In the medical field, they say that “cleanliness is half of health.” That means that a clean environment and a clean body leave much less room for germs to do their dirty work. Safeguarding hygiene and sanitation make the body less inviting to illness and increases resistance to bacteria when it does arrive.
When it comes to pressure injuries, cleanliness plays a dual role. Maintaining a clean health facility and ensuring that residents are washed properly help promote overall health, thereby contributing to the prevention of pressure injures and other conditions.
Then there is the element of treatment. Not all pressure injuries can be prevented, despite our best efforts. And when they do develop, they need to be treated as quickly and efficiently as possible.
And according to Steven Smet, an Advanced Practice Nurse specializing in wound care, the first, crucial step is cleaning the wound.
Our first priority with any open wound is to ensure that the harmful elements are removed so that healthy tissue can take its place and the wound can start to heal properly. Then the wound must be washed of all bacteria, and the bacteria-friendly elements must be removed as well to prevent infections.
Cleaning a wound, however, is more complex than it seems, and cleaning it improperly could do more harm than good. But a number of proven techniques can help tend a wound with confidence and efficiency.
Make TIME for Healing
Smet recommends the TIME system of wound assessment as an effective method for treating pressure injuries. When surgery is not the ideal solution, creating a wound bed helps the wound heal properly.
TIME stands for Tissue, Infection, Moisture, and Edge:
1. Tissue - Remove the dead (necrotic) cells and other elements that are present in wound. The Red-Yellow-Black system is a simple guideline for how to determine the severity of the wound. Black color is the most severe and indicates necrotic tissue that must be removed.
2. Infection - With any open wound, there is a chance for bacteria to enter. Check for signs of infection such as redness, swelling, and pain. Bacteria also tends to spread, so identifying an infection early is essential for stunting it.
3. Moisture - Look out for seeping liquids, especially from inflammation. Dealing with exudate requires finding its source so that you are treating the cause, not the symptom.
4. Edge - Look for non-responsive cells. An effective wound bed would help healing around the edges.
The process starts with Tissue for reason, and that is because cleaning of the wound is the most essential element. In fact, cleaning not only deals with the dead tissue that obstructs the healing process but also lowers the bacterial load to fight infections.
What to Use to Clean a Wound - And What Not To
There are three types of good agents for cleaning a wound and one potentially harmful one.
Three good agents:
1. NaCl .9% saline or clean tap water
2. Wound cleansers (flamirins, isorins)
3. Prontosan (polyhexanide and undecylenamidopropyl Betaine) with a minimum exposure time of at least 10 minutes
One harmful agent:
DO NOT CLEAN with hydrogen peroxide. It could have a toxic effect on healthy tissue and impede healing rather than promote it.
Methods of Debridement
Removing dead tissue from a wound is called debridement. The process must be handled with great care because the tissue around the blackened parts may be fragile. It is also possible to remove tissue to the point where you reach the bone.
In other words, you can't be too careful when removing dead tissue.
Mechanical debridement could be effective but it is extremely painful. The biggest advantage is that it does not require special training to do it. Another method is called sharp debridement, which is essentially cutting away the offensive tissue. This requires specialized training, and increases the chances of infection if not handled in a sterile environment. This method is also painful.
A less painful alternative is known as biological debridement, which consists of ointments and dressings. It is painless for the patient, and does not put any healthy tissue at risk. The FDA has approved medicinal honey as a form of dressing, though not as a method of debridement on its own.
Another (controversial) alternative that is also painless and not dangerous for healthy skin, and may well be even more effective in attacking dead skin, is maggot therapy. While it sounds medieval to consider using maggots to eat away the dead skin, the method is gaining popularity. It has been approved by the FDA as a prescription medication under the supervision of doctors. The maggots are applied to a wound through a special dressing. They eat away at the dead skin and do not touch any of the healthy tissue. Research has found this method more effective than others.
Cleaning Wounds is First Step to Treating Them
Creating a proper wound bed will go a long way in healing. And it all starts with proper cleaning of the wounded area. The TIME method helps ensure that the process is handled in a systematic manner, with all of the bases covered. And using proper methods for cleaning and debridement ensure that the process will be as efficient as possible.
That's another way to understand the saying that cleanliness is half of health. Because when the wound is cleaned properly, half the work is done. In fact, with a wound bed in place and all of the obstacles removed, the body is left unhindered to perform its magic on the wound.