Cleaning a Wound

How to Clean a Wound During First Aid
By an eHow Contributor

All open wounds are contaminated to some extent and are potential sites for infection. The best way to prevent infection is to remove all debris from the wound and discourage further growth of bacteria.

Preparation

1. Scrub hands thoroughly with soap and disinfected water.
2. Put on medical exam gloves to prevent the spread of infectious disease. (Avoid latex.)
3. Prepare a disinfectant solution of 1 oz. povidone-iodine and 1 liter disinfected water. See "How to Disinfect Water." Set the disinfectant solution aside for about five minutes. [NOTE - Others say that sterile saline or plain tap water are better than a povidone solution of any strength.  See appendix.]

Irrigation and Scrubbing

1. Scrub the area around the wound using a nailbrush and disinfectant solution. Scrubbing may be painful to the injured person, but it is important that all debris is removed.
2. Sterilize a pair of tweezers using the disinfectant solution.
3. Remove all large pieces of dirt, debris, dead skin and flakes of clotted blood from the wound.
4. Draw the disinfectant solution into an irrigation syringe.
5. Hold the syringe perpendicular to the wound, about 2 to 3 inches above it. Angle the syringe and tilt the wound so that the solution will flood the wound and drain away from the opening.
6. Press down on the plunger to emit a forceful stream of solution.
7. Repeat the irrigation using 1/2 to 1 liter of solution. You may need to use more if the wound is especially dirty.
8. Rinse the wound liberally with disinfected water, because the disinfectant solution may cause irritation to the skin if left on.
9. Recheck the wound for bleeding; blood clots may have been dislodged. You may have to apply pressure to stop bleeding. See "How to Stop Mild Bleeding During First Aid."
10. Check the clothing and area around the injured person to make sure his or her skin won't be exposed to disinfectant solution for a prolonged period of time, because this may cause burning.
11. Bandage the wound immediately after it has been thoroughly cleansed of all debris. See "How to Bandage a Wound During First Aid."

Read more: How to Clean a Wound During First Aid | eHow.com
 
 

Cost- And Time-Effective Strategies For Wound Care

Some more notes:
Most important step is wound irrigation with fluid under pressure to remove bacteria and contamination
30-60-cc syringe to push fluid through a 19-gauge catheter with maximal hand pressure.
minimum of 250cc or 60cc / cm wound length
OR high volume of fluid under low pressure may be good
Povidone-Iodine Solution 10% (Betadine) is tissue toxic and did not reduce infection
NEVER use hydrogen peroxide - it is also tissue toxic
Tap water: low cost, available
Tap water is a safe and effective solution for cleaning recent wounds
requiring closure and is the treatment of choice
Ideal time frame, within 8-12 hours for penetrating injury of the extremity,
6-10 hours for wounds of the extremities and up to 10-12 hours for face and scalp
Sutures: percutaneous w/absorbable for low-to-medium wounds. Interrupted same as others
Glue: Faster repair time, less painful, doesn't require removal, best for facial lacerations in children
Glue best choice for short (< 6-8 cm), low tension (<0.5 cm gap), clean edged, straight to curviliean not crossing joints of creases

Don't glue: stellate wounds, bites, punctures, crush wounds, mucosal surfaces, axillae and perineum (high-moisture areas), hands, feet and joints (unless kept dry and immobilized)
Steri-Strips: least reactive, lowest tensile strength, may require benzoin, avoid in hairy and wet areas.
Steri-strips similar to closure w/glue

For head wounds, can tie hair to close wound!  Twist hair on either side and tie twists together.
Lacerations 10 cm or less and hair longer than 3 cm

Delayed Primary Closure recommended for contaminated wounds: Clean and debride then
separate wound edges with gauze, and apply bulky dressing.
Need antibiotics for open joint or wound fractures, human, dog and cat bites, intraoral lacerations, immnocompromised, heavily contaminated wounds (e.g. feces, etc.)
Bacitracin or Neosporin best for postclosure
Sterile gloves have no advantage over nonsterile.
Small, simple hand lacerations (<2cm don't require primary closure)
 

Closure of Simple Lacerations

Treat a laceration at home only if it's small, shallow, in an "unimportant area," and the skin along the laceration matches up perfectly (and remains together when undisturbed). In general, you should see the doctor for lacerations where:
     the cut is gaping.
     the edges can be pulled more than 1/8 inch apart with traction on nearby skin.
     the cut is over a knuckle.
     the cut is on the face or genitals
     the cut might be contaminated with foreign material.
     the cut was caused by human or animal teeth.
     there is numbness, deep pain, or inability to move a part fully.
 

Clean the cut. Benzalkonium chloride towelettes or Betadine prep pads can be used as an antiseptic. After cleaning, dry the skin. Keep the cut closed with direct pressure until the bleeding is stopped and it tends to remain closed by itself.

Butterfly bandages and Steri-strips will hold without special preparation. But it you think the wound may be prone to opening (in which case I really recommend you go get stitches) and are determined to treat it yourself, you may want to prepare the skin so strips will stick longer and tighter. If you have Benzoin (a "stick-um" liquid), apply a thin coating on each side of the cut and allow it to dry completely. Nail polish remover can also be used to remove skin oils for a more secure "hold," but you must be careful not to get it in the cut.
 

