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Wound infection is a major challenge for clinicians globally, with accurate and timely identification of wound infection being critical to achieving clinical and cost-effective management, and promotion of healing. This paper presents an overview of the development of the International Wound Infection Institute (IWII)'s 2022 Wound Infection in Clinical Practice consensus document. The updated document summarises current evidence and provides multidisciplinary healthcare providers with effective guidance and support on terminology, paradigms related to biofilm, identification of wound infection, wound cleansing, debridement and antimicrobial stewardship. Integral to the update is revision of wound infection management strategies which are incorporated within the IWII's Wound Infection Continuum (IWII–WIC) and management plan. The aim of the 2022 IWII consensus document update was to provide an accessible and useful clinical resource in at least six languages, incorporating the latest evidence and current best practice for wound infection and prevention. Dissemination techniques for the consensus are discussed and highlighted. [ABSTRACT FROM AUTHOR]

Objective: To summarise the findings on the effect of the clinical use of 0.1% polyhexanide–propylbetaine (PHMB/betaine) solution/gel on acute and hard-to-heal (chronic) wound healing. Method: A literature search was conducted in MEDLINE, CINAHL, Embase, Scopus and the CENTRAL Trials Registry of the Cochrane Collaboration. Paired reviewers conducted title and abstract screening and full-text screening to identify experimental, quasi-experimental and observational studies. Study quality and risk of bias were not formally evaluated. Results: A total of 17 studies met the eligibility criteria. The findings from 12 studies indicated that the use of 0.1% PHMB/betaine solution/gel had: a low risk of contact sensitivity; could help debridement during wound cleansing; aided effective wound bed preparation; reduced wound size, odour and exudate; improved pain control; reduced microbial load; and enhanced wound healing. The results of three studies indicated that both 0.1% PHMB and saline solution were effective in reducing bacterial load, while another showed that adding 0.1% PHMB to tie-over dressings had no effect on reducing bacterial loads in wounds. Another study concluded that disinfection and granulation of pressure ulcers with hydrobalance dressing with 0.3% PHMB was faster and more effective than using 0.1% PHMB/betaine. Conclusion: The findings of this literature review showed that 0.1% PHMB/betaine solution/gel appeared to be useful and safe for wound cleansing, was effective in removing soft debris and slough from the wound bed, and created a wound environment optimal for healing. Although these actions cannot be attributed solely to this treatment modality, these results do highlight the unique action of this combined product. However, more robust studies are needed to confirm these results. [ABSTRACT FROM AUTHOR]

Background: The short-term application of negative pressure wound therapy with instillation and dwell time (NPWTi-d) enables the delivery of topical wound solutions, the solubilisation of debris and cleansing of the wound bed. The application of NPWTi-d may support the transition of the wound to a more manageable state and minimises the use of more invasive techniques. Method: In this case series, we describe the process of applying NPWTi-d early as part of a contaminated wound treatment plan. Results: The case series included 15 patients in the preoperative setting. Wound types included surgical dehiscence, hard-to-heal wounds, heel pressure ulcers, diabetic foot ulcers, a cat bite and an amputation left open. Normal saline or a 0.125% sodium hypochlorite solution were instilled and allowed to dwell for five minutes, followed by 15 minutes of continuous negative pressure at –125mmHg. NPWTi-d was continued for 4–36 hours, or until the operating room became available. After NPWTi-d, we observed a decreased amount of devitalised tissue in the wound bed and reduced oedema and erythema in the periwound area. Patient white blood cells also significantly decreased in all cases after NPWTi-d (p<0.001). Conclusion: Short-term use of NPWTi-d may be a useful option for supporting the surgical treatment of contaminated lower extremity wounds. [ABSTRACT FROM AUTHOR]

A break in skin integrity must be repaired as quickly as possible to avoid excess blood and fluid loss, and to minimise the onset of infection. Hard-to-heal wounds, in which the progression of the wound healing response is compromised, present several challenges to healing (for example, the presence of devitalised tissue acting as a physical barrier to healing and as a focus for bacterial contamination with the potential for subsequent infection). The objective of this article is to present, as a narrative review, the clinical evidence supporting the use of a unique hydro-responsive wound dressing (HydroClean, HRWD1, PAUL HARTMANN AG, Germany). The dressing provides a simple treatment option to address a number of clinical challenges clinicians must overcome in order to facilitate wound healing progression. These studies demonstrated that this product supported successful debridement/cleansing of a wide variety of wounds, including hard-to-heal wounds, enabled wound bed preparation, and lead to positive healing outcomes, including in wounds that previously had failed to heal. The simplicity of using HRWD1 as a single dressing can help clinicians overcome a variety of challenges when treating both acute and hard-to-heal wounds, which, with the benefit of proven patient outcomes, could make it an ideal choice for a first-line treatment. [ABSTRACT FROM AUTHOR]

