{{Short description|Dilute solution used as an antiseptic}} '''Dakin's solution''' is a dilute solution of sodium hypochlorite (0.4% to 0.5%) and other stabilizing ingredients, traditionally used as an antiseptic, e.g. to cleanse wounds in order to prevent infection.<ref name=levine>{{cite journal | last=Levine | first=Jeffrey M. | title=Dakin's solution: past, present, and future | journal=Advances in Skin & Wound Care | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=26 | issue=9 | year=2013 | issn=1527-7941 | doi=10.1097/01.asw.0000432051.59348.cd | pages=410–414 | pmid=23958873 }}</ref> The preparation was for a time called also '''Carrel–Dakin solution''' or '''Carrel–Dakin fluid'''.<ref>{{Cite web |title=Dakin's Solution: The Recipe for Turning Dirty Wounds Into Clean Wounds |url=https://www.kumc.edu/school-of-medicine/academics/departments/history-and-philosophy-of-medicine/archives/wwi/essays/medicine/dakins-solution.html |access-date=2024-10-14 |website=www.kumc.edu |language=en-us}}</ref>
==Use== Carrel and Dakin used a variety of apparatuses to infuse the solution continuously over the wounds. In modern typical usage, the solution is applied to the wound once daily for lightly to moderately exudative wounds, and twice daily for heavily exudative wounds or highly contaminated wounds.<ref name=century1>{{cite web |website=Century Pharmaceuticals, Inc.|url=http://www.dakins.net/faq |title=Dakin's solution FAQ |accessdate= 2018-06-14}}</ref>
The healthy skin surrounding the wound should preferably be protected with a moisture barrier ointment (e.g., petroleum jelly) or skin sealant as needed to prevent irritation.<ref name=webmd>{{cite web |url=https://www.webmd.com/drugs/2/drug-62261/dakins-solution/details |title=Dakin's solution, Non- |website=WebMD |accessdate= 2018-06-14}}</ref>
==History== The solution takes the name from British chemist Henry Drysdale Dakin (1880–1952) who developed it in 1916, during World War I, while he was stationed at a field hospital in Compiègne. He worked there in collaboration with French physician Alexis Carrel, and the particular use they made of the solution is known as the '''Carrel–Dakin method''' for wound treatment.
Sodium hypochlorite solution had been developed as a bleaching agent around 1820 by the French chemist Antoine Labarraque, as a cheaper substitute for Claude Berthollet's potassium hypochlorite solution, produced as ''Eau de Javel'' since the late 18th century. Around that time, he also discovered the disinfectant properties of his ''Eau de Labarraque'', which was quickly adopted for that purpose.<ref name=scott>{{cite book | last=Labarraque | first=Antoine Germain | title=On the Disinfecting Properties of Labarraque's Preparations of Chlorine: Particularly in Preventing Putrefaction ... Also in Medical and Surgical Practice, and in the Diseases of Horses, with an Appendix by the Translator | publisher=S. Highley | date=1828 | url=https://books.google.com/books?id=pD0XAQAAMAAJ |translator=Scott, James}}</ref> His work greatly improved medical practice, public health, and the sanitary conditions in hospitals, slaughterhouses, and all industries dealing with animal products.<ref name="nbu">[https://archive.org/stream/nouvellebiograph28hoef#page/n173/mode/1up Labarraque, Antoine-Germain], ''Nouvelle biographie générale'', volume 28 (1859), columns 323–324.</ref> However, those products were too concentrated and alkaline for use on wounds, as they strongly irritated healthy tissues.<ref name=dauf/>
