DIY DAKIN`s SOLUTION | Wounds Africa

DIY Dakin`s solution: Is it still relevant today?

What is Dakin`s solution?

Dakin`s solution is not much more than diluted bleach (a dilute aqueous solution of sodium hypochlorite -NaOCl). While its recipe is simple, it has played a pivotal role in the history of wound care. It was developed in 1915, during World War I, by the English biochemist Henry Drysdale Dakin (1880–1952), in collaboration with Dr. Alexis Carrel (1873–1944), a French surgeon. The aim was to create a wound antiseptic that was both bactericidal and less toxic to human tissues than existing agents such as carbolic acid and previous formulations of iodine. Consider that antibiotics were not invented then, and using topical antiseptics in battlefield wounds could be limb- and life-saving.

Figure 1. Henry Dakin and Alexis Carrel. The image is from an interesting article published by James Patton on the University of Kansas Medical School website. Click on the image above to read the full article that sheds more insight into these two scientists. Source: https://www.kumc.edu/school-of-medicine/academics/departments/history-and-philosophy-of-medicine/archives/wwi/essays/medicine/dakins-solution.html

Figure 2. While Henry Dakin formulated the solution, Alexis Carrel developed a system to deliver it to the wound. The latter consisted of a vial containing the solution and a tube delivering it into the wound. The tube could be adapted to fit several arms to irrigate more complex wounds.

The original Dakin's solution was a 0,5% bleach solution to which 4% boric acid was added as a buffer since sodium hypochlorite is caustic. The boric acid helped keep the pH stable. Dakin and Carrel discovered that infections were more readily prevented by irrigating the wounds with the solution at regular intervals, usually every two hours. This intermittent wound irrigation with Dakins solution was known as the Carrel-Dakin method and became the standard of care in Allied military hospitals during the war. Sometimes the solution was poured into wounds, but when there was undermining or sinuses, the solution was led to the depth of the wound cavity by a drain. The treatment dramatically reduced mortality, amputations, and the incidence of gas gangrene in battlefield injuries. Carrel and Dakin's collaborative work was widely disseminated, including their influential 1917 publication, "The treatment of infected wounds," in the British Medical Journal.

Following the war, Dakin's solution remained in clinical use but began to decline with the advent of systemic antibiotics such as sulfonamides in the 1930s and penicillin in the 1940s. These drugs offered systemic infection control, reducing the need for continuous topical antiseptic irrigation. Moreover, the limitations of Dakin's solution became more apparent over time, including its tissue toxicity at higher concentrations, labor-intensive application protocols (needing to be applied often), and short shelf life.

By the 1960s and 1970s, the principles of moist wound healing and the development of non-cytotoxic topical agents shifted the standard of care away from chemical antiseptics like Dakin's.

Dakin`s solution: contemporary relevance

Interest in hypochlorite-based solutions re-emerged in the 1990s and 2000s due to rising rates of chronic wounds, biofilm-related infections, and multidrug-resistant organisms (e.g., MRSA). Recent studies have demonstrated that diluted formulations (typically 0.025–0.125%) retain antimicrobial efficacy while minimizing cytotoxic effects on fibroblasts and keratinocytes.

With our increasing knowledge of the role of biofilms in chronic wounds, it is exciting to see whether bleach has superior biofilm-disrupting properties compared to other antimicrobial solutions. The available literature shows that Dakin`s solution with concentrations ≥ 0.125% (0.125 mg/mL NaOCl) is a reasonable anti-biofilm product, but not necessarily superior to other topical antimicrobial products.

Figure 3. Dakin`s solution is available commercially in several countries. Since the formulation is not patentable, anyone can make it and sell it under the respective regulations of their country. In Europe, Dakin`s solution is not widely used. In the United States, however, Dakin`s solution still has quite many users, and Century Pharmaceuticals provides a range of concentrations.

Today, Dakin’s solution is commercially available in the United States and is FDA-cleared as a medical device (e.g., Dakin’s Wound Cleanser 0.125%). In modern formulations of Dakin`s solution, Boric acid is no longer used since it may have tissue-irritating properties; it has been substituted by more modern buffering methods. However, higher strength formulations (0.5%) are not FDA-approved as drugs and may pose a greater risk of tissue damage if used inappropriately.

