Irrigation

Effective high-pressure irrigation decreases bacterial count and helps to remove foreign bodies, thereby reducing the risk of wound infection. 12 Because of the discomfort involved, local anesthetic should be given prior to irrigation. Irrigation pressures of 5 to 8 psi are recommended, which is easily achieved using a 19-gauge needle with either a 35-mL or 65-mL syringe.3 Sufficient pressures will not be generated using a bulb syringe or fluid directly from the intravenous fluid bags. Although the exact volume of irrigant required is not known, some authors have found 60 mL/cm of wound length as a useful guideline.2 The other approach is to use 1 L of saline as a standard volume, although a large prospective observational study found little correlation between the incidence of infection and the volume of irrigation, provided at least 200 mL was used.4

Wound soaking is not effective in cleansing contaminated wounds and may actually increase wound bacterial counts. 5 Scrubbing traumatic wounds with a sponge is also ineffective and inflicts trauma and impairs resistance to infection.

Saline, the least expensive irrigant, also has the lowest toxicity. There is no added benefit to the addition of an antiseptic (such as povidone-iodine or hydrogen peroxide) to the irrigant.6 These agents are actually toxic to open wounds and impair resistance. Povidone-iodine, hydrogen peroxide, chlorhexidine, and detergents all cause tissue and fibroblast toxicity. Therefore, although these agents are bactericidal, they are not beneficial in wound care.

Universal Precautions should be observed while participating in wound care. Irrigation is often a time when contaminated fluid can be splashed onto the health care workers. Barrier protection should be used. Irrigation wet shields attached to the irrigation system may prevent some of the splashing associated with irrigation but are still not a substitute for Universal Precautions.

Recently, the need for routine irrigation of traumatic wounds has been questioned, particularly for simple nonbite, noncontaminated wounds in highly vascular areas, such as the scalp and face.78 Although irrigation produced a slight trend toward a better outcome (less wound infection and optimal cosmetic appearance), the results were not statistically significant.7 However, this was a nonrandomized observational study and therefore routine irrigation is still recommended at this time.

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