Topical Antiseptics in Treating Contaminated Wounds

Introduction

Everybody experiences wounds, and the healing process usually goes unnoticed or is said to heal without any complications. Not every wound will take the same time to heal. Wound healing depends on the type of wound and the treatment process involved. A topical antiseptic application can result in a positive outcome for wound healing by reducing the chance of infection.

What Are Wounds?

A wound is a cut or damage to tissue, including skin, organs, and mucous membranes. Wounds are of various types, which are classified as given below:

1) Based on Causes:

• Surgical Wound - Wounds due to surgical incisions.
• Penetrating Wound - Wounds due to injuries by gunshots or stabs.
• Blunt Wounds - Sports injuries, road traffic accidents, and falls are included in blunt wounds.
• Burn Wound - Wounds due to burns.

2) Based on the Duration of Wound Healing:

• Acute Wounds - Wounds take less time to heal (immediately to a few weeks).
• Chronic Wounds - Wounds that take more time to heal (four weeks to 3 months).

3) Based on Integrity of Skin:

• Open wound.
• Closed wound.

What Are Contaminated Wounds?

Cuts or bruises on the skin or any tissue that are contaminated by external factors like microorganisms, water, dust, or spores are known as "contaminated wounds."

According to the degree of contamination, wounds are classified into four classes.

• Class 1 - Clean wounds:

  • Uninfected wounds without any resulting inflammation

• Class 2 - Clean contaminated wounds:

  • Wounds that lack unusual contamination but enter respiratory, digestive, and urinary tracts during surgeries

• Class 3 - Contaminated wounds:

  • Open fresh wounds that accidentally result in inflammation

• Class 4 - Dirty, infected wounds:

  • Old traumatic wounds with improper cleaning result in dirty, infected wounds

How Are Contaminated Wounds Treated?

Steps followed in the treatment of contaminated wounds include:

• First, bacteria are removed by cleaning with force:

  • Mechanical forces are used to remove the bacteria, and other particles adhere to the wound site. In many instances, cleaning the wound site alone can improve healing.

• Second, cleansing of the wound is done:

  • Debridement (cleansing) helps reduce the bacterial loads and remove the dead tissue and prevent any delay in the healing process.

  • Cleansing of the wound is done by choosing a suitable antiseptic.

  • There are two methods of cleansing, as given below:

    • Irrigation

      • One of the most appropriate methods for cleansing a wound. Irrigation should be done with a solution that is non-toxic, effective, reduces the infection, is not allergic to the tissue, and is also cost-effective.

      • Such fluids are normal saline, sterile water, or tap water. During the unavailability of these fluids, potable water (drinking water) is also effective.

      • High-Low-pressure irrigation is used for cleaning wounds.

      • Pressure irrigation is used to clean dirty or heavily contaminated wounds. This can be done by using a syringe.

    • Scrubbing

      • Scrub gently using a sponge, if available, with minimal tissue damage. Start by scrubbing the surface around the wound. And then proceed to the inner side of the wound.

      • It is done gently to prevent an increase in inflammation.

• Third, wound debridement is done:

  • The contamination in the edges of the wound, which cannot be removed by irrigation and scrubbing, should be debrided (cutting the dead tissue). Irrigate the wound again to prepare it for dressing.

• At last, wound dressing is done:

  • Wipe away any debris remaining on the wound. Apply a suitable antiseptic solution and wipe the wound, and using a gauge, cover the wound properly in place without much pressure.

What Are Topical Antiseptics?

Topical antiseptics are those agents that, when applied topically (directly on the affected region), kill, reduce, or stop the number of growing microorganisms (bacteria), thereby preventing the spread of infection.

What Are the Types of Topical Antiseptics?

There are various types of antiseptics, such as alcohols, anilides, biguanides, bisphenols, peroxygens, silver compounds, chlorine, iodine, and quaternary ammonium compounds. The most commonly used products include chlorhexidine, povidone- iodine, hydrogen peroxide, alcohol, acetate, boric acid, sodium hypochlorite, and silver nitrate.

• Alcohol:

  • Ethanol and isopropyl alcohol are usually used. Alcohols kill a wide range of bacteria and viruses. It works by denaturation of proteins.

• Iodine:

  • Tincture of iodine, having approximately two percent of iodine, is used widely. It is considered an antiseptic with the most efficacy in reducing infectious complications. It is effective against various bacteria, viruses, and protozoans. Absorption of povidone-iodine in pregnant and lactating women is a concern for causing hypothyroidism.

• Biguanides Such as Chlorhexidine and Polyhexanide or Polyhexamethylene Biguanide (Phmb) Act as Topical Antiseptics:

  • Chlorhexidine:It works by breaking through the cell membrane and precipitating the cell contents. It is shown to have less effect on fungi and certain types of bacteria.

  • PolyHexanide/ Polyhexamethylene Biguanide(PHMB): It is an antiseptic agent which is highly compatible with the tissues and is non-irritant. Its antiseptic property does not hamper the wound-healing process.

• Halophenols:

  • Chloroxylenol is the main halophenol used in antiseptics. It works by breaking into the cell wall and stopping the working of enzymes. It acts only on certain types of bacteria and is less effective against fungi and viruses.

• Bisphenols:

  • Their effects can be enhanced by changing the formulations with other antiseptics. Though the specific mode of action is unknown, it is understood that bisphenols act by disrupting the cell membrane of the infecting organism.

• Silver Compounds:

  • These are antiseptics being used for a long time. Antibiotic silver sulfadiazine is mainly used nowadays. It acts by directly acting on the genetic material in humans.

• Hydrogen Peroxide:

  • It is widely used for antisepsis. It is a colorless clear liquid available in variable concentrations. Relatively high concentrations are preferred.

When Are Antiseptics Indicated?

The use of antiseptics in wound treatment is indicated in the following instances:

• Prevention of infection.

• Prevention of post-surgical wound infections.

• For the debridement (cleaning) of contaminated wounds.

How Do You Choose the Right Antiseptic?

• Efficacy: Antiseptics showing their effectiveness on a wide range of bacteria are desirable. Limited effects on fungi and spores can also be chosen.

• Tolerability: The degree to which the effects of antiseptic solution can be tolerated. The right antiseptic should be tolerated by the tissue and should not cause any adverse reactions.

How Can Wound Contamination Be Prevented?

Wound contamination can be prevented by:

• Avoid touching the wound with bare hands.

• Washing the wound with running water.

• Cleaning with a proper antiseptic solution.

• Covering with a proper gauge or dressing.

• Keeping the wound site clean and dry.

Conclusion

Topical antiseptics play an important role in wound healing. Wound healing, on the other hand, occurs naturally; external topical antiseptic application reduces the risk of infection and delays in healing time. With proper quality care for the contaminated wound, any future complications can be avoided.