The Practice of Wound Hygiene: Breaking down barriers for effective wound cleansing and surrounding skin management

Abstract

Statement of Clinical Problem: Wound hygiene is defined as the process of cleansing the wound and surrounding skin to remove bacteria, residual dressings, inorganic material or unhealthy or devitalized tissue. The process should be performed at each dressing change or wound assessment. In the clinical setting, wound hygiene is often not performed, or done insufficiently and ineffectively, leading to persistent inflammation, infection, and delayed wound healing.

Past Management: Despite the availability of wound cleansers and surfactants, most of our providers use moistened saline soaked gauze to perform wound hygiene resulting in often-aborted painful, time consuming procedures often necessitating twenty minute delays to apply topical analgesics.

Current Clinical Approach: Our wound clinic evaluated a monofilament debridement mitt (MDM) designed to augment wound hygiene. MDMs were saturated with normal saline, a hypochlorous acid solution or a preservative-free polyxmer cleanser and applied in a circular motion for 3 to 5 minutes to lower extremity hyperkeratotic skin associated with venous hypertension or lymphedema, "road rash" abrasions and wounds with loose non-adherent slough. MDM application pressure was increased per patient tolerance to achieve adequate wound hygiene.

Results: Over twenty patients have received MDM wound hygiene. Clinicians report easier removal of inorganic material, residual dressings, devitalized tissue, fewer or less extensive debridement procedures, more effective wound cleansing, cleaner peri-wound skin, and faster procedure times. Patients reported wound hygiene with MDM as "comfortable" and were impressed with skin and/or wound appearance.

Conclusions: A wound hygiene protocol that incorporates MDM had been adopted by our wound clinic and is in the process of being adopted in other areas of the hospital, including the Emergency Department, Medical-Surgical units, and for lymphedema rehabilitation patients.