References
Use of wet-to-moist cleansing with different irrigation solutions to reduce bacterial bioburden in chronic wounds
Abstract
Objective:
The influence of different irrigation solutions, in conjunction with wet-to-moist cleansing, on the reduction of sessile, non-planktonic bacteria which colonise wounds, has not been investigated. In this study, the antibacterial effect of different irrigation solutions, during a 20-minute wet-to-moist cleansing, has been evaluated in chronic wounds.
Methods:
This study was designed as a prospective cohort study with 12 study arms and was conducted between June 2011 and April 2016. Patients with chronic wounds present for more than three months, irrespective of previous treatments, were recruited into this study. Quantitative wound swabs were obtained before and after a 20-minute, wet-to-moist cleansing, using different wound irrigation solutions. Sterile 0.9% saline served as a control.
Results:
We recruited 308 patients, of which 260 patients with 299 chronic wounds were eligible for analysis. Staphylococcus aureus was the most common recovered (25.5%) microorganism, of which 8% were meticillin-resistant Staphylococcus aureus (MRSA) strains. Although 0.9% saline supported cleansing of the wound bed, it did not significantly reduce the bacterial burden. The highest reduction of bacterial burden was achieved with an aqueous solution containing betaine, zinc and polyhexamethylene biguanide (polihexanide; ln RF=3.72), followed by a 3% saline solution containing 0.2% sodium hypochlorite (ln RF=3.40). The most statistically significant reduction of bacterial burden, although not the highest, was achieved with povidone-iodine (ln RF=2.98; p=0.001) and an irrigation solution containing sea salt 1.2% and NaOCl 0.4% (ln RF=2.51; p=0.002).
Conclusion:
If a reduction of bacterial burden is warranted, wound irrigation solutions containing a combination of hypochlorite/hypochlorous acid, or antiseptics such as polihexanide, octenidine or povidone-iodine, ought to be considered.
Wound bed preparation (WBP) is the first step in the care of any chronic skin defect after identification and management of underlying, responsible, pathological factors, such as ischaemia, pressure or diabetes.1,2 The aim of WBP is to eliminate necrotic tissue, debris and microbial bioburden from the wound bed through techniques of maintenance debridement. Furthermore, it is to safeguard the wound edges, protect the periwound skin, and to support and facilitate optimal healing.3
The most effectively used step of WBP is sharp mechanical debridement, followed by other methods including autolytic, enzymatic, biologic (larval debridement), or wet-to-dry debridement.3,4 Other than debridement, a wet-to-dry method of wound cleansing (or more correctly, a ‘wet-to-moist technique’) has been also described,5 which should not be confused with the wet-to-dry method of debridement.3
Register now to continue reading
Thank you for visiting Wound Central and reading some of our peer-reviewed resources for wound care professionals. To read more, please register today. You’ll enjoy the following great benefits:
What's included
-
Access to clinical or professional articles
-
New content and clinical updates each month