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Chronic venous insufficiency (CVI) and venous leg ulcers (VLUs) have major financial implications for patients and healthcare professionals. VLUs, in particular, require significant care, can be slow to heal, and have a high rate of recurrence. These factors combine to make VLUs a major burden on the healthcare system. Recent estimates show that the cost of treatment of VLUs per patient in the United States is $10,000 to $12,000 per year, with the average lifetime cost of care greater than $40,000. Infected VLUs often require surgical debridement for the removal of bacterial burden and biofilm. The use of negative pressure wound therapy with instillation and dwell (NPWTi-d) has shown to decrease OR visits, length of hospitalization, and therapy days in lower extremity and trunk wounds. In 2017, a novel reticulated open cell foam dressing with through holes (ROCF-CC) was introduced as a dressing option with NPWTi-d. ROCF-CC assists in removing thick wound exudate and infectious materials. This dressing option is especially helpful for wound cleansing when debridement is not possible or appropriate in patients.

Father Damien de Veuster, or Saint Damien of Molokai (1840-1889), was one of the pioneers of the holistic approach to care provision for leprosy patients and contributed to the overcoming of the patients’ social stigmatization. He devoted his life to the lepers living in America’s only leper colony, on the Hawaiian island of Molokai, where people with leprosy were required to live under government-sanctioned medical quarantine. Father Damien gained practical skills in caring for the sick, eagerly learning wound cleansing, bandaging techniques, and drug administration from a nurse. Mahatma Gandhi said that Father Damien's work had inspired his own social campaigns in India.

The burn patient is easily subject to colonization by microorganisms and infection, due to reduced defence capabilities and immune dysfunction. Moreover, burn units and intensive care units are characterized by a selection of resistant bacterial strains. If the burn patient is not adequately cared for in terms of infection prevention and control, sepsis is inevitable. Nowadays, several different antiseptics and antiseptic dressings are used in the topical treatment of burns, each with positive and negative effects. Topical antiseptics allow control of bacterial load, but they can also cause cytotoxicity and reduce healing rate. Choosing the most effective antiseptic is crucial to preventing infection from compromising wound healing. The present study aims to review the available literature in order to highlight evidence on the use of topical antiseptics in burns.Les patients brûlés sont facilement colonisés et infectée, en raison de diminution des capacités de défense et de la fonction immunitaire. En outre, les services de réanimation et les CTB ont une prévalence élevée de bactéries multirésistantes. Si les mesures préventives et les soins sont mal conduits, la survenue d’infection est inéluctable. Actuellement, de nombreux antiseptiques et pansements antiseptiques sont disponibles, chacun avec ses avantages et inconvénients. Ils ont en effet la capacité de diminuer la charge bactérienne locale, mais sont susceptibles d’obérer la cicatrisation par cytotoxicité. Le choix de l’antiseptique peut donc être crucial. Cette revue de la littérature a pour but de dégager des données factuelles concernant l’usage des antiseptiques chez les brûlés.

Microbiology diagnostics are frequently performed in patients with chronic wounds. However, there is currently a lack of uniformity with respect to indications as well as the practical implementation of such workup. The fact that diagnostic results may be significantly affected by the sampling technique used as well as the preceding (wound) preparation underscores the need for uniform standards, which have been missing so far. In Germany, bacteriologic wound swabs are routinely performed, particularly with the intent to screen for multiresistant pathogens. For this indication, prior wound cleansing should be avoided, and sampling using the Essen Rotary technique provides a quick and easy-to-use option. If there is clinical suspicion of an infection, wound cleansing with sterile saline solution (0.9 %) and/or sterile cotton gauze should be carried out prior to obtaining bacteriologic swabs. While routine diagnostic biopsies are generally not required in chronic wound patients, they may be useful in case of clinically suspected wound infections, particularly in patients with deep ulcerations, diabetic foot syndrome, severe soft tissue infection, or fistula tissue. Moreover, biopsies are indispensable in the microbiology workup of specific pathogens such as mycobacteria, Leishmania, actinomycetes, Nocardia ssp. or molds.

Background and Aim: Surgical site infection (SSI) remains an important concern in Japan. The Japanese Soci‐ ety for Infection and Prevention Control disclosed that the incidence of SSIs has been lowered only by a fraction over the past 10 years. The importance of taking steps to reduce the occurrence of SSIs is recognized by many hospitals, but to date, no truly effective countermeasures have been reported. We executed a plan to better un‐ derstand the spec fic surveillance needs at St. Marianna University School of Medicine Hospital and then de‐ velop and institute procedures that would reduce the incidence of SSIs. Methods and Results: In 2005, we began development of an enhanced SSI surveillance system. With our basic CDC-based surveillance system in place, we assembled a team of doctors and nurses to oversee surveillance. We practiced strict record keeping and data analysis, gleaned information from staff, and enlisted the coopera‐ tion of other departments. New procedures were established accordingly and implemented in three phases. Be‐ tween 2005 and 2013, we witnessed informative fluctuat ons in the incidence of SSIs. Key components of our new system were standardized postoperative wound cleansing, use of buried absorbable sutures to close surgical wounds, consistent provision of 6 antibacterial agents, each one active against a common organ spec fic patho‐ gen, and establishment of a prophylactic protocol. New methods of information sharing were also instituted. We lowered the incidence of SSIs from 8% in 2006 to approximately 6.9% in 2012. We continue to monitor the number of SSIs occurring and are encouraged by a steady decline. Conclusion: Establishment of the SSI team at our hospital has proven to be a useful multidisciplinary approach to nosocomial infection awareness and control. Gradual introduction of the system to the various departments and step-by-step implementation have decreased the occurrence of SSIs and the nosocomial spread of infectious agents.