Wound bed preparation has come into sharper focus over the past decade, with strategies identified to improve wound condition. This article focuses on implementing a wound cleansing policy and measuring, through audits, how this change affected rates of wound infection. From 2016 onwards, the Skin Integrity Team at Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust took steps to revise and improve wound care practices. This resulted in the introduction of a wound cleansing pathway incorporating a surfactant-based cleanser in place of saline, with subsequent staff training and other changes made to practice. This study details the steps taken to implement the new pathway, which brought a reduction in wound infections of 84.3% between 2017 and 2019. [ABSTRACT FROM AUTHOR]

Objective: The burden of wound care within the NHS is estimated at a cost of £5.3 billion per year and is set to rise annually by 30%. This case series describes the results of using polyhexanide (PHMB) and betaine wound irrigation solution and gels (Prontosan, B.Braun Medical Ltd., UK) across the UK in hard-to-heal (also described as chronic) wounds up to 20 years' duration, with an observation period of greater than one month. Over half of the hard-to-heal wounds were healed and vast improvements to all other wounds were observed. Improvements to wound bed condition were reported as early as two days after commencing initial treatment, with decreases in malodour, exudate, slough and pain reported across the case series. In addition to wound bed improvements, a reduction in dressing change frequency of 55% was observed in hard-to-heal wounds under the new treatment regime. [ABSTRACT FROM AUTHOR]

The care of any wound in the community requires multidisciplinary working between healthcare professionals. In this article, the authors offer five generalisable principles that colleagues providing community care can apply in order to achieve timely wound healing: (1) assessment and exclusion of disease processes; (2) wound cleansing; (3) timely dressing change; (4) appropriate (dressing choice; and (5) considered antibiotic prescription. High-quality wound care is an essential aspect of healthcare practice but lacks an evidence base and standardised practice at present. The practice and teaching of wound care should be more greatly emphasised in healthcare training for all disciplines. [ABSTRACT FROM AUTHOR]

On 20 November 2018, following the International Society for Paediatric Wound Care conference, a closed panel meeting took place in which the use of a surfactant-based gel (PluroGel (PMM), Medline Industries, Illinois, US) in paediatric wound care was discussed. The authors shared their experiences, thoughts, experimental data and clinical results. The panel identified the need for a product that can gently cleanse paediatric wounds and remove devitalised tissue without causing discomfort or skin reactions, as well as potentially promote healing. In adults, PMM has been shown to assist healing by hydrating the wound, controlling exudate and debriding non-viable tissue. Islands of neo-epithelium have also been reported to appear rapidly in different parts of the wound bed. No adverse effects on these proliferating cells have been observed. In vitro data suggest that PMM can remove biofilm, as well as potentially promote healing through cell salvage. The panel, therefore, set out to discuss their experiences of using PMM in the paediatric patients and to establish a consensus on the indications for its use and application in this population. This article will describe the main outcomes of that discussion and present case studies from paediatric patients with a variety of wound types, who were treated with PMM by members of the panel. [ABSTRACT FROM AUTHOR]

A biofilm can be described as a microbial colony encased in a polysaccharide matrix which can become attached to a wound surface. This can affect the healing potential of chronic wounds due to the production of destructive enzymes and toxins which can promote a chronic inflammatory state within the wound. Biofilms can be polymicrobial and can result in delayed wound healing and chronic wound infection resistant to antibiotics, leading to prolonged hospitalisation for some patients. There appears to be a correlation between biofilms and non-healing in chronic wounds. It is suggested that biofilms are a major player in the chronicity of wounds. They are a complex concept to diagnose and management needs to be multifactorial. [ABSTRACT FROM AUTHOR]

Wound cleansing is considered to be an integral part of wound care, nevertheless wound cleansing is very often said to be a ritualistic procedure that is undertaken with very little thought or rational (Magson- Roberts 2006). Is wound cleansing a procedure that needs to be performed and what is the difference between wound cleansing and debridment. The aim of this article is to consider the need for wound cleansing; the solutions used and the preferred method of cleansing wounds. [ABSTRACT FROM AUTHOR]

Objective: To assess current acute wound management in English emergency departments. Method: All English emergency departments including minor injury units (n=207) were successfully contacted and a telephone questionnaire was completed. This considered wound treatment policy; management including cleansing, analgesia, dressing selection, suturing, referral patterns, medical photography and antibiotic use. Results: There was a 100% response. Only 40% of departments had a wound treatment policy. Most had implemented staff training, however the nature and timing of this was variable. Wound cleansing was performed by all departments. Most administered analgesia. Suturing was selectively performed by all departments. There was great diversity regarding dressing selection. The most common reasons for referral to specialist units were the complexity of injury and cosmetically sensitive areas. Photographs were regularly taken in one third of units questioned. Conclusion: This study confirmed an absence of a standard protocol for early soft tissue wound management in the emergency department setting. Key areas that could be improved are dressing simplification, more defined referral criteria and introduction of standardised protocols with structured teaching programmes. We propose a simple approach to management of acute soft tissue wounds that can be applied to most situations. [ABSTRACT FROM AUTHOR]

Wound cleansing is considered to be an integral part of wound care. Nevertheless, it is often said to be a ritualistic procedure that is undertaken with little thought or rationale (Magson-Roberts, 2006). Is wound cleansing therefore a procedure that needs to be performed? The aim of this article is to consider the need for wound cleansing, the solutions used and the preferred method of cleansing wounds. [ABSTRACT FROM AUTHOR]

