Wound cleaning, what do you use?

Discussions of the best (or worst) equipment to have on hand for use in the event of an injury during an emergency.

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sarteam 2
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Re: Wound cleaning, what do you use?

Post by sarteam 2 » Tue Apr 26, 2011 8:28 am

For superficial wounds (bumps and scrapes) most replies are basically correct. A dilute solution of betadine and cover with a dressing, neosporin has been shown to be effective.
Hydorgen peroxide has come under fire to its effectivness, it is at least better than nothing. The old standard of debreeding wounds is under review and appears to be on its way out with heavy antibiotic treatment being prefered. Wound closure with staples or dermabond should be considered with deeper lacerations. Any deep wounds past the dermal layer needs immediate professional attention.
You may have to be your own doctor, the best treatment is to use caution and avoid injury in the first place.
Good luck on z day

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Re: Wound cleaning, what do you use?

Post by dallas » Tue Apr 26, 2011 9:22 pm

You do not want to close any dirty wound.

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Re: Wound cleaning, what do you use?

Post by CrossCut » Tue Mar 02, 2021 8:24 am

Necro alert, this just looked like the best thread to revive to post this:

Comparative in vitro evaluation of the antimicrobial activities of povidone-iodine and other commercially available antiseptics against clinically relevant pathogens

TL;DR summary, povidone-iodine is equal or superior to some other antiseptics against the microbes they tested. Was a bit surprised that tetanus/c. tetani wasn't one they tested against, but it may be that they didn't consider it a "clinically relevant pathogen" since we have a vaccine and antitoxins to treat it now. In the Zpaw however that might not be the case, and I've seen other studies that povidone-iodine has activity against tetanus both in it's spore and vegetative/reproducing states so something to consider.

Fair disclosure: "This study was funded by Mundipharma Singapore Holding Pte. Limited.", and Mundipharma makes/distributes Betadine.

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Re: Wound cleaning, what do you use?

Post by Blast » Tue Mar 02, 2021 10:23 am

Don't forget honey!
Honey: its medicinal property and antibacterial activity: https://pubmed.ncbi.nlm.nih.gov/23569748/

Abstract
Indeed, medicinal importance of honey has been documented in the world's oldest medical literatures, and since the ancient times, it has been known to possess antimicrobial property as well as wound-healing activity. The healing property of honey is due to the fact that it offers antibacterial activity, maintains a moist wound condition, and its high viscosity helps to provide a protective barrier to prevent infection. Its immunomodulatory property is relevant to wound repair too. The antimicrobial activity in most honeys is due to the enzymatic production of hydrogen peroxide. However, another kind of honey, called non-peroxide honey (viz., manuka honey), displays significant antibacterial effects even when the hydrogen peroxide activity is blocked. Its mechanism may be related to the low pH level of honey and its high sugar content (high osmolarity) that is enough to hinder the growth of microbes. The medical grade honeys have potent in vitro bactericidal activity against antibiotic-resistant bacteria causing several life-threatening infections to humans. But, there is a large variation in the antimicrobial activity of some natural honeys, which is due to spatial and temporal variation in sources of nectar. Thus, identification and characterization of the active principle(s) may provide valuable information on the quality and possible therapeutic potential of honeys (against several health disorders of humans), and hence we discussed the medicinal property of honeys with emphasis on their antibacterial activities.


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Re: Wound cleaning, what do you use?

Post by VXMerlinXV » Tue Mar 02, 2021 4:14 pm

I carry iodine, but I use it to clean water for irrigation or to disinfect skin, in almost no situation would I use iodine itself for wound cleaning, there’s a ton of data that the tissue damage done with more concentrated iodine prolongs the healing process. The one caveat would be a iodine wet to dry dressing on an open fracture, in an effort to avoid osteomyelitis, but even then it’d be on our way to definitive care. In the absence of surgical intervention, I’d really weigh using iodine like this.
My posts are my opinion, and do not reflect the standing or policy of any group I may be associated with. Nothing typed here should be considered medical advice, or permission from myself or any governing body to perform medical intervention. If this is a medical emergency, please get off your computer and dial the appropriate local response number.