Several published reviews and recommendations exist for the use of negative pressure wound therapy (NPWT) with instillation and a dwell time (NPWTi-d) in acute and chronic wounds. Specific dressings for use with NPWTi-d have also been developed, including a reticulated open cell foam dressing with through holes (ROCF-CC) that assists in removing thick wound exudate and infectious materials. ROCF-CC is especially helpful for wound cleansing when debridement is not possible or appropriate in patients. We report our initial experiences in using NPWTi-d with ROCF-CC in patients with pressure ulcers. An algorithmic approach was used to determine appropriate treatment to reach the goals of therapy (i.e., wound bed preparation, granulation tissue formation, and removal of infectious materials). Previous therapies included honey and gauze soaked in Dakin’s solution. All patients received antibiotics and debridement when possible. Five patients (3 females and 2 males) received NPWTi-d with ROCF-CC (instillation of saline or a hypochlorous solution with a dwell time of 10 minutes, followed by 2-3 hours of -125 mmHg NPWT). Patient comorbidities included obesity, diabetes mellitus, hypertension, and peripheral artery disease. Mean age of patients was 65.2 years (range: 50-82 years). After an average of 6 days of therapy (range 2-9 days), all wounds treated with NPWTi-d with ROCFCC showed rapid granulation tissue formation. We also noted improved removal of devitalized tissue and subsequent granulation tissue formation in patients receiving hypochlorous solution compared to patients receiving saline during NPWTi-d with ROCF-CC. All patients were eventually transferred to a skilled nursing facility. In our clinical practice, NPWTi-d with ROCF-CC provided effective and rapid removal of the thick exudate and infectious materials and promoted excellent development of underlying granulation tissue.

This study was necessitated by the international recognition of wound-related pain (WRP) as a must-address issue and patient-centred concerns. The aim of this study was to assess patients' WRP experiences at rest and in relation to dressing change. This descriptive study utilised a WRP questionnaire which incorporated a visual analogue scale of 0-10 for data collection. A total of 109 patients participated in this study; 95·4% of the participants experienced wound pain at rest and during performance of activities of daily living, which were moderate (47·1%) and severe (30·8%) in intensity. Also, 91·7% of the participants experienced wound dressing change-related pain, mostly as moderate (47·0%) and severe (28·0%) pain. The major factors that worsened WRP experiences were touch/handling, change in position/movement, wound cleansing, removal of dressings and usage of honey as a dressing agent, while the use of analgesic and brief rest between dressing change were considered the major strategies that can relieve WRP. WRP experiences have been reported by patients at rest, during performance of activities of daily living and at wound dressing change. A need to incorporate WRP assessment has been observed, which is vital in improving wound care outcome.

a b s t r a c t Introduction: Hydrotherapy is widely used in burns management however there are risks associated with its use, in particular cross-infection. Data regarding indications and tech- niques in common use is deficient. This study aimed to investigate hydrotherapy practices in the UK and Ireland. Methods: A survey of the hydrotherapy practice of major burn care providers was performed by e mail and where necessary, follow up telephone contact. Results: The survey included 28 burn care providers. 27 reported using hydrotherapy. Only 11 (41%) had defined indication criteria with 4 (15%) implementing a specific protocol. Variations in hydrotherapy practice were seen. Conclusion: Hydrotherapy is used nationwide, however considerable variation in practice exists. One area worthy of further consideration is the need for appropriate standards of infection control.

The treatment of patients with chronic wounds is becoming increasingly complex. It was therefore the aim of the members of the working group for wound healing (AGW) of the German Society of Dermatology (DDG) to report on the currently relevant aspects of non-interventional, topical wound treatment for daily practice. -Beside necessary procedures, such as wound cleansing and debridement, we describe commonly used wound dressings, their indications and practical use. Modern antiseptics, which are currently used in wound therapy, usually contain polyhexanide or octenidine. Physical methods, such as negative-pressure treatment, are also interesting options. It is always important to objectify and adequately treat pain symptoms which often affect these patients. Modern moist wound therapy may promote healing, reduce complications, and improve the quality of life in patients with chronic wounds. Together with the improvement of the underlying causes, modern wound therapy is an important aspect in the overall treatment regime for patients with chronic wounds.

ZusammenfassungEs gibt eine statistisch nicht erfasste Patientenzahl, die über Jahre chronische Wunden an ihren Unterschenkeln haben. Viele dieser Patienten haben eine Odyssee von Krankenhausaufenthalten, Versorgungen in Wundzentren und anderen Versorgungsstrukturen erlebt. In der langen Krankheitsphase steht bei diesen Patienten weniger die Therapie als das Herstellen von „Normalität“ im Alltag und die Symptomkontrolle im Vordergrund. Normalität im Alltag bedeutet für oftmals die Auseinandersetzung mit chronischen Schmerzen und der starken Exsudation. Häufig ist zu beobachten, dass die Wundreinigung und die Sicherstellung der Kausaltherapie, in diesen Fällen also die Durchführung einer komplexen Kompressionstherapie, kaum bis gar nicht toleriert wird. Viele dieser Patienten gelten nicht selten als austherapiert. Anhand eines Fallbeispiels soll aufgezeigt werden, wie es gelingen kann, diesen Patienten nachhaltig zu helfen.

