Effectiveness of solutions, techniques and pressure in wound cleansing

Abstract

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:

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  The evidence supports the use of potable tap water for cleansing lacerations in both adults and children and postoperative wounds in adults only.

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  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.

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  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.

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  Povidone-iodine is an effective cleansing solution for contaminated wounds.

Pressure for wound cleansing:

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  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:

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  Evidence to support or refute swabbing and scrubbing to cleanse wounds is lacking.

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  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.

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  The evidence for showering ulcers and other chronic wounds is lacking; therefore, this technique of wound cleansing should be undertaken with caution.

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  Whirlpool therapy is effective to reduce pain and inflammation in surgical wounds and improve the healing rate in pressure ulcers.

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  The evidence to support the use of Sitz bath for patients following episiotomy is limited.