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Re: Wound cleaning, what do you use?

Post by CrossCut » Wed Mar 03, 2021 10:23 am

VXMerlinXV wrote:
Tue Mar 02, 2021 4:14 pm
I carry iodine, but I use it to clean water for irrigation or to disinfect skin, in almost no situation would I use iodine itself for wound cleaning, there’s a ton of data that the tissue damage done with more concentrated iodine prolongs the healing process. The one caveat would be a iodine wet to dry dressing on an open fracture, in an effort to avoid osteomyelitis, but even then it’d be on our way to definitive care. In the absence of surgical intervention, I’d really weigh using iodine like this.
Including in a Zpaw? I'd think reducing the risk of infection would outweigh most if not all other concerns, although there does seem to be a lot of conflicting info on whether PVP-I actually does that or not.

Of the most common reasons I've seen for not using an antiseptic solution for wound irrigation, most appear secondary or even trivial if the risk of infection can be reduced.

-Delayed healing (assuming a situation where additional recuperation/light duty time and extra dressing changes aren't a problem)
-Additional cost of the antiseptic and any additional wound irrigation supplies needed (our families / pets are worth it)
-Scarring/Cosmetic concerns (survivors dig scars)
-Pain associated with the antiseptic solution (within reason)

But I'm ready to be wrong about this too.

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Re: Wound cleaning, what do you use?

Post by VXMerlinXV » Wed Mar 03, 2021 1:50 pm

In broad strokes, yep, my choice for cleaning wounds in the zpaw would be drinking water. Slowing the healing process with something like iodine is more of an infection risk than the benefit gained from a betadine washout. I mean, obviously if we had no drinking water, gallons of iodine, and a dirty wound, I’d make an exception, but that sounds like a fairly far fetched scenario. If you’re looking for a deeper dive into the science behind austere wound care, check out the prolong fieldcare working groups guide and podcast, as well as the ICRC manual for conflict zone med. Both are evidence based and reviewed, and written with the expectation that there may not be higher levels of care reachable.

Given my choice, I’d start with high quality H2O, and then maybe some modified daken’s if the wound was especially dirty or we were struggling to manage it. (See below)

https://prolongedfieldcare.org/2018/04/ ... yment/amp/
My posts are my opinion, and do not reflect the standing or policy of any group I may be associated with. Nothing typed here should be considered medical advice, or permission from myself or any governing body to perform medical intervention. If this is a medical emergency, please get off your computer and dial the appropriate local response number.

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Re: Wound cleaning, what do you use?

Post by woodsghost » Wed Mar 03, 2021 2:30 pm

VXMerlinXV wrote:
Wed Mar 03, 2021 1:50 pm
In broad strokes, yep, my choice for cleaning wounds in the zpaw would be drinking water. Slowing the healing process with something like iodine is more of an infection risk than the benefit gained from a betadine washout. I mean, obviously if we had no drinking water, gallons of iodine, and a dirty wound, I’d make an exception, but that sounds like a fairly far fetched scenario. If you’re looking for a deeper dive into the science behind austere wound care, check out the prolong fieldcare working groups guide and podcast, as well as the ICRC manual for conflict zone med. Both are evidence based and reviewed, and written with the expectation that there may not be higher levels of care reachable.

Given my choice, I’d start with high quality H2O, and then maybe some modified daken’s if the wound was especially dirty or we were struggling to manage it. (See below)

https://prolongedfieldcare.org/2018/04/ ... yment/amp/
Is there a publication you or someone else might suggest for a one-stop-shop on austere health and wound care? I have "Where there is no doctor." Is there a better publication available in hard copy?

Thanks!
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Re: Wound cleaning, what do you use?

Post by VXMerlinXV » Wed Mar 03, 2021 10:22 pm

woodsghost wrote:
Wed Mar 03, 2021 2:30 pm


Is there a publication you or someone else might suggest for a one-stop-shop on austere health and wound care? I have "Where there is no doctor." Is there a better publication available in hard copy?

