The presence of biofilm, devitalized tissue, and other contaminants on the surface of the wound bed can impede wound healing. Therefore, wound cleansing solutions to remove debris, contaminants, and biofilm from the wound bed are an important aspect of wound management. This article will explore the benefits and applications of wound cleansers in wound management.

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What Is Wound Cleansing?

According to the TIME model of wound management, the preparation of the chronic wound bed is an integral part of wound care. Along with tissue debridement, wound cleansing is routinely employed for the preparation of an optimal wound bed that is conducive to healing. Wound cleansing refers to the use of fluid solutions to remove bacterial debris, necrotic tissue, wound slough, and other foreign contaminants from the wound bed. 

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A popular method of wound cleansing is "irrigation". During wound irrigation, a fluid jet is applied to the wound bed at a pressure that helps to gently remove the debris from the wound surface. Irrigation is often regarded as one of the most effective methods of wound cleansing. As there is a risk of potential tissue injury and trauma, wound care specialists and podiatrists should ensure that the wound cleansing method is gentle enough. 

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Wound Cleansing Agents

An ideal wound cleanser is non-toxic to human cells, hypoallergenic, cost-effective, and readily available. The most popular wound cleanser that is commonly used by wound care specialists and podiatrists is normal saline. The routine use of other agents such as antiseptics and antimicrobials is debated because of their potential adverse effects on the tissues. Some commonly used wound cleansing agents are described below.

Normal Saline And Water 

Normal saline (0.9% NaCl) is a commonly used irrigation solution used in wound care. Compared to other wound cleansing agents, it is non-toxic and does not cause harm to human tissues. It is an isotonic solution and does not interfere with the normal process of wound healing. However, it is not as effective in cleansing necrotic wounds and does not have any antimicrobial properties. 

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Normal tap water can become colonized with microbes and could therefore be a potential source of infection. In addition, tap water is not isotonic. Therefore, the use of tap water should be avoided especially in open wounds.

Reactive Solutions

Specific solutions such as povidone iodine and peroxide are cytotoxic and can cause harm to the tissues. Hydrogen peroxide can interfere with the normal wound healing mechanism and might be counterintuitive to use. Hence it is now rarely used as a cleansing agent. Povidone iodine has antimicrobial properties and is used in the management of acute open wounds. However, it should be avoided in chronic wounds and should not be used for more than 7 days.

Antimicrobial Solutions

Antimicrobial cleansing agents have bactericidal properties and might be indicated in wounds with infection or extensive bacterial colonization. Some examples of antimicrobial cleansers include hypochlorous acid, polyhexamethylene biguanide, and octenidine. As normal saline and sterile water may not be effective against the biofilm present on the wound surface, antimicrobial agents might be needed. Unlike antibiotics, antimicrobial agents do not result in bacterial resistance and have a broad spectrum of activity. In addition, several safe, non-toxic antimicrobial solutions have been developed which makes them ideal wound cleansers.

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Wound Cleanser Benefits

Following are the advantages of using wound cleansers in wound management:

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• Decreased Wound Bioburden: The presence of biofilm on chronic wounds is a leading cause of impediment in healing. Wound cleansing agents such as hypochlorous acid can disrupt the wound biomembrane. Hence wound cleansing agents can decrease wound infection rate which improves healing rates.
• Improved Visualization of the Wound Bed: The presence of necrotic debris, devitalized tissue, wound exudate, and slough can obscure the visualization of the chronic wound bed. Wound cleansing helps to remove the debris and foreign contaminants from the wound bed which helps clinicians to inspect and visualize the edges of the wound bed. This allows them to monitor the progress of wound healing. 
• Improved Wound Healing: Wound cleansers improve wound healing rates. This is because they aid in the removal of biofilm, exudate, slough, and necrotic debris which normally impede healing. However, it is important to ensure that the cleansing agent used is not cytotoxic to human cells.
• Anti-inflammatory Effect: Certain wound cleansers such as hypochlorous acid have anti-inflammatory properties. Hypochlorous acid downregulates the matrix metalloproteinases and activity of other proinflammatory cytokines in the wound bed. As chronic wounds have prolonged and protracted inflammation, the effect of wound cleansers in diminishing inflammation accelerates wound healing. 

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Wound cleansers are an integral part of biofilm management in modern wound care. When selecting a cleansing agent, it might be helpful to consider whether the cleanser has appropriate antimicrobial activity, is non-toxic, and is safe for the wound granulation tissue. The choice of the cleanser is also guided by the wound characteristics and patient requirements. The use of antimicrobial wound cleansers can also help to reduce the widespread use of systemic antibiotics.