Antiseptic and Wound Cleansing - Literature review Example

Antiseptic and Wound Cleansing xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Name xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Course xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Instructor xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Date Introduction Wound cleansing is a very vital practice for wound management for it optimizes the healing environment and leads to a decrease to potential infection. It is worth noting that, wound cleansing has been practiced since days in memorial as an integral part of acute traumatic wounds as well as chronic wounds (Benbow 2011b). From the fact that there is no single test that can ascertain that whether the bacterial load in a wound is capable of causing an infection and therefore, wounds should be cleansed to incapacitate the bacterial inoculums so that the host defense can handle them comfortably. This been the case, I have came to understand that, cleaning wounds is a vital practice which helps in the healing process of the wound in a big way. But the choice of the antiseptic is the main issue that was contentious in my understanding for wound cleansing. The choice of the cleansing agent has remained a contested issue for the use of antiseptics has remained questionable all through. However it is a matter of fact that, research depicts that the ultimate goal of wound management is to minimize the risk of opportunistic infection while taking good care of the development of healthy granulation tissue that contributes to the healing process of the entire wound. With a clear understanding of the healing process, strategies that contribute to tissue repair process beyond just managing the surface bacterial contamination, need to be adhered to when cleansing the wound (Towler 2001). Review of the literature According to Atiyelo, Dibo and Hayek (2009), antiseptics are antimicrobial agents that kill, inhibit and even reduce the number of microorganisms and thus control wound infections. However, in many cases, they have only been used to prevent or treat infection in wounds. It is also worth noting that, antiseptics have for a long time be considered drugs by the food and Drug Administration and this on the other hand means that they are treated as so. Antiseptics are active against resident and transient flora on the skin and are able to reduce the number of microbial by mechanical removal, chemical action or at times both. Research conducted by Thomas and others (2009) depicts that, antiseptics use different mechanisms in their formulations and therefore acts at various rates and persistence intervals, display diverse levels of toxicity and therefore have high chances of bringing about resistance. Antiseptics are however well positioned to actively facilitate the healing process of wound for their diverse spectrum of functionality. For instance, they can not compare to antibiotics which are only obliged to acting on specific targets, for they have multiple agents and target a much wider spectrum of activities, dealing with bacteria, fungi, viruses, protozoa and even prions (Drosou , Falabella & Kirsner 2003). Controversies in using antiseptics From a study by Drosou , Falabella and Kirsner (2003), the use of anti infective agents on open wounds such as burns, chronic ulcers and lacerations have been marred with lots of controversy. However, in clinical environments, they are commonly used for both intact skin and wounds. As stated above, the use of the same on open wounds has been contested whereby many authors have cited cytotoxicity data and therefore discouraged against open wounds. This is attributed to that fact that, many antiseptics are said to have detergents which are too harsh when used on wounds or non intact skin (Lindsay 2007). This therefore means that there has not been a conclusive solution for the validity of the use of antiseptics on open wounds for some authors are for the use of antiseptics while others discourage the use of the same. Types of antiseptics There are different categories of antiseptics which include ethanol, triclocarban, chlorhexidine, bisphenols, chlorine compounds and many others. However, the most common products used for clinical practice are povidone iodine, chlorhexidine, hydrogen peroxide, boric acid, just to mention but a few. It is a point to note that, antiseptics have a very broad spectrum antimicrobial effect and are toxic to bacterial cell metabolism and therefore is vital in wound management rather that antibiotic action such as enzyme inhabitation and are believed to be non toxic to tissues. Cleansing the wound (practice) In a wound, the divided edges of the wound are more prone to infection that the unwounded tissue. Main 2008 stated that, antiseptics do more harm than good on wounds especially when they are expected to heal. This being the case, cleansing of wounds using antiseptics have been left to those wounds which are non healing or mostly where the local bacterial burden is much heavier that the healing of the wound. This is correlated to the notion that, antiseptics are quickly denatured by contact with body fluids and toxic to healing tissue as it is well put by Watret and Armitage (2002). However, according to Owens , White and Wenke (2009), infected wounds can have underlying problems and normal saline and water may not be helpful especially in the presence of biofilms which are commonly known to be resistant to irrigation and antibiotics. This therefore calls for cleansing using antiseptics so as to guard the wound against more infection and aid healing. Biofilms are complex microbial communities which are surrounded by slime like substance which is a combination of extracellular matrix proteins, nucleic acids and polysaccharides