Pet cat bites are common—the most typical patient being a child, and the most typical locality hands and face. The normal flora of a pet cat’s mouth houses very potent pathogens. Therapeutic measures include wound cleansing, prophylaxis against tetanus and possibly rabies. Antibiotic prophylaxis should be administered in the cases of all but the mildest superficial wounds especially if the wound is in the hand or face. We present a review on the medical care of cat bite wounds and a typical case of a patient who developed rapid symptoms and signs of infection after a pet cat bite and nearly required hospitalization. The clinical picture was consistent with a Pasteurella infection.

The antibiotic treatment of microbial pathogens of the skin and wounds could so far not fulfil the expectations of an effective and permanent elimination of pathogens so that local treatment with antiseptic agents as a flanking measure to wound cleansing and debridement has become increasingly more established. Because an antiseptic treatment does not actually represent a treatment of infections, the current antimicrobial treatment strategy for infections in skin and wound areas consists of combined antibiotic and flanking antiseptic administration following debridement. However, the combined therapy is not always successful. There is an urgent need for new forms of therapy particularly to combat multiresistant pathogens in biofilms in infections of chronic and other complicated wounds.

We describe our experience with a novel foam dressing architecture in tandem with negative pressure wound therapy and instillation (NPWTi‐d) for removing viscous wound exudate and infectious materials. A retrospective review was conducted of the outcomes of 21 patients who received NPWTi‐d using a reticulated open cell foam instillation dressing with through holes (ROCF‐CC) designed to facilitate the removal of thick wound exudate and infectious materials. NPWTi‐d with ROCF‐CC was used to treat large complex chronic wounds with viscous wound exudate that contained substantial areas of devitalised tissue. Debridement was performed as appropriate or available. NPWTi‐d with ROCF‐CC assisted in loosening, solubilising and detaching viscous exudate, dry fibrin, wet slough and other infectious materials. Percent surface area of black non‐viable tissue and yellow fibrinous slough was reduced to ≤ 10% in 18/21 (85·7%) and 12/21 (57·1%) wounds, respectively, after an average of 1–3 applications (3–9 days) of NPWTi‐d with ROCF‐CC. Preliminary evidence suggests that adjunctive use of NPWTi‐d with ROCF‐CC may help clean large, complex wounds when complete surgical debridement is not possible or appropriate and/or when areas of slough and non‐viable tissue remain present on the wound surface.

Background: Diabetic ulcer is an open wound on the skin layer to the dermis due to hyperglycemia and neuropathy. This condition often causes infection and becomes an inhibitor in the wound healing process. Red fruit oil soap can be used as an alternative cleansing to reduce the number of bacterial colonies and accelerate the wound healing process.Aims: This present study aimed to observe the effect of red fruit oil soap in the cleansing process to reduce the number of bacterial colonies and the wound healing process in grade II Diabetic ulcer patientsMethods: This is a quasi-experimental study with the pre-test post-test non-equivalent control group design. Wound cleansing in the intervention group used 0.9% NaCl solution and red fruit oil soap with a pH of 5.74, while the wound cleansing in the control group used 0.9% NaCl solution. Bacterial colonies were assessed and the type of bacteria was observed by the swab method. The wound healing was assessed with Bates-Jensen Wound Assessment Tool (BWAT) instrument for 14 days with observations every 3 days. Analysis test used Mann Whitney and Repeated Measure ANOVA.Results: There was no difference in the mean of the number of bacterial colonies between the wounds that were cleansed with 0.9% NaCl solution and red fruit oil soap and the wounds which were cleansed by using 0.9% NaCl solution (p> 0.05). The mean of the number of colonies in the intervention group until the 14th day reduced by 3.14x106 and in the control group was reduced h 1.40x106. There was a significant decrease in the wound healing scores in each group, in each assessment for 14 days.Conclusion: This study found that the wound cleansing using red fruit oil soap and 0.9% NaCl solution could reduce the number of bacterial colonies on the wound surface and accelerate the wound healing process among patients with grade II diabetic ulcer.

Aim. To improve the treatment of patients with burns, provide the protection and creation of an optimal «wet» environment for wound healing. Methods. Results of «Biokol», «Biokol-gel» and «Gelepran» regenerative complexes use to treat burn wounds of II-IIIA degree were examined. 75 patients with burns of II-IIIA degree involving 4 to 80% of body surface were examined. Patients were divided into 2 groups. The first group (main group) consisted of 40 patients who were treated using «Biokol» wound dressings and «Biokol-gel». The second group (control group) consisted of 35 patients in whom «Gelepran» hydrogel wound dressing was used. Treatment results were evaluated on the basis of clinical, cytological and microbiological examinations of wound content. Results. 4-5 days after treatment initiation a significant decrease of pathogenic microorganisms detection rate was registered in both groups accompanied by edge epithelization. The rate of Ps. aeruginosa, Рroteus, Kl. pneumonea detection varied from 2.5 to 5% in patients of the first group and from 2.5 to 8.5% - in patients of the second group. No cases of St. viridians detection were registered in patients of the first group. Cytologic picture was described as inflammatory in 76% of patients of the first group and in 59% of patients of the second group, as inflammatory-regenerative in 24 and 32% of cases accordingly. On the sixth day of treatment the detection rate for the inflammatory type of cytogram has reduced, resulting in reduction of neutrophils count to 62% in the first group and to 72% in the second group. An increase of fibroblasts number reaching 30% in the first group and 23% in the second group was also observed, corresponding to the clinical course. Conclusion. Combined use of wound dressing and gel (regenerative complex) showed the best result. «Biokol-gel» created a moist environment activating wound cleansing of residual fibrin and necrotizing tissues and reducing the epithelilization time compared to the «Gelepran» wound dressing. «Biokol» also acted as a mechanical protection and provided the maintenance of favorable conditions in the wound.

