Wound cleansing has been part of routine wound care to remove surface debris, dried up exudate, and other proteinaceous materials that could trigger a pro-inflammatory response, promote bacteria growth, and impair normal wound healing. The need and technique for wound cleansing, however, has recently been challenged. Moore and Cowman1 reviewed randomized controlled trials that evaluated wound cleansing for pressure ulcers. Of all the randomized controlled trials reviewed, the authors did not find evidence to support the use of any particular wound cleansing solution or technique that promotes healing of pressure ulcers. Furthermore, there is evidence to dispute the notion that using nonsterile tap water could increase wound infection.2
Nonetheless, evidence should always be appraised critically and interpreted with caution considering the context in which evidence was developed. Before we adopt the use tap water for cleansing, we should question about the source of tap water, hygienic practice of the person with wounds, and other co-existing factors that put the person at risk for wound infection. Unless the underlying factors of pressure ulcers, including moisture, shear, friction, and nutrition, have been adequately addressed, routine cleansing of the wound is not likely to yield significant improvement in the healing. Based on results of the recent poll posted on this website, 90% of you believe that cleansing is needed, particularly for wounds that have deep sinus and undermining. However, irrigation of wounds with tunnels should be done with caution. It is important to ensure that the irrigation solution is retrieved by gently expressed the areas with undermining. Otherwise, excess residual fluid left in wound may spill over to the periwound skin causing maceration and potentially promote bacteria growth.
1. Moore ZE, Cowman S. Wound cleansing for pressure ulcers. Cochrane Database Syst Rev 2013;3:CD004983.
2. Fernandez R, Griffiths R. Water for wound cleansing. Cochrane Database Syst Rev 2012 Feb 15;2:CD003861.