Safety and cost-effectiveness of a pure hypochlorous acid cleansing solution in wounds and non-intact skin management: a narrative review.

OBJECTIVE: Wound cleansing is an essential part of wound bed preparation and its importance in wound management is supported by numerous international guidelines and consensus documents. Cleansing solutions are used by healthcare professionals for wounds and non-intact skin. However, some of these solutions may not be effective in addressing the condition of the wound or safe enough to be used in certain patients due to the solution's potential for irritation or toxicity. According to guidelines, solution of pure hypochlorous acid (pHA; free of hypochlorite derivatives) provides a good balance between safety and efficacy. This narrative review discusses the clinical evidence available on the use of a pHA solution (Vashe Wound Solution; Urgo Medical North America, US) formulated at 330ppm with a tightly controlled, slightly acidic pH (pH 3.5-5.5).

METHOD: A literature search of the Embase, MEDLINE, Google Scholar and TRIP databases was conducted (firstly in December 2025 and updated in June 2026), for original clinical studies reporting the use of the pHA solution, including randomised controlled trials, comparative studies, observational studies, case series/reports and health economic evaluations. Outcomes relating to efficacy, safety, tolerability, acceptability and costs were synthesised narratively.

RESULTS: A total of 56 publications were identified and included in the analysis. These clinical evaluations analysed the data of 2968 wounds in 2682 patients, including 140 preterm infants, neonates and children. The treated indications were wounds presenting with risk or clinical signs of local infection, infected wounds, skin tissue or mucosa, including wounds at debridement stage or requiring thorough cleansing, and patients with fragile, immature or non-intact skin. Across the different studies, consistent and concordant outcomes were noted, with a favourable benefit/risk profile of the solution, regardless of the method of application, treated indications and patient populations. Cleansing with the pHA solution, using soaked gauze or different irrigation techniques, to remove debris, slough and foreign bodies from the wound and skin, was found to significantly reduce bacterial growth compared to saline, soap and water, or standard of care, resulting in fewer wound-related complications. The cleanser solution also appeared to facilitate wound debridement, promote wound healing and be cost-effective in numerous indications. The safety profile of the pHA solution was 'very good', and no complication related to its use was reported in any of the clinical evaluations, including in preterm infants.

CONCLUSION: The clinical evidence identified in this review consistently supported the pHA solution with a slightly acidic pH as a useful option in the management of wounds and non-intact skin, aligned with its intended use, particularly in situations where infection control and tissue tolerability are important considerations. Conducting additional high-quality comparative studies would be worthwhile to strengthen the available evidence.