The Importance

of Acidic pH on
Wound Healing
Why All the (pH)uss About
Microenvironments?
By Martha Kelso, RN, HBOT, CEO, WCP
 The Importance of Acidic pH
on Wound Healing
Why All the (pH)uss About
Microenvironments?
By Martha Kelso, RN, HBOT, CEO, WCP

The Wound Microenvironment Benefits of Acidic pH

Every wound or ulcer has factors that influence the wound Chronic wounds are ideal microenvironments for bacterial
bed environment and how it reacts. Many of these factors growth. In fact, bacterial infection is one of the most preva-
occur at a microscopic level and therefore can be referred lent causes of poor wound healing. Wound bed bacteria can
to as the wound microenvironment. Inside this microenvi- spread into surrounding tissue, resulting in a localized in-
ronment, factors are at play that influence whether a wound fection. If that infection is left untreated, the spread of bac-
heals or becomes chronically stalled. teria can result in a systemic infection. The cost associated
with wound infections and/or sepsis can be extraordinary.
The microenvironment is critical to healing or delay of wound Treating the side effects of antibiotic usage also can be ex-
healing. For example, elements inside the microenvironment pensive. Research shows that an alkaline pH in the wound
determine whether the wound becomes colonized versus bed can contribute to creating an unsuitable environment
critically infected. Those same elements determine whether for healing by encouraging the growth of pathogenic bacte-
proteases (i.e. MMPs) create prolonged inflammation and ria. In contrast, an acidic wound bed can stunt pathogenic
therefore delay wound healing. bacteria growth and keep the wound bed microenvironment
in check and moving toward the desired healing trajectory.
Another important consideration is the oxygen level . Is there
enough oxygenation? Are we stunting oxygenation or pro- In chronic wounds, an imbalance often exists between how
moting adequate oxygenation to our wound microenviron- much oxygen the tissue needs to regenerate or heal versus
ment? Is our wound microenvironment promoting positive how much oxygen is readily available to help with the task.
wound healing factors through the pH of the wound or are Inadequate oxygenation can slow the healing process or
we allowing wounds to become chronically stalled? These cause the wound to stall completely. Lack of oxygen also
factors are relevant for consideration and these questions can encourage other types of anoxic bacteria to proliferate
are valid when considering influences on the healing pro- in the wound, further damaging or destroying the already
cess (or lack thereof). As clinicians and nurses, we should suffering microenvironment. An acidic pH can improve the
be cognizant of these factors or elements, recognize their tissue oxygenation, which is an essential condition for suc-
importance, and understand how to mitigate their existence cessful wound healing.
in favor of a positive outcome.
 Saline solution encourages removal of microorganisms and
biological and environmental debris. Most saline solutions,
however, do not contain a preservative. Saline solution is not
cytotoxic but it is not bactericidal either. Once applied to the
wound, bacterial growth can occur and expose the wound
to opportunistic microorganisms. Hypochlorous acid, on
the other hand, is produced naturally by the body’s immune
cells in response to invading pathogens. When used as a
wound cleansing agent, it acts as a preservative by inhib-
iting the growth of microorganisms within the solution and
therefore within the wound microenvironment.

Ideally, your wound cleansing agent would not contain

any sodium hypochlorite (NaOCl) since this can increase
the solution’s pH. We don’t want to harm healthy tissue
or healthy skin. Instead, we want to establish the ideal mi-
croenvironment and support the physiological healing pro-
When considering stalled tissue in the microenvironment, cess. Removing inflammatory stimulants and local barriers
consider removing others culprit, such as MMPs, that can is ideal. Preservation of tissue safety is a key component
lead to delayed wound healing when present in excess of balancing or modulating the wound microenvironment.
by suppressing tissue proliferation and migration. A more This balance can be achieved when using an ideal wound
acidic environment can reduce the activity of MMPs and cleanser. Reach for an acidic noncytotoxic bactericidal
restore the healing state in the wound. Bacterial biofilm can cleansing agent for your wound cleansing practices.
maintain prolonged inflammation in the wound microenvi-
ronment, ultimately leading to the failure of wound healing. Science
Conversely, an acidic environment can reduce the growth Hypochlorous acid can easily penetrate pathogenic cells
rate of bacterial load in the biofilm. and destroy them from the inside. Because pathogen’s
cell was are negatively charged, sodium hypochlorite (also
Most wound beds are predominately alkaline; however, an known as Dakin’s solution) cannot easily penetrate them. At
acidic wound bed has a positive influence on wound heal- the same concentration, the biocidal activity of hypochlor-
ing. Healthy skin has a slightly acidic pH, ranging from 4.0 ous acid is 80 times stronger than sodium hypochlorite. De-
to 6.3. The chronic wound generally has an alkaline pH, spite hypochlorous acid and sodium hypochlorite looking
ranging from 7.15 to 8.93. Wounds with an alkaline pH have similar, they are still quite different. Keep in mind that hy-
demonstrated lower rates of healing. An acidic environment pochlorous acid is one of the major inorganic bactericidal
in a wound bed is an additional benefit that can reboot the compounds of innate immunity and is effective against a
wound towards healing. broad range of microorganisms.

