Comparative Efficacy of Hypochlorous Acid and Mafenide Acetate in Reducing Infection Rates in Postoperative Burn Patients: A Retrospective Cohort Study

Abstract Infection is a leading cause of mortality in patients with third-degree burns, contributing to over 75% of burn-related deaths. Despite the widespread use of hypochlorous acid and mafenide acetate as wet dressings in burn care, direct comparisons of their effectiveness are limited. Thus, this study evaluates the relative efficacy of hypochlorous acid and mafenide acetate in managing infections and improving survival outcomes in postoperative burn patients. This retrospective study included adults with second and third-degree burns who underwent excision and grafting between January 2012 – February 2024 at an American Burn Association-verified burn center. Infection, mortality, length of stay, number of operations, and complications were compared across initial antiseptic treatment using chi-square and Mann-Whitney tests. The study cohort comprised 274 patients, the majority of whom sustained flame burns (63.1%), with an average total body surface area burned of 11.2±13.7%. Within the cohort, 88.7% received mafenide acetate and 11.3% hypochlorous acid. Thirteen patients (41.9%) who received hypochlorous acid developed an infection requiring antibiotics, which on average, took 6.85±5.71 days to develop. This was not statistically different from those in the mafenide acetate group, of which 90 patients (37.0%) developed an infection (p=0.5840) which took 6.50±8.47 days to develop (p=0.4436). Mortality was also not significantly different between groups. No significant differences were found between hypochlorous acid and mafenide acetate in infection, mortality, or morbidity outcomes. Both treatments are viable antiseptic options for postoperative burn care, and clinicians can be flexible in choosing either treatment based on patient needs, cost, or availability without compromising care quality.