Objective: This cohort study evaluated the clinical efficacy of singlet oxygen, ActiMaris (AM) a hypertonic (3%) ionised (pH 9.8) sea water solution. It was assumed that when used for wound cleansing, disinfection and the reduction of inflammation, AM would be safe and effective. Method: Between May 2008 and May 2009, ambulant patients presenting at one of four wound healing centres were included in the study. Patients had critically colonised and/or infected, malodorous wounds, covered with slough/fibrin or wounds showing inflammation of the periwound skin. Wounds were assessed in terms of percentage changes in fibrin, slough and granulation tissue, they were assessed clinically and high resolution digital photographs were scored by a physician who was blinded to treatment allocation. Results were compared at baseline (week 0) and following 42 days of AM treatment (week 6). Results: Seventy-three patients were included in the analysis. Dressing changes were at 2-day intervals on average, and the median treatment period was 46.04 days (range: 3-197). At 42 days, 33% (n=24) of included wounds had healed, 57% (n=42) had improved and 10% (n=7) remained stagnant. Cleansing and wound disinfection with AM was effective. In 31 patients (42%) wounds had showed clinical signs and symptoms of critical colonisation and/or infection at day 0, whereas at day 42 the infection was completely eradicated. Inflammation was reduced in 60% (n=44) of cases and patients did not report pain or discomfort when using AM. Conclusion: The use of singlet oxygen was shown to be safe and the results of this study indicate AM to be useful for wound cleansing, disinfection, reducing inflammation and promoting wound healing. Conflict of interest: The centres were supplied with the study product by the sponsor. The authors have no financial interest in writing this article. [ABSTRACT FROM AUTHOR]

Over the past two decades a body of evidence has been generated to support the traditional use of water in cleansing wounds, with studies showing that the use of clean water does not increase the risk of infection or delay healing. However, recent advances in the understanding of wound management have encouraged reforms and led to the development of wound cleansing agents that have the potential to improve clinical outcomes. This article draws on in vitro and in vivo evidence including comparative studies of patients with acute and chronic wounds to consider the evidence supporting alternatives to water in wound cleansing. [ABSTRACT FROM AUTHOR]

The concept of wound bed preparation can be implemented using the TIME paradigm. Chronic wounds are mostly characterised by prolonged inflammation and increased bioburden. Removal of wound biofilm and devitalised tissue, which is an ideal environment for bacterial growth, can help address the I in TIME. Wound cleansing aims to remove contaminants, debris, dressing remnants and superficial slough from the wound. Some wound cleansers contain surfactants, which reduce the surface tension of a liquid, enabling it to spread further over a surface. This article describes how these solutions can be used to debride the wound surface without damaging healthy cells. [ABSTRACT FROM AUTHOR]

Wound coatings can severely delay chronic wound healing by inducing ischaemia and degradation of viable tissue and increasing susceptibility to infection. It is, therefore, essential to cleanse wounds gently and thoroughly to remove the detrimental coatings. In this study, an in-vitro model that mimics wound coatings (human plasma dried onto adhesive glass slides) was used to compare the efficacy of four sterile solutions used to cleanse wounds: saline and Ringer's (both salt solutions), a betaine surfactant-containing wound rinsing solution (Prontosan® B. Braun) and an antiseptic solution (Octenisept® Schülke & Mayr). Both salt solutions and the wound rinsing solution were found to remove protein from the test wound coatings, whereas the test coatings became fixed and insoluble when immersed in antiseptic solution. [ABSTRACT FROM AUTHOR]

Objective: To develop an in-vitro model to evaluate the efficiency of wound-rinsing solutions in removing adherent, hydrophobic, denatured proteins. We hypothesised that saline solutions would be less effective than surfactant-containing solutions in removing denatured proteins. Method: Prepared slides containing dried blood plasma or fibrin were incubated for up to one hour in histological troughs filled with one of four test solutions: physiological saline solution, Ringer's solution, a surfactant-containing solution and an antiseptic. The concentration of dissolved proteins was measured using a modified Biuret test. Results were analysed by plotting protein concentration against the incubation time. Results: During the incubation period, the protein concentration increased in all of the test solutions, with the lowest concentration reported in the two saline-based solutions. These stayed clear, while the surfactant-containing solution become opaque, indicating that the surfactant had encased hydrophic substances, such as denatured proteins. Conclusion: Ringer's solution and saline are inappropriate solvents for adhering wound coatings. A sterile, surfactant-containing wound rinsing solution contains the essential properties for thorough and gentle cleansing of chronic wounds. Declaration of Interest: None. [ABSTRACT FROM AUTHOR]

The article focuses on the use of chlorhexidine gluconate in wound cleansing. It is said that chlorhexidine in a 4% dilution should only be utilized as an antiseptic hand wash, a pre-operative hand scrub and to prepare skin for surgery while a 0.05% dilution has been used as a wound cleanser for many years. But it is claimed that water alone would be sufficient to remove bacteria from a wound and the active agents of chlorhexidine seem to be inactivated by body fluids and hard tap water.