So, back to the critical question: Is there still a role for Dakin`s solution in modern wound care today? No and yes - probably in that order. We have done a thorough deep dive into the available literature on this topic and have not become much wiser. You will find several case studies of severe, limb-threatening wounds that were saved with Dakin`s solution. However, we lack well-designed studies and do not have decisive evidence that merits the routine use of Dakin`s in chronic wound care. On the other hand, given that Dakin`s has a long track record dating all the way back to 1915, it appears to be a safe product, mainly when used in weaker formulations.

We know that wound healing prefers a slightly acidic environment. Dakins solution on the other hand,is an alkaline product with a pH of between 9-10. The theory is a trade-off situation: antimicrobial power versus ideal healing environment. Dakin’s solution is not primarily used to promote healing directly — it is used to reduce heavy bioburden. At high pH, hypochlorite (OCl⁻) is more stable and effective at disrupting cell membranes, proteins, and DNA. The alkaline pH helps Dakin’s penetrate biofilms and denature bacterial toxins.So although it’s not ideal for granulation or epithelialization, "it clears the battlefield" so those phases can resume. Again, we have other irrigation solutions in our arsenal that also have good antimicrobial properties without the potential cytotoxicity. So Dakin`s position as an wound irrgation solution is still debatable.

The World Union of Wound Healing Societies (WUWHS) and the European Wound Management Association (EWMA) have concluded that there may be a limited place for weak formulations of Dakin`s solutions in modern wound care. It may have a niche role—used selectively for critically colonized, malodorous, or necrotic wounds where the microbial burden impedes healing. Furthermore, it may still have an important role in areas with limited resources since it can be readily and cheaply made anywhere: you only need clean water and bleach.

Figure 4. A simple online search will find several interesting case studies where Dakin`s solution was used in critical wounds with good results. Click on the image above to get to the original article: Source: https://pmc.ncbi.nlm.nih.gov/articles/PMC7949605/

Conclusion:

Dakin`s solution still seems popular among some wound care providers, particularly in the United States. It is recommended not to use a concentration higher than 0.125%. However, the solution has largely been supplanted by newer, more tissue-compatible antiseptics such as hypochlorous acid (HOCl)-based solutions (e.g., Microdacyn), polyhexamethylene biguanide (PHMB), and modern variations of iodine. In our experience, the latter provides reliable results in critically colonized, malodorous, and necrotic wounds. The key to getting good results with any antiseptic solutions is to apply them regularly, at least several times daily. This was already discovered by Dakin and Carrel, who over 100 years ago advised irrigating the wounds every two hours. Today, most antiseptic products also come in a gel formulation, which increases application intervals and thus makes them more practical in clinical use.

At our clinic, we have never used Dakin`s solution, so we have no hands-on experience with this product. We have hydrochloric acid-based solutions, PHMB, and iodine products, and we feel that this covers our needs.

Incidentally, when we use negative pressure treatment with irrigation (iNPWT), there is no consensus on which irrigation solution is best suited. iNPWT is an interesting concept since it allows for regular wound irrigation, making it an ideal setting to try different solutions. Our clinic has attempted 0,9% saline, hypochlorous acid, PHMB solutions, 2% vinegar, and 2% iodine solutions as irrigation solutions in >200 patients. We have not seen any apparent differences and usually use regular 0,9% saline as our default irrigation fluid. Concerning Dakin`s solution for irrigation with iNPWT, we only found limited case studies and one pilot study.

An important aspect of Dakin`s solution is that it is very cheap. This makes it a good choice for wound care in regions with few other resources. Below is a recipe for making Dakin`s solution.

In conclusion, we find that Dakin`s solution may retain a limited but potentially valuable role in contemporary wound care when used judiciously and at appropriate concentrations (0.125%). It should not be used as a routine wound rinse for wounds that are not critical.

Figure 3. Chlorine and bleach are the same product. There are a confusing number of household bleaches available on the market. Most of them are at 5-6% concentrations. Ensure to use a product containing pure chlorine/bleach (NaOCl). Pool chlorinating liquid is not suitable as it includes many other ingredients!

