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Importance of Wound Cleansers in Wound Healing

We can all recollect our childhood memories wherein contracting bruises and injuries would be a routine affair. Attending to such wounds would be a critical task for the elders. It required cleaning with an appropriate cleanser as to eliminate chances of infection. This would be followed by an antimicrobial dressing with periodical changes without disturbing the wound and perineal skin. A quick healing would be everyone’s lookout.
Wound cleansing is an integral part of wound bed preparation so as to optimize the wound environment by removing debris and reducing bacterial load on the wound site. This in turn creates optimal local conditions for wound healing. It also facilitates wound assessment by optimizing visualization of the wound.
Thus, wound cleansing is a combination of debridement + application of topical antimicrobial agents (wound cleansers and dressings) to facilitate wound healing.

What is an ideal wound cleanser?

An ideal wound cleanser besides being hypoallergenic (minimizes the possibility of an allergy), is readily available, cost effective and stable. It is also,

  • Non-toxic to human cells;
  • Effective against a variety of microbes;
  • Remain effective in the presence of organic material;
  • Safe for a variety of wounds;
  • Does not cause pain;
  • Does not require irrigation at high pressures;
  • Effectively removes loose tissue and debris from the wound bed.

Choosing the correct wound cleanser

Wound irrigation is considered to be the most effective method of wound cleansing. It is the steady flow of a solution across an open wound surface to achieve wound hydration, remove debris and assist with visual examination. Choosing an appropriate solution is a critical step in wound cleansing. Solutions intended for topical use include topical cleansers, antibiotics, antifungals, antiseptics and anesthetics. Some of the conventional topical irrigants are:

  • Normal saline solution: It is isotonic and the most commonly used wound cleansing solution due to safety (lowest toxicity) and physiologic factors. It is also cost-effective and available in many different formats such as unit dose, half liter, liter, and spray bottles. However, it does not clean dirty necrotic as effectively as other solutions. Similar wound infection rates have been reported with potable tap water. The date of opening a saline container has to be noted as bacterial growth may take place after 24 hours of opening the container and it then needs to be discarded.

    The Medtronic Covidien Sterile Saline Water, features 0.9 percent sterile saline and is available in a variety of sizes and configurations. Different packaging options are also available for convenience.

    The McKesson Sterile Saline Wound Flush, is a 0.9 percent USP sodium chloride solution and has a saline stream of 4 to 13 psi. It is used for moistening absorbent wound dressings, cleaning minor cuts and burns, and superficial abrasions.

  Medtronic Covidien Sterile Saline Water   McKesson Sterile Saline Wound Flush
  • Sterile water: Prepared by distillation, sterile water is nonpyrogenic and contains no antimicrobial or bacteriostatic agents or added buffers. It is a less expensive alternative to isotonic saline. It is hypotonic and may cause hemolysis when absorbed by tissues during surgical procedure. Excess volume may cause toxicity.
  • Potable water: It is used in the event when saline or sterile water are not available. It works well in austere environment and is as effective as normal saline in countering bacterial growth.
  • Commercial wound cleansers: Increasingly used as wound cleansers, they consist of surfactants, wetting agents, moisturizers, and/or antimicrobials. They remove, rather than kill bacteria. Due to the surfactant content in cleansers, less force is required to remove bacteria and cellular debris. Each surfactant molecule has a hydrophilic head that is attracted to water molecules and a hydrophobic tail that repels water and simultaneously attaches itself to wound contaminants. These opposing forces loosen the particles and suspend them in water. Thus, commercial cleansers are best suited for wounds with adherent cellular debris and or for dirty necrotic wounds.

    The Medline Skintegrity Wound Cleanser, chooses mist or stream delivery to loosen and remove protein and wound debris with a non-ionic surfactant. It is non-cytotoxic. The trigger sprayer delivers a PSI of 8.6 at 3 inches spraying distance.

    Likewise, the Dermagran Wound Cleanser, is gentle on the skin and contains both zinc and Vitamin B6. It not just cleanses but also prepares the wound bed with an optimal healing environment. Its 360 degrees delivery system meets the AHCPR guidelines for irrigation pressure. It is one of the lowest cytoxic formulations in the market.

  Medline Skintegrity Wound Cleanser   Dermagran Wound Cleanser
  • Povidone iodine: A broad spectrum antimicrobial solution, it is effective against a variety of pathogens. However, it is cytotoxic to healthy cells and granulating tissues. It dries up and discolors the skin besides causing local irritation to the peri-wound skin.

    The Purdue Betadine Antiseptic Solution, has povidone-iodine as its active ingredient. It is active against a broad spectrum of pathogens, in vitro. It is used against topical infections.

 Purdue Betadine Antiseptic Solution

  • Hydrogen peroxide: A 3 percent solution of hydrogen peroxide is often used as a wound antiseptic. It lifts debris and necrotic tissue from the wound surface when used at full strength. However, its use remains controversial. Some studies have found it cytotoxic to healthy cells and granulating tissues, whereas, others have sown no negative effect. Some studies have also found it ineffective in reducing bacterial count. Its use is recommended post irrigation with a normal saline.
  • Sodium hypochlorite: It has a bactericidal effect against microorganisms found in open wound. Occasionally, it is used over cancerous growth to control bacteria and minimize odor. Since, it is cytotoxic to healthy cells and granulating tissues, its use is not recommended beyond 7 to 10 days.

How to apply a wound cleanser?

Certain significant aspects have to be kept in mind before beginning to clean a wound. The cleansing solution has to be at room temperature or slightly warmer. Hands need to be washed and gloves applied. Let’s briefly look at the manual cleansing technique for different types of wounds:

  • For a linear incision: Pour the solution in a tray, moisten the gauze pad and squeeze out the excess. Wipe the wound from top to bottom in one motion. Discard the gauze pad and use a new one repeating the same steps. For each downward stroke, a new gauze pad has to be used.
  • For an open wound: Pour the solution in a tray and moisten the gauze pad squeezing out the excess. Clean the wound in a half or full circle, beginning from the center and moving outwards. For each circle, a new gauze pad has to be used. Clean at least one inch past the edges of the dressing or at least 2 inches beyond the wound margins if not applying a dressing. Pat the wound dry by using dry gauze pads.
  • Utilizing a spray cleanser: Apply the spray directly to the wound or spray it on a gauze pad and then clean the wound. This cleansing method requires the use of personal protective equipment such as gloves, gown or mask with an eye shield, as to prevent exposure to airborne microorganisms and debris.
  • Saline flush: Position the individual in a manner that the solution flows by gravity from the upper to the lower end of the wound. Firm pressure has to be applied to the container placed at a correct angle on the wound site. Using a gauze pad, pat the wound dry.

 

For at-home wound cleansing, the same procedure may be involved, including frequent dressing changes and cleaning. This will expedite healing and eliminate any chances of infection. However, a health care provider may have to be consulted if the wound worsens. It can get aggravated with signs of infection, such as, redness, swelling, pain, fever, and increased drainage.