Wound Cleaning, Skin Protectants, Antimicrobial Sprays

A surgical wound is an incision or cut into the skin that is normally made during surgery by a scalpel. It can also be the result of a drain placed into the body during surgery. The wound size can vary greatly, and is usually closed with sutures, but some are left open to heal.

What are the Various Types of Surgical Wounds?

Surgical wounds can be placed into one of four categories. These categories depend on how clean or contaminated the wound is, where the wound is located on the body, and the risk of infection.

Class I is considered a clean wound. This classification shows no signs of inflammation or infection, and often involves the skin, eye, or vascular system. Class II wounds are considered clean-contaminated. Although they may not show signs of infection, they are at an increased risk of getting infected. This can be due to their location; for example, surgical wounds in the gastrointestinal (GI) tract may be at a higher risk of becoming infected. Class III is considered a contaminated wound. An outside object has come in contact with the skin and this type of wound is classified as having a high risk of infection. For example, a gunshot wound may contaminate the skin surrounding the area where the surgical repair happens. Class IV is considered a dirty-contaminated wound. These wounds can include ones that have been exposed to fecal material.

What are the Risk Factors and Symptoms for Wound Infections?

The chance of a surgical wound to become infected after surgery is between 1% and 3%. Risk factors for developing a surgical wound infection include having a weakened immune system or diabetes. Abdominal surgeries, emergency surgeries, and surgeries that last longer than 2 hours bring a higher risk of infection, also.

Surgical wounds are monitored frequently to make sure they are healing properly. Signs of an infection include increased redness and pain around the incision. Other signs can be the presence of pus, a foul smell, delayed healing, or drainage from the wound. Sometimes, an infected surgical wound can appear deeper or dried out, and fever may accompany this type of infection.

What are Beneficial Wound Cleansing Practices?

Cleaning a wound is extremely important. It removes free-floating bacteria and loose debris, provides protection to promote an optimal environment for healing, and helps wound assessment by optimizing visualization of the wound. A wound should be cleaned every time the dressing is changed, unless it is contraindicated. Choosing and using the correct wound cleanser should be considered. A wound cleanser should be nontoxic to tender tissue, hypoallergenic, readily available, and stable. It should also be effective in the presence of organic material, such as slough, necrotic tissue, or blood. It needs to be able to reduce the number of microorganisms that form on the surface of the wound.

Before beginning, make sure the cleansing solution is at room temperature or slightly warmer. It can take up to 40 minutes after cleaning for a wound to regain its original temperature for proper healing. Once the solution is warm, hands need to be washed and gloves applied.

A manual cleansing technique for a linear incision or wound is to pour the irrigation solution into a tray. Moisten clean gauze pads in the solution and squeeze out the excess. Gently wipe the wound from top to bottom in one motion, beginning directly over the wound. Throw away the used gauze pad. Using a new moistened gauze pad, repeat the cleaning by using a gentle downward stroke which is parallel to the wound. Repeat the steps, working outward from the wound in parallel lines to the incision. Be sure to use a new gauze pad for each downward stroke. If needed, dry the wound by following the same procedure as for cleaning, using dry gauze pads.

A manual cleansing technique for an open wound is to pour the irrigation solution into a tray. Moisten gauze pads in the solution and squeeze out the excess. Gently clean the wound in a half or full circle, beginning in the center and working towards the outside. Use a new gauze pad for each circle. Clean at least 1 inch past the edges of the new dressing, or 2 inches beyond the wound margins if not applying a dressing. If needed, dry the wound by using the same cleaning procedure. Gently pat the wound dry by using dry gauze pads.

A manual cleansing technique utilizing spray cleansers is to either apply the cleanser directly to the wound, or spray it onto a clean gauze pad and then apply it to the wound. Generally, wound irrigation that involves spraying, squirting, or pressure release of fluid should require the use of personal protective equipment, such as gloves, gown, and mask with an eye shield, to prevent exposure to airborne microorganisms and debris. Protect the equipment, environment, and other supplies from contamination from spray aerosolizing by removing or covering the supplies. Hold the spray bottle about 1 inch from the wound. Aim the nozzle at the wound and squeeze the bottle, directing the cleanser along the sides and base of the wound. With a clean gauze pad, blot up excess moisture, then dry the surrounding skin.

To clean a wound with a saline flush, position the affected individual so that the cleansing solution will flow by gravity from the upper end of the wound to the lower end. Twist off the top and position the container at any angle required to access the area that is to be cleaned or moistened. Apply firm pressure to the container to have the correct flow rate. With a clean gauze pad, blot up the excess moisture, then dry the surrounding skin. After cleaning the wound, dispose of the waste in a trash bag, then remove and discard gloves and any other equipment used for the cleansing.

For at-home wound cleansing, the same procedures may be involved, including frequent dressing changes and cleaning. Often, an individual is discharged from the hospital before a surgical wound has completely healed. Therefore, it is essential that a patient follow all at-home wound care instructions. Following the directions properly will promote healing and decrease the chance of infection.

Rehabmart is pleased to carry a wide range of wound cleansers from well-respected vendors, such as McKesson Medical-Surgical, DeVilbiss, Independence Medical, Medline, Sammons Preston and North Coast.

Hulet Smith, OT
Rehabmart Co-Founder & CEO

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