Infections of contaminated or colonised acute or chronic wounds remain a grave risk for patients even today. Despite modern surgical debridement concepts and antibiotics, a great need exists for new therapies in wound management. Since the late 1990s, advantageous effects of negative pressure wound therapy (NPWT) have been combined with local antiseptic wound cleansing in the development of NPWT with instillation (NPWTi). This article summarises the current scientific knowledge on this topic. MEDLINE literature searches were performed on the subject of negative pressure wound and instillation therapy covering publications from the years 1990 to 2013 (36 peer-reviewed citations) and regarding randomised controlled trials (RCTs) covering wound care with bone involvement (27 publications) or soft-tissue wounds without bone participation (11 publications) from 2005 to 2012. The use of NPWTi in the therapy of infected wounds appears to be not yet widespread, and literature is poor and inhomogeneous. However, some reports indicate an outstanding benefit of NPWTi for patients, using antiseptics such as polyhexanide (concentration 0·005–0·04%) and acetic acid (concentration 0·25–1%) in acute and chronic infected wounds and povidone-iodine (10% solution) as prophylaxis in contaminated wounds with potential viral infection. Soaking times are recommended to be 20 minutes each, using cycle frequencies of four to eight cycles per day. Additionally, the prophylactic use of NPWTi with these substances can be recommended in contaminated wounds that cannot be closed primarily with surgical means. Although first recommendations may be given currently, there is a great need for RCTs and multicentre studies to define evidence-based guidelines for an easier approach to reach the decision on how to use NPWTi.

A new method (V.A.C.ULTA Therapy System, KCI USA, Inc., San Antonio, TX) combines the benefits of negative pressure wound therapy (NPWT; V.A.C. Therapy, KCI USA, Inc.) with regulated, periodic instillation of user-selected topical wound solutions (V.A.C. VeraFlo Therapy, KCI USA, Inc.). In simulated wound model studies comparing solution distribution using NPWT with and without a soak phase, the instillation soak phase allowed for uniform solution distribution across the wound bed, whereas continuous (no soak) irrigation resulted in uneven coverage. Additional in vitro work illustrated that bacterial particle aerosolisation during wound cleansing was significantly decreased using NPWT with instillation (NPWTi) versus commercially available low-pressure wound cleansers (P < 0·05). In porcine studies, NPWT with saline instillation induced 43% more granulation tissue versus NPWT (P < 0·05) and was as effective at wound cleansing as pulsed lavage. These studies have demonstrated that NPWTi may be an effective wound management therapy that provides both wound cleansing and NPWT benefits.

The wet-to-dry phase as a basic accompanying measure in dressing changes on secondary healing wounds was first described and instructed 1989 by G. Kammerlander at the university hospital of Zurich. This development traces back to collective years of practical experiences at the Clinic of dermatology of the university hospital Zurich (Prof. U.W. Schnyder/G. Kammerlander). The positive empirical experiences over more than one and a half decade now require underlying this method with scientific facts. Using a literature survey, the importance and significance of this practical experience will be confirmed and supported. This article will show this established and widely-used method in an updated version.

Wound healing is a complex series of events that are interlinked and dependent on one another. Acute wounds usually follow a well-defined process. In the past this model of healing has been applied also to chronic wounds, but it is well known that chronic wound healing is different from acute wound healing. Wound bed preparation as a concept allows the clinician to focus systematically on all of the critical components of a non-healing wound to identify the cause of the problem, and implement a care programme in order to achieve wound healing. To assist with implementing the concept of wound bed preparation, the TIME acronym was developed in 2002 by a group of wound care experts. It is important to understand wound bed preparation and TIME within the context of total patient care. Debridement is an integrated part of wound management, achieving certain goals and, thus, creating a healthy wound bed, margins and peri-wound skin with the objective to promote and accelerate healing. Debridement is defined as the removal of foreign material and necrotic tissue from a wound and it can also help to stimulate wound healing. However, not all methods of debridement are the same. Each method has advantages and disadvantages that must be clearly understood. Wound cleansing loosens and washes away cellular debris such as bacteria, exudate, purulent material and residual topical agents from previous dressings. Failure to use the correct method for a given wound may lead to further delays in wound healing, increase patient suffering, and unnecessarily increase the cost of care. Aim of this review is to give an overview of current standards and definitions concerning wound bed preparation and debridement.

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.

