1. Wound Cleansing & Wound Irrigation
Diane L. Krasner
PhD, RN, FAAN
&
Lia van Rijswijk
DNP, RN, CWCN
Module #9
Revised September 2018

2. Disclaimer
The Why Wound Care? education and recruitment campaign has been developed by our all-volunteer nursing and medical advisory boards. Website, logistics, marketing and exhibition support is provided by HMP with help from unrestricted educational grants from our corporate sponsors. A list of corporate sponsors can be found in the “About” tab. All educational materials were developed and are donated by our advisory board members. Neither HMP nor our corporate sponsors were involved in the selection, development, or content of these educational materials.
Conflict of Interest: Dr. Diane Krasner and Dr. Lia van Rijswijk declare that they have no potential conflict of interest related to the content of this presentation.

3. Objectives To discuss the rationale for cleansing wounds
To describe the underlying principles for irrigating wounds
To describe methods and solutions for wound cleansing and wound irrigation

4. Wound Cleansing & Wound Irrigation Purpose
Removal from the wound bed of - Proinflammatory material (e.g. devitalized tissue, bacteria) - Foreign bodies
© Diane L. Krasner Used with permission
Rodeheaver GT, Ratliff CR. Wound cleansing, wound irrigation, wound disinfection. In Krasner DL, ed. Chronic Wound Care: The Essentials. Malvern, Pa: HMP Communications, 2014: Downloadable at

5. Wound Cleansing & Wound Irrigation Principles
The force of fluid application and type of solution used is based on the condition of the wound bed (assessment).
Balance need for debris removal with need to prevent damage to healthy granulation tissue.
Gentle flushing (e.g., pouring fluid from bottle) is usually sufficient for clean wounds with low levels of exudate.

6. Wound Cleansing
The use of fluids to gently remove loosely adherent contaminants and devitalized material from the wound surface
Sterile or non-sterile solutions may be used
Not debridement
May require some force (syringe)
Rodeheaver GT, Ratliff CR. Wound cleansing, wound irrigation, wound disinfection. In Krasner DL, ed. Chronic Wound Care: The Essentials. Malvern, Pa: HMP Communications, 2014: Downloadable at

7. Wound Irrigation
The use of hydraulic forces - generated by the stream of fluid – to loosen wound surface debris and flush it from the wound
Devices used for wound irrigation include syringes and pulsed lavage. Pressures are measured in psi (pounds per square inch)
Most commonly used pressure: 4 – 15 psi
35 ml syringe and
19 G angiocath
or 100 ml. single use squeeze bottle = 7-8 psi
Rodeheaver GT, Ratliff CR. Wound cleansing, wound irrigation, wound disinfection. In Krasner DL, ed. Chronic Wound Care: The Essentials. Malvern, Pa: HMP Communications, 2014: Downloadable at

8. Caution:
Avoid traumatizing the wound (mechanical or chemical) during wound cleansing & wound irrigation
Mechanical trauma includes using fluids that are cold (body temperature fluids are also less painful!)
Avoid cytotoxic cleansing agents (such as antiseptics). They can damage healthy cells.

9. Usual Cleansing Solutions include:
Normal saline solution
pH balanced wound cleansers
Note: Do not confuse wound cleansers
with skin / incontinence cleansers!
Tap water (from a safe water source)

10. The Evidence
No differences have been noted in the rates of infection and healing between the use of tap water and sterile normal saline in the cleansing of acute and chronic wounds.
Research on the effectiveness of wound cleansing (methods and solutions) is very limited.
Pre-clinical studies have shown that some solutions (e.g., antiseptics) damage cells needed for wound healing.
Fernandez, R., Griffiths, R. Water for wound cleansing. Cochrane Database of Systematic Reviews, February 15, DOI: / CD pub3
Moore, ZEH, Cowman, S. Wound cleansing for pressure ulcers. Cochrane Database of Systematic Reviews, March 28, DOI: / CD pub
Rodeheaver GT, Ratliff CR. Wound cleansing, wound irrigation, wound disinfection. In Krasner DL, ed. Chronic Wound Care: The Essentials. Malvern, Pa: HMP Communications, 2014: Downloadable at

11. Making Saline Solution at Home
1 teaspoon Salt
1 quart Water* or
8 teaspoons Salt
1 gallon Water*
* Known, non-contaminated, safe water source

12. Commercial Wound Cleansing Solutions contain surfactants (surface active agents)
Surfactants help to break the bonds between foreign bodies and the wound surface

13. Antimicrobial Solutions
May be used in certain circumstances and/or for short periods of time
- for infected wounds
- for non-healable wounds
- for palliative wounds
© Diane L. Krasner Used with permission

14. Antimicrobial Solutions
Examples:
- Acetic Acid
Dakin’s Solution
Hydrogen peroxide
Povidone-iodine
Silver
© Diane L. Krasner Used with permission
Stop use when wound bed contains predominantly healthy tissues

15. Caution:
Protect yourself from splash-back and prevent environmental contamination.
Follow infection control measures for safe wound cleansing and irrigation:
Gloves
Masks / Face Shields PRN
Gowns PRN
Backsplash guard PRN

16. Cleanse or irrigate
the wound at every dressing change (unless there is an order specifying not to)

17. Key Concepts Aseptic Care Assessment Caring Evidence-based Practice
Healing
Infection
Infection Control
Pain
Prevention
Safety
Treatment

18. Key Diagnoses Alteration in Comfort r/t Impaired Skin Integrity
Impaired Tissue Integrity
Potential for Infection
Potential for Injury

19. Key Practice Issues
Nurses frequently assess and change dressings without cleansing the wound.
Wound cleansing should be a step in every dressing change protocol, unless orders specify otherwise.
Proper attention to infection control measures and splash-back is critical for safety reasons

20. Websites for Further Information on Wounds
- Association for the Advancement of Wound Care
- National Pressure Ulcer Advisory Panel
- Wound Healing Society
- Wound Ostomy Continence Nurses Society
- Wounds Canada