{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T14:13:49Z","timestamp":1788444829107,"version":"build-2803163510"},"reference-count":12,"publisher":"BMJ","issue":"7","license":[{"start":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T00:00:00Z","timestamp":1783987200000},"content-version":"unspecified","delay-in-days":13,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,6,30]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Surgical site infections (SSIs) impose a significant clinical and economic burden on the healthcare systems. To date, traditional preventive strategies have frequently failed to demonstrate definitive efficacy. Hypochlorous acid (HOCl) has emerged as a compelling antimicrobial alternative, characterised by potent microbicidal properties and excellent biocompatibility. Hypoclates:Peritonitis investigates the clinical impact of an HOCl-based lavage strategy in patients undergoing surgical treatment for secondary peritonitis. The trial evaluates the primary endpoint of postoperative SSI incidence up to day 10 (\u00b12 days), hypothesising that the antimicrobial and biocompatible properties of HOCl significantly lower infection rates compared with standard isotonic lavage.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using a sequential, quasi-experimental design, this mono-centric study assesses the clinical impact of adopting an intensified, multi-day HOCl-lavage protocol (Granudacyn) for patients with secondary peritonitis. We will compare a prospective intervention group (n\u2248100) against a preceding cohort of equal size that received standard isotonic irrigation. The primary endpoint is defined as the frequency of SSIs\u2014inclusive of superficial, deep and organ\/space infections according to Centers for Disease Control and Prevention criteria\u2014monitored through hospital discharge or up to postoperative day 10 (\u00b12 days). Secondary evaluative measures include the length of intensive care unit and total hospital stay, the duration of postoperative antibiotic therapy and the cumulative morbidity burden as calculated by the Comprehensive Complication Index.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Ethical clearance for this trial was provided by the Institutional Review Board of the Medical Faculty of Heidelberg University (S-523\/2025). To facilitate knowledge transfer and evidence-based practice, the study results will be presented at international scientific meetings and published in peer-reviewed journals, thereby contributing to the refinement of SSI prevention protocols in emergency visceral surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>German Clinical Trials Register (DRKS), DRKS00038630.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-119499","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T17:05:46Z","timestamp":1784135146000},"page":"e119499","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["HYPOChLorous Acid TEsting Studies in secondary peritonitis (Hypoclates:Peritonitis): extended hypochlorous acid versus isotonic lavage for the prevention of surgical site infections in secondary peritonitis in Germany \u2013 protocol for a sequential, quasi-experimental cohort study"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-4549-6392","authenticated-orcid":false,"given":"Tobias","family":"Hoch Al Hessen","sequence":"first","affiliation":[{"name":"Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany"},{"name":"Witten\/Herdecke University, Witten, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-9702-5982","authenticated-orcid":false,"given":"Niels","family":"Siegel","sequence":"additional","affiliation":[{"name":"Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-1509-0377","authenticated-orcid":false,"given":"Mika P","family":"Nadvornik","sequence":"additional","affiliation":[{"name":"Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany"},{"name":"Heidelberg University Medical Faculty Heidelberg, Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Axel","family":"Kramer","sequence":"additional","affiliation":[{"name":"Institute of Hygiene and Environmental Medicine, Universit\u00e4tsmedizin Greifswald, Greifswald, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan M","family":"Harnoss","sequence":"additional","affiliation":[{"name":"Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0895-4015","authenticated-orcid":false,"given":"Pascal","family":"Probst","sequence":"additional","affiliation":[{"name":"Department of Surgery, Cantonal Hospital Thurgau, Frauenfeld, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Al-Saeedi","sequence":"additional","affiliation":[{"name":"Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Loos","sequence":"additional","affiliation":[{"name":"Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph W","family":"Michalski","sequence":"additional","affiliation":[{"name":"Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian C","family":"Harnoss","sequence":"additional","affiliation":[{"name":"Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,15]]},"reference":[{"key":"2026090306254325000_16.7.e119499.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhin.2008.04.020"},{"key":"2026090306254325000_16.7.e119499.2","article-title":"Intracavity lavage and wound irrigation for prevention of surgical site infection","volume":"10","author":"Norman","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"key":"2026090306254325000_16.7.e119499.3","doi-asserted-by":"crossref","DOI":"10.1186\/s13063-022-06975-6","article-title":"Peritoneal antiseptic irrigation to prevent surgical site infection after laparotomy for hepatobiliary or gastrointestinal surgery (PAISI)-protocol for a randomized controlled study","volume":"23","author":"Mueller","year":"2022","journal-title":"Trials"},{"key":"2026090306254325000_16.7.e119499.4","doi-asserted-by":"crossref","unstructured":"Tran K , Spry C . Antimicrobial or antiseptic cleansers for wounds: cadth health technology review. Ottawa (ON), 2023.","DOI":"10.51731\/cjht.2023.671"},{"key":"2026090306254325000_16.7.e119499.5","doi-asserted-by":"crossref","DOI":"10.1186\/s12893-025-02774-3","article-title":"Wound irrigation and peritoneal lavage with antiseptic\/antibiotic solution before wound closure during gastrointestinal surgery: a systematic review and meta-analysis","volume":"25","author":"Uchino","year":"2025","journal-title":"BMC Surg"},{"key":"2026090306254325000_16.7.e119499.6","unstructured":"World Health Organization . Global guidelines for the prevention of surgical site infection. Geneva, Switzerland, 2018."},{"key":"2026090306254325000_16.7.e119499.7","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1111\/wrr.12689","article-title":"Irritative potency of selected wound antiseptics in the hen\u2019s egg test on chorioallantoic membrane to predict their compatibility to wounds","volume":"27","author":"Harnoss","year":"2019","journal-title":"Wound Repair Regen"},{"key":"2026090306254325000_16.7.e119499.8","article-title":"Antimicrobial efficacy, mode of action and in vivo use of hypochlorous acid (HOCl) for prevention or therapeutic support of infections","volume":"18","author":"Boecker","year":"2023","journal-title":"GMS Hyg Infect Control"},{"key":"2026090306254325000_16.7.e119499.9","doi-asserted-by":"crossref","DOI":"10.2340\/actadv.v102.1624","article-title":"Effect of Stabilized Hypochlorous Acid on Re-epithelialization and Bacterial Bioburden in Acute Wounds: A Randomized Controlled Trial in Healthy Volunteers","volume":"102","author":"Burian","year":"2022","journal-title":"Acta Derm Venereol"},{"key":"2026090306254325000_16.7.e119499.10","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s00104-015-0121-x","article-title":"Die chirurgische Therapie der sekund\u00e4ren Peritonitis. Ein weiter andauerndes Problem. [Surgical treatment of secondary peritonitis: A continuing problem]","volume":"88","author":"van Ruler","year":"2017","journal-title":"Chirurg"},{"key":"2026090306254325000_16.7.e119499.11","first-page":"310","article-title":"Perioperative Antibiotic Prophylaxis and Antimicrobial Therapy of Intra-Abdominal Infections","volume":"30","author":"Hagel","year":"2014","journal-title":"Viszeralmedizin"},{"key":"2026090306254325000_16.7.e119499.12","unstructured":"European Parliament and Council of the European Union . Regulation (EU) 2016\/ 679 of the european parliament and of the council - of 27 april 2016 - on the protection of natural persons with regard to the processing of personal data and on the free movement of such data, and repealing directive 95\/ 46\/ EC (general data protection regulation). 2016."}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2026-119499","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T13:26:21Z","timestamp":1788441981000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2026-119499"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":12,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7,15]]},"published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1136\/bmjopen-2026-119499"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2026-119499","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]}}}