How To Clean A Wound: The Controversy Of Antiseptics
What do you do when your little one scrapes their leg? Do you rush off to your medicine cupboard to grab your bottle of Dettol of Savlon? This may actually not be necessary. Whilst it’s important you clean a wound as soon as possible in order to reduce the risk of infection, what you clean it with has been an area of debate in the medical world for years. Research has shown that running tap water over a wounds is just as effictive in cleaning a wound. Antiseptics may actually damage the skin and slow down the healing process.
WHAT IS THE DIFFERENCE BETWEEN AN ANTISEPTIC AND A DISINFECTANT?
A Biocide is the general term for a chemical agent that inactivates microorganisms and depending on their activity they can either inhibit the growth of, or kill microorganisms completely.
Both antiseptics and disinfectants inactivate microorganisms. These terms are often used interchangeably but there is a very big difference. Antiseptics are biocides that are used on living tissues and disinfectants are biocides used on inanimate objects or surfaces. So for example in your kitchen, you would use an antiseptic to wash your hands and a disinfectant to wash the countertops.
HOW SHOULD I CLEAN A WOUND?
Before you clean a wound you have to stop any bleeding. This is done by applying direct pressure. Of course the wound may still continue to bleed a little for a while and/or when you clean the wound it may start to bleed again. As long as the wound is not bleeding excessively you can proceed to clean it.
For most simple wounds I would simply recommend rinsing them under cool running water. In the ER and in theatre we always clean wounds with lots and lots of water. If you are out and about and don’t have running water, you can always use bottled water. If this weren’t available then I would rinse the wound with a diluted antiseptic such as cetrimide or povidine-iodine (if of course there are no known allergies). If you are going to use an antiseptic, use it only once to initially clean and never chronically. When you clean the wound again after a day or so use water. Don’t ever use rubbing alcohol or peroxide to clean an open wound.
You can gently rub off any foreign material using a piece of gauze soaked in water. Use tweezers to remove any debris that may still remain. Remember to disinfect the tweezers before use.
Once the wound is clean you can then apply a moist dressing. You can use petroleum jelly or what I love to use is a lanolin ointment such as a nipple cream. To find out more about moist healing you can read my previous blog: https://www.oneaid.co.za/picking-scabs-popping-blisters/
WHAT ABOUT ANTIBIOTIC CREAMS?
These include creams such as Supiroban, Fucidin and Neosporin. I do not recommend using an antibiotic cream for a simple wound. Most wounds heal very well on their own.
The problem with using these creams is the possibility of developing bacterial resistence. If the wound were to get infected later on and you have been applying an antibiotic cream since day one, this cream would not be very effective against the infection.
Technically you can develop resistence towards antiseptics but this is very unlikely since antiseptics have a broader spectrum of microorganisms they inactivate than antibiotic creams. If the wound was very contaminated and has a high chance of infection then I would rather apply a very thin layer of an antiseptic cream.
Newer research has found that the body’s surface actually supports wound healing on its own. We all have bacteria that live on our skins that cause us no harm. These bacteria help protect us from pathogens in the environment. Using creams and solutions that have antimicrobial activity will upset the balance of organisms on our skins and interfere with this defense system.
WHAT ARE THE SIGNS OF AN INFECTED WOUND?
After you have cleaned the wound and applied a dressing it’s important to monitor the wound for any signs of infection over the next few days:
- Swelling;
- Redness;
- Increasing pain;
- Bad smell from the wound;
- Warm skin around wound;
- Wound is leaking pus; and/or
- Body temperature > 38 degrees Celsius.
If you notice any of these above changes, go straight to the emergency room.
If you are anything like my mother you probably have very old big bottles of antiseptics lying around. One of my microbiology Professors at University once told us that microorganisms can grow on the surface of these antiseptic liquids after a while. Also the antiseptic components of these solutions deteriorate after some time so always check the expiry dates. Rather buy smaller bottles and don’t keep them too long after they have been opened.
RESOURCES
https://emj.bmj.com/content/19/6/556.1
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC88911/
https://www.sciencedirect.com/science/article/pii/S1743919117305368
https://www.woundsresearch.com/article/1585
https://www.woundsresearch.com/article/1586
