One of the challenges facing the caregiver in austere settings is how to prevent infection in open wounds. After a disaster, people may be forced to perform activities of daily survival to which they are not accustomed. Injuries may occur as a result. Infections will be more likely in areas where hygiene and sanitation are questionable; without advanced medical care, a bad outcome may be the end result.
A simple and affordable method that was used as far back as World War I may be the answer for the medic: Wound care with Dakin’s solution.
Dakin’s solution is the product of the efforts of an English chemist, Henry Drysdale Dakin, and a French surgeon named Alexis Carrel. In their search for a useful antiseptic to save the lives of wounded soldiers during WWI, they used sodium hypochlorite (household bleach) and baking soda to make a solution that had significant protective effect against infection. The chlorine in the solution had a solvent action on dead cells, which prevented the accumulation of bacteria in open wounds.
(As an aside, both sides in the war were also using chlorine in gaseous form as an anti-personnel weapon!)
Today, Dakin’s solution is still considered effective enough to be used after surgery and on chronic wounds, like bedsores, by many practitioners. It’s easily prepared and can be made stronger or milder by varying the amount of bleach used. Use it simply to clean the wound during dressing changes by pouring onto the affected area, or to moisten dressings used in an open wound.
Dakin’s Solution Recipe
To make Dakin’s solution, you’ll need just a few items. This recipe is from Ohio State University’s Department of Inpatient Nursing:
- Unscented household bleach (sodium hypochlorite solution 5.25%, avoid more concentrated versions).
- Baking soda (sodium bicarbonate)
- A pan with a lid
- Sterile measuring cup and spoon (sterilize by boiling)
- Sterile canning jar and lid
Of course, wash your hands beforehand, just as you would with any medical procedure. Then:
1. Put 4 cups (32 ounces) of water into the pan and cover with the lid.
2. Boil the water for 15 minutes with the lid on.
3. Remove from the heat source.
4. Use the sterile spoon to add ½ teaspoon of baking soda to the water.
5. Add bleach (sodium hypochlorite 5.25%) in the amount needed (see below).
6. Pour into sterile canning jar and close with a sterile lid.
7. Label and store in a dark place.
The amount of sodium hypochlorite to add:
Full Strength (0.5%): 95 ml (about 3 oz. or 6 tablespoons)
Half Strength (0.25%): 48 ml (3 tablespoons plus ½ teaspoon)
!/4 Strength (0.125%): 24 ml (1 tablespoon plus 2 teaspoons)
1/8 Strength (0.0625%): 12 ml (2 ½ teaspoons)
Note: 3 teaspoons = 1 tablespoon = 14.7 ml; 2 tablespoons = 1 US ounce = 29.5 ml
Once canned, it’s been said that Dakin’s solution will remain potent for about 30 days. For survival purposes, however, I would make it as I need it for wounds or maybe have just make just a few jars at a time. Once open, discard the remainder after a day or so.
You may also consider Century Pharmaceutical’s buffered version of Dakin’s. The company states that they have tested their solutions and found unopened (and opened bottles below) bottle shelf life results:
“Product Shelf life based on thousands of stability studies performed in the past:
Dakin’s Full Strength® (0.50%) — 12 months Dakin’s Half Strength® (0.25%) — 24 months Dakin’s Quarter Strength® (0.125%) — 24 months Di-Dak-Sol® (0.0125%) — 24 months
How long does Dakin’s Solution® last once the bottle has been opened? Recently we performed a study that provides a high degree of assurance that once any Dakin’s product is opened it can be kept open for at least 2-3 months and still maintain its stability. However, the bottle must be kept free of contamination while open, and must be stored at room temperature and protected from light, as stated on the label.”
Using Dakin’s Solution on Wounds
Pour into wound once daily for mildly infected wounds, twice daily for heavily infected wounds with drainage of pus. Alternatively, moisten (not soak) dressings used inside the wound (not on top of the skin) with a mild strength solution and observe progress. I would prefer using it as a cleanser as opposed to a regular component of a wet dressing. Some studies show that use in this manner may be injurious to developing cells. Having said that, if you’re dealing with a severe infection (as opposed to preventing one), it may be reasonable to incorporate Dakin’s into the dressing.
Dakin’s solution can be used as a mouthwash for infections inside the oral cavity, but must never be swallowed. Swish for about a minute before spitting it out no more than twice a week.
Full strength may irritate skin, so consider protecting skin edges with petroleum jelly or other skin protectant/moisture barrier. Look for evidence of skin rashes, burning, itching, hives, or blisters. If irritation occurs, drop down to a milder strength or discontinue. Do not use in those allergic to Chlorine.
It should be noted that not all practitioners agree about the benefits of Dakin’s solution. Certainly, there may be other options with regards to regular wound care, including sterile normal saline and sterilized tap water. Antibiotics also play an important role in treating infected wounds, and a good supply is important for any medic in a remote setting. However, Dakin’s is well tolerated by patients and is simple to make with affordable ingredients. It’s another tool in the medical woodshed for scenarios where modern medical help is not on the way.
Joe Alton MD
Learn about wound infections and 150 more medical topic in remote or disaster settings by getting a copy of our 700 page third edition of The Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way.