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Treatment of Field Water with Sodium Hypochlorite for Surgical Irrigation

Cyr, Steven J. MD; Hensley, Donna; Benedetti, Gary E. MD

The Journal of Trauma: Injury, Infection, and Critical Care: August 2004 - Volume 57 - Issue 2 - p 231-235
doi: 10.1097/01.TA.0000091111.17360.1E
Original Articles

Background: 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.

Methods: 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.

Results: 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.

Conclusions: Our field-expedient modification of Dakin’s solution could substitute for sterile irrigation fluid when it is neither available nor logistically feasible.

From the Department of Orthopaedic Surgery (S.J.C.), 59th Medical Wing, and the Clinical Investigations Division (D.H.), Lackland Air Force Base, Texas; and the Department of Orthopaedic Surgery (G.E.B.), 74th Medical Group, Wright-Patterson Air Force Base, Ohio.

Submitted for publication February 6, 2003.

Accepted for publication June 18, 2003.

Poster presented at the Society of Military Orthopaedic Surgeons Annual Meeting, San Diego, California, December 2002.

Address for reprints: LtCol Gary Benedetti, MD, Department of Orthopaedic Surgery, 74th Medical Group, 4881 Sugar Maple Drive, Wright-Patterson AFB, Ohio 45433.

© 2004 Lippincott Williams & Wilkins, Inc.