiseptic agents are reactive chemicals that are cytotoxic to normal tissue. (Treatment of Pressure Ulcers, Clinical Practice Guideline #15, U.S. Department of Health and Human Services Agency for Health Care Policy and Research, pg. 50.) In the home care setting Medicare will not reimburse for dressing supplies if patients are receiving wound care treatment with products containing harmful substances, such as povidone iodine or hydrogen peroxide. When using a static support surface the guidelines recommend considering the characteristics of stiffness (indentation load deflection of 25% of 30 pounds), density (1.3 pounds/cubic foot) and thickness (3 to 4 inches). If the patient is unable to assume a variety of positions or compresses the static support surface, or if the pressure ulcer does not heal, the guidelines recommend use of a dynamic support surface and a low-air-loss bed or air-fluidized bed if the patient has a large Stage III or Stage IV ulcer. Care of pressure ulcers requires that: 1) pressure be relieved with frequent repositioning and pressure intensity be reduced with adequate support surfaces; 2) nutrition be addressed and malnutrition corrected; and 3) topical or local wound care be based on the use of physiologic products to cleanse the wound, the removal of necrotic tissue via debridement, and the use of dressings that support moist wound healing. JoAnn Maklebust, MSN, RN, CS, NP Mary Sieggreen, MSN, RN, CS, NP, CNS Detroit, MI

Inhaling Aerosolized Dakin's Solution

We report a case of acute, reversible bronchospasm secondary to the accidental inhalation of aerosolized Dakin's solution (onequarter strength sodium hypochlorite solution).

Wound isolate of Salmonella typhimurium that became chlorate resistant after exposure to Dakin's solution: concomitant loss of hydrogen sulfide production, gas production, and nitrate reduction

A strain of Salmonella typhimurium isolated from a decubitus ulcer that was being treated topically with half-strength Dakin's solution became H2S negative, nitrate negative, and unable to produce gas from glucose. Experimental data suggested that these effects were associated with the development of chlorate resistance. Thirty-five other strains of Salmonella spp. that were made chlorate resistant also became negative for these three tests.

Experimentally induced dentoalveolar ankylosis in rats.

Dentoalveolar ankylosis is a common complication after replantation of teeth with injured periodontal ligaments. This is a serious complication for the tooth since it leads to progressive root resorption. In young individuals it may also cause infra-occlusion and reduced development of the alveolar process. The purpose of this study was to develop a method applicable to rats in order to follow the effect of systemic and local factors on the development of ankylosis and their possible effect on the length of the functional period of the ankylosed tooth before exfoliation. The maxillary first molars in adult rats were extracted. The periodontal ligaments were devitalized or removed before replantation of the teeth. Dentoalveolar ankylosis was clinically established 2 weeks after replantation. Induction was most reproducible after devitalization or removal of the PDL cells with Dakin's solution and after keeping the rats on a liquid diet up to 3 weeks after replantation. Exfoliation of the teeth usually occurred 6 weeks after replantation. Histological examination showed that the PDL was replaced by bone. The ankylosed teeth showed root resorption to a varying degree. The resorption was in some cases occasionally located in the supra-crestal part of the tooth. A bone-like tissue in the root canal was a rather common finding. In one of the ankylosed teeth cartilage formation was found adjacent to the cementum.

Influence of irrigation and intracanal dressing on the healing process of dogs' teeth with apical periodontitis.

Dogs' teeth with apical periodontitis were treated endodontically, Dakin's solution being used in an experimental group as the irrigation solution, and camphorated paramonochlorophenol as an intracanal dressing. For a second group of teeth, the irrigation solution used was physiologic saline, dry cotton only being placed into the pulpal chamber to take the place of an intracanal dressing. In a second visit, overinstrumentation and a new application of the same kind of dressing were performed, the root canals being then filled with gutta-percha cones and zinc oxide-eugenol cement. Other specimens were treated, in one visit, where physiologic saline or Dakin's solution were the irrigation solutions. The animals were sacrificed 6 months after the obturation of the root canals. Histologic exams showed better results for the experimental group where Dakin's solution and camphorated paramonochlorophenol had been used, with signs of repair characterized by newly formed cementum and bone tissue, as well as a marked reduction in size of the periapical lesions. No differences were seen in the results with physiologic saline or Dakin's solution as irrigants.

Effects of Topical Antimicrobial Agents on the Human Neutrophil Respiratory Burst

The neutrophil oxidative burst plays an important role in killing intracellular microorganisms. We studied the effects of topical antimicrobial agents on the N-formyl-L-methionyl-L-leucyl-L-phenylalanine-stimulated oxidative burst of human peripheral blood neutrophils, using a flow cytometric assay. Mafenide acetate, sulfadiazine silver, gentamicin sulfate, neomycin sulfate-polymyxin B sulfate (Neosporin GU irrigant), acetic acid, amphotericin B, and povidone-iodine inhibited the neutrophil oxidative burst at or below clinical concentrations, while 0.25% modified diluted sodium hypochlorite (Dakin's) solution caused cell death. Bacitracin-polymyxin B sulfate (Polysporin) greatly augmented the respiratory burst; this effect was due to the bacitracin component. Diluted gentamicin and acetic acid also augmented intracellular hydrogen peroxide production, but to a lesser extent than Polysporin. Inhibition of the respiratory burst of neutrophils might be considered when these agents are used for topical wound care, although clinical correlates of these effects have not been determined.