Pertinent Insights On Antimicrobial Dressings And Infection Control

Author(s): 
Clinical Editor: Kazu Suzuki, DPM, CWS

These expert panelists debate the use of antimicrobial dressings versus regular wound dressings, the efficacy of antiseptics and whether sterile gloves are useful in reducing the risk of infection.

Q:

Do you use any antiseptic, such as alcohol, hydrogen peroxide, Dakin’s solution or povidone-iodine solution for wounds?

A:

Although he notes that the above listed antiseptics are toxic to wounds and prevent wound healing, Khurram Khan, DPM, says their judicious use may be required as necessary on infected wounds. With infected wounds, he says his first concern is resolving infection. Once the infection has resolved, Dr. Khan shifts his attention to wound healing.

   Dr. Khan uses alcohol sparingly around wounds to clean the area and employs hydrogen peroxide around the wound to cleanse any bleeding/dry blood. He will use Dakin’s solution sparingly for severely infected wounds but only for one or two days until the infection resolves. As for povidone-iodine, he will use this in wounds as needed until any infection and cellulitis resolves, especially in the hospital setting. Dr. Khan also uses povidone-iodine in wounds that are macerated to help in the drying process and when splinting is required.

   Once cellulitis resolves, Dr. Khan switches the dressing to a less toxic dressing that will help with the wound healing process. He also uses Hibiclens quite a bit when scrubbing a wound, and cites research showing that H2O2 and iodine decrease migration of fibroblasts whereas chlorhexidine and silver enhance growth at low doses.1 Therefore, he says using a chlorhexidine scrub for one minute with a saline rinse will not destroy the wound healing potential and research has shown this to inhibit bacterial growth on skin for up to eight hours.1

   Kazu Suzuki, DPM, CWS, does not see a good reason to recommend alcohol or hydrogen peroxide for wound irrigation, either at home or in the clinic. He also avoids using Dakin’s solution (diluted bleach solution), which is often recommended for packing infected wounds.

   “Those aseptic solutions are terribly irritating and toxic to the granulation tissues in the wound bed,” he says. “Unfortunately, we do encounter many of our wound care patients, coming in for the first visit, using these antiseptic solutions to ‘clean’ the wounds and we have to teach them that ‘you should not put any liquid in your wounds that you wouldn’t put in your eyes.’”

   Thanh Dinh, DPM, does not routinely use antiseptic solutions for cleansing wounds. In addition to demonstrating little benefit over saline irrigation, antiseptic solutions are more likely to cause cellular toxicity to healing wounds, according to Dr. Dinh. Furthermore, she notes limited data on systemic absorption of these solutions and limited evidence for effective prevention of infection.

   Similarly, Ryan Fitzgerald, DPM, stresses the importance of managing the potential for wound colonization and infection, noting this often includes the use of antiseptic wound cleansers and dressings. However, he urges clinicians to be careful when selecting an antiseptic as many can be too caustic to the fragile wound environment.

   Dr. Suzuki only uses an antiseptic solution when using a Betadine solution for dry gangrenous wounds to “temporize” those wounds. Theoretically, he says Betadine will dehydrate the gangrenous wounds and make them less likely to turn into “wet” gangrene. This also provides time to schedule for surgical or auto-amputation, according to Dr. Suzuki. However, he notes such an effect is anecdotal and he is unaware of any good study tracking the natural history of gangrenous wounds and the effect of Betadine use.

   For an antiseptic, Dr. Fitzgerald often utilizes Dakin’s solution in significantly contaminated wounds. In those patients with suspected Pseudomonas infection, he frequently uses an acetic acid in conjunction with standard of care modalities to promote wound progression toward healing.

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