WOUND CLEANSING

Mr Zairuddin Abdullah Zawawi Orthopaedics Dept HRPZ II

Wound Cleansing: The process of removing inflammatory contaminants from the wound surface

Necrotic Tissue Excess Exudate

Impede Healing
Increase the risk for infection

Foreign Objects

Wound Cleansing
Purpose:

helps optimize wound healing decreases the potential for infection loosens and washes away cellular debris ( (bacteria, exudate, purulent material and residual topical agents)

Wound Cleanser
Antiseptic

Non antiseptic

Cleansing Solutions

Normal Saline Povidone Iodine Hydrogen Peroxide Sodium Hypochlorite (Dakin Solution)

Normal Saline

The preferred cleanser for most wounds (physiologic and safe) Will not clean well in dirty, necrotic wounds Not to use in MRSA

Povidone Iodine

Cytotoxic to healthy cells and granulating tissues. Broad spectrum antimicrobial effective against a variety of pathogens including Staphylococcus aureus. Dries and discolors skin. May cause local irritation to the periwound skin.

Hydrogen Peroxide

Cytotoxic to healthy cells and granulating tissues. Effervescent cleansing action helps to lift debris from the wound surface when used at full strength (If used full strength, irrigation with normal saline after use is recommended) Ineffective at killing bacteria. Do not use on wounds with sinus tracts.

Sodium Hypochlorite (Dakin Solution)

Cytotoxic to healthy cells and granulating tissues. Bactericidal effect against most organisms commonly found in open wounds. Frequently used in pressure ulcers with necrotic tissue to help control infection. Occasionally used over cancerous growths to control bacteria and minimize odor

Acetic Acid
Cytotoxic to healthy cells and granulating tissues. Bactericidal (against many Gram-positive and Gramnegative organisms, especially Pseudomonas aeruginosa)

Super-oxidized Solution

Oxidized Water

Water is broken down into oxygen, ozone and other oxidized species
Reacts with water forming hypochlorous acid (HOCl) Neutralization with NaOH converts a portion of the HOCl to sodium hypochlorite (NaOCl)

Chlorine

Antimicrobial

Bactericidal Virucidal Fungicidal Sporicidal

PHMB

Polyhexamethylen e biguanide Antimicrobial Help soften and remove slough Reduce biofilm formation

Wound Cleansing
Delivery Systems

Clean, granulating wounds Low pressure irrigation

Necrotic tissue or significant contamination High Pressure Irrigation Scrubbing Soaking

AHRQ (Agency for Healthcare Research and Quality) advised against the use of:

Povidone iodine Hydrogen peroxide Sodium hypochlorite Acetic acid

WOUND DRESSING MATERIAL