Acetic acid dressings: Finding the Holy Grail for infected wound management

MATERIALS AND METHODS

This is a prospective analysis of 100 patients having infected wounds which were treated at a tertiary care centre over a period of 2 years (October 2013-October 2015). Most of the patients included in the study had already been treated by standard techniques such as saline, povidone-iodine, eusol and hydrogen peroxide. Inclusion criteria took into account a failed attempt by standard techniques to weed out wound infection by referring doctor. Patients having systemic manifestations of infection were excluded from the study. Rest of all wounds were included in the study.

Approval was obtained from the Institutional Ethics Committee. Various dilutions of acetic acid were tested against common bacterial flora in our hospital to determine the appropriate concentration of acetic acid to inhibit the growth of these pathogens [Table 1]. Inoculum size of an overnight culture was adjusted to McFarland 0.5 corresponding to 1.5 × 108 cfu/ml for all dilutions. As per results the results, 1% acetic acid was chosen for dressings.

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All patients were explained the procedure and written informed consent was obtained. Same protocol was followed in all patients for dressings. After removal of the dressing, immersion bath with 0.1% acetic acid was given for 15 min since this solution, although not bactericidal, helps in creating an acidic environment. Then, wounds were cleaned with normal saline. After that, the wound was covered with non-adhesive sterile Vaseline gauze, over which gauze soaked in 1% acetic acid solution was kept and then wound was closed with sterile dressings. About 1% acetic acid was prepared from diluting acetic acid with normal saline. During this period, no systemic antibiotics were given to the patients.

For each wound, the swab was collected before using acetic acid dressing and further on days 3, 7, 10 and 14. This was processed for isolation of bacteria and fungi. Clinical isolates were tested for minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of acetic acid using the standard technique (tube dilution) by the microbiologist. Isolated bacteria were also tested for antibiotic sensitivity.

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For standardisation, pH of various dilutions of vinegar (4%, 1% and 0.1%) was measured using digital pH meter (pHep®-Accuracy ± 0.1 20 C/68 F) [Table 2]. Wound surface pH monitoring was performed using pH indicator strips.

The wounds were assessed clinically for the amount of discharge, odour, wound size and quality of granulation tissue on alternate days and photographs were taken after proper consent of the patients. No growth on culture with uniform layer of granulation was considered as the primary end point of treatment and patient was posted either for skin grafting or flap cover surgery as per need.

The data collected has been subjected to statistical analysis using SPSS software version 22 (IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY:IBM Corp.) and various descriptive statistics will be used to calculate frequencies, percentage, mean and standard deviation. Numerical data such as age, MIC and MBC has been expressed as mean, whereas categorical data such as sex, aetiology of wound, isolated organisms, number of days to achieve no growth on culture and uniform coverage of wound by granulation has been expressed as percentages.

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