The Safe Use of Pure Hypochlorous Acid as a Cleanser of Skin and Wounds on the Premature Infant

Problem: Premature infants (<37 wks) have fragile, translucent skin and are sensitive to cleansing agents such as hydrogen peroxide, povidone iodine, Dakins Solution, chlorhexidine, etc.(1). Antibacterials such as silver sulfadiazine cannot be used in infants because of the risk of toxicity. Fungal infections are common related to the high humidity necessary for neonates. Pure hypochlorous acid can remove microorganisms and fungi, is non-cytotoxic, is safe for use around the eyes, ears, mouth, and genitalia, and has been demonstrated to be safe in young children (2). It has not been studied in premature infants. Methods: Pure hypochlorous acid* was used to treat the skin and wounds on 5 premature infants (<37 weeks gestation). Two of these infants required phototherapy (Bili lights) to control jaundice. Wounds on the patients included rashes, crusting, and open wounds. The hypochlorous acid was used for bathing and temporary wound soaks prior to wound care. No vigorous wiping was used because of diminished cohesion between the epidermis and dermis in the preterm babies (1). Results: The hypochlorous acid was well-tolerated in all patients and no safety issues arose. The bacterial colonization was controlled and fungal infections did not occur. High humidity was able to be maintained with a decrease of trans-epidermal water loss (TEWL). Skin irritation due to the cleansing did not occur. Bili lights could be used as indicated. Conclusions: Pure hypochlorous acid with no hypochlorite has a pH of 5.1-5.6. This is compatible with the premature infants skin whose pH is 5.6. The reported safety around the eyes, ears, nose, mouth, and genitalia coupled with its lack of cytotoxicity (3) make the agent ideal for use in preterm babies. This series of premature infants demonstrates the safety of pure hypochlorous acid and extends the usage age younger than that previously reported for children (2).