Ideal Wound Cleansing

Incorporating a wound cleanser that encourages a shift of
the wound bed microenvironment from chronically stalled
to healing is prudent. Cleansing of a wound is generally
performed to remove surface contaminants, bacteria, non-
viable tissue, and exudate from the wound bed and sur-
rounding skin. With the right cleansing agent, you also can
effectively remove stimulants and localized barriers (as re-
viewed above) in the wound microenvironment to get the
healing process moving. In addition, by choosing the right
cleanser, healthy cells and tissue can be safely preserved
and even stimulated to continue growing.

Research has shown that antiseptic wound cleansers have

a negative impact on healing. Some examples of antiseptic
products included in these studies are alcohols, iodine, ch-
lorhexidine gluconate, silver, and hydrogen peroxide. Prod-
ucts that are cytotoxic damage human cells and/or wound
tissue and consequently slow down or stall wound healing. Indications and Application
Bactericidal properties in a wound cleanser do not have to Nexodyn, one brand of hypochlorous acid, has been cleared
be cytotoxic. by the Food and Drug Administration (FDA) for several indi-
cations, including leg ulcers, stasis ulcers, diabetic ulcers,
Stage I-IV pressure ulcers, postsurgi- The antimicrobial preservative effectiveness of hypochlorous acid has been
cal wounds, grafted and donor sites, demonstrated against the organisms in the table below with in vitro testing
1st and 2nd degree burns, minor cuts, (Time Kill Assay):
minor burns, superficial abrasions,
and minor skin irritations. Nexodyn
should be used with each dressing
change. The whole ulcer or wound
should be abundantly sprayed with
Nexodyn then allowed to dry. No rins-
ing is required. Additional applications
of Nexodyn can be repeated consec-
utively if necessary or desired. Once
the solution has dried in the wound
bed, you can then follow with your
standard dressing change as ordered.
Nexodyn does not harm the skin if
sprayed outside the wound.

Martha Kelso, RN, HBOT, CEO, WCP Wound Care Plus, LLC, is the founder
and Chief Executive Officer of Wound Care Plus, LLC (WCP). As a visionary and
entrepreneur in the field of mobile medicine, she has operated mobile wound care
practices nationwide for many years. She enjoys educating on the art and science
Conclusions of wound healing and how practical solutions apply to healthcare professionals
Nexodyn is an FDA-cleared hypo- today. Martha enjoys being a positive change in healthcare impacting clients suf-
chlorous acid-based wound cleanser fering from wounds and skin issues of all etiologies.
developed for the topical treatment
and use in the field of acute and chron-
ic wound management. This version
of hypochlorous acid has a desired
acidic pH of 2.5-3.0 as well as a high
purity of free chlorine species derived
from HClO. The free chlorine species
has 40-70 ppm and long stability of 30
days from first date of opening.
Editor’s note: Access a recording of The Role of Wound
Despite the bactericidal activity of Cleansing in the Management of Wounds webinar.
Nexodyn being fast and effective to
the bacteria listed at the end of this This white paper has been produced through collabora-
article, it is not cytotoxic to human tion between Wound Care Advisor, Angelini Pharma, and
cells at the 40-70 ppm. An additional the author.
benefit is how fast and simple apply-
ing Nexodyn is when used for wound Link to The Role of Wound Cleansing in the Management
irrigation during your normal treatment of Wounds webinar:
https://woundcareadvisor.com/webinar-innovations-in-wound-care/
regimen. Nexodyn is a cost-effective
solution for wound cleansing with
many benefits that should be incor-
porated into your daily wound routine
and cleansing practice. Choosing this
wound cleansing agent will benefit the
wound microenvironment, encourage
wound healing through modulation of
key wound factors that could stall out
wound healing, and is easy to use.