Wound Irrigation

Wound healing is affected by infection, tension, perfusion, and alignment. Cleaning a wound with tap water or isotonic saline removes debris and bacteria mechanically from the wound and reduces infection rates. One study found no clinically important differences in infection rates between wounds irrigated with tap water or a normal saline solution (Valente et al., 2003).

Many studies recommend 7 psi (lb/in2) or greater for adequate irrigation of dirty wounds and 0.5 psi for clean wounds. Irrigation of the wound with a 35-mL syringe and a 19-gauge needle produces 7 psi, whereas using a bulb syringe only produces 0.5 psi, which is inadequate to flush and decontaminate a dirty wound. The potential for lateral subcutaneous dissemination with use of high-pressure irrigation can make a clean wound more susceptible to infection, so it should be reserved for contaminated wounds where benefits are greater than the risk of dissemination. The low-pressure bulb syringe is used for clean lacerations. The pressure is more important in dislodging adherent bacterial and small particles than the amount of solution used. Splash protection should be used by all health care personnel (Edlich et al., 2010).

There is debate on using povidone-iodine (Betadine) to cleanse dirty wounds. In general, avoid Betadine surgical scrubs within the laceration because it can be toxic to tissue. If used, dilute Betadine 1:10 with water. Chlorhexidine and hydrogen peroxide may also be toxic to tissue inside a laceration and should be used with care. Poloxamer-188 solutions are safe to use within wounds and are even used on oph-thalmologic skin surgeries to cleanse the conjunctiva and by dentists to cleanse oral mucosa.

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