Hypochlorous wound cleansers

[marienm, RN, CCRN]

Is anyone using these in their Burn ICU? (One brand name is Vashe, but there are others, I think.) How do you use it? How often do you use it? What did you use before hypochlorous? Are you seeing fewer infections than before? What about pseudomonas infections (for which the Vashe rep claims Vashe is superior to chlorhexidine gluconate)? I am....not totally sold on this product, but I wonder whether we are using it as effectively as we could be. (Yes, we have reached out to the reps and our infection control department. I'm looking for some solid bedside anecdotes here!)

[michksmith14, MSN, RN]

Hi Marienm,

I don't work in a Burn ICU but I do work in a wound clinic. We use Vashe in our office. Essentially it's Dakin's solution. We usually soak gauze with it and allow that to dwell on the wounds or gently wipe the wounds with the vashe-soaked gauze. If we don't use this, we use saline. If you're wanting to get a wound culture, it should be done before using Vashe or the results will not be accurate. Certainly Vashe will kill more bugs than saline alone. Our providers really like it.

Vashe will not help treat pseudomonas. The best treatment for that is 0.25% Acetic Acid solution (very dilute vinegar). We will wash wounds this this or have the VNA do this daily to help pseudomonas.

[WestCoastSunRN, MSN, CNS]

Interesting! We don't use this. Just Chlorhexidine. I wonder what peeps in the ABA think about it? There is so much variability among burn units, I do wonder how much we could improve through agreement and standardization of evidence-based practice.

[marienm, RN, CCRN]

Thank you both! My understanding of Vashe is that it is similar to Dakin's (diluted bleach...which we used to use on occasion, and I've definitely used for nec fasc wounds, either instilled into the dressing via catheter between dressing changes or wet-to-dry dressing) with the advantage being that Vashe is much gentler on healthy tissue than Dakin's. Also, the Vashe reps swear (of course) that their product is superior when it comes to pseudomonas.

We have recently had several patients with burns on the back/axillae (places we commonly see pseudomonas) and I feel like we're seeing it even more than we used to when washing with CHG! Our current protocol calls for wetting the dressing q6 to q8 with Vashe, with dressing changes as scheduled by the MD depending on when the most recent surgery occurred. We also wash the tissue with Vashe during the dressing change. We are starting to think it is just making these hard-to-dry areas too wet.

We've sometimes used Sulfamylon solution, but never acetic acid. I'll have to try to find some research! Thanks for the thought @michksmith14. @WestCoastSunRN, I am right there with you! One of these years I want to apply for one of those ABA residency grants to visit another burn unit!

[michksmith14, MSN, RN]

Acetic Acid is pretty old school but it does the trick ? Good luck!