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What about using povidone iodine, hydrogen peroxide,
Dakin's, acetic acid and other agents?
- Please refer to the AHCPR Clinical
Practice Guideline for a detailed discussion of these and
other cleansers.
- In short, it has been determined that these products may
actually slow wound healing. Some of these products are
cytotoxic to human fibroblasts, reduce white blood cell
viability and decrease phagocytic efficiency. Studies
show that most of these products must be diluted to avoid
these toxic effects and a dilution guide is available
through the AHCPR guideline.
- On a more practical level, many of these products are
drying agents as well as antimicrobial. We have already
identified that exudate is
necessary to create an evironment which stimulates more
rapid wound healing. By drying the wound bed, the exudate
and all its beneficial cells are removed from the area.
Dry tissue tends to necrose and serve as a bacterial
medium.
- In addition, we know that most wounds should be
considered as contaminated and contaminated wounds will
heal. The constant application of an anti-microbial agent
is not necessary to produce rapid wound healing or avoid
infection. In fact, there are clinical studies
which have shown that a wound maintained in a moist
environment (with exudate) has a lower infection rate
than a wound which is dry.
Is there a role for povidone iodine, hydrogen
peroxide, Dakin's, acetic acid and other agents?
- Certainly! When discussing wound care, remember
that there are chronic wounds and acute wounds. An
acute wound, like a laceration, will most likely heal in
an individual who has no medical problem that would delay
wound closure. Avoiding infection is important in
these cases, and maybe the healthcare provider feels
comfortable using some of these products. Also, in
a chronic wound that has an infection, it may be
appropriate to use these products until the infection has
resolved.
- From personal experience, I now apply a transparent film
to all my minor cuts and abrasions, as I have found that
my acute wounds heal very quickly with this protocol.
I may also cleans the wound with one of the above
products prior to the film's application.
Reference source: AHCPR Clinical Practice Guideline with cites
from (Custer, Edlich, Prusak, et al., 1971; Johnson, White, and
McAnalley, 1989; Rodeheaver, Kurtz, Kircher, et al., 1980;
Rydberg and Zederfeldt, 1968).
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