Thanks!
So, like all great medical questions, I'm going to say it depends.

Thanks for coming to my Ted Talk.


:lol: Whoo... anyway, it does depend, mostly on two major factors: A) Who you are and B) Where you want to bring the book. So, I work as both an RN and Paramedic, and have had positions in ER's, ICU's, EMS, Critical Care Transport, as well as backcountry and remote short contracts. If you have an experienced medical background, I'd have one series of recommendations. Personally, if I had to pick one volume to keep, it's a binder that I keep up to date with relevant medical threat assessment/area study data, clinical practice guidelines, medication charts, recipes and instructions (how to make dakin's, how to use my Instapot to sterilize tools, etc) and treatment algorithms for things I don't normally encounter. It's a 2" binder that I update 2-3 times a year. For something published, Auerbach's Wilderness Medicine is hard to beat. I have the last edition, I have not read the current version. But it's a full size medical text. Perfect for my home library, but not something I would pack anywhere shy of a clinic setup. For ruck or vehicle level kit, assuming you want a physical book and not a digital reference, the CoROM field guide is pretty comprehensive, but has a global focus so some of the data may just not apply.

For someone with some training but little patient contact time, I would think about Brady's Emergency Care and Transportation of the Sick and Injured for home, the NOLS wilderness first aid text is also relevant, but I have not read it through so I can not contrast the two. For your pack I would say the AAOS wilderness medical field guide, or honestly and good BLS/AEMT field guide.
My posts are my opinion, and do not reflect the standing or policy of any group I may be associated with. Nothing typed here should be considered medical advice, or permission from myself or any governing body to perform medical intervention. If this is a medical emergency, please get off your computer and dial the appropriate local response number.

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Re: Wound cleaning, what do you use?

Post by woodsghost » Thu Mar 04, 2021 9:01 am

VXMerlinXV wrote:
Wed Mar 03, 2021 10:22 pm
woodsghost wrote:
Wed Mar 03, 2021 2:30 pm


Is there a publication you or someone else might suggest for a one-stop-shop on austere health and wound care? I have "Where there is no doctor." Is there a better publication available in hard copy?

Thanks!
So, like all great medical questions, I'm going to say it depends.

Thanks for coming to my Ted Talk.


:lol: Whoo... anyway, it does depend, mostly on two major factors: A) Who you are and B) Where you want to bring the book. So, I work as both an RN and Paramedic, and have had positions in ER's, ICU's, EMS, Critical Care Transport, as well as backcountry and remote short contracts. If you have an experienced medical background, I'd have one series of recommendations. Personally, if I had to pick one volume to keep, it's a binder that I keep up to date with relevant medical threat assessment/area study data, clinical practice guidelines, medication charts, recipes and instructions (how to make dakin's, how to use my Instapot to sterilize tools, etc) and treatment algorithms for things I don't normally encounter. It's a 2" binder that I update 2-3 times a year. For something published, Auerbach's Wilderness Medicine is hard to beat. I have the last edition, I have not read the current version. But it's a full size medical text. Perfect for my home library, but not something I would pack anywhere shy of a clinic setup. For ruck or vehicle level kit, assuming you want a physical book and not a digital reference, the CoROM field guide is pretty comprehensive, but has a global focus so some of the data may just not apply.

For someone with some training but little patient contact time, I would think about Brady's Emergency Care and Transportation of the Sick and Injured for home, the NOLS wilderness first aid text is also relevant, but I have not read it through so I can not contrast the two. For your pack I would say the AAOS wilderness medical field guide, or honestly and good BLS/AEMT field guide.
This is fantastic information and I really appreciate your time and expertise in this. From the above I can chart my course. Thank you.
*Remember: I'm just a guy on the internet :)
*Don't go to stupid places with stupid people & do stupid things.
*Be courteous. Look normal. Be in bed by 10'clock.

“It's a dangerous business, Frodo, going out your door. You step onto the road, and if you don't keep your feet, there's no knowing where you might be swept off to.” -Bilbo Baggins.

