Page updated 30 April 2007
Wound Cleansing
Prior to cleansing the wound the nurse should consider the following issues:
- What is the purpose of cleansing the wound?
- Does the wound need cleansing?
- What are the indications for cleansing the wound?
- What method should be used to cleanse the wound?
- Is an aseptic technique necessary?
- What solution should be used to cleanse the wound?
Introduction
Although there is now a general move away from mechanical cleansing of the wound surface there are occasions when it is necessary to remove residues of slough or other debris from the wound or surrounding skin. The routine use of antiseptic solutions has little place in wound management (Value for Money Unit, 1996).
Wound Cleansing Agents
For routine wound cleansing, normal saline 0.9% is the preferred solution of choice. It should be warmed to body temperature (Thomas, 1990) before use to avoid lowering the temperature of the wound and impairing the healing process. However, the use of tap water for cleaning chronic wounds has been shown to have no detrimental effects to healing in any way (Young, 1995). To ensure fibres are not left in the wound irrigation should be carried out rather than swabbing the wound surface. However too low a pressure for irrigation may not be useful in removing exudate while too high a pressure may cause damage to granulating tissue. A variety of irrigation products are available and include steripods, sachets, aerosols, and syringes. Always read manufacturers instructions before use.
In some circumstances, the medical staff may request unfamiliar wound cleansing solutions. The following information should assist you with selecting the appropriate solution for wound cleansing based on current research based evidence. Notice that most are BAD for wound healing.
Acetic Acid 3%
- Effective against Pseudomonas aeruginosa but short acting. Apply twice daily as a wet-to-dry dressing
- Can cause stinging
Solutions containing cetrimide (e.g. Tisept, Cetrimide, Savlon)
- Used for emulsifying and detergent properties for dirty wounds
- Cytotoxic effect on fibroblast cells
- May cause skin irritation and sensitivity
- Use with caution
Chlorhexidine
- 0.05% solutions recommended for use on wounds
- Effective against Gram-positive and negative organisms and some fungi, not spores
- Sensitisation may occur
- Avoid contact with eyes
Hexachlorophane
- Sterzac dusting powder used for Staphylococcus aureus colonisation of intact skin or small wounds
- May be absorbed from large raw areas (eg burns) or in neonates and the may cause deafness
Chlorinated solutions (e.g. Eusol, Dakin's solution)
- Traditionally used as desloughing agents
- Short shelf life
- Rapidly de-activated
- Require frequent changes of dressings
- Chemically unstable
- Adverse effects - delay healing, irritant, reduce capillary flow, depress collagen synthesis, cause over-granulation, localised oedema, cell toxicity
- Use discouraged
Dyes (e.g. Brilliant green, gentian violet, mercurochrome, potassium permanganate)
- Traditionally used as astringents to dry up macerated skin around wounds
- Inhibits wound healing
- Use discouraged
Hydrogen Peroxide
- Used to clean dirty, sloughy, infected, necrotic wounds, not recommended for clean wounds
- May chemically interact with other topical medicaments
- Contamination with organic material results in loss of effectiveness
- Stings on application
- May be caustic to wounds and surrounding skin
- Check in-use dilution
- Irrigated under pressure or into enclosed body cavities may cause oxygen embolus and surgical emphysema
Povidone Iodine (e.g. lnadine, Betadine, Videne, etc)
- Broad spectrum of antibacterial activity
- Bacterial effect is reduced by contact with pus and exudate
- Apply at regular intervals
- Low risk of sensitivity
- Do not use alcoholic solutions
- Delays wound healing and risk of iodine toxicity if used in open wounds (Lawrence 1998)
Silver Nitrate 0.5% - 0.25% aqueous solution
- Bacteriostatic, has a broad anti-bacterial spectrum
- Application painless
- No local sensitivity
- Stains tissue
- May effect water and electrolyte balance and cause metabolic disturbances
Sugar (50% caster, 50% icing sugar mixed to a paste with sterile water)
- Recommended for use in infected, dirty, malodourous wounds
- Frequent packing of wounds is necessary - twice daily or more often
- May cause bleeding when granulation tissue well formed
- Non toxic effects
- All pastes should be stored in a refrigerator
Varidase
- Facilitates cleansing of necrotic and infected wounds
- Reconstitute the powder with sterile sodium chloride 0.9%
- Stable for up to 24 hours if stored in a refrigerator
- Can be injected under dry eschar or applied on the surface of scored necrotic tissue
- May be reconstituted as a jelly by dissolving the contents of one vial into 5ml of sterile water and mixing the resulting solution with 15ml of lntrasite gel
- Apply dressings once or twice daily; cover with a secondary dressing (Ruffer and Hill, 2001)
Sodium Chloride (e.g. 0.9% solution)
- Ideal for topical irrigation and cleansing of wounds
- Has no antiseptic properties, but on irrigation dilutes the concentrations of bacteria in the wound
Tap Water
- Acceptable alternative for the cleansing of acute traumatic soft-tissue wounds and chronic wounds such as leg ulcers
- Used to irrigate and clean wounds
- Has no antiseptic properties
- Has no detrimental effects on healing
- Open wounds should only be soaked in water for a short period of time as water is hypotonic and causes cells within tissues to swell and eventually rupture because of the effect of osmotic pressure
- Ensure the water comes from a properly treated supply and is lukewarm
- Run tap water for a few minutes before wound cleansing to flush out any potentially high levels of bacteria
- Emollients may be added to lukewarm water to moisturise the skin
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