Current guidelines suggest early surgical treatment of open fractures. This rule in open hand fractures is not well supported and may be unpractical. Furthermore, desirable debridement and washout can be obtained in the emergency department (ED). The purpose of this study was to evaluate the relationship between the level of contamination, quality of washout in the emergency room, and the development of infection. Sixty-one patients with open fractures of the hand were retrospectively reviewed for demographic and fracture characteristics, and other complications. The infection rate was 14.8%. Contamination was present in 43 patients (70.5%). One thousand milliliters or more were used to obtain a grossly clean wound in 43 patients (70.5%). No significant relationship was found between fracture type, finger involved, hand dominance, comorbidities, and development of infection. The amount of fluid used for washout was significantly related to infection (P = 0.047), whereas wound contamination was not (P = 0.259). Type of oral antibiotic was significantly related to infection (P = 0.039). The level of contamination was not a significant factor in predicting infection, whereas the amount of fluid used for washout and the oral antibiotic type were significant factors in preventing infection. Since administration of intravenous antibiotics and thorough wound cleansing can be performed on open hand fractures in the ED under adequate anesthesia, most open fractures in the hand do not need to be treated early in the operating theater.

Background: Although various solutions have been recommended for cleansing wounds, normal saline is favoured as it is an isotonic solution and does not interfere with the normal healing process. Tap water is commonly used in the community for cleansing wounds because it is easily accessible, efficient and cost effective; however, there is an unresolved debate about its use. Objectives: The objective of this review was to assess the effects of water compared with other solutions for wound cleansing. Search strategy: For this update we searched the Cochrane Wounds Group Specialised Register (Searched 22 February 2010); The Cochrane Central Register of Controlled Trials (CENTRAL) ( The Cochrane Library, 2010 Issue 1); Ovid MEDLINE – 2007 to February Week 2 2010; Ovid MEDLINE – In-Process & Other Non-Indexed Citations (Searched19 February 2010); Ovid EMBASE – 2007 to 2010 Week 06; EBSCO CINAHL – 2007 to 22 February 2010. Selection criteria: Randomized and quasi-randomized controlled trials that compared the use of water with other solutions for wound cleansing were eligible for inclusion. Additional criteria were outcomes that included objective or subjective measures of wound infection or healing. Data collection and analysis: Two review authors independently carried out trial selection, data extraction and quality assessment. We settled differences in opinion by discussion. We pooled some data using a random-effects model.

Contexto: Existe consenso de que a limpeza de feridas reduz as taxas de infeção. Contudo, há algum debate na praxis clínica sobre as suas potenciais vantagens e desvantagens. Objetivos: Identificar e sintetizar as melhores evidências sobre a eficácia de soluções de limpeza para o tratamento de feridas. Método de Revisão: Seguiu-se a metodologia do Joanna Briggs Institute. Foram incluídos estudos que consideravam doentes com feridas crónicas e agudas. Dois revisores independentes realizaram a avaliação crítica, a extração e a síntese dos dados. Resultados: Foram incluídos 3 ensaios clínicos aleatorizados (n=718) e os resultados da meta-análise mostraram não existirem diferenças nas taxas de infeções quando se compara a água corrente com o soro fisiológico (OR=0,79; lC 95%= 0,36-1,72; p=0,55). Para as feridas agudas, o odds ratio foi de 0,98 (IC 95%= 0,43-2,25). Conclusão: Não há evidências de que a utilização de água corrente para limpar feridas em adultos aumente as taxas de infeção/cicatrização. Pode existir uma diminuição das taxas de infeção quando é utilizada iodopovidona nas feridas de origem cirúrgica. Background: There is a consensus that wound cleansing reduces infection rates. There is, however, some debate in clinical circles about the potential advantages and disadvantages of cleansing wounds. Objectives: To identify and synthesize the best available evidence on the effectiveness of cleansing solutions for wound treatment. Review method: This systematic review followed the Joanna Briggs Institute methodology and included studies that considered patients with chronic and acute wounds. Critical appraisal, extraction and synthesis of data were performed by two independent reviewers. Results: Three randomized clinical trials (n=718) were included and the results of the meta-analysis showed no difference in the wound infection for the Tap Water versus Sterile Saline comparison (OR=0,79; 95% Cl= 0,36-1,72; p=0,55). For acute wounds, the odds ratio was 0,98 (95% CI= 0,43-2,25). Conclusion: There is no evidence that using tap water to cleanse acute and chronic wounds in adults increases infection or healing rates. There may be a trend towards a lower wound infection rate when povidone-iodine is used in surgical wounds. Marco contextual: Existe consenso en que la limpieza de heridas reduce las tasas de infección. Sin embargo, existe un debate sobre sus potenciales ventajas y desventajas en la práctica clínica. Objetivos: Identificar y sintetizar las mejores pruebas sobre la eficacia de las soluciones de limpieza para el tratamiento de heridas. Metodología: Se siguió la metodología del Instituto Joanna Briggs y se incluyeron estudios que consideraron a los enfermos con heridas crónicas y agudas. Dos revisores independientes realizaron el análisis crítico, la extracción y la síntesis de los datos. Resultados: Se incluyeron 3 ensayos clínicos aleatorios (n=718). Los resultados del metanálisis mostraron que no existen diferencias en las tasas de infecciones cuando se compara el agua potable con el suero fisiológico (OR=0,79; lC 95%= 0,36-1,72; p=0,55). Para las heridas agudas, la razón de momios fue 0,98 (IC 95%=0,43-2,25). Conclusión: No hay pruebas de que el uso de agua potable para limpiar heridas en adultos aumente las tasas de infección/cicatrización. Puede existir una reducción en las tasas de infección cuando se utiliza povidona yodada en las heridas quirúrgicas.

