Principles and methods for selecting wound cleaning solutions

Why is it important to choose the right wound cleaning solution?

Wound cleaning is the most basic and crucial step in wound care. Its purpose is not only to remove surface dirt and bacteria, but more importantly, to create a clean environment conducive to healing while avoiding secondary damage to fragile new tissue. Choosing the wrong cleaning solution, such as an overly irritating disinfectant, may kill bacteria while also destroying growth factors and fibroblasts essential for healing, thus delaying the healing process and leading to dry wounds, increased pain, or even tissue necrosis. Therefore, understanding the characteristics and applicable scope of different cleaning solutions is an important aspect of modern scientific wound care, directly affecting the effectiveness of subsequent treatments and the speed of healing.

Is saline solution a universal choice?

Physiological saline, or 0.9% sodium chloride solution, is one of the most commonly used and safest solutions for wound cleaning. Its osmotic pressure is similar to that of human blood plasma, classifying it as an isotonic solution. It does not cause cell dehydration or excessive water absorption, therefore it has virtually no toxicity to granulation tissue and epithelial cells and does not cause pain. It is suitable for most wounds, especially during the proliferative and epithelial stages of wound healing, for daily cleaning and moist dressings, effectively flushing away debris and loosely attached necrotic tissue. However, physiological saline itself has no bactericidal or bacteriostatic effect. For wounds with significant infection, abundant necrotic tissue, or biofilm formation, its cleaning ability may be insufficient, requiring the use of other solutions with debridement or antibacterial properties. Overall, however, it is the preferred and safest solution for home care and most clinical situations.

When should we consider using antibacterial solutions?

When a wound shows clear or suspected signs of infection, such as increased local redness, swelling, heat, and pain, purulent discharge or odor, delayed wound healing, or when the patient is immunosuppressed, antibacterial solutions should be considered. Commonly used antibacterial solutions include polyhexamethylene biguanide solution, povidone-iodine, and hypochlorous acid solution. Polyhexamethylene biguanide is a broad-spectrum antibacterial agent, effective against both bacteria and fungi, with low cytotoxicity and minimal impact on fibroblasts and keratinocytes. It is often used for chronically infected wounds and foot ulcers. Povidone-iodine is a classic broad-spectrum antibacterial agent, but traditional povidone-iodine is cytotoxic and may delay healing; therefore, sustained-release or modified povidone-iodine dressings are recommended rather than direct rinsing. Hypochlorous acid solution has strong oxidizing and antibacterial properties and can effectively combat biofilms, but the concentration and duration of use must be carefully controlled to avoid damaging healthy tissue. It is important to clarify that antibacterial solutions are primarily used to control bacterial load in wounds and cannot replace systemic antibiotics for treating severe infections.

How to treat wounds with necrotic tissue or biofilm?

For wounds covered with necrotic tissue (such as black eschar or yellow necrotic tissue), the goal of cleaning is to promote autolytic debridement or assist mechanical debridement. In this case, in addition to keeping the wound moist with saline, solutions that soften necrotic tissue, such as Ringer's solution, may be necessary. Ringer's solution has an ionic composition closer to extracellular fluid, better maintaining cell viability. Wound cleaning solutions containing surfactants can reduce surface tension, allowing for better penetration and loosening of necrotic tissue, facilitating rinsing and removal. When a biofilm is present in the wound—a protective film composed of bacterial colonies and their secreted extracellular matrix—routine cleaning is often ineffective. In this case, in addition to using solutions with anti-biofilm properties, such as hypochlorous acid or acetic acid, it is crucial to combine physical debridement methods, such as gentle mechanical debridement (using wet-to-dry gauze or debridement pads). This is the most critical step in breaking down the biofilm.

How should you choose a cleaning solution for home care?

For the care of acute minor wounds or stable chronic wounds in a home setting, the principles are safety, simplicity, and effectiveness. When treating fresh abrasions or cuts, the first step should be to thoroughly rinse with running clean tap water or saline solution to remove dirt; this is more important than using any disinfectant. After rinsing, you can further clean with cotton swabs moistened with sterile saline solution. For routine dressing changes, small vials of sterile saline solution are the best option. Absolutely avoid using hydrogen peroxide, alcohol, or high-concentration iodine tincture to directly rinse or apply to the wound. These solutions can cause severe pain, damage newly formed granulation tissue, and may introduce bacteria deeper into the tissue due to strong bubbling or protein coagulation. If the wound shows signs of infection, seek medical attention promptly for professional evaluation and the use of appropriate antibacterial products, rather than self-medicating with strong disinfectants.

What are the essential steps to follow when cleaning a wound?

Regardless of the solution chosen, proper technique is crucial. The cleaning pressure should be moderate; a 35 ml syringe connected to a 19-gauge blunt needle is recommended. This effectively removes impurities without pushing bacteria into deeper tissues or damaging granulation tissue. The solution temperature should be close to body temperature (approximately 37 degrees Celsius). Solutions that are too cold or too hot can irritate the wound and impair local blood circulation. Cleaning should proceed from the cleanest area of the wound to the dirtiest areas, or in a circular motion from the center outwards, avoiding introducing bacteria from surrounding skin. Cleaning should be performed each time the dressing is changed, using a sufficient volume of solution to ensure thorough cleaning. After cleaning, gently blot the surrounding skin with sterile gauze, keeping the wound bed moderately moist.

Wound cleaning is the foundational step in wound healing, and proper solution selection and application are half the battle. The core principle is to choose isotonic solutions that are non-toxic and non-irritating to tissues, such as physiological saline, and to use antibacterial or debridement solutions only when necessary, always with the ultimate goal of protecting new tissue and promoting healing. When faced with complex, infected, or slow-healing wounds, seeking professional guidance from a wound care specialist nurse or physician is the most reliable way to make the best choice. For more information on Innomed®Super Absorbent Dressing, refer to the Previous Articles. If you have customized needs, you are welcome to contact us; You Wholeheartedly. At long-term medical, we transform this data by Innovating and Developing Products that Make Life easier for those who need loving care.

Editor: kiki Jia