Wound Hygiene

Wound Hygiene^1,2 is a anti-biofilm protocol of care designed to clean and decontaminate a wound, and overcome the barriers to healing often caused by the presence of biofilm. Just as we follow basic hygiene every day by washing our hands, brushing our teeth and showering, we should apply regular basic hygiene to wounds to keep them clean and remove biofilm. By implementing Wound Hygiene, you can give every wound the best chance of healing.

1. Cleanse

Definition: 
Actively removing surface contaminants, loose debris, slough, softened necrosis, microbes and/or remnants of previous dressings from the wound surface and its surrounding skin.^{1, 2}

Rationale:
Cleanse with intent to remove devitalized tissue, debris and biofilm.^{1, 2}

2. Debride

Definition: 
Physically removing biofilm, devitalized tissue, debris and organic matter using mechanical aids.^{1, 2}

Rationale:
Debridement that does not achieve pinpoint bleeding may not physically remove the biofilm. Applied mechanical force and shear, in combination with a liquid surfactant or antimicrobial solution, is needed to break up and disrupt biofilm.^{1, 2}

3. Refashion

Definition:
Agitating the wound edge to stimulate the expression of growth factors, to kick start the formation of healthy skin.^1,2

Rationale:
Devitalized tissue, callus, hyperkeratotic debris and senescent cells at the wound edges may be harbouring biofilm. Removal is necessary to facilitate epithelialization and wound contraction.^1,2

4. Dress

Definition:
Applying a dressing to address any residual biofilm and prevent contamination and recolonization, and therefore biofilm reformation.^1,2

Rationale:
Biofilm can reform rapidly, and repeated debridement alone is unlikely to prevent its regrowth. Applying topical antimicrobials and antibiofilm agents can address residual biofilm and prevent its reformation.^1,2

The need for a holistic approach to Wound Hygiene

Embedding Wound Hygiene into a proactive wound healing  strategy means²: 
- Embedding Wound Hygiene into a holistic strategy that includes assessment and monitoring of the patient.
- Implement Wound Hygiene at every dressing change until healing occurs
- Recognizing  the crucial 5 stages of the healing trajectory:
    1. Necrotic tissue
    2. Slough tissue
    3. Unhealthy granulating tissue 
    4. Healthy granulating tissue 
    5. Epithilializing tissue 
 

References:

1. Murphy C, Atkin L, Swanson T, Tachi M, Tan YK, Vega de Ceniga M, Weir D, Wolcott R. International consensus document. Defying hard-to-heal wounds with an early antibiofilm intervention strategy: Wound Hygiene. J Wound Care 2020; 29(Suppl 3b):S1–28

2. Murphy C, Atkin L, Vega de Ceniga M, Weir D, Swanson T. International consensus document. Embedding Wound Hygiene into a proactive wound healing strategy. J Wound Care 2022;31:S1–S24