Guideline on different types of wound cleansing agents

Normal Saline
Isotonic sodium chloride, 0.9%
Advantages:
Isotonic to body tissue
Has no detrimental effect on living tissue
Can be used to irrigate body cavities
Economical
Disadvantages:
No antiseptic prope11ies
Care should be taken in extensive wounds where systematic absorption may
occur, pat1icularly in clients with severe renal or cardiac dysfunction
Chlorhexidine Gluconate
An antiseptic and disinfectant which is produced in a variety of strengths using
aqueous or alcohol diluents
Advantages:
Effective against a wide range of Gram negative and Gram positive bacteria
Low toxicity to granulation tissue
Systemic absorption and toxicity are rare
Useful for disinfecting inanimate objects
Disadvantages:
Skin sensitivity may occur
Not isotonic
Ineffective against fungi and viruses
ClIlorlIexidineGlucon.ate&
Use to clean dirty wounds. Cetrimide is a surfactant which has emulsifying and
detergent properties
Advantages:
Effective against Gram negative and Gram positive bacteria
Cetrimide has a detergent effect used to clean debris from wound
Useful for disinfecting inanimate objects
Disadvantages:
Cetrimide is very toxic to fibroblasts
Severe skin iITitations may occur
Povidone-Iodine
Povidone-iodine is an iodophore in which iodine is bound to the carrier molecule,
povidone. The complex, povidone-iodine slowly liberates inorganic iodine when in
contact with the skin and mucous membranes. There is a lower in-itant potential for
this form of iodine
Advantages:
Effective against Gram positive and Gram negative bacteria, spores, fungi and
vilUses
Is available in lotions, creams, ointments and impregnated dressing products,
mouth gargles, surgical sClUbs
Does not tend to stain
Disadvantages:
Skin sensitivity may occur
Has been reported to be toxic to fibroblasts
Risk of systemic absorption when used in large or deep wounds or for extended
periods oftime
Systematic side effects following absorption include cardiovascular toxicity,
renal toxicity, hepatotoxicity and neuropathy
Remark: 70% alcohol may be lIsed for skin disinfection after povidone-iodine
cleansing
Hydrogen Peroxide
A mild antiseptic that converts to oxygen and water when it comes in contact with
catalase, an enzyme found in blood and most tissues
Advantages:
The liberated oxygen creates a bubbling effect that can aid the mechanical
debridement of debris i'om wounds
May have a gelIDicidal effect against anaerobic bacteria because or the release of
oxygen
Disadvantages:
Has a cytotoxic effect on fibroblasts
Reported cases of oxygen embolus and surgical emphysema following irrigation
under pressure or irrigation into closed cavities with hydrogen peroxide
Can dissolve clots and cause bleeding
Remark: need to dilute with normal saline and rinse wound with normal saline
afterward
PWH n'olley Items - Wound Cleansing Agents
Description of Products Volume
items
Normal Saline 0.9 % Sodium ChlOlide Inigation Solution 1000 ml
Chlorhexidine 0.05% Chlorhexidine Solution 25 ml
Gluconate 0.05% Chlorhexidine Solution 500ml
(Hibitane)
Chlorhexidine Cetrimide 1% ( Cetavlon ) 500 ml
Gluconate &
Cetrimide
Povidone-Iodine Povidone Iodine Solution 10% 500ml
(Betadine)
Hydrogen Hydrogen Peroxide ( 10 vol.) 3% 450ml
Peroxide
Best Practice Guideline
Care of surgical site closed by primary intention
1. A surgical site should be protected with sterile dressing
2. Surgical dressing used should be absorbent and non-adherent
3. Surgical site should be kept intact for at least 48 hours
post-operatively unless indicated e.g. wound inspection by medical
staff
4. If mild dressing strike through occurs within 48 hours post-operatively,
reinforce a sterile top-up dressing unless not applicable e.g. Tegaderm
Dx.
