Wound Cleaning Techniques

[BonnieSc]

I have another question from the developing world... the standard method here for wound cleaning is pretty rough-literally rough. Basically, they take 2x2s moistened with normal saline and scrub the wounds with them (while the patient moans or screams). They tell me this is necessary to clean the wound. They usually use five or six 2X2s to scrub each wound.. less if the wound is "clean", more if it is "very dirty".

I can't seem to find any evidence against this because no one else is doing it! All the literature I've found says to use NS to clean the wound, meaning, as I understand it, a spray of normal saline, not gauze scrubbers.

Has anyone seen this technique used? Any opinions?

[ThinkerBelleRN, BSN, RN]

Where do you work as a wound care nurse? In our wound care unit, we use either normal saline or a cleaning solution form a company I cannot "advertise" here. We usually just irrigate the wounds, and soak the wound bed for a few minutes with a piece of gauze and saline or wound cleanser. We can gently wipe the wound and lift some loose slough and fibrin layer, but we never scrub.

[yesitslaura]

New granulation tissue is very fragile. Sounds like this method has a very high potential for damaging new, healthy tissue. In fact, here that would be a legal risk for a nurse trying to debride a wound! A gentle irrigation is all that is needed for cleansing.

[TammyG]

Oh, my, that is not good. As yesitslaura says, you don't want to scrub wounds because you will rub out the new granulation tissue, which is just one or two cells thick, and the wound will never heal. lt should not be hard to find evidence-based guidelines supporting gentle irrigation.

[Saifudin]

If wet to dry dressings are being used less due to removing new granulation tissue, how could 'rough scrubbing' be of benefit? It sounds like a form of sharp debridement. And no prepping the patient with pain meds sounds pretty sadistic.

[BonnieSc]

Well, to be honest, we're also doing sharp debridement.This is a culture war that I'm not sure I'm going to win, but since my job is teaching nursing students as well as nurses, I'm trying to start with sneaking in some irrigation techniques in my work with students without undermining the nurses. I think they do see that irrigating "first" does mean they have to do less scrubbing to get the result they want.I appreciate the responses very much. I have found the evidence for gentle irrigation, but not against rough cleaning; I know that sounds illogical, but in this nursing culture it isn't good enough. I think showing evidence that they shouldn't do what they're doing has more of a chance of being effective. The biggest trouble is that it is ingrained in them that research and evidence from the developed world is not relevant to them. Sometimes this is true, but wound healing is wound healing.

[TammyG]

It is hard to believe that there is an institution in the United States in 2015 that follows practices like this. There should be dozens of articles finding that rubbing newly epithelized and granulating tissue is going to destroy those tissues. All those studies by Miller & Dyson in the 1990's. If you check back here next week, I will try to include them. Good luck.

[BonnieSc]

I'm not in the US, I'm sure you'll be relieved to hear! I'm in the developing world. Any help you can provide would be greatly appreciated.

[Ankle]

I have a client with a ankle wound lots of slough and sntyl not working bad odor and drainage !! Help

[LDRNMOMMY, BSN, RN]

Where do you work as a wound care nurse? In our wound care unit, we use either normal saline or a cleaning solution form a company I cannot "advertise" here. We usually just irrigate the wounds, and soak the wound bed for a few minutes with a piece of gauze and saline or wound cleanser. We can gently wipe the wound and lift some loose slough and fibrin layer, but we never scrub.

When I worked in an outpatient wound care clinic, we used this same technique.