Wound cleansing is an interesting dilemma. What? How can that be a dilemma? Everyone knows that you cleanse a wound before dressing it. This is what has been taught for years. Wound cleansing began in the late 19th or early 20th century once the germ theory was proposed and accepted, and hygiene was successful in reducing infections and death, and improving wound outcomes. The whole purpose of cleansing a wound is to remove necrotic or infectious material from the wound to prevent or reduce infection. But there are several things to consider if you are going to cleanse a wound.

Assess the Wound Before Cleansing

First, is the wound dirty? Does it need to be cleansed? When a wound is sprayed with a cleanser the wound is cooled. Cooling a wound impairs and slows healing, potentially inhibiting/delaying healing for 4-8 hours.¹ If the wound is not dirty, don’t clean it. There should be debris or blood in the wound that needs to be rinsed out. If you have a clean wound, consider NOT cleansing it. Another option might be to use warmed saline to cleanse wounds. Second, how are you going to clean the wound? Just flushing with a solution should be good enough, but I have seen some nurses muck around in the wound, touching and stroking it.

Even though they are wearing gloves, this increases risk of infection. Simple flushing with a loaded syringe works well, with care not to use too much pressure so tissue is not disturbed. Certainly we don’t want cleansing to infect or damage the wound. Third, what will be used to clean the wound? We are taught to select a wound cleanser and a means to deliver that cleanser. Certainly, many things have been tried and are used. Normal saline is considered the standard, as it is physiologic. A number of commercial cleansers are actually toxic to the wound unless they are diluted 10 to 100 fold.² Surprisingly, tap water is as useful as normal saline and has the benefit of being less expensive and overall having better patient acceptance.³

Evaluating the Impact of Cleaning a Wound

So, the point is, cleansing a wound needs careful consideration, just like other elements of wound care. Judging whether a wound actually needs to be cleansed or not is the first consideration. Certainly a draining, odorous wound with slough and necrosis would need cleansing. But what about a pink, clean, granulating wound that just had a clean, intact dressing removed? Does it really need to be cleansed, or are we actually doing harm to the wound? I think it is important that we think carefully about what we are doing in regard to wound cleansing, and why we are doing something, rather than just doing it because we think it is what is expected.

Sources

1. Large, A, Heinbecker, P. The Effect of Cooling on Wound Healing. Annals of Surgery: Nov. 1944-Vol 120-Issue 5-pp 727-741.

2. U.S. Dept. of Health and Human Services, AHCPR Publication No. 95-0652, Wound Cleansing, December 1994, pp. 50-51. 3. Beam, JW. Wound Cleansing: Water or Saline? J. Athl Train. 2006; 41(2): 196-197.

About The Author

Aletha Tippett MD is a family medicine and wound care expert, founder and president of the Hope of Healing Foundation®, family physician, and international speaker on wound care.