5. The reinforced top-up dressing should be inspected or changed when
soaked through
6. If excessive bleeding is found on surgical site, monitor patient's vital
signs and report to surgeon promptly for fmiher intervention
7. If wound dressing was contaminated by client's excreta, it should be
changed as soon as possible
8. Wound dressing must be changed under aseptic techniques
9. Permission should be obtained fi-om surgeon when POP slab I
splintage must be removed during dressing change
IO.Nurses should observe and document wound condition, peri-wound
area and characteristics of exudate of a surgical site in patient's case
note or Surgical Wound Assessment Form 2 - Closed Wound (WA 2)
II.Surgeon has been infOlmed for any wound abnormalities observed
12.Nurses should follow hospital infection control policy and standard
precaution when handling patient's surgical site
13. Health education on wound care should be provided
Guideline on different types of wound dressings
Non-Adherent and Absorbent Dressing
Preparation: sheet
Products:
Cosmopore
Airstrips
Primapore
TegadelID Pad
Properties:
If exudates is minimal, it will provide sufficient absorbency and will prevent dressing
from sticking to wound surface, thus making for comfOliable, non-traumatic removal
Less likely to shed fibres
Provides dry wound healing environment
Can be left intact for several days
Indications:
Wound of the epidermis
Surgical wound closed by primary intention
Contra-indications:
Wound with moderate to heavy exudate
Deep cavity wound
Non .. Adherellt Dry or/FilIll C6ateu Dressing
Preparation: sheet
Products:
Melolin
Telfa
Properties:
Thin perforated plastic film coating, or nonstick agent attached or bonded to an
absorbent pad. May be single or double sided.
Non-adherent dry dressing, protective
Less likely to shed fibres
Need secondary dressing
Indications:
Wound of the epidermis
Surgical wound closed by primary intention
Contra-indications:
Wound with moderate to heavy exudate
Deep cavity wound
Non-Adherent M o i ~ t oi-Tldle GnisDressing
Preparation: sheet
Products:
Jelonet
Grassolind
Bactigras
Fucidin inteliulle
Properties:
Cotton or rayon cloths impregnated with substances such as paraffin or petrolatum
Paraffin reduces adhesions and allows non-traumatic removal
Provide a moist wound environment that facilitates epithelial cell migration
Need secondary dressing
Jelonet , Grassolind - Tulle Gras with paraffin
Bactigras - Tulle Gras with antiseptics ( 0.5% Chlorhexidine Acetate)
Fucidin intertulle - Tulle Gras with antibiotics ( 2% Sodium Fusidate )
Indications:
Wound of the epidermis
Surgical wound closed by primary intention
Bactigras - provides a medium for antiseptic therapy in contaminated or infected
wounds
Fucidin intertulle - antibacterial agent
Contra-indications:
Wound with moderate to heavy exudate
2
Deep cavity wound
Patient with allergic reaction to synthetic fabric or paraffin products
Transparent Semi-permeable Film Dressing
Preparation: sheet / spray
Prodncts:
Opsite
Tegadenn
Suprasorb F
Properties:
Provides a moist environment
Provides autolysis of eschar and acts as a second skin to protect against friction
Water vapor permeable and water / bacteria impenneable
Reduces pain, keeps nerve endings moist
Allows inspection of wound through dressing
Indications:
Protection
Stage I, Stage II, utilized for superficial wounds with minimal exudate to no exudate
Dry necrotic wound which require debridement
Contra-indications:
Wounds with infection, undennining, tracts, moderate to heavy exudate or fragile
peri-wound skin
Hydrocolloid SheetDressing
Preparation: sheet
Products:
DuodennCGF
Duodenn extra thin
Comfeel Plus ulcer dressing
Com feel Plus transparent dressing
Suprasorb H - Standard