which are attached to the surface, mostly a wound (Cutting 2010) Amid all the controversies, wound that has been actively cleansed using antiseptics heal quickly than those which have not been cleansed using the same. This is due to what has been proven that microorganisms in wounds cause fermentations and putrefaction and lead to suppuration in living tissue (Cutting 2010). However, literature depict that, prolonged use of antiseptics and topical antibiotics has been said to delay healing. Nevertheless, the wound toxicity of chlorhexidine and povidone iodine was said to be less than it was believed which is an attribution to the increasing recognition of the role played by bacteria in delaying wound healing and the importance of removing dead tissue, any foreign material and in the long run providing clean granulation which will trigger the healing process of the wound (Drosou, Falabella & Kirsner 2003). In as much as there have been literatures that are for the use of antiseptics in cleansing wounds, there has been literature opposed to the same in equal measure. But it is a point worth noting that, antiseptics are very useful in decreasing bacterial load. But the antiseptic chosen should be non toxic, effective and should not by any chance delay healing. Most published data depict that, cadexomer iodine are effective antibacterial agents and depress increased inflammatory responses (Cutting 2010). This therefore means that, there is still hope in the notion that, antiseptics can be a very important tool in wound management and cleansing. However, these antiseptics should not be used frequently for this is said to incapacitate the healing process of the wound. Based on the finding from the above literature, it is difficult to just consider that antiseptics in general are safe to use. However, it is clear that, effective use of an antiseptic on a wound relies on frequent dressing changes. This may not be very favorable to the patient bearing in mind that, even there have been tremendous changes on wound management like the advent of moist wound healing which means that frequent dressing would interfere with the healing process and therefore incapacitate the wound management process (Drosou, Falabella & Kirsner 2003). As noted above, antiseptics like hydrogen peroxide are highly recommended. This is due to the fact that, it releases molecular oxygen when it comes into contact with the tissue. When this happens there becomes a process referred to as oxidizing which destroys anaerobic bacteria and removes slough from the wound. Studies have revealed that, hydrogen peroxide is cytotoxic to fibroblast unless it is diluted. It is therefore worth concluding that, the choice of an antiseptic to cleanse a wound should reduce the number of microorganisms and also be harmless to the body’s defenses and most importantly, should not interfere with the healing process of a wound. It is a matter of fact that, many antiseptics have been detrimental to the healing of the wound for they first destroy cell walls without considering the identity of the entire cell. This is the reason why they are said to be toxic to the wound healing cells which in the long run exposes the patient to more infections and thus such antiseptics have been substantially discouraged (Benbow 2011a). Conclusion Conclusively, when selecting the antiseptic to be used in the cleansing of the wound, it is very important to understand the properties and effects of various agents on microorganisms and wound healing cells. The best antiseptic should be the one that will effectively reduce the number of microorganisms while minimizing tissue irritation and interference with the wound healing process (Cutting 2010). Due to the controversy correlated to the use of antiseptics on wound treatment, normal saline or tap water are the accepted methods used to cleanse wounds to assist healing. There is much controversy surrounding the use of antiseptics like iodine; many studies advice the use of these antiseptics in conjunction with antibiotics for effective healing of wounds. Cleaning a wound is highly recommended and therefore should be given first priority whenever there is a wound. However, data from clinical research on the effectiveness of some cleansing agents or antiseptics are still lacking. There is a need to harness scientific evidence and new findings from clinical research to determine which antiseptics are the most effective for wound cleansing and management. Bibliography Benbow M (2011a) Wound care: ensuring a holistic and collaborative assessment. Wound Care. 16(Suppl 9): S6–16 Benbow M (2011b) Using Debrisoft for wound debridement. Journal of Community Nursing 25(5): 17–18 Cutting K (2010) Addressing the challenge of wound cleansing in the modern era. Br J Nurs 19(Suppl 11): S24–9 Drosou, A.;Falabella, A. & Kirsner, R. S. (2003). Antiseptics on Wounds. An Area of\ Controversy. Wounds,15(5):149-66. Main RC (2008) Should chlorhexidine gluconate be used in wound cleansing? J Wound Care 17(3): 112–4 Towler J (2001). Cleansing traumatic wounds with swabs, water or saline. J Wound Care 10(6): 231–4 Lindsay E (2007) To wash or not to wash: What is the solution for chronic leg ulcers? Wound Essentials 2: 74–83 Thomas GW, Rael LT, Bar-Or R, Shimonkevitz R, Mains CW, Slone DS, Craun ML, Bar-Or D. Mechanisms of delayed wound healing by commonly used antiseptics. J Trauma 2009;66:82–91. Drosou , Falabella & Kirsner 2003. Antiseptics on wounds: an area of controversy. Wounds 2003;15:149–66. Owens BD, White DW, Wenke JC. Comparison of irrigation solutions and devices in a contaminated musculoskeletal wound survival model. J Bone Joint Surg Am 2009;91:92 8. Watret L, Armitage M (2002) Making sense of wound cleansing. Journal of Community Nursing 16(4): 27–34 Read More