Jacqui Fletcher, BSc (Hons), RN.
Senior Lecturer, University of Hertfordshire, Hatfield, HertfordshireThe aim of cleansing wounds is simply to remove loose debris (including dressing residue) or foreign bodies to allow thorough assessment of the wound.
The aim of cleansing wounds is simply to remove loose debris (including dressing residue) or foreign bodies to allow thorough assessment of the wound.
There are also social and psychological considerations, especially if the wound is heavily exuding or malodorous (Fletcher, 1997).
In the past, a wide selection of solutions has been used for swabbing and irrigating wounds. The use of hypochlorites (Moore, 1992) and antiseptics (Lawrence et al, 1996) has been widely reviewed and general consensus suggests that their usage is not justified in the majority of cases (Box 1).
Two solutions are recommended for cleaning wounds: normal saline and tap water. There is recent evidence to demonstrate that there is no significant difference in healing rates or frequency of wound infection when using either of these solutions (Griffiths et al, 2001; Selim et al, 2001). The choice of which solution to use depends on availability, cost and ease of use.
While tap water is usually an inexpensive option that is readily available in whatever quantity is required, it is not always the best choice. For example, if the wound to be irrigated is above the eye, a means of transporting the water to the patient, such as a syringe, is required and this may involve an additional cost. Limb wounds also need special consideration, since it may not be possible to immerse the limb adequately to achieve the desired level of cleansing. In such circumstances it may be possible to use a shower-head attachment to irrigate the wound.
Immersion of patient's legs in buckets of water is a method commonly used by staff in leg ulcer clinics (Morison and Moffatt, 1994). While this method is efficient in terms of cleansing and is frequently preferred by patients, who may have been wearing the same bandages for a week, difficulties may occur if large quantities of water are required - water is both heavy and cumbersome to transport and health and safety issues must be addressed.
Many practitioners prefer the use of normal saline over water, possibly because of its sterility or the variety of user-friendly formats in which it is available (Table 1).
- Sachets. The most familiar presentation of saline is the sterile sachet, which comes in 25ml or 100ml sizes. They are easy to carry but can be difficult to handle. It is recommended that the packaging is wiped with an alcohol swab before opening, which adds to the cost. Once opened, the sachet must be used immediately by pouring directly onto the wound or poured into a container.
- Plastic pods. Several companies now produce saline in single-use plastic 'pods'. These have advantages over the sachets in that there is no need to pour out the solution - it can be squeezed directly from the pod onto the wound. In addition, the pod may be kept safely upright, and used in stages when cleaning a wound, without spillage of the solution remaining in the pod.
- Aerosol spray cans. This delivery mechanism allows for the use of either very small or reasonably large amounts of saline. The same aerosol may be used on several occasions and for different patients, provided that sensible precautions are used to prevent cross-infection.
Fletcher, J. (1997)Wound cleansing. Professional Nurse 12: 11, 793-796.
Griffiths, R.D., Fernandez, R.S., Ussia, C.A. (2001)Is tap water a safe alternative to normal saline for wound irrigation in the community setting? Journal of Wound Care 10: 10, 407-410.
Lawrence, J.C., Harding, K.G., Moore, D.J. (1996)The use of antiseptics in wound care (three critiques). Journal of Wound Care 5: 1, 44-47.
Moore, D. (1992)Hypochlorites: a review of the evidence. Journal of Wound Care 1: 4, 44-53.
Morison, M, Moffatt, C. (1994)A Colour Guide to the Assessment and Management of Leg Ulcers (2nd edn). London: Mosby.
Selim, P., Bashford, C., Grossman, C. (2001)Evidence-based practice: tap water cleansing of leg ulcers in the community. Journal of Clinical Nursing 10: 372-379.