Almost a century later Carrel and Dakin observed that few doctors at the time practiced asepsis, and moreover there were no studies of the effectiveness of various antiseptics for wounds. They set out to look for a substance that did not irritate skin, yet had sufficient bactericidal power. Dakin tested more than 200 substances, measuring their action on tissues and bacteria. He found chloramines to be the best, for being stable, non-toxic, and not very irritating, yet powerful bactericides, presumably due to their release of hypochlorous acid. However, the difficulty of procuring them led him to choose "hypochlorite of soda" as a practical alternative.<ref name=dauf/><ref name="dakin1">{{Cite journal |last=Dakin |first=H. D. |date=1915-08-28 |title=On the use of certain antiseptic substances in the treatment of infected wounds |journal=BMJ |volume=2 |issue=2852 |pages=318–320 |doi=10.1136/bmj.2.2852.318 |pmid=20767784 |issn=0959-8138 |pmc=2303023 |doi-access=free}}</ref><ref name="dakin2">{{Cite book |last1=Dakin |first1=H. D. |title=A Handbook of Antiseptics |last2=Kunham |first2=E. K. |publisher=Macmillan |year=1918 |location=New York}}</ref><ref name="dakin3">{{Cite journal |last=Dakin |first=H. D. |year=1915 |title=Sur certaines substances chlorées antiseptiques propres au traitement des plaies |journal=Comptes rendus de l'Académie des Sciences |language=fr |volume=CLXI |page=150}}</ref>
Between the two World Wars, the preparation was often called "Carrel–Dakin solution," even though Dakin did the bulk of the research work that led to its formulation. The name of Carrel was dropped after World War II, presumably due to his active involvement in eugenics movements and the advocacy of elimination of "inferior" humans.<ref name=levine/>
Since penicillin became established as an antibiotic in 1943, use of Dakin's solution and other topical antiseptics for wound treatment has declined, and their use is frowned upon in modern medical care.<ref name="berg">{{Cite book |last1=Bergstrom |first1=N. |title=Treatment of Pressure Ulcers: Clinical Practice Guideline |last2=Bennett |first2=M. A. |last3=Carlson |first3=C. E. |publisher=DIANE Publishing Company |year=1997 |isbn=978-0-7881-2418-1 |series=AHCPR pub |display-authors=et al}}</ref> However, the solution continues to be used (as of 2023)<ref name=levine/> due to its broad activity against aerobic and anaerobic organisms, including fungi and antibiotic-resistant organisms, its very low cost, and its wide availability.<ref name=doug>{{cite journal | last=Doughty | first=Dorothy | title=A Rational Approach to the Use of Topical Antiseptics | journal=Journal of Wound, Ostomy and Continence Nursing | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=21 | issue=6 | year=1994 | issn=1071-5754 | doi=10.1097/00152192-199411000-00008 | pages=224–231 |pmid=7704129}}</ref><ref name="altun">{{Cite journal |last1=Altunoluk |first1=Bülent |last2=Resim |first2=Sefa |last3=Efe |first3=Erkan |last4=Eren |first4=Mustafa |last5=Benlioglu |first5=Can |last6=Kankilic |first6=Nazim |last7=Baykan |first7=Halit |date=2012-03-04 |title=Fournier's Gangrene: Conventional Dressings versus Dressings with Dakin's Solution |journal=ISRN Urology |volume=2012 |pages=1–4 |doi=10.5402/2012/762340 |issn=2090-5815 |pmc=3329652 |pmid=22567424 |doi-access=free}}</ref><ref name="corn">{{Cite journal |last1=Cornwell |first1=Patricia |last2=Arnold-Long |first2=Mary |last3=Barss |first3=Stephanie Bernahl |last4=Varnado |first4=Myra F. |date=2010 |title=The Use of Dakin's Solution in Chronic Wounds: A Clinical Perspective Case Series |url=https://journals.lww.com/00152192-201001000-00015 |journal=Journal of Wound, Ostomy & Continence Nursing |volume=37 |issue=1 |pages=94–104 |doi=10.1097/WON.0b013e3181c78874 |pmid=20075698 |issn=1071-5754|url-access=subscription }}</ref> In emergency situations, it can be produced on the field from liquid bleach and sodium bicarbonate.<ref name="ohio">{{Cite web |title=How to Make Dakin's Solution |url=https://www.itstactical.com/wp-content/uploads/2012/01/Dakins_Solution.pdf |access-date=2023-12-04 |website=Center for Health Information, Department of Inpatient Nursing, The Ohio State University Medical Center}}</ref><ref name="clwk">{{Cite web |title=Skin and Wound Product Information Sheet - Dakin's Solution |url=https://www.clwk.ca/get-resource/dakins-solution/ |access-date=2024-03-24 |website=British Columbia Provincial Nursing Skin & Wound Committee}}</ref>
