Podcast Episode 28: Wound Hygiene

Hello, my name is Terry Swanson and I'm a nurse practitioner in Warrnambool, Victoria in Australia. I'm here today to talk to you about wound hygiene or wound cleansing. I was part of an international consensus that developed a consensus document entitled Define hard to heal wounds with an early anti-biofilm intervention strategy, wound hygiene. This document is about why we therapeutically cleanse a wound to manage infection or to prevent a wound infection from escalating to a more severe infection. The term wound hygiene was chosen because hygiene is understood by everyone. With the pandemic today, we all understand about hand hygiene, the importance of washing our hands, and not only the frequency but the quality of which we do so. We know about oral hygiene and cleaning our teeth and removing the biofilm that occurs within 24 hours within our mouth. So there are four easy steps in which I'm going to talk to you today about. Step one is therapeutic cleansing of the wound and the peri-wound. Two is debridement and I'll explain further what that means about refashioning the wound edge and then proactive wound dressings that may be provided to you or prescribed to you by a health care professional. In a wound that is hard to heal means that it is healable, it has potential to heal, it has enough flow, and it is non-cancerous. So therefore, if the reason that it's not healing is due to the bacteria on the wound, then the therapeutic cleansing and debridement interventions that we do will assist with that healing. We've known for since 2008 that there is bacteria likes to group together and it's called a biofilm. And it encases itself in a sugar coating and it is spread throughout the wound to different parts and maybe in the deeper layers of that wound bed. In order for our solutions and our dressings to be most effective and to reduce that impediment to healing, we need to do these four steps because they have to disrupt that encased sugar casing and remove and disrupt that biofilm. So we use what we call antimicrobials and antimicrobials is an umbrella term, an overall term that is a product designed to actively or passively kill the germs, the bacteria in the wound or the surrounding skin. An antibiotic is used for bacteria that aren't encased in that sugar coating and is for bacteria that's replicating and those are our antibiotics. antiseptics are the solutions and the dressings that we use in our wounds to cleanse. The newer generation antiseptics are preferred because they don't kill off the healing cells and they're quite selective. And disinfectants are what we use to clean our tables or surfaces prior to doing a wound dressing procedure. So in order to cleanse a wound, the healthcare professional needs to diagnose the wound and understand what they're seeing in regards to the wound condition. Therapeutic cleansing needs to occur at each dressing change, and what is recommended by clinicians around the world is an antiseptic surfactant because it disrupts that bacteria but also makes the job easier. And where do they clean? They clean the wound and any area covered by the dressing or a bandage. So we do this proactively using these antiseptics. Debridement is removing that mechanically with sterile scissors, scalpels, curettes, or sharp debridement or surgical debridement. Mechanical debridement is when you or a healthcare professional uses gauze or a cleansing pad moistened with the antiseptic to go in circles to clean the wound and the periwound. Now we don't need sterile solutions for a limb or an arm or body, the skin around the wound. But we do prefer clean or sterile solutions for cleaning in the wound, especially when you may have had repeated infections or there's exposed structures. So this mechanical cleansing and debridement can be done by any healthcare professional. And in fact, it can be done by most patients once they're taught correctly about the sequencing and preventing that contamination. Once we cleanse the bride and make sure that we're recleansing the edges, and that's called refasting those edges because the healing cells come from the wound edges. and if they're got crusty remnant dressings and they're not moist, then that migration, that movement from the wound edges may not occur. So they multiply the wound edge so they can come across to the other side of the wound. If you have a lot of debris in that wound or it's too dry, or you've got dead tissue in that wound, then it's not encouraging that migration across the wound. So that's why we, again, another reason why we have to cleanse and debride so those healing cells can travel across the wound. So you can cleanse with the therapeutic irrigations. You can do that with a syringe and needle, remembering to protect your face. You can do a soak with some gauze and the solution. We do like to warm up the solution so it doesn't sort of shock the wound too much. Then we cleanse the surrounding skin with our pH neutral cleansers, and then we pat dry. Then we cleanse the wound, either with that gauze or those pads, and then we may debride using more sharp instruments if required, but that's done with somebody who is skilled to do so. There are times when it's important not to debride and your healthcare professional will help guide you with that. We then, after we've cleansed, debrided, and make sure we cleansed or refashioned the wound edge, we redress the wound. Um, we do this so that we can keep the wound as optimal condition for healing. And so it needs to be warm and clean and prevents bacteria from migrating back into the wound from the skin or when you're traveling around, um, going to different appointments or just living your, your normal life. We prepare the wound for the dressings to make sure that their activity that they're designed to do is most effective. So the dressings that we do to manage wound infections or hard to heal wounds after we've done all the cleansing, debridement, refashioning the wound edge can be determined as antimicrobial or antifungal, so they're active ingredients that kill or reduce the bacteria in the wound. And then there are non-medicated dressings by the action without chemicals of what they do, and they do that by, they may have high sugar content like honey and pull the fluid from the wound and then they dry out the bacteria. There are dressings that actually due to to negative and positive charges, attract the bacteria to the dressing, and then it's bound to the dressing. And then when you pull out the dressing, it takes all that bacteria with it. There are other dressings that pull the bacteria into the dressing and hold it as well. And that's called sequestering. So we may have osmotic binding, we may have hypertonic. So your clinician may prescribe to you salt dressings are high in salt content, which also pull the fluid from the wound and deal with that bacteria there. We do this to prevent the reformation of that biofilm that I talked about earlier, to suppress or decrease the microbes in that, and we may alternate the different types of dressing in order to deal with different types of bacteria in the wound. But every two weeks, a health care professional or somebody needs to make the decision, do I continue on this treatment or can I step down? So the reasons that we therapeutically cleanse and proactively debride the wounds and the surrounding skin is to disrupt that biofilm, cleanse away the excess exudate from the wound, because we know that that can be detrimental to the healing. We prepare the wound for the wound dressing and by cleaning the wound out it assists the health care professional and yourself in getting a full assessment of that wound. We need to remove that debris, non-viable tissue, remnants of previous dressing, and foreign bodies from that wound so it can be in its optimal condition for healing. By doing all this, we provide a balanced and optimal wound environment to get you on the road to healing sooner than later. So it really is worth the investment in taking the time to cleanse, debride, refashion those wound beds, and use a proactive wound dressing that prevents the migration of the bacteria and deals with whatever bacteria may be in the wound. Thank you.