URGO MEDICAL : Wound care

Diagnostic procedure and good practice in the application of local care.

The clinician must ensure that the diagnostic process and evaluation is complete and that the origin of the wound has been found.

The wound must be cleaned according to local protocol, with water or normal saline.
Avoid the systematic use of antiseptics
If an antiseptic is used first, rinse the wound thoroughly with a normal saline before applying an appropriate dressing depending on the condition of the wound.
If a non-adhesive dressing is used, hold this dressing in place with an elastocated or multi-stretch adhesive plaster.

Antiseptics are antimicrobial substances characterised by a fast action and a broad spectrum.
Antiseptics are different from antibiotics that specifically and definitively eliminate certain bacteria sensitive to the antibiotic used.
Antiseptics are bactericidal, virucidal and fungicidal.
Their action is reduced by the presence of organic matter. All skin debris from wounds is organic matter.
Antiseptics have a cytotoxic affect on keratinocytes and also fibroblasts, which can lead to delayed healing.
The use of antiseptics on damaged skin before their effectiveness has been demonstrated can encourage the emergence of bacterial strains multi-resistant to antibiotics through the transfer of plasmids. Antiseptics can also cause systemic or local side effects.
13% of patients suffering from ulcers are allergic to Betadine (Barbaud multi-centre Study in Nancy, France).

GOOD USE OF ANTISEPTICS

ANTISEPSIS IN HEALTHY SKIN

Antisepsis of clinician’s hands or pre-surgical skin preparation of patients is recommended.
The purpose of hand-washing is to eliminate potentially contaminating flora and prevent infections transmitted by the hands. Disinfection of healthy skin before performing a surgical operation is essential and must follow strict guidelines.
Its purpose is to eliminate skin microorganisms and reduce the risk of infection.

ANTISEPSIS FOR DAMAGED SKIN

Antiseptics will disrupt the barrier function of the skin by destroying all commensal flora and selecting resistant microorganisms.
Antiseptics have many side effects, they are cytotoxic, and can lead to a delay in wound healing.
It has not been demonstrated that the use of antiseptics is effective on damaged skin, however, several studies have attempted to demonstrate that antiseptics are effective for burnsand as they are currently recommended for burns and epidermal necrolysis.
The potential risks should be weighed against the expected benefits for the patient if antiseptics are used in the treatment of leg ulcers.
The results of a controlled study examining the performance of antiseptics in these situations is still awaited.