17.3 Wound cleansing

Wounds that are healthy and free from debris do not require cleansing. Routine cleansing of a healthy wound removes beneficial chemicals, can damage delicate tissue, will delay wound healing and can be painful. However, all traumatic wounds are considered contaminated and should be cleaned thoroughly, rinsing the wound under running warm water is very effective.

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.

Antiseptics may be appropriate in heavily contaminated wounds or immunosuppressed patients. Do not use antiseptics containing cetrimide as it has been shown to have a toxic effect on fibroblasts, and may delay healing. Its use should be restricted to A&E only, where the detergent effect would be useful for removing foreign material, such as dirt or tar from wounds.

It is not necessary to dry the wound bed following cleansing as this will cause trauma to the wound bed and damage delicate tissue.

Potable water

  • If home circumstances allow, good quality, warm mains potable tap water is the first line choice of cleaning agent and is suitable for irrigating the majority of wounds. Where this is unavailable boiled, cooled to warm water or distilled water can be used.
  • An appropriately clean container should be used and a clean dressing technique employed.

Sterile water

  • Sterile water can be considered when potable water is not available.

Sodium chloride 0.9%

  • 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).
  • Warm isotonic saline may help where the wound cleansing process is painful or uncomfortable.

Please see 13.11 Skin cleansers, antiseptics, and desloughing agents

Antiseptics

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.

Octenilin® Irrigation solution and gel
  • Irrigation solution 350ml bottle (£4.60)
  • Wound gel (£4.78 = 20ml)

Notes

  1. Wound irrigation solution and gel for cleansing, moisturising and decontamination of acute and chronic wounds to aid in the efficient wound bed preparation
  2. Removes wound debris and biofilms
  3. Contains Octenidine HCl
  4. For short term use only. Not suitable for repeat prescription.
Octenisan® Wash Mitts
  • Octenidine HCl wash mitts (£3.09= 10 mitts)

Notes

  1. Antiseptic single use wash mitts for bedside washing
  2. Use one mitt per body area
  3. Leave impregnation solution on skin for at least 30 seconds; rinsing with water afterwards is not necessary
  4. Do not use in combination with products containing povidone-iodine (PVP-I)
  5. For short term use only. Not suitable for repeat prescription
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).
  • Please see section 13.11.5 Oxidisers and dyes

 

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