17.3 Wound cleansing

Wound debridement of necrotic and sloughing tissues is an essential part of wound cleansing which together with fluid irrigations is required to be undertaken to remove:

  • Superficial slough or excessive wound exudates.
  • Particulate contamination from dressing material e.g. hydrogel.
  • Contamination from debris in traumatic wounds.
  • Heavy colonisation, with or without biofilm.

It may also be necessary to remove debris from the peri-wound, and to maintain hygiene standards and re-hydrate the surrounding skin. Wound irrigation is effective when applied under gentle pressure, consider showering.

If home circumstances allow, good quality, warm mains tap water is the first line choice of cleaning agent. Where this is unavailable boiled, cooled to warm water or distilled water can be used.

Warm sterile saline should be used for cleansing surgical sites for the first 48 hours post-surgery. Patients can safely shower 48 hours after surgery. (NICE CG74 2008)

Drinking water (Tap)
Sodium chloride

Antiseptics

The routine use of antiseptic solutions to clean wounds has little place in wound management. Traditional antiseptics such as cetrimide (e.g. Savlon® and Trisept®) may have toxic effects on healing tissue and may delay healing. Antiseptics should be limited to accident and emergency departments. However even then the benefits are unclear over copious irrigation with water or saline.

Routine cleaning of contaminated wounds is ineffective. There have been recent additions to solutions available for wound care but their use should be initiated only with the support and guidance of a Tissue Viability Nurse.

Permitabs® (potassium permanganate)

This preparation is very effective in drying up weeping eczematous legs. One tablet dissolved in 4 litres of water provides a 0.01% (1 in 10,000) solution (BNF).

 

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