The Latest on Advanced Wound Cleaning: Beyond the Paper Cut

by James Hubbard, MD, MPH

If you want to expand your survival-medicine knowledge beyond first aid but don’t know where to start, wound treatment is a great choice. Whether it’s during a disaster or just in your everyday life, you’ll eventually face a wound of some sort.

You can learn a lot of advanced but easy-to-follow treatment details from my two affordable, interactive e-books, The Survival Doctor’s Guide to Wounds and The Survival Doctor’s Guide to Burns. They cover gashes, bites, burns and more. I’ve also come across an excellent review regarding certain aspects of wound care: the Wilderness Medical Society Practice Guidelines for Basic Wound Management in the Austere Environment, published last summer.

To create the recommendations in this report, researchers reviewed available studies for objective evidence of what works and what doesn’t. In this post I’ll go into some of their conclusions about cleaning a wound. Some of the findings may surprise you.

Plain Water Is Usually Best

In my books and posts on wounds, I suggest that drinkable water is one of the best options for cleaning a wound. The review goes a little further and says it is the fluid of choice (saline is just as good but no better).

Many doctors use povidone-iodine (Betadine) to clean wounds, and you may have used hydrogen peroxide. Even so, disinfectants such as these can potentially damage tissue a bit. The authors of this review, however, find that the risk is great enough for them to actually advise against using disinfectants or adding them to the water if it’s already drinkable. They also advise against adding soap for the same reason.

Damaging the tissue provides the bad bugs with a clear advantage. You see, you’re never going to clean out all the germs in a wound. All you can do is try to flush out most of them to give your immune system a fighting chance against those left. If the tissue is damaged, this can impair the body’s fighting ability, and the leftover bacteria will have a better chance of surviving—and, in a day or two, multiplying into a significant infection.

My take on this advice is in austere situations, we have to use what’s available. If water is scarce, the possible harm to tissues when using other solutions is outweighed by getting the wound clean. On the other hand, any harm to the tissues should be avoided if possible, especially in times when antibiotics, etc., are scarce also. So the more dilute you can make the solution, the better.

Exception: The review suggests that if you’re bitten by an animal that could have rabies, irrigating with a povidone-iodine solution has been shown to decrease your risk of that horrible infection. And that’s worth the risk of a little tissue damage. The next best is chlorinated water, with soap if available. Of course, you’ll also need to get expert care and possible shots within 24–48 hours of exposure, if possible. Click here for more about preventing rabies.

Pressure Helps, to a Point

After you’ve stopped the bleeding and picked out obvious debris, pressure irrigation (pressure washing) is the method of choice to clean most wounds. I’ve recommended that in the absence of running tap water, you might do this by using a bulb syringe (like the one used for cleaning ears or a baby’s nose) or even by sticking a pinhole in a plastic container filled with water. But apparently that only provides a “low pressure” of less than 6 pounds per square inch.

The review suggests that a “high pressure” of 6–15 psi, provided by something like pushing water through a syringe attached to a needle or IV catheter, cleans the wound better and definitely is important for cleaning a wound associated with a broken bone (an open fracture). For example, a 35 ml syringe and 19-gauge needle can provide a psi of around 8. (To give you an idea of the size: For a shot, a health care provider usually uses a needle a little smaller than this and a syringe of about 5 ml.)

Just don’t go overboard. Pressures greater than 15 can actually push bacteria and debris deeper into the tissue rather than flushing them out. Fortunately, you’re very unlikely to get to that pressure unless you’re using something like a water flosser or pulsating showerhead massager.

More is Better

The review suggests using about a minimum of 1 liter (quart) of solution all the way up to 10 liters if available. I would suggest the amount depends on how deep and dirty the wound is and how much solution you have available, unless it’s an open fracture. With that, you irrigate to the max.

Warm Is Better

Take my word for it. Irrigating a wound with any solutions hurts. The review found that most people say warming the solution a little takes some of the sting out.

What about you? Do you have any further tips on cleaning? Do you agree or disagree with anything mentioned?

Here’s another effective way to start expanding your medical knowledge beyond first aid: Take The Survival Doctor’s Emergencies Training Course, a professionally produced video course hosted by yours truly.