Historical Use of Sodium Hypochlorite

The history of the use of hypochlorite as a disinfectant and antiseptic goes back hundreds of years. It was used for the treatment of wounds and burns even before the revolutionary work of Lister and Koch. Among early uses, the Marquis de la Motte used a hypochlorite solution for the treatment of gangrene in 1732 [1]; and Paris surgeons used it for the treatment of burns, operative wounds, and ulcers [1]. As noted in the background section, Semmelweis used hypochlorite as an antiseptic hand wash to reduce the very high incidence of puerperal fever (childbed fever) during childbirth in a Vienna hospital. He ensured that his hands, and the hands of his assistants, were washed in a hypochlorite solution. He also insisted that a hypochlorite solution be used on any instruments likely to come in contact with the vaginal canal. While Semmelweis' technique resulted in a drastic decrease in the death rate from puerperal fever, his contemporaries largely ignored his work [1, 2]. Koch reported the antiseptic properties of hypochlorites in 1880 [3]; however, the widespread acceptance of hypochlorite, and recognition of its activity in wounds, would await the work of Carrel and Dakin. The conditions of trench warfare during the First World War resulted in large numbers of casualties with wounds contaminated by soil and human and animal excrement. These conditions led to a high incidence of wound infection and gangrene [4]. Existing antimicrobial compounds such as phenol, mercuric chloride and tincture of iodine proved to be unsuitable for antiseptic treatment of large traumatic wounds. These compounds could not be used in the volume necessary to debride and disinfect the wounds without producing toxic or highly irritating effects [5]. To combat the high mortality that resulted from the wound infections of war, Nobel Laureate Dr. Alexis Carrel enlisted the aid of a noted chemist, Henry Dakin, to formulate a non-irritating solution that had significant antiseptic effect [2]. Dakin examined over 200 substances in his search for a solution that met Carrel's requirements [6]. Among the substances examined were ingredients that FDA now considers to be Category I under the First Aid Antiseptics TFM: phenol, hydrogen peroxide and tincture of iodine. Dakin rejected these substances as either too toxic or irritating (phenol and iodine) or because of insufficient antimicrobial activity (hydrogen peroxide) [5]. Dakin determined that sodium hypochlorite at concentrations of 0.45-0.5%, in a buffered solution, had the best combination of non-irritating properties and antimicrobial effectiveness.

Carrel used Dakin's solution in a specific treatment regimen that involved, among other things, irrigating debridement and use of large volumes of their hypochlorite solution on the wounds [7]. Further, the concentration of sodium hypochlorite in Dakin's solution was higher than commonly used today, so that successful use in large wound areas over a period of days constitutes significant exposure, but had its limitations [8]. Antibiotics, introduced after World War II, often do not reach bacteria in deep wounds or necrotic tissue, and often have activity against only a limited spectrum of organisms. Additionally, with widespread use of antibiotics, many resistant strains of bacteria began to appear. Because of the limitations of antibiotics, today, topical antiseptics have again increased in use [9]. Recently, McDonnell noted that '[t]here now appears to be yet another resurgence in the clinical use of Dakin's solution' [8]. Recent antiseptic uses of sodium hypochlorite cited in published literature include use for burns, wounds, pressure sores and deep ulcers.

In an article that discusses the safety of 0.1-0.5% sodium hypochlorite for the treatment of burns, Cotter notes the use of 0.05-0.2% sodium hypochlorite during the Second World War, and the recent usage of 0.08% buffered sodium hypochlorite [10]. An article by Wright, and a letter by Thomas both note recent use of sodium hypochlorite as a burn antiseptic [9, 11, 12, 26]. Bloomfield discussed the use of 0.125 and 0.25% sodium hypochlorite by hospitals for wounds, pressure sores and ulcers [13]. Articles by Lineaweaver and Kozol, and letters by Raffensperger and Barese, also note recent use of sodium hypochlorite for wound treatment [8, 14-17, 29, 30]. An article by Slahetka [18] describes the use of 0.45-0.5% sodium hypochlorite solutions for the treatment of deep ulcers in geriatric patients.

As noted previously, sodium hypochlorite has been used for a variety of medical uses. It is one of the most widely used of all endodontic irrigating solutions. Concentrations of 2-5.25% have been recommended for this purpose [19]. In his study of five solutions, Berutti noted that '[a]lthough numerous endodontic irrigant solutions have been proposed, sodium hypochlorite has been shown to be the most effective' [20].

In addition to many medical uses, sodium hypochlorite has also been widely used for a number of non-medical uses, notably for water purification. Since its introduction, chlorination has become one of the most widely used and effective methods for providing safe drinking water to the world's population [21, 22].

The long historical use of sodium hypochlorite for wounds, burns and other medical indications, as well as the recent and current use of the ingredient as a topical antiseptic, demonstrate that sodium hypochlorite has been used for a material time and a material extent without significant evidence of toxic effects. Further assurance of the ingredient's safety is provided by its history of use for a variety of other medical and non-medical purposes.

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