EWMA Council

Is it safe to use saline
solution to clean wounds?
INTRODUCTION
The delivery of wound care has become increasingly
technology based. However, some of the
main problems related to impaired healing in
wounds may be related to basic aspects such as
cleansing, when it would be expected that, since
enough evidence exists to indicate best practice
in relation to the procedure (Blunt, 2001; Ellis,
2004), healthcare professionals should have
knowledge of this evidence.
In primary health care in Portugal, wounds
(chronic or acute) are usually cleansed with a sterile
0.9 % (w/v) sodium chloride solution, usually
termed physiological saline because it is isotonic
for human cells (Flanagan, 1997) and innocuous
and it is, therefore, generally the first choice solution
for cleaning wounds (Davies, 1999). Isotonic
sodium chloride solution is one of the best agents
for cleaning open wounds because it removes debris
and bacteria without cell destruction (Pina,
1999, Cochrane, 2004). The major aim in wound
cleaning is removal of organic and inorganic residues
before application of the dressing thus maintaining
an optimal environment at the wound site
for healing (Morison et al., 1997). Other benefits
of wound cleaning are: (i) to hydrate the wound
surfaces and create a moist medium more favorable
for healing; (ii) to preserve the surrounding
skin, removing residues of glue and excess of
humidity that can cause maceration, as well as
erosion by action of enzymes of the exudates and
toxic bacteria present on skin; (iii) to facilitate
the visualization of the size and extension of the
wound; (iv) to minimize the trauma of the wound
due to the continuous use of adherent materials;
(v) to reduce the risk of infection; and (vi) to
promote the comfort of the ill person. (Morison
et al., 1997; Agreda & Bou, 2004):
The technique of wound cleansing has evolved
through time. Thomlinson (1987) has demonstrated
that the technique of rubbing the wounds
EWMA Journal 2007 vol 7 no 2
(with a swab held on a forceps) from the clean
area to the dirty area, up and down and from the
center to the border, only resulted in distribution
of bacteria upon the surface of the wound. Additionally,
the use of the swab and vigorous rubbing
can cause trauma, especially in epithelial cells, as
well as leave residues (little filaments of the swabs)
that could delay healing by acting as foreign bodies
that could remain in the deep tissues and serve
as a focus of infection (Wood, 1976).
In conclusion, the best choice for wound cleansing
is the irrigation technique. Irrigation consists
of gently removing residues on the surface of the
wound as well as other contaminants (Lawrence,
1997-1998). This is achieved by using fluids at
constant pressure or pulsated pressure (Cooper
et al., 2003).
The optimal pressure for irrigation is achieved
using a 35 ml syringe with a 19 G caliber needle.
The disadvantages of this method are mainly:
- the detachment of the needle during irrigation
with the risk of causing injury to the
patient and/or the professional;
- the production of aerosols that could contaminate
the environment or the professionals.
At present, the professionals of the Health Subregion
of Coimbra perform the cleaning of wounds
by irrigation, using flasks of sodium chloride solution
of 100 cc, 500 cc or 1000 cc, with a transfer
attached. The same flask with transfer is used in
several patients with resulting risk of contamination.
OBJECTIVES
The present study was undertaken with the objective
of evaluating the level of microbial contamination
of physiological saline flasks used in health
centers for wound cleaning and identifying those
microorganisms found.
�
Scientific Article
João Carlos Gouveia
Christina Miguens
C. S. Pampilhosa Serra,
P. Serra.,
Portugal
gouveia.miguens@sapo.pt