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Re: Wound cleaning, what do you use?

Post by CrossCut » Tue Mar 09, 2021 7:31 am

VXMerlinXV wrote:
Wed Mar 03, 2021 1:50 pm
In broad strokes, yep, my choice for cleaning wounds in the zpaw would be drinking water. Slowing the healing process with something like iodine is more of an infection risk than the benefit gained from a betadine washout. I mean, obviously if we had no drinking water, gallons of iodine, and a dirty wound, I’d make an exception, but that sounds like a fairly far fetched scenario. If you’re looking for a deeper dive into the science behind austere wound care, check out the prolong fieldcare working groups guide and podcast, as well as the ICRC manual for conflict zone med. Both are evidence based and reviewed, and written with the expectation that there may not be higher levels of care reachable.

Given my choice, I’d start with high quality H2O, and then maybe some modified daken’s if the wound was especially dirty or we were struggling to manage it. (See below)

https://prolongedfieldcare.org/2018/04/ ... yment/amp/
Thanks, I have frequented that site and check occasionally for new updates but must have missed that one. FWIW, when I tried locating the source for their Dakin's recommendation, whether civilian or military, I could only find these - and only when Dakin's was used with negative pressure bandages:

Invasive Mold Infections Following Combat-related Injuries, https://academic.oup.com/cid/article/55 ... login=true
Topical therapy was commonly used, including specific antifungal agents or, more commonly, the disinfectant sodium hypochlorite (0.025% Dakin solution instilled in wound vacuum device) [40]. Anecdotally, Dakin solution was felt to be effective, leading to common use in the latter half of the investigation period; however, no outcome difference was apparent.
and this:

Guidelines for the Prevention of Infections Associated With Combat-Related Injuries: 2011 Update, https://pubmed.ncbi.nlm.nih.gov/21814089/
In severe injuries that cannot undergo adequate surgical debridement (e.g., extensive high bilateral lower extremity injuries with perineum involvement secondary to explosive trauma), where the possible risk of local tissue damage from antiseptics is outweighed by preventing or controlling infection, anecdotal success with topical antiseptics (e.g., Dakin’s) in conjunction with NPWT has been reported (personal communication, Dr. Romney Andersen).
Even the prolongedfieldcare's statement that:
Additives such as iodine, bacitracin, or alcohol are not associated with reduced infection.6
isn't entirely correct. If you check their references for what they base that statement on, it was an animal study on goats, and alcohol and iodine weren't even tested:
"Comparison of irrigation solutions and devices in a contaminated musculoskeletal wound survival model.", https://journals.lww.com/jbjsjournal/Ab ... in.12.aspx,
"the goats were assigned to four treatment groups: normal saline solution, bacitracin solution, castile soap, and benzalkonium chloride."
And to make matters even more confusing, a later animal study in 2018 (completed after the article at the prolonged field care site) came to a similar conclusion with Dakin's and musculoskeletal wounds as the one they cite as proof that bacitracin and benzalkonium chloride doesn't reduce infection:

Rapid degradation and non-selectivity of Dakin’s solution prevents effectiveness in contaminated musculoskeletal wound models, https://www.sciencedirect.com/science/a ... 8318304376
We did not observe evidence of a therapeutic benefit following Dakin’s solution treatment for any tested concentration or application method in two contaminated musculoskeletal wound models. Despite confirmation of robust bactericidal activity in vitro, our findings suggest DS at current clinically-used concentrations does not kill tissue surface-attached bacteria, nor does it necessarily cause host tissue toxicity that exacerbates infection in the setting of complex musculoskeletal injury.
If there was any common themes in the studies I found (with different antiseptics being tested), it was that (1) most worked great in a petri dish but the results couldn't be consistently replicated in animal/human studies, and (2) that antiseptic irrigation use might be limited to situations "where the possible risk of local tissue damage from antiseptics is outweighed by preventing or controlling infection", as already stated, but there seems to be no medical consensus on which antiseptic is best.

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