(PI-014) Gaps in Practice: Wound Irrigation versus Wound Cleansing
Co-Author(s):
Joyce Black, PhD, RN, FAAN – University of Nebraska Medical Center; Andrew Chinofsky, BSN, CWOCN – Tower Health- Pottstown
Introduction: The latest International Wound Infection Institute (IWII) consensus guidelines offer three parts to wound bed preparation:wound cleansing, wound debridement, and prevention and treatment of biofilm.Historical and cultural practice of wound bed preparation has been with the use of a non-cytotoxic cleanser.Many commercially available cleansers come in two forms, bottles and sprays.Per the IWII guidelines, wound irrigation for cleansing needs to be performed with 4-15 pounds per inch (PSI).Clinically the author has found that bedside clinicians, both nursing and providers, do not follow the guidelines due to logistical constraints.Identified challenges to guidelines implementation are knowledge gap, burden of supplies, and logistics of manufacturer instructions. For example, cleansers that are supplied in a spray bottle can offer appropriate PSI, but only in stream mode at a certain distance, which can create a risk for microbial exposure to the clinician. Observed methods of wound cleansing include a variety of solutions, both cytotoxic and non-cytotoxic.Most clinicians were observed using a 10mL prefilled normal saline solution (NSS) syringe with no angiocath “squirted” onto the wound bed. For some chronic wounds or actively infected wounds, the clinicians utilized a pure Hypochlorous Acid preserved cleanser (pHA) soaked into gauze and applied directly to the wound for 5-10 minutes.
Methods: A survey monkey was sent to surgical nursing staff, surgical residents and trauma surgeons asking about their practice on wound cleansing.
Results: The survey resulted in 23 responses that showed that 56% of participants cleansed the wound at every dressing change, of those who did cleanse the wound, 86% cleansed with irrigation while 17% soaked the wound.The three options for solutions listed were NSS (87%), a hypochlorite solution (39%), and pHA (58%).
Discussion: From the results of a survey monkey, there is a disconnect between the IWII guidelines and current practice. The authors hypothesize that this may be the logistical constraints of the current guidelines.It may also reflect a lack of operational definitions for wound irrigation or cleansing. The use of hypochlorite or pHA seemed to be driven more by providers orders, rather than a treatment guideline when treating chronic wounds that would benefit from biofilm based wound care.More research should be performed to evaluate if soaking with a pHA solution would be adventitious over irrigation with NSS as a treatment guideline for wound cleansing/ wound bed preparation. Operational definitions around wound cleansing should also be clarified.
Trademarked Items:
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