Mechanical Cleansing of a Wound

Mechanical cleansing, also known as mechanical debridement, is one of the oldest and simplest forms of wound care techniques still used to treat pressure ulcers (bedsores), burns and surgical wounds. Mechanical cleansing is characterized by the use of moisture and mechanical stress to remove dead, dying or infected tissue from a wound to create a healthy environment for vital new tissue.

Indications

• Mechanical cleansing is appropriate when most or all of a wound is affected by dead or dying tissue. Necrosis and eschar are superficial and dark in color; slough is moist, yellow or green and involves deeper tissues of chronic wounds. Traumatic wounds may contain foreign material, such as gravel, dirt or debris that must be removed before healing can begin.

Selection

• The type of mechanical cleansing depends on the size, location and depth of the wound. Select the method that most aggressively removes the unhealthy tissue without damaging newly forming, healthy tissue. Discontinue its use when the wound bed is clean and beefy red.

Types

• Wet-to-dry dressings: Saline-moistened gauze is placed in the wound once or twice daily and allowed to dry, taking unhealthy tissue with it when removed. This technique is inexpensive, requires no special equipment and is easy for anyone to perform. However, overly dry gauze can stick to the wound and remove healthy new tissue growth.

  Pressurized irrigation: A device such as a Waterpik® delivers a stream of water or saline under pressure to loosen and remove dead tissue. This technique can be used to target specific tissues, small areas and pockets with varying degrees of pressure. The pressure of the liquid may accidentally force bacteria or foreign materials deeper into a wound, causing a systemic infection. Use cautiously for patients with other underlying health problems.

  Hydrotherapy: Circulating water or saline lifts foreign material and damaged or infected tissue from a submerged wound. Use this method for large wounds and burns. The basin or tub must be thoroughly disinfected before and after use to prevent new wound infection or cross-contamination between patients.

Advantages

• Mechanical wound cleansing is inexpensive and requires no advanced training, making it a good choice for home care, community living environments and long-term care facilities. The treatments can be performed using supplies commonly found at the drug store. It is a good option when there is no urgent need to disinfect or remove non-vital tissue from a wound.

Disadvantages

• Mechanical cleansing removes all loose tissue, including fragile, healthy tissue, so healing may be delayed if used inappropriately or for too long.

  Aggressive pressure may be painful and damage a healing wound.

  Ineffective sanitization of equipment can contaminate or infect an otherwise clean wound.

  Mechanical cleansing is not an option when the infection is present in surrounding tissue or the bloodstream.