How to make Dakin`s solution yourself

Homemade Dakin`s solution can be made with or without baking powder as an additive. We recommend you use the recipe that includes baking powder for two reasons. The chlorine in the diluted form is quite unstable. The baking powder is a buffer, making the solution more stable and extending its shelf life. Dakin`s solution without baking powder only has a shelf life of 24-48 hours. With added baking powder, Dakin`s solution can be stored for 5-7 days.

Furthermore, buffering with baking powder makes the solution less harsh on skin and tissues. The literature states that homemade Dakin`s solution has a shelf life of 24-48 hours( unbuffered) and 5-7 days (buffered), respectively. We recommend you use the shortest shelf life numbers. In other words, we recommend a 24-hour shelf life for the solution without baking powder and a 5-day shelf life for the solution with baking powder.

By the way, baking powder is mainly sodium bicarbonate but may include other agents (like cornstarch or acids). These additives are not considered harmful to tissues ( after all, we eat them in baked goods), and many use regular baking powder to make Dakin`s solution. However, pure sodium bicarbonate is preferred in clinical settings for more accurate buffering and sterility.

The recipes below are to make 1 litre of Dakin`s 0.125% solution:

Recipe 1: With Baking Powder (Buffered)

To sterilize, boil water for 15–20 minutes (if using tap water). Cool to room temperature.
Measure 24 mL of 5.25% bleach and pour into a clean glass container.
Add 976 mL of sterile/distilled/cooled boiled water.
Add ~1/8 teaspoon of baking powder (or ~0.4 g sodium bicarbonate).
Mix gently until fully dissolved.
Label the container with:
- “Dakin’s Solution 0.125%”
- Date of preparation
- “Store in refrigerator; discard after 5–7 days.”

Recipe 2: Without Baking Powder (Unbuffered)

Follow steps 1–3 as above.
Skip step 4 (no baking powder).
Label the container with:
- “Dakin’s Solution 0.125% – Unbuffered”
- Date of preparation
- “Use within 24–48 hours.”

Storage Instructions

Store in the refrigerator in an amber glass or opaque container.
Keep out of the reach of children
Do not use if discolored, cloudy, or smells strongly of chlorine.
Discard after:
- 24–48 hours (unbuffered) and refrigerated
- 5–7 days (buffered and refrigerated)

References

Carrel A, Dakin HD. On the treatment of infected wounds. Br Med J. 1917;1(2937):318–21.
Lineaweaver W, Howard R, Soucy D, McMorris S, Freeman J, Crain C, et al. Topical antimicrobial toxicity. Arch Surg. 1985;120(3):267–70.
McDonnell G, Russell AD. Antiseptics and disinfectants: activity, action, and resistance. Clin Microbiol Rev. 1999;12(1):147–79.
Kramer A, Dissemond J, Kim S, Willy C, Mayer D, Papke R, et al. Consensus on wound antisepsis: update 2018. Skin Pharmacol Physiol. 2018;31(1):28–58.
Kassel R, Triplet J, Gwinn M. Evaluation of low-concentration hypochlorite solutions for use in wound care. J Wound Ostomy Continence Nurs. 2017;44(3):273–9.
Lipsky BA, Hoey C. Topical antimicrobial therapy for treating chronic wounds. Clin Infect Dis. 2009;49(10):1541–9.
Hijazi K, Lowe T, Meharg C, Berry SH, Foley J, Hold GL. Microbial biofilms in chronic wounds: microbiology, biomarkers and antimicrobial therapy. J Wound Care. 2016;25(1):S1–11.
Century Pharmaceuticals. Dakin’s Wound Cleanser [510(k) Summary – K150208]. U.S. Food and Drug Administration; 2016. Available from: https://www.accessdata.fda.gov
Thorn RM, Greenman J. Hypochlorous acid, hypochlorite and chloramines as antimicrobials for wound care: a review. J Wound Care. 2020;29(7):354–63.
Armstrong DG, Bohn G, Glat P, Lalonde C, Mandeville R, Sarnow M. Efficacy and safety of a superoxidized solution in the management of chronic wounds. Adv Skin Wound Care. 2005;18(7):373–6.