Suprasorb H - Thin
3
Properties:
Hydroactive particles absorb wound exudate
Gel formation at wound surface provides moist wound environment
Supports autolytic debridement, especially for wounds with slough or a combination
of necrosis and exudate
Provides mild to moderate absorption of exudate
Occlusive dressing
Indications:
Protection
Stage I, Stage II pressure ulcer
Wounds with minimal to moderate exudate
Contra-indications:
Wound with heavy exudate, dry eschar, tracts, undennining, infection or fragile
peri-wound skin
Hydrocolloid Paste lPowder
Preparation: Paste / powder
Products:
Duoderm paste
Stomahesive powder
Comfeel paste
Com feel powder
Properties:
Hydroactive paliicles bound in an emollient or powder base
Gel fonning, provides moist wound environment
Reduces dead space in cavity wounds
Increases absorbency, thus extends life of hydrocolloid dressing
Reduces pain, keeps nerve endings moist
Eliminates the need for gauze packing with associated traumatic removal of
granulating tissue
Indications:
Deep wounds with minimal to moderate exudate require cavity filling
4
Contra-indications:
Infected wound
Wound with heavy exudate
Sinus tract or undermining with unknown origin
Foam Dressing
Preparation: sheet / filler; adhesive / non-adhesive
Products:
AlIevyn
Biatain
Suprasorb P
Lyofoam
Properties:
Semi-occlusive, absorptive wound dressing
Provides and maintains a moist wound environment
Absorbs moderate to heavy exudate
Adhesive dressing is primarily indicated for moderate to heavy exuding pressure
ulcers and leg ulcers with healthy surrounding skin
Non-adhesive dressing is primarily indicated for moderate to heavy exuding leg ulcers
and non-infected diabetic foot ulcers with fragile sUlTounding skin
Indications:
Stage II, III, IV pressure ulcer, leg ulcer
Wounds with moderate to heavy exudate
Wound with hyper-granulation tissue
Contra-indications:
Wounds involving exposed muscle, tendon or with active vasculitis, deep systemic
infections, arterial ischemic lesion
Hydrogel Wound Dressing
Preparation: gel sheet / amphorus gel
Products:
Duodenn Gel
IntraSite Gel
5
Purilon Gel
Suprasorb G
Gellipelm Suprasorb
Properties:
A type of colloid consisting of polymers that expand in water, but are insoluble
Provides and maintains a moist wound environment for cell migration
Absorbs exudate
Cleanses and debrides wounds with slough and necrotic tissue by supporting autolytic
debridement
Promotes granulation tissue growth
In ampholUs gel form, fills dead space in deep wound
Maceration may occur with liberal use of gel
Indications:
Stage III I IV pressure ulcer and those covered with eschar
Wound with minimal exudate
Contra-indications:
Wound with heavy exudate
Infected wound
Calcium Alginate Dressing
Preparation: sheet / filler
Products:
Algisite M
Kaltostat
SeaSorb
SuprasorbA
Properties:
Natural polysacchmide from seaweed
Active ion exchange at wound surface forms soluble sodium alginate ( gel) that
provides a moist wound environment
Biodegradable in wounds
Absorbs moderate to heavy amounts of exudate
Some products can have haemostasis effect depend on the calcium ingredient
6
Keeps nerve endings moist, reduces pain
Indications:
Wound with moderate to heavy exudate
May be used in infected wound under supervision
Contra-indications:
Wound with minimal exudate or in the presence of hardened eschar
Patient with a known allergy to alginate dressing
Others:
Sodium Chloride Dressing
Preparation: sheet
Product:
Mesal!
Properties:
Mesalt consists of a soft non-woven material impregnated with sodium chloride
It facilitates the cleansing of exuding, sloughy or infected wounds
Indications:
Wound with moderate to heavy exudate
Infected wound such as ulcers, decubitus etc.
