“the importance of hygiene cannot be overstated.” [Murdjenovich, 2011]
In 2017/18 almost 4 million patients received treatment for a wound [Guest, 2020], placing significant pressure on NHS resources. Whereas acute wounds tend to have good healing rates, chronic wounds often take much longer to heal. A recent UK study reported that 89% of acute wounds healed within a twelve month period, compared to only 49% of chronic wounds. 51% of chronic wounds had not healed and continued to require management. [Guest, 2020]
The skin surrounding a wound is particularly vulnerable and periwound problems occur frequently with a negative impact on the healing of the wound itself [Bianchi, 2012] . Periwound skin damage contributes to longer healing times, