Antiseptics & Wound Cleaning

Overview

Background

• Wound cleansing is a fundamental element of wound management

• It aims to remove debris, contaminants, bacteria, non-viable tissue and excess exudate fro the wound bed and surrounding skin

• Wounds should be adequately cleansed initially and at every dressing change, including chronic wounds (reduce the risk of biofilms)

Cleansing Solutions

• Use sterile 0.9% sodium chloride

  • Running water or a gentle skin cleanser (like Cetaphil Gentle Skin Cleanser) can be used if sodium chloride is not available

• Antiseptics should only be used in dirty or clinically infected wounds

  • Broad spectrum of activity

  • Can impair wound repair

    • Cytotoxic to cells involved in the healing process

• Avoid cytotoxic antiseptics (e.g. hydrogen peroxide, sodium hypochlorite) and topical antibiotics (e.g. chloramphenicol, mupirocin)

  • Cytotoxics impair wound healing

  • Antibiotics contribute to antibiotic resistance

Antiseptic: Chlorhexidine + Cetrimide

Product

Savlon 0.1%-0.5% Antiseptic Cream

Directions

• Clean the surrounding skin and apply directly to the affected area(s) or with a piece of cotton wool

• This is for short term use; typically ONE dose is enough

Special Instructions

• Stop using if you develop a rash

Side Effects

• Skin irritation

Pregnancy

• Safe to use

• Category A

Breastfeeding

• Safe to use

Children

• Use in 3+ years

Precautions

Contraindications

• Open head/neck wound

• Deep wounds

• Genital wounds

• Breast if breastfeeding

• Allergy

Other Notes

• Narrower spectrum of activity than povidone iodine

• Inactivated by contact with organic material

• Cetrimide provides additional disinfectant properties - should not be used on chronic wounds

• Useful in iodine allergy

Antiseptic: Povidone Iodine

Product

• Betadine 10% Antiseptic Liquid

• Betadine 5% Cream/Ointment

Directions

Solution

• Clean the surrounding skin and apply undiluted to the affected area(s) for THREE minutes then rinse off, up to THREE times daily

• This is for short term use; typically ONE dose is enough

Cream/Ointment

• Clean the surrounding skin and apply undiluted to the affected area(s) up to THREE times daily

• This is for short term use; typically ONE dose is enough

Special Instructions

• Stop using and see your doctor if you develop a metallic taste, burning in the mouth or vomiting - these are early signs of systemic iodine absorption

Side Effects

• Skin irritation

Pregnancy

• Safe to use

• Category not listed

Breastfeeding

• Safe to use

Children

• Use in 2+ years

Precautions

• Pregnancy

• Breastfeeding

Contraindications

• Thyroid disorders

• Hypersensitivity to iodine or povidone

• Infants <6 months

• Deep wounds

• Serious burns

Other Notes

• Broad spectrum of activity

• Cytotoxic with frequent exposure

• Risk of systemic absorption

Antiseptics: Comparatives

• Chlorhexidine is generally first line, one dose is enough and has less risks

• Povidone iodine is broader spectrum and useful for severe wounds

Inappropriate Treatment

• Hydrogen peroxide

  • Has little evidence that it’s effective in reducing bacterial counts in wounds

  • Converts to highly reactive free radicals that damage granulation tissue and impairs wound healing

  • Can cause the new epithelium on the wound surface to lift

• Sodium hypochlorite

  • Rapidly inactivated by blood, pus and organic matter

  • Toxic to fibroblasts - primary connective tissue cells that maintain structural integrity and heal wounds

  • Highly irritant

• Topical antibiotics (e.g. chloramphenicol, mupirocin)

  • Have no effect on healing

  • Can promote antibiotic resistance

• Chlorhexidine and povidone iodine

  • Not appropriate for non-infected wounds or venous leg ulcers