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.

Wound cleansing has been practised for centuries and despite our advances in the medical field there is still much confusion about which solution to use for cleansing wounds in practice. From boiled water to cytotoxic chemicals the annihilation of bacteria has become our biggest obsession but it should not be at the expense of the healing process. As multi-resistant organisms begin to reduce our options for antibiotic use it appears that dilution remains the solution to pollution.

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.

Introduction. Wound cleansing for diabetic wound care always used 0.9% of NaCl or other commercial solutions. Currently, the use of guavas leaves extract (Psidium guajava L) as an alternative wound cleansing solution has been started to be introduced as a part of complementary nursing. The aim of this study was to compare the effectiveness of commercially wound cleansing solution of 0.9% NaCl and guavas leaves extract in wound healing process of diabetes mellitus patients. Methods. This study used six respondents as a sample, by using quasi experiment methods of 4 times wound cleansing. In this experiment, the control group used NaCl 0.9% while a group of sample used guavas leaves extract as wound cleansing solutions. Result. The experimental result revealed that there was a significant result between types of wound cleansing solution effectiveness in NaCl 0.9% with an extract guavas leaves for some wound characteristics (Presentation of wound slough P value: 0.043; presentation of wound granulation Pvalue: 0.037 (α=0.05)). However, There were no significant result of effectiveness comparison between wound cleansing solution (NaCl 0.9% and Guavas Leaves Extract) for wound dimension and epithelial tissue characteristics (Wound wide Pvalue:0.184; wound long Pvalue: 0.361; epithelial tissue presentation Pvalue:0.072 (α=0.05). Discussion. These results confirmed that guava leaves extract can serve as an alternative wound cleansing solution as commercial wound cleansing solution such as 0.9% NaCl. Keywords: Guavas leaves extract, Diabetes mellitus, wound care, wound cleansing solution

Atiyeh BS, Dibo SA, Hayek SN. Wound cleansing, topical antiseptics and wound healing. Quality of care is a critical requirement for wound healing and ‘good’ care of wounds has been synonymous with topical prevention and management of microbial contamination. Topical antiseptics are antimicrobial agents that kill, inhibit or reduce the number of microorganisms and are thought to be essential for wounds infection control. However, they have long and commonly been used on wounds to prevent or treat infection, the merits of antiseptic fluid irrigation have received little scientific study. Unlike antibiotics that act selectively on a specific target, antiseptics have multiple targets and a broader spectrum of activity, which include bacteria, fungi, viruses, protozoa and even prions. Although certain skin and wound cleansers are designed as topical solutions with varying degrees of antimicrobial activity, concerns have been raised. Wound cleansers may affect normal human cells and may be antimitotic adversely affecting normal tissue repair. Repeated and excessive treatment of wounds with antiseptics without proper indications may have negative outcomes or promote a microenvironment similar to those found in chronic wounds. However, when applied at the proper times and concentrations, some classes of antiseptics may provide a tool for the clinician to drive the wound bed in desired directions. The present review summarises the various antiseptics in use and their negative impact on the wound healing mechanisms. It is clear that the role of antiseptics on wounds and their role in wound care management need to be reconsidered.

Dog bite injury is a common reason for presentation to emergency departments. However the nature of this problem in Australia has not been closely studied and a number of unresolved questions remain regarding management options. This prospective study of 101 cases was undertaken to collect demographic information about victims and assailants, to describe the spectrum of injury seen and to report outcome following a standard management protocol. In common with other studies, young males were bitten most frequently, usually by German Shepherds, Heelers and Terriers. Nearly half (48%) of the facial injuries occurred in children under 10 years old. The infection rate in this study, using wound cleansing and prophylactic penicillin in all cases, was only 4%. Wound swabs on presentation were unhelpful. Controversies still exist regarding wound closure and the use of prophylactic antibiotics.

Highly effective means of stopping capillary-parenchymatous bleeding — one of the main causes of death in people from 1 to 34 years of age in traffic accidents — were developed. Biologically active wound dressings that reduce purulent-necrotic wound cleansing time by 3 times, healing time by 2.5 times, and hospital stays by 6 times were developed.

Background: Hydrogen peroxide solutions of lowconcentrations are important antiseptics anddeodorants used in hospitals and as home-remedies. The preparations have the disadvan-tage of being unstable when exposed tosunlight and when stored for a long time. Theydecompose slowly, releasing oxygen and waterthus decreasing the available hydrogen peroxidefor antimicrobial action.Objective: To assess the quality of hydrogenperoxide solution-based antiseptics available inDar es Salaam.Methodology: One hundred and sixty-five sam-ples were collected at random from pharmaciesand medical stores, and analysed. One hundredand forty samples were hydrogen peroxide solu-tions intended for wound cleansing and 25 sam-ples were eardrops. Among these samples, 116were from manufacturer A, 24 from manufacturerB and 25 samples of eardrops were from manu-facturer C.Results: Eighteen (26%) of the samples frommedical stores failed to meet specifications. Ofthe 70 samples from pharmacies, 20 (29%) failedto meet the BP 2005 specifications. All the 25samples of eardrops failed to comply with speci-fications. The average hydrogen peroxide con-tents (±SD) of the samples from medical storesand pharmacies were 6.6±0.6%,6.8±0.4% w⁄vrespectively. The difference was statistically sig-nificant (P

Significance: Traumatic injuries are the leading cause of morbidity and mortality in children. The purpose of this review is to provide an overview of the initial assessment and management of traumatic and burn wounds in children. Special attention is given to wound cleansing, debridement techniques, and considerations for pain management and psychosocial support for children and families. Recent Advances: Basic and translational research over the last 5–7 years has advanced our knowledge related to the optimal care of acute pediatric traumatic and burn wounds. Data concerning methods, volume, solution and timing for irrigation of acute traumatic wounds, timing and methods of wound debridement, including hydrosurgery and plasma knife coblation, and wound dressings are presented. Additionally, data concerning the long-term psychosocial outcomes following acute injury are presented. Critical Issues: The care of pediatric trauma and burn-related wounds requires prompt assessment, pain control, cleansing, deb...

Aim: This evaluation aimed to determine whether the use of a haemoglobin spray solution expedited sloughy wound healing. Method: A descriptive evaluation was undertaken within a community setting exploring 25 patients presenting with sloughy healing and non-healing wounds, and the effects of 8 topically administered haemoglobin treatments over a 4-week period. Standard wound cleansing and dressing management were continued, with no changes to pre-evaluation regimens, and care being provided by the patients themselves or by a carer. Data were collected weekly with regard to primary outcomes of slough reduction, wound surface area reduction, patient ease of use (self-care), and overall product experience. Results: At 4 weeks, all wounds demonstrated positive measured endpoints of slough elimination and continued wound-size reduction. Patients and carers found the product easy to use (self-caring) with an overall positive wound care experience. Conclusion: The administration of a haemoglobin spray solution on patients presenting with sloughy wounds resulted in positive healing outcomes of slough elimination and wound reduction alongside positive self-care and product satisfaction. Continued evaluation is recommended to build upon the evidence of this form of treatment.

Chronic wound management remains challenging in clinical practice, especially in the presence of bacterial bioburden and slough. To resolve these clinical challenges, it is essential clinicians implement the TIME framework (tissue, inflammation/infection, moisture, edge of wound) as a model of effective wound bed preparation. As a result of advances in technology and wound care therapies, on the market today are products that can help reduce the wound bed clinical challenges recommended by the TIME framework. This article looks at a wound cleansing solution that reduces the wound bed bioburden by breaking down biofilms and debriding slough.

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.

Objective The purpose of this study was to determine (1) the rate of contamination for a normal saline solution prepared with distilled water and salt when stored at room temperature and (2) when stored under refrigerated conditions; and (3) to compare the rate of contamination for solutions prepared and stored under controlled conditions with those prepared and stored in patients' homes. Design This quasi-experimental study examined the bacterial content of saline made with distilled water and stored at room temperature and that of saline stored in a refrigerator. Setting A large urban home health agency was the setting for the study. Methods Eight teaspoons of table salt were added to 1-gallon jugs of distilled water purchased from a grocery store to produce a normal saline solution. Two gallons of the prepared solution were stored at room temperature (80 degrees F) and 2 were stored in a refrigerator (48 degrees F). Cultures were taken from each of the 4 bottles of prepared solution immediately following preparation and at weekly intervals until bacterial growth occurred, or 4 weeks after preparation. Results All tested solutions were negative for bacterial growth at baseline. Cultures of the solution stored at room temperature were positive for bacterial growth 2 weeks after preparation, whereas those stored under refrigerated conditions remained free of bacterial contamination 4 weeks after preparation. Two "patient-prepared" solutions were tested at 3 weeks, and both were negative for bacteria at that time. Three patient-prepared solutions were tested at 4 weeks, of which 2 showed no bacterial growth in 48 hours, whereas 1 revealed 600 cfu/mL of Pseudomonas species. Conclusions The results of this small study suggest that saline solutions produced by adding table salt to distilled water will remain bacteria-free for 1 month if refrigerated. Additional studies are needed to confirm these findings.

Important improvements have been made in wound care over the last decade. However, few data are available on the influence that these have outside their intended use. This study aimed to clarify the effects of the use of wound cleansers on bacterial contamination of the immediate surroundings. Little evidence was found from either laboratory or clinical settings that wound-derived micro-organisms become airborne during wound cleansing. Bacterial dispersion around wounds may be attributed to general activity rather than wound cleansing. If simple precautions are taken, risks for personnel and patients in hospitals and consultation rooms during wound cleansing can be minimized.

washing. Materials and Methods: This interventional study was conducted in the Infectious Disease Ward of the Imam Khomeini General Hospital. Twenty patients with wounds needing sterile washing and 10 medical interns enrolled in the study. Each intern performed wound washing for two patients using Safe Irrigator Syringe. After performing wound irrigation, an interview was performed to assess the applicability and efficacy of the new device and method. Results: All of the interns stated that the new device is quite applicable for wound washing and is easy to handle. Nine interns believed that Safe Irrigator Syringe is superior to the conventional devices regarding efficacy and performer’s satisfaction, while one intern believed that it is similar to the conventional methods. Conclusions: The designed Safe Irrigator Syringe seems to be applicable in wound irrigation and superior to the conventional devices regarding efficacy and user comfort.

