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Clean or aseptic approach to wound cleansing

It can be confusing to know how and when to cleanse wounds. The idea that the more you cleanse a wound and remove bacterias the faster the improvement is a false one, but often mirrored by a patients loved ones ‘mums dressing hasn’t been changed since yesterday’.

The body is healing the wound rather than the dressing with the latter providing the optimum environment of wound bed preparation to allow the natural healing process.

When it comes to cleansing wounds and reducing the risk of infection or cross contamination. The first stage is good hand hygiene.

Hands are the most common carrier of pathogens and in the community with sometimes poor access to soap and water, there are hand cleansers and gels which must be carried.


The two most common community cleansing techniques are:

Aseptic technique – Acute Wounds. Aseptic technique means using practices and procedures to prevent contamination from pathogens. Dressing packs are a good go to as often contain all you need to apply an aseptic technique:

  1. A clear available work space.
  2. A sterile dressing/procedure pack.
  3. Access to hand washing sink or alcohol hand wash.
  4. Non-sterile gloves to remove old dressing.
  5. Apron.
  6. Appropriate dressings.
  7. Appropriate solution for cleaning the wound such as normal 0.9% saline.

Clean Technique: For chronic wounds such as leg ulcers. Clean technique is defined as a modified aseptic technique used for certain procedures that acknowledges the use of some non-sterile items/fluids but aims to reduce the risk of contamination by pathogenic (harmful) micro-organisms eg chronic leg ulcer care.

  1. A clear available work space.
  2. Non-sterile gloves
  3. Access to hand washing sink or alcohol hand wash.
  4. Non-sterile gloves to remove old dressing.
  5. Apron.
  6. Appropriate dressings.
  7. Types of cleansing fluid Cleansing can be achieved with either tap water or warm normal 0.9% saline.

Tap Water

Any fears regarding bacterial contamination of tap water appear to be unfounded (Angeras and Bradbard, 1992). Beam (2006) in an extensive review found tap water to be equally effective to saline when used as a cleansing agent. Methods of cleansing Wound and skin cleansing is best achieved by gentle irrigation either by showering, irrigating with a jug of warm water or saline or by irrigation with a syringe. The patient often appreciates irrigation or short immersion of the wounded are in a bowl or bath. This practice is useful for skin care and cleansing particularly in patients with leg ulceration (Lawrence, 1997). Care must be taken to avoid prolonged immersion of the wound and cross infection. Lawrence (1997) suggests using disposable plastic bags to line the bowl. Care must be taken in the cleaning of lifting equipment and the bath if this is the chosen method of care

Wound Cleansing 

REMEMBER: Wound cleansing is NOT indicated for most wounds and should only be performed with a specific goal or aim. 

To remove excess exudate, slough or necrotic tissue. To remove remnants of old dressing material. To remove dirt and debris from traumatic wounds which could cause wound infection (Sibbald 2001).


References

Angeras, A and Bradband, A. (1992) Comparison between sterile saline and tap water for cleansing of acute traumatic soft tissue wounds. European Journal of Surgery 158 (33): 347 – 350

Beam J.W. (2006) Wound cleansing: water or saline? J Athl Train, 41: 196-197 Chintz, H, Vibits, H and Cortz, T. (1989) Need for surgical wound dressing. British Journal of Surgery, 76: 204-205 De Smet

Lawrence, J.C. (1997) Wound Irrigation. Journal of Wound Care 6 (1): 23 – 26

Prevention of health associated infections (NICE 2019) accessed on 10th May 2019. available at:

https://pathways.nice.org.uk/pathways/prevention-and-control-of-healthcare-associated-infections#path=view%3A/pathways/prevention-and-control-of-healthcare-associated-infections/prevention-and-control-of-healthcare-associated-infections-in-primary-and-community-care.xml&content=view-index

Sibbald, R.G. (2001) What is the bacterial burden of the wound bed and does it matter? In: Cherry. W. Harding, K.G and Ryan, T.J. (Eds) Wound Bed Preparation, London: Royal Society of Medicine Press Ltd, pp 41-50