Question

23)   Wound cleansing
Briefly describe the following wound cleansing techniques (20-40 words each)

23.1)   Swabbing

23.2)   Irrigation

23.3)   Soaking

Answer 1

Ans) The role of the HCA and AP is dependent
on local organisational protocols. Howev-
er, every HCA and AP involved in wound
care needs to be aware of the evidence-
based recommendations pertaining to
wound cleansing in all aspects of wound
care. Even if the HCA or AP is not involved
in the actual procedure of wound cleans-
ing, he or she may be responsible for pre-
paring the patient and wound for wound
cleansing and dressing changes.
Having selected the appropriate solutions,
there are several techniques available for
cleansing the wound; however, like select-
ing the appropriate solution, selecting the
most appropriate technique is mainly de-
pendent on the findings of assessment, lo-
cal protocol and patient choice.
For example, for a patient with a leg ulcer,
good hygiene can greatly improve quality of
life. Immersing the limb in warm water as-
sists in the removal of build-up of exudate
and slough, while cleansing the affected
area without damaging granulation or epi-
thelialising tissue. It also has the benefit of
allowing the patient to wash the leg and foot
and maintain personal hygiene (Watret and
Armitage, 2002; Lindsay, 2007).
A patient with a pilonidal sinus or burns,
for example, may find bathing or shower-
ing the method of choice. This method gives
the patient the control and autonomy, where
appropriate, to remove his or her own dress-
ings—and it involves him or her directly in
his or her own care. To prevent the risk of
cross-contamination, it is important to fol-
low infection-control policies with regards
to using the appropriate equipment, for ex-
ample, lining the bucket, and washing thebath, shower and equipment etc.

23.1) Swabbing :
Swabbing the wound using a gloved hand is
preferred to using forceps. However, it is im-
portant to use non-woven gauze swabs, as
gauze and cotton wool have been shown to
shed fibres into the wound. Swabbing with
a soaked non-woven gauze has been used
to remove slough and loose necrotic tissue
—although swabbing clean
granulating or epithelialising wounds can
cause trauma to the wound.
Young (1995) suggests that swabbing
is unlikely to damage slough and necrotic
tissue and explains that it is the amount of
pressure applied that is important, although
measuring appropriate pressure is difficult.
Today, a monofilament fibre debrider is
available that is capable of removing slough
gently without causing trauma or pain.
Monofilament fibre debrider
(Debrisoft)
Debrisoft is described by its manufacturer
as a fast-acting, highly efficient, active de-
bridement system that can rapidly remove
wound debris, necrotic material, slough,
bacteria and exudate from the wound bed,
as well as scaly hyperkeratotic tissue from
surrounding skin.
Although it is referred to as a debrider, De-
brisoft can also be used to cleanse wounds,
for example, superficial slough and crusting
Debrisoft comprises a pad of 100% knitted
mono-filament (single) polyester fibres, with
the outer surface coated with polyacrylate,
thus providing stability and preventing shed-
ding of fibres.
Haemmerle et al (2011) explain that the
debrider can be used like a gauze swab or
any other cleansing materials; it can be used
with a selected cleansing solution of choice,
reducing pain and saving time.
23.2) Irrigating :
Cleansing by irrigation is considered advan-
tageous, in that there is no problem with
shedding fibres into the wound; however,
there has been a lot of debate with regards
to the most appropriate equipment and
amount of pressure required to effectively
cleanse a wound without causing trauma
Today, there are commercial products
available including spray cans and pods that
have been designed to deliver irrigation at
the appropriate pressure without causing
trauma. They also eliminate the need for
supplementary equipment, such as syringes
and forceps.

23.3) Soaking :

- Warm soaks or local heat
Soak the wounded area in warm water or put a warm, wet cloth on the wound for 20 minutes three times a day. Use a warm saltwater solution containing 2 teaspoons of table salt per quart of water. Use this solution to remove all the pus and loose scabs.

Patient care:
Patients should be kept informed of any in-
tended procedure: explain to them what you
are going to do and gain their consent. Place
them in a comfortable position and ensure
they feel comfortable and not overexposed.
Make sure everything is prepared before
starting the procedure and ensure the solu-
tion is, where possible, at body temperature.
Some patients may be concerned that you
are not going to wash the wound, as it has
been deemed unnecessary and so will re-
quire an understanding by them of your ra-
tionale.
At the end of the procedure, make sure
the patient is comfortable. Dispose of any
fluids and dispose of or clean any equip-
ment used, as per local infection-control
policies. Report any changes or concerns to
the registered nurse.