Use of wet-to-moist cleansing with different irrigation solutions to reduce bacterial bioburden in chronic wounds

Abstract

Objective: The influence of different irrigation solutions, in conjunction with wet-to-moist cleansing, on the reduction of sessile, non-planktonic bacteria which colonise wounds, has not been investigated. In this study, the antibacterial effect of different irrigation solutions, during a 20-minute wet-to-moist cleansing, has been evaluated in chronic wounds. Methods: This study was designed as a prospective cohort study with 12 study arms and was conducted between June 2011 and April 2016. Patients with chronic wounds present for more than three months, irrespective of previous treatments, were recruited into this study. Quantitative wound swabs were obtained before and after a 20-minute, wet-to-moist cleansing, using different wound irrigation solutions. Sterile 0.9% saline served as a control. Results: We recruited 308 patients, of which 260 patients with 299 chronic wounds were eligible for analysis. Staphylococcus aureus was the most common recovered (25.5%) microorganism, of which 8% were meticillin-resistant Staphylococcus aureus (MRSA) strains. Although 0.9% saline supported cleansing of the wound bed, it did not significantly reduce the bacterial burden. The highest reduction of bacterial burden was achieved with an aqueous solution containing betaine, zinc and polyhexamethylene biguanide (polihexanide; ln RF=3.72), followed by a 3% saline solution containing 0.2% sodium hypochlorite (ln RF=3.40). The most statistically significant reduction of bacterial burden, although not the highest, was achieved with povidone-iodine (ln RF=2.98; p=0.001) and an irrigation solution containing sea salt 1.2% and NaOCl 0.04% (ln RF=2.51; p=0.002). Conclusion: If a reduction of bacterial burden is warranted, wound irrigation solutions containing a combination of hypochlorite/hypochlorous acid, or antiseptics such as polihexanide, octenidine or povidone-iodine, ought to be considered.

Anti-biofilm activity of antimicrobial hypochlorous wound irrigation solutions compared to common wound antiseptics and bacterial resilience in an innovative in-vitro human plasma biofilm model (hpBIOM)

“…2). This underlines the dose-dependency of antiseptics and antimicrobials as well as the relevance of additional aspects such as dilution, mechanical detachment/debridement and reduction in surface tension to the overall antimicrobial and cleansing effects of especially wound irrigation solutions reported in other studies (25,26). The discrepancies in studies evaluating different forms of chlorine-releasing solutions, reporting higher efficacies, than reported in this study, mainly derive from the vast heterogeneity of study designs.…”

Antimicrobial Hypochlorous Wound Irrigation Solutions Demonstrate Lower Anti-biofilm Efficacy Against Bacterial Biofilm in a Complex in-vitro Human Plasma Biofilm Model (hpBIOM) Than Common Wound Antimicrobials

“…This underlines the dose-dependency and differential approach antiseptics and antimicrobial irrigation solutions apply (“pharmacological” vs. “mechanical”) in terms of antimicrobial efficacy. The relevance of additional aspects such as dilution, mechanical detachment/debridement, and reduction in surface tension to the overall antimicrobial and cleansing effects of especially wound irrigation solutions reported in other studies ( Kammerlander et al, 2011 ; Assadian et al, 2018 ) is indirectly highlighted here. On the other hand, this aspect needs to be accounted for as a limitation to this study and the here reported results: the intention of this work was to evaluate the anti-biofilm effect of the antimicrobial hypochlorous agents within antimicrobial wound irrigation solutions compared to a PHMB-based irrigation solution and the antiseptic OCT/PE.…”

In Vitro Efficacy of Bacterial Cellulose Dressings Chemisorbed with Antiseptics against Biofilm Formed by Pathogens Isolated from Chronic Wounds

“…The results show that PHMB substantially removes biofilm and can prevent biofilm formation [ 22 , 23 , 24 , 25 , 26 , 27 , 28 ]. PHMB is reported as an effective antibacterial agent with prolonged action (minimum 2–3 h after exposure) and a low potential to induce microbial resistance [ 17 , 20 , 29 ]. Studies have shown that PHMB is well-tolerated when administered topically on the skin, mucosa, or the wound has low toxicity to eukaryotic cells and rarely causes allergies [ 17 , 19 , 30 ].…”

“…Therefore, PVP-I should not be used longer than seven days, and it is not recommended for patients with thyroid problems. Povidone-iodine has a brown color that fades with the loss of povidone antimicrobial activity [ 17 , 29 , 55 ].…”