Wound cleansing

Wounds that are healthy and free from debris do not require cleansing. Routine cleansing of a healthy wound removes beneficial chemicals, can damage delicate tissue, will delay wound healing and can be painful. However, all traumatic wounds are considered contaminated and should be cleaned thoroughly, rinsing the wound under running warm water is very effective.

It may also be necessary to remove debris from the peri-wound, and to maintain hygiene standards and re-hydrate the surrounding skin. Wound irrigation is effective when applied under gentle pressure, recommend showering.

Antiseptics may be appropriate in heavily contaminated wounds or immunosuppressed patients. Do not use antiseptics containing cetrimide as it has been shown to have a toxic effect on fibroblasts and may delay healing. Its use should be restricted to A&E only, where the detergent effect would be useful for removing foreign material, such as dirt or tar from wounds.

It is not necessary to dry the wound bed following cleansing as this will cause trauma to the wound bed and damage delicate tissue.

Potable water

• If home circumstances allow, good quality, warm mains potable tap water is the first line choice of cleaning agent (not for aseptic wound dressings) and is suitable for irrigating the majority of wounds. Where this is unavailable boiled, cooled to warm water or distilled water can be used.
• An appropriately clean container should be used, and a clean dressing technique employed.

Sterile water

• Sterile water can be considered when potable water is not available.

Sodium chloride 0.9%

• Warm sterile saline should be used for cleansing surgical sites for the first 48 hours post-surgery. Patients can safely shower 48 hours after surgery (NICE NG125 Surgical site infections: prevention and treatment (April 2019))
• Warm isotonic saline may help where the wound cleansing process is painful or uncomfortable.

Please see 13.11 Skin cleansers, antiseptics, and desloughing agents

Skin barrier / protection products

Assessment

• Patients should be assessed holistically and re-assessed on an individual basis - consider using a barrier preparation to prevent skin damage in adults who are at risk of developing a moisture lesion or incontinence associated dermatitis as identified by a skin assessment (NICE, 2014). Please consider further guidance on soap substitutes for vulnerable skin.

Check the formulary for the preferred product

• Medi Derma-S products are the first line choice.

Check the indication when selecting the product

• Barrier creams, films, and foam are indicated when patients skin is at risk of damage from exposure to moisture e.g. incontinence, excess exudate, sweat. Soap substitutes are used on vulnerable skin. Proshield foam and spray are used to cleanse severely excoriated skin, and this is normally for short term use.

Request the appropriate quantity of barrier product

• Barrier creams should be applied very sparingly so that skin can be seen beneath. If the skin appears oily then too much cream has been applied.

Choose the correct product size for the area to be covered-cost information please see below

• Medi Derma-S barrier cream
  • 2g single use sachet (x4 applications)
  • 28g tube (x56 applications)
  • 90g tube (x180 applications)
• Use a pea sized amount of cream only. For patients with incontinence this can be applied after every third wash
• Medi Derma-S barrier film
  • 1ml foam applicator covers 15 x 15 cm² (packs of x5)
  • 3ml foam applicator covers 25 x 25 cm² (packs of x5)
  • 30ml, 50ml and 75ml spray/aerosol – number of applications available will depend on the individual patient and the area requiring treatment

Check the number and range of products being prescribed for the patient and whether they are on repeat prescription

Consider the frequency of product use, according to manufacturer's instructions

• Medi Derma-S barrier cream lasts up to x3 episodes of incontinence
• Medi Derma-S barrier film will last up to 72 hours without re-application

Please see 13.2.2 Barrier preparations; where barrier preparations are not required, and a standard emollient is appropriate please see 13.2.1 Emollients