Dakin's solution

Dakin's solution is a dilute solution of sodium hypochlorite (0.4% to 0.5%) and other stabilizing ingredients, traditionally used as an antiseptic, e.g. to cleanse wounds in order to prevent infection.[1] The preparation was for a time called also Carrel–Dakin solution or Carrel–Dakin fluid.

Use

Carrel and Dakin used a variety of apparatuses to infuse the solution continuously over the wounds. In modern typical usage, the solution is applied to the wound once daily for lightly to moderately exudative wounds, and twice daily for heavily exudative wounds or highly contaminated wounds.[2]

The healthy skin surrounding the wound should preferably be protected with a moisture barrier ointment (e.g., petroleum jelly) or skin sealant as needed to prevent irritation.[3]

History

The solution takes the name from British chemist Henry Drysdale Dakin (1880–1952) who developed it in 1916, during World War I, while he was stationed at a field hospital in Compiègne. He worked there in collaboration with French physician Alexis Carrel, and the particular use they made of the solution is known as the Carrel–Dakin method for wound treatment.

Sodium hypochlorite solution had been developed as a bleaching agent around 1820 by the French chemist Antoine Labarraque, as a cheaper substitute for Claude Berthollet's potassium hypochlorite solution, produced as Eau de Javel since the late 18th century. Around that time, he also discovered the disinfectant properties of his Eau de Labarraque, which was quickly adopted for that purpose.[4] His work greatly improved medical practice, public health, and the sanitary conditions in hospitals, slaughterhouses, and all industries dealing with animal products.[5] However, those products were too concentrated and alkaline for use on wounds, as they strongly irritated healthy tissues.[6]

Almost a century later Carrel and Dakin observed that few doctors at the time practiced asepsis, and moreover there were no studies of the effectiveness of various antiseptics for wounds. They set out to look for a substance that did not irritate skin, yet had sufficient bactericidal power. Dakin tested more than 200 substances, measuring their action on tissues and bacteria. He found chloramines to be the best, for being stable, non-toxic and not very irritant, yet powerful bactericides, presumably due to their release of hypochlorous acid. However, the difficulty of procuring them led him to choose "hypochlorite of soda" as a practical alternative.[6][7][8][9]

Between the two world wars the preparation was often called "Carrel–Dakin solution", even though Dakin did the bulk of the research work that led to its formulation. The name of Carrel was dropped after World War II, presumably due to his active involvement in eugenics movements and the advocacy of elimination of "inferior" humans.[1]

Since penicillin became established as an antibiotic in 1943, use of Dakin's solution and other topical antiseptics for wound treatment has declined, and their use is frowned upon in modern medical care.[10] However, the solution continues to be used (as of 2013),[1] due to its broad activity against aerobic and anaerobic organisms, including fungi and antibiotic-resistant organisms, its very low cost, and its wide availability.[11][12][13] In emergency situations, it can be produced on the field from liquid bleach and sodium bicarbonate.[14]

Formulation

Dakin's original solution contained sodium hypochlorite (0.4% to 0.5%), prepared by treating calcium hypochlorite with sodium carbonate ("washing soda"). The solution left after removal of the insoluble calcium carbonate still contained some soda.[6] Boric acid (4%) was then added as a buffering agent to maintain a pH of between 9 and 10. Dakin found that alkalinity outside this range was too irritating.[15] The solution, while unstable, if made to the correct pH remains effective for at least a week.[15]

Other formulations have been developed over time. Already in 1916, Marcel Daufresne substituted sodium bicarbonate for Dakin's boric acid as buffering agent.[6][15] This formulation is the basis of current commercial products.[16]

The concentration chosen by Dakin (0.5%) was the maximum highest concentration found tolerable to the skin. It is the concentration recommended by the U. S. Center for Disease Control (CDC) as a household disinfectant.[17] In one study, bactericidal effects of sodium hypochlorite solution were observed at concentrations as low as 0.025%, without any tissue toxicity in vivo or in vitro. It recommended that concentration be adopted as a "modified Dakin's solution" for wound dressing.[18]

See also

References
  1. Jeffrey M. Levine (2013): "Dakin’s Solution: Past, Present, and Future". Advances in Skin & Wound Care: The Journal for Prevention and Healing, volume 26, issue 9, pp. 410–414.
  2. Century Pharmaceuticals, Inc.: "Dakin's solution FAQ". Accessed 2018-06-14.
  3. "Dakin's solution, Non-". WebMD online page. Accessed on 2018-06-14.
  4. Scott, James, transl. (1828). On the disinfecting properties of Labarraque's preparations of chlorine Published by S. Highley.
  5. Labarraque, Antoine-Germain, Nouvelle biographie générale, volume 28 (1859), columns 323–324.
  6. Marcel Daufresne (1916), "Mode de préparation de l'hypochlorite de soude chirurgical - Differénce entre la soulution de Dakin et celle de Labarraque". Presse médicale, volume xxiv, p. 474.
  7. Henry D. Dakin (1915): "On the use of certain antiseptic substances in the treatment of infected wounds". British Medical Journal, volume 2, issue 2852, pp. 318–310.
  8. H. D. Dakin and E. K. Kunham (1918). A Handbook of Antiseptics. Published by Macmillan, New York.
  9. H. D. Dakin (1915): Comptes rendues de la Academie des Sciences, CLXI, p. 150. Cited by Marcel Dufresne, Presse médicale' (1916)
  10. N. Bergstrom, M. A. Bennett, C. E. Carlson, et al. (1994): "Treatment of Pressure Ulcers". Clinical Practice Guideline, number 15. Publication 95-0652 of the Agency for Health Care Policy and Research (AHCPR), Rockville, MD.
  11. D. Doughty (1994): "A rational approach to the use of topical antiseptics". Journal of Wound Ostomy & Continence Nursing, volume 21, pp. 224–231.
  12. B. Altunoluk, S. Resim, E. Efe, et al. (2012): "Fournier's gangrene: conventional dressings versus dressings with Dakin's solution" ISRN Urology, PMC 3329652, PMID 22567424, doi:10.5402/2012/762340
  13. P. Cornwell, M. Arnold-Long, S. B. Barss, M. F. Varnado (2010): "The use of Dakin's solution in chronic wounds". Journal of Wound Ostomy & Continence Nursing, volume 37, pp. 94–104. doi:10.1097/WON.0b013e3181c78874
  14. "How to Make Dakin's Solution". Center for Health Information, Department of Inpatient Nursing, The Ohio State University Medical Center. Accessed on 2018-06-14.
  15. Glenn E. Cullen and Roger S. Hubbard (1919): "Note on the stabilization of dilute sodium hypochlorite solutions (Dakin's solution)". Journal of Biological Chemistry, volume 37, pp. 511–517.
  16. Century Pharmaceuticals, Inc. (2006): "Dakin’s Solution products" Material Safety Data Sheet (MSDS). Accessed on 2018-06-14
  17. https://www.cdc.gov/infectioncontrol/pdf/guidelines/disinfection-guidelines-H.pdf
  18. J. P. Heggers, J. A. Sazy, B. D. Stenberg, L. L. Strock, R. L. McCauley, D. N. Herndon, and M. C. Robson (1991): "Bactericidal and Wound-Healing Properties of Sodium Hypochlorite Solutions: The 1991 Lindberg Award". Journal of Burn Care & Rehabilitation, volume 12, issue 5, pp. 420–424. doi:10.1097/00004630-199109000-00005
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