Abstract
Aim: To explore the effectiveness of wound cleansing agents and techniques to reduce wound infection and promote wound healing in an adult population with acute and chronic wounds.
Background: Wound care remains a challenge to health professionals and is a financial burden to the health system. Wound cleansing is an important part of the integral approach to wound care, and it involves selection of cleansing solutions and techniques. Normal saline and tap water are the most common solutions used for wound cleansing, but they are not effective in removing biofilms on wounds, and traditional antiseptics are harmful to healthy issues. Modern antimicrobial solutions are considered destructive to bacteria, viruses and fungi, but not the granulating tissue. However, wound cleansing practice is mainly based on expert opinions and case studies, and there is limited robust evidence that antimicrobial solutions are able to reduce infection and enhance wound healing. Furthermore, whilst wound irrigation with low pressure is preferable in the literature, swabbing is still common practice.
Methods: An integrative review was chosen as the methodology for this dissertation. A systematic literature search was undertaken from four electronic databases: CINAHL, MEDLINE, Ovid Emcare and Google Scholar. The Joanna Briggs Institute's quality appraisal tools were applied to critique RCTs and cohort studies. Data extraction and analysis was undertaken and the review is presented in a narrative format.
Results: Fourteen studies were included in this review, comprising 11 studies pertaining to solutions and three for techniques. Whilst six out of ten studies reported that antiseptic solutions had the potential to be safe and effective in reducing bacterial loads, four others reported no significant difference or favoured isotonic or hypotonic solutions. Tap water was considered a safe and cheap alternative solution to clean wounds instead of normal saline. In terms of cleansing technique studies, wound irrigation with low pressure was the most effective.
Conclusions: Antiseptic solutions may reduce the bacterial load and prepare a wound bed. However, there is no robust evidence that antiseptic solutions reduce infection and promote wound healing. Wound irrigation with low pressure is more effective. A systematic approach for wound cleansing therefore is the best evidence-based practice: A thorough wound cleansing manner is more important than individual antiseptic solutions.