To secure the closure, press the skin edges together. (They should fit perfectly. If not, you have a problem.) Attach the butterfly or Steri to one side and pull gently across the cut. You can use your other hand to hold the wound closed. When you see the skin puckering slightly and the wound looks tightly closed, push the second side of the butterfly down. For a longer cut, you may need three or four butterflies or Steris.

When the wound seems closed, move the extremity around to be sure the wound stays closed and the tapes won't pull off.  Now pad the wound with a non-stick pad, then gauze placed directly over top. If necessary, trim the pad to fit. If the wound is on an extremity, bind the dressing with a kling wrap. Secure the bandage with Coban wrap or tape. See the section on wound dressings.

If you decide to treat a sharp laceration over a moving surface (such as knee, elbow, or knuckle), you need to provide protection against motion for the first few days. Think about what you'll do during the 7-10 days' healing time -- and consider stitches.
 
 

The wound has been cleaned. Benzoin has been placed and allowed to dry completely. Now a Steri-Strip has been placed. Steri-Strips or a butterfly bandage can secure a closure -- either to help you ride out with a cut that will need stitches, or as permanent treatment for minor, sharp cuts.

Steri-Strips don't stretch. But the skin over this knuckle will. The joint must be kept from moving until the early healing is complete. Here a short splint of aluminum with foam has been placed and taped. Cuts over moving areas must be secured, so the moving skin doesn't pull the cut back open.

If you're treating the cut at home, leave the butterflies or Steris until they peel off on their own. Keep the wound covered with a dry dressing and keep it clean. Avoid bumping the area. It takes between 10 and 14 days before the cut is strong enough for routine duty without a dressing.

Watch for:
See the doctor if there is redness around the wound, red streaks, swelling, drainage, fever, tender bumps in the groin or armpit upsteam from the wound, or an unexplained increase in pain or tenderness.  See section on infection.
 

Appendix

Normal isotonic saline is generally favored to cleanse wounds. Two investigators from Australia studied the Cochrane Controlled Trials Register and 4 other major databases to report in 2008[1] on 11 randomized and quasi-randomized controlled trials that compared rates of infection and healing with water and saline, as well as no cleansing. Tap water was statistically more effective than saline at reducing infection rates in adults with acute wounds and no different than saline in children. No statistically significant differences in infection rates were seen when wounds were cleansed with tap water or not cleansed at all. So you have lots of choices when confronted with an acute wound.

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Or you could be sensible and equip your self with a quart Mason jar and a measuring teaspoon and a box of (non-iodized if you're the nervous type)salt. Stir this combo up (1 tsp/qt) and you'll have yourself pretty close to God's designated 385 mOsm/L. Wash away, and preserve those cells for healing.

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It wasn't clear to me whether the tap water was running water or just tap water in a bowl or on a pad. Certainly one advantage to using running tap water is the old "the solution to pollution is dilution" paradigm and I suspect we dilute more effectively this way than with the standard of irrigating with syringes or other irrigating devices and normal saline. (Do I really think my ED colleagues take the time to irrigate with "100 cc's of normal saline"on the wounds they suture--generally no.) I've been using running tap water (liberally) with soap and towel drying for both initial cleansing of most wounds with some irrigation of suturable wounds with saline primarily to get the soap out! Wounds near the eye and those which are bleeding profusely are exceptions. Generally I find soaking wounds to be subptimal as a sole method of cleansing because it often leaves debris behind, doesn;t get into the depth of many wounds or under flaps.

On follow ups, I use only running tap water and soap and towel drying. Providing they can tolerate the procedure I let my patients do even initial cleansing themselves. It saves my staff time and gives us an opportunity to observe and educate them on wound care. I'm so glad I can refer to this study when my colleagues or assistants look askance because they think I'm practicing suboptimal care.

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HYPERTONIC SALINE WET TO DRY WORKS WELL & HELPS DEBRIDE
Don't know why hypertonic saline approx 2.5-5% is not tested along with NS...I've used it many times in surgical wounds where thers a superficial infection & skin separation. Using the hypertonic saline in a wet to dry dressing fashion & changing it 2-3 times a day keeps the area remarkably clean & doesn't seem to impair granulation the way Betadine has been reported to do. The salt (iodized table is fine) draws out edema & prevents bacterial growth. Works great on kids skin wounds & pustules of various sorts too.
    The only reason hypertonic saline is not tested against Commercial antibacterial salves etc , is that there's no money in it & it beats most of them I believe. Google hypertonic saline... there's some interesting info there... one report even used 5% saline ointment in a subacute to chonic eye condition. And if you want a non-addicting sinus cleanser when you have sinusitis for any reason, fill you nasal passages with hypertonic saline sol'n, I use 1/4 teaspoon silt per 4 oz H20.. but you can look up a more precise measurement. When you have a cold, do it at bedtime for a much better sleep. With your head tipped back over a cushioned tub edge you can use a mini baster from Walmart or just pour it in your nostrils... hold it there as long as you can, breathing though your mouth.(60 seconds is fine)..snort it into the toilet & repeat once more. With kids you can get empty atomizers at Walgreens & atomize the solution but it only works about half as well. B.H. CROWELL, M.D. ret