Contra-indications:
Patient with a known allergy to the dressing components
Mesalt should not be used on dry wounds with low levels of exudate
Mesalt should not be allowed to come into direct contact with exposed bone or tendon
Infected wounds should be evaluated on a regular basis and treated appropriately
7
Quick Guide of Wound Dressings
Dressing Groups Products Absorptive Wound Indications Contraindications
power stage
Non-adherent & Cosmopor Minimal I Wound of epidermis Moderate to heavy exudate
absorbent Airstrips Surgical wound closed by primary intention Deep cavity wound
Primapore
Tegaderm Pad
Non-adherent dry or Melolin Minimal I Wound of epidermis Moderate to heavy exudate
HIm coated Telfa Surgical wound closed by primary intention Deep cavity wound
Non-adherent moist Jelonet Nil I, II Wound of epidermis Moderate to heavy exudate
or tulle gras Grassolind Surgical wound closed by primary intention Deep cavity wound
Bactigras Allergic reaction to
Fucidin intertulle synthetic fabric or paraffin
Transparent Opsite Nil I, II Protection Wounds with infection,
semi-permeable fIlm Tegaderm Stage I, II wounds with minimal exudates to
Suprasorb F no exudate moderate to heavy
Dry necrotic wound which require exudates or fragile
debrid=ent peri-wound skin I
Hydrocolloid sheet DuodermCGF Minimal to I, II Protection Heavy exudate
Duoderm extra thin moderate Stage I, II pressure ulcer Dry eschar, tracts,
Comfeel Plus Wounds with minimal to moderate exudate undermining
Comfeel Plus Infection or fragile
transparent peri-wound skin
Suprasorb H -
standard
Suprasorb H - thin
Quick Guide of Wound Dressings
Dressing Groups Products Absorptive Wound Indications Contraindications
power stage
Hydrocolloid paste / Duode=paste Minimal to II, III Deep wounds with minimal to moderate Heavy exudate
powder Stomahesive powder moderate exudate require cavity filling Infected wound
Comfeel paste Sinus tract or undermining
Comfeel powder with unknown origin
Foam dressing AlIevyn Moderate to II, III, IV Wounds with moderate to heavy exudate Wounds involving exposed
Biatain heavy Stage II, III, IV pressure ulcer, leg ulcer muscle, tendon or with
Lyofoam Wound with hyper-granulation tissue active vasculitis, deep
Suprasorb P systemic infections, arterial
ischemic lesion
Hydrogel . Duode=Gel Minimal III,IV Stage III I IV pressure ulcer and those Heavy exudate
I
(gel sheet / amphorus IntraSite Gel covered with eschar Infected wound
gel) Purilon Gel Wound with minimal exudate
Suprasorb G
Gellipenn Suprasorb
I
, Calcium Alginate Algisite M Moderate to II, III, IV Wound with moderate to heavy exudate Wound with minimal
Kaltostat heavy May be used in infected wound under exudate or in the presence
SeaSorb supe:tV!slOn of hardened eschar
SuprasorbA Known allergy to alginate
----- - -
dressing
Quick Guide of Wound Dressings
Dressing Groups Products Absorptive Wound Indications Contraindications
power stage
Sodium Chloride Mesalt Moderate to II, III Wound with moderate to heavy exudate Known allergy to dressing
heavy Infected wound such as ulcers, decubitus components
etc. Dry wound with low level
I
of exudate
J
Direct contact with
exposed bone or tendon
- - - - - -
Aquacel dressing
- Hydrofiber wound dressing
Description:
A soft, sterile, non-woven dressing composed of hydrocolloid fibers ( sodium
carboxymethylcellulose)
Highly absorbent dressing absorbs exudates and creates a soft gel which
maintains a moist environment which supports autolytic debridement
It absorbs exudates vertically to minimize the risk of maceration
Indications:
Leg ulcers, pressure ulcers ( stage II-IV) and diabetic ulcers
Surgical wounds, second degree burn wound, oncology wounds
Contra indications:
Individuals who are sensitive to the dressing or its components
3,d degree burn wound
Direction to use:
Clean the wound area with an appropriate wound cleanser
Apply the dressing to wound and cover with a moisture retentive dressing
Aquacel should overlap lcm or 1/2 inch onto the skin surrounding to the wound
because it will shrink after contact with fluid
When using Aquacel ribbon in deep cavity, leave at least 2.5 cm outside the
wound for easy retrieval
Dressing should be changed when it is saturated with exudates or the cover
dressing is leaking