Approximately 10 million patients with traumatic wounds are treated in US emergency departments annually. The practice of wound cleansing or antiseptic management has a dichotomous history anchored in tradition and science. The merits of antiseptic fluid irrigation of traumatic wounds have received little scientific study. The purpose of this article is to critically evaluate the potential harm to patient outcome by the use of antiseptics on acute wounds. First, animal and cell culture data that describe the effects of topical antiseptics on wound healing are offered. Second, human case studies are presented to illustrate the potential harm of the indiscriminate use of antiseptics. Finally, data from previously published reviews are presented and evaluated for clinically based evidence to justify the current practice of antiseptic use in acute traumatic wounds. (J Am Podiatr Med Assoc 95(2): 148–153, 2005)

Background This systematic review updates a previous review published in 2001. Cleansing is a vital component of wound management; however; little attention has been give to the solutions and techniques used for cleansing purposes. The objective of this review was to assess the effectiveness of different solutions, pressures and techniques used for wound cleansing to prevent infection and promote wound healing. Search strategy Randomised and clinical controlled trials were identified using the Cochrane Central Register of Controlled Trials (CENTRAL). Additional searches of other databases and hand searches of journals and bibliographies was undertaken to identify further trials. Selection criteria All randomised and clinical controlled trials involving adults and/or children whose wounds were cleaned with commercial cleansers, normal saline, water, chlorhexidine, hydrogen peroxide or povidone-iodine were eligible for inclusion. Studies that utilised solutions for preoperative skin cleansing, compared solutions for burns or dental procedures, and those that compared dressings for patients with ulcers were excluded from this review. Outcomes included rate of healing, incidence of infections or levels of bacterial count. Selection of potential articles, assessment of methodological quality and data abstraction was conducted independently by two reviewers. Trials with similar patients, comparisons, and outcomes were pooled. The data were analysed using Cochrane Review Manager 4.2. Where pooling was inappropriate, trials are discussed in a narrative review. Results Fourteen randomised controlled trials were included that compared various solutions for wound cleansing. The evidence indicates that there is no difference in the infection and healing rates in acute and chronic wounds cleansed with either tap water or normal saline. An irrigation pressure of 13 psi is effective for cleansing wounds and reducing infection without causing tissue trauma. There were no studies comparing common techniques for wound cleansing such as swabbing or scrubbing. Showering postoperative wounds did not demonstrate any difference in infection rates; however, it increased the morale of the patient. Whirlpool therapy was effective in reducing inflammation and pain in surgical wounds. Conclusions These conclusions are based on the best available clinical evidence. However, there is an urgent need to support these findings with rigorous research as some of the conclusions are based on single studies with limited sample sizes. Solutions for wound cleansing: • The evidence supports the use of potable tap water for cleansing lacerations in both adults and children and postoperative wounds in adults only. • Potable tap water as well as boiled and cooled water is also an effective wound cleansing solution. This finding, however, is based on a trial that had a small sample size. • The evidence to support the use of potable tap water is limited (only one study with low power); therefore, further studies are required to confirm that assumption. • Povidone-iodine is an effective cleansing solution for contaminated wounds. Pressure for wound cleansing: • A pressure of 13 psi is effective in reducing infection and inflammation in both adults and children with lacerations and traumatic wounds. Techniques for wound cleansing: • Evidence to support or refute swabbing and scrubbing to cleanse wounds is lacking. • The review demonstrated no evidence of a difference in the wound infection and healing rates between wounds that were showered and those that were not. • The evidence for showering ulcers and other chronic wounds is lacking; therefore, this technique of wound cleansing should be undertaken with caution. • Whirlpool therapy is effective to reduce pain and inflammation in surgical wounds and improve the healing rate in pressure ulcers. • The evidence to support the use of Sitz bath for patients following episiotomy is limited.

WOC nurses may be asked to manage small burn wounds or to follow up with patients who have residual wound care issues after recovering from a major burn injury. Aspects of care include identifying patients who warrant a higher level of burn care expertise, managing small wounds, recognizing the common complications of burns, and determining the needs of patients undergoing burn rehabilitation. Persons managing burn wounds will incorporate a variety of techniques to facilitate wound cleansing and dressing, pain management, psychological support, and minimization of complications. In addition, depending on the setting, extent, and nature of the wounds, the patient's abilities and rehabilitation requirements will need to be determined. The patient and his or her family need to be educated about the normal changes that follow a burn injury and how to manage these issues. (J WOCN 2002;29:76-82.)

Whether to use clean or sterile technique in the management of acute and chronic wounds is a question that researchers and clinicians have been asking and attempting to answer with certainty since the 1800s. Because patient situations are unique, particularly in the home, the structured guidelines one finds for wound cleansing and dressing are not universally applicable. The key to current WOCN practice is to critically examine wound care regimens, remain current in wound care strategies, and base practice on best current evidence along with government policies.

A critical aspect of effective and cost-efficient wound management is infection prevention and actions taken to minimize bacterial levels in the wound. This article describes effective wound cleansing and debridement, appropriate use of advanced dressings, procedures for dressing changes, and the appropriate use and understanding of topical antimicrobial agents.