==Formulation== Dakin's original solution contained sodium hypochlorite (0.4% to 0.5%), prepared by treating calcium hypochlorite with sodium carbonate ("washing soda"). The solution left after removal of the insoluble calcium carbonate still contained some soda.<ref name=dauf/> Boric acid (4%) was then added as a buffering agent to maintain a pH of between 9 and 10. Dakin found that alkalinity outside this range was too irritating.<ref name="cullen">{{Cite journal |last1=Cullen |first1=Glenn E. |last2=Hubbard |first2=Roger S. |year=1919 |title=Note on the stabilization of dilute sodium hypochlorite solutions (Dakin's solution) |url=http://www.jbc.org/content/37/4/511.full.pdf |journal=Journal of Biological Chemistry |publisher=Elsevier BV |volume=37 |issue=4 |pages=511–517 |doi=10.1016/s0021-9258(18)87389-6 |issn=0021-9258 |doi-access=free}}</ref> The solution, while unstable, remains effective for at least a week, if made to the correct pH.<ref name=cullen/>
Other formulations have been developed over time. In 1916, Marcel Daufresne substituted sodium bicarbonate for Dakin's boric acid as buffering agent.<ref name=dauf>{{cite book |first=Marcel |last=Daufresne |year=1916 |chapter-url=https://archive.org/stream/BIUSante_100000x1916xartorig#page/n475/mode/2up/search/dufresne |chapter=Mode de préparation de l'hypochlorite de soude chirurgical - Differénce entre la soulution de Dakin et celle de Labarraque |title=Presse médicale |volume= xxiv |page= 474 |publisher=Masson et Cie |language=fr}}</ref><ref name=cullen/> This formulation is the basis of current commercial products.<ref name=century2>{{cite web |website=Century Pharmaceuticals, Inc. |year=2006 |url=https://static1.squarespace.com/static/5870167de58c6269874802d1/t/5871101020099e63d33d78f9/1483804689015/msds.pdf |title=Dakin's Solution Material Safety Data Sheet (MSDS) |accessdate=14 June 2018 |archive-date=15 June 2018 |archive-url=https://web.archive.org/web/20180615055546/https://static1.squarespace.com/static/5870167de58c6269874802d1/t/5871101020099e63d33d78f9/1483804689015/msds.pdf |url-status=dead }}</ref>
The concentration chosen by Dakin (0.5%) was the maximum highest concentration found tolerable to the skin. It is the concentration recommended by the U.S. Centers for Disease Control (CDC) as a household disinfectant.<ref>{{cite web|url=https://www.cdc.gov/infectioncontrol/pdf/guidelines/disinfection-guidelines-H.pdf|title=Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008|website=cdc.gov}}</ref> In one study, bactericidal effects of sodium hypochlorite solution were observed at concentrations as low as 0.025%, without any tissue toxicity in vivo or in vitro. It recommended that concentration be adopted as a "modified Dakin's solution" for wound dressing.<ref name="heggers">{{Cite journal |last1=Heggers |first1=J P |last2=Sazy |first2=J A |last3=Stenberg |first3=B D |last4=Strock |first4=L L |last5=McCauley |first5=R L |last6=Herndon |first6=D N |last7=Robson |first7=M C |year=1991 |title=Bactericidal and Wound-Healing Properties of Sodium Hypochlorite Solutions: The 1991 Lindberg Award |journal=Journal of Burn Care & Rehabilitation |publisher=Oxford University Press (OUP) |volume=12 |issue=5 |pages=420–424 |doi=10.1097/00004630-199109000-00005 |issn=0273-8481}}</ref> Currently, various concentrations are sold for wound cleansing including Anasept (0.057%),<ref>{{cite web |url=http://anacapa-tech.net/live/wp-content/uploads/2017/08/SDS-Anasept-Cleanser-Rev-02.pdf |title=Safety datasheet |website=anacapa-tech.net |access-date=2023-12-05 |archive-date=2024-04-21 |archive-url=https://web.archive.org/web/20240421224624/https://anacapa-tech.net/live/wp-content/uploads/2017/08/SDS-Anasept-Cleanser-Rev-02.pdf |url-status=dead }}</ref> 1/4 strength Dakin's (0.125%), and Di-Dak-Sol or Dakin's Wound Cleanser (0.0125%) which is 1/40 strength.<ref>{{cite web | url=https://getdakins.com/shop/ | title=Compare Dakin's Over-the-Counter Wound Care Products - Dakin's Wound Care | date=3 June 2020 }}</ref>
==See also== * Chlorine-releasing compound * Hydrogen peroxide * Povidone-iodine * Phenol ("carbolic acid") * Eusol
==References== {{reflist}}
Category:Antiseptics