Procedure for the use of Potassium
Permanganate soaks in Primary Care
Guidance for Community–based Healthcare
Professionals
Written by Julie Hewish, Senior Tissue Viability Nurse
January 2015
The content and structure of this procedure have been adapted with kind permission from
Helen Harris, Tissue Viability Nurse, Bath and North East Somerset NHS Trust.
Procedure for the use of Potassium Permanganate soaks in
Primary Care
Page
Introduction
3
What is Potassium Permanganate used for?
3
Page 2 of 8
Precautions
3-4
Instructions for use
5-7
Audit and review
7
References
7
Final Version: 15th January 2015: Community Tissue Viability Service
Procedure for the use of Potassium Permanganate soaks in
Primary Care
Potassium permanganate is often prescribed for weeping, exuding skin or for blistered areas
that require drying up. It is available as a solution for further dilution and as a tablet
preparation, which is dissolved in water and further diluted to a specified concentration.
This product is for external use only and can be fatal if ingested orally due to local
inflammatory reactions that block the airways or cause perforations of the gastrointestinal
tract. This can also lead to death through toxicity and organ failure (NHS England, 2014)
(appendix 1)
Potassium permanganate must not be used as a first line, stand-alone treatment. Investigations
to identify and manage underlying causes of skin deterioration and/or increased exudate
levels must be carried out in order to implement a holistic management plan. Potassium
permanganate must only be used when all standard treatments have been exhausted. This
treatment is usually instigated under the guidance of Dermatology or Tissue Viability.
1.0 BACKGROUND
Potassium permanganate is an oxidising agent with disinfectant, deodorising and astringent
properties. Its chemical formula is KmnO4. In its raw state potassium permanganate is an
odourless dark purple or almost black crystal, granular powder or tablet. The main form of
use is a potassium permanganate solution that is made by dissolving crystals or powder in
water. Within the Oxford Health NHS Foundation Trust the more convenient tablet form is
used to prepare topical solutions.
3.0 PRECAUTIONS

Potassium permanganate is dispensed as tablets and concentrated solutions are caustic
and can burn the skin. Even fairly dilute solutions can irritate skin and repeated use
may cause burns. Staff must therefore ensure that they wear the appropriate protective
clothing when working with potassium permanganate (see Section 4). Potassium
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Procedure for the use of Potassium Permanganate soaks in
Primary Care
permanganate presents in tablet form which must not be handled as it can stain the
skin and turn nails brown but this does resolve. It can be fatal if the tablets or diluted
solution is ingested

Potassium Permanganate stains floor surfaces, clothing and carpets permanently.

Avoid contact with the eyes and buccal mucosa.

Do not use soap or detergent in conjunction with treatment as this will react with the
solution which will discolour and give off an unpleasant odour.

Any leftover tablets should not be disposed of via household waste. Any excess
tablets should be returned to a pharmacy for disposal. This may be done by a
responsible family member, the patient or the District Nursing Team based upon a
robust clinical risk assessment for safe disposal.

Do not store any excess diluted solution. The solution should be made up just before it
is to be used. If the solution is left, it will start to oxidise and go brown after which
time it should not be used. This may also increase the risk of accidental ingestion.
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Procedure for the use of Potassium Permanganate soaks in
Primary Care
PROTOCOL FOR USE
Potassium Permanganate should be used in practice according to the manufacturer’s
instructions and the patient’s prescription.
Potassium Permanganate soaks are for external use only and can be fatal if ingested orally
due to local inflammatory reactions that block the airways or cause perforations of the
gastrointestinal tract. This can also lead to death through toxicity and organ failure (NHS
England, 2014) (Appendix 1)
Prior to administration:

This product should be prescribed for a patient following guidance from a specialist
team

Treatment should be supported by a clear care plan that reflects the instructions given
within this clinical protocol. This should be available within the patients notes.

There should be relevant documentation to support medicine administration (e.g Pink
Form for District Nurses).

This product should be stored and used in line with this clinical protocol and
manufacturers recommendations. Both the tablets and solution could be mistaken for
sweets or a harmless drink. Children and cognitively impaired individuals are
particularly vulnerable.

Therefore a documented clinical risk assessment and management plan relating to
safe administration and excess tablet disposal should be available in the patient’s
notes.

Ensure patient informed consent prior to administration.

Read the manufacturers guidance on administration and dosage carefully
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Procedure for the use of Potassium Permanganate soaks in
Primary Care
Equipment required: Disposable cups, washing up bowl or bucket, bin liner, (preferably
white to visualise colour of solution), disposable apron and gloves.
• Clean your hands (see standard infection prevention and control policy)
• Wear non sterile examination gloves to prevent contact of tablet with skin
• In line with manufacturer’s dilution guidance, drop one tablet into a disposable cup and fill
with warm tap water to allow the tablet to start dissolving.
Caution: Sometimes potassium permanganate tablets are halved for perceived smaller amounts of
solution. This must be carried out with extreme caution as the chemical is an irritant to mucus
membranes and splitting the tablets will affect the accuracy of the dilution.
• At all times ensure the tablet does not drop into the bowl or come into contact with the skin.
• Line a washing up bowl or bucket with a bin liner and fill with warm tap water.
• When the solution in the cup has gone very dark (the tablet will still be dissolving),
carefully add this concentrate to the washing up bowl or bucket.
• Do not allow the dissolving tablet to fall into the bowl
• The resultant colour in the bowl should be transparent rose pink/purple – NOT DARK
PURPLE.
• If the resultant solution is too light in colour, add more tap water to the remainder of the
tablet in the disposable cup and add to the solution in the washing up bowl.
• If the resultant solution is too dark in colour, discard some solution and add more tap water.
• Immerse the limb in the solution for 10 minutes.
A potassium permanganate solution of 1 in 1000 may be used as wet soaks to blistering
wounds or skin. Strips of dressing pack gauze should be soaked in the solution and wrapped
around the affected area for 20-30 minutes (DermNet, 2013, accessed 7/1/15)
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Procedure for the use of Potassium Permanganate soaks in
Primary Care
• After the treatment, dispose of solution in the toilet. The dilute solution will not stain the
toilet as it is a weakened solution and the disposal is transient. After flushing, flush again.
• Disposal of the tablet and cup must be in clinical waste.
• Always clean hands after removal of protective clothing. (See standard infection prevention
and control policy.)
Excess Product Disposal
Remember this product is for external use only and should be swallowed. Therefore on
completion of treatment, excess tablets should not be disposed of via household waste but
returned to a pharmacy for disposal. This may be done by a responsible family member or the
patient.
The District Nursing Team may remove the tablets from the patients home should a clinical
risk assessment deem this to be the safest method. Where possible seek consent from the
family or patient to remove the prescribed product.
5.0 AUDIT AND REVIEW
• In the light of new evidence.
• Investigate any adverse events relating to the use of potassium permanganate as per
guidance above.
Reference:
DermNet NZ (2013) Potassium Permanganate. www.dermnetnz.org/treatments/permanganate.html
accessed (7/1/2015)
NHS England (2014) Patient safety alert: Stage One: Warning Risk of death or serious harm
from accidental ingestion of potassium permanganate preparations
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Procedure for the use of Potassium Permanganate soaks in
Primary Care
Appendix 1
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Final Version: 15th January 2015: Community Tissue Viability Service