Wound Irrigation to Cleanse Non-Infected Chronic Wounds: Clinical Effectiveness and Exploration of International Practice in Home and Community Care

Wound cleansing is an important factor when considering overall wound hygiene. Currently, there are several methods of wound cleansing; however, it is reported that irrigation and swabbing are the two methods primarily used in various health care settings worldwide. About ten years ago, the practice of wound cleansing changed as experts opined that swabbing wounds during wound cleansing had adverse effects on wound healing. Many felt that nurses were unable to differentiate between non-viable and viable tissue, resulting in damage to new tissue. Practice was changed to favour wound irrigation over swabbing because it is reportedly sufficient to reduce the pain associated with wound cleansing and remove debris; however, it is vigorous enough to disrupt bacterial adhesion while leaving healthy new granulation and epithelial tissue intact. There are several ways to perform wound irrigation, including using sterile disposable bottles of normal saline with a predetermined pressure range, drawing saline into a syringe and attaching an intravenous catheter of a specific diameter to achieve the recommended pressure, or modifying equipment not designed for wound irrigation to achieve a desired pressure. The technique of swabbing can also be inconsistent, as it is entirely dependent on the clinician and the force they use to manually remove debris from the wound bed. Some experts in the field of wound care believe that wound cleansing is performed in a ritualistic manner rather than being clinically required, and therefore hypothesize that nurses performing this skill do not fully understand the theoretical basis behind the skill, resulting in poor execution of the technique.

The aim of this study is to systematically summarize and evaluate the current evidence for two wound cleansing techniques (irrigation versus swabbing), conduct a randomized controlled trial to measure the outcomes of irrigation versus swabbing in chronic wounds, and understand the knowledge and perceptions of nurses working internationally in home and community care in the care and management of chronic wounds to gain insight into what factors might influence decision making.

This project is a collaboration between the Swedish Centre for Skin and Wound Research (Örebro University), the Skin Integrity Research Group at Ghent University (Belgium), Queen’s University (Ontario, Canada), and the South East Local Health Integration Network (Kingston, Canada).