Antiseptics versus potable water for wound cleansing a review of the clinical effectiveness and guidelines

Summary: A wound is a disruption of the skin, and alters the normal structure and function of the skin. Approximately 1.5% of the population may have a wound of some kind at any one point and time. There are numerous types of wounds, the types of wounds include simple laceration, complicated lacerations, large tissue defects, burns, pressure ulcers, diabetic foot ulcers and venous ulcers. The process of wound cleansing involves the application of a fluid to remove debris, wound discharge and metabolic wastes, to generate the ideal conditions for wound healing. Wounds are cleansed to remove foreign bodies such as debris and excess exudate, necrotic tissues, which could become a focus for infection. Wound cleansing is a vital component of wound bed preparation, however, how a wound should be cleansed and what types of fluid should be used to clean a wound remain a topic of debate. Currently, healthcare professionals primarily depend on ritualistic practice rather than research evidence. Normal saline (0.9%) has been viewed by some as the favoured wound cleansing solution; this is because it is an isotonic solution and does not interfere with the normal healing process, damage tissue, cause sensitization or allergies or alter the normal bacterial flora of the skin. Tap water has also been recommended as it has advantages of being efficient, cost-effective and accessible. However, clinicians have been warned against using tap water to clean wounds that have bone or tendon is exposed, in those cases normal saline is preferred. However, the reason for this recommendation is unclear. As the debate over which solution to use for wound cleansing continues, it remains unclear which solutions are appropriate to use. As a result, the purpose of this review is to examine the comparative clinical effectiveness of potable water compared to saline or antiseptic agents such as triclosan, chlorhexidine, hexachlorophene, povidone iodine, hydrogen peroxide, or alcohol and to examine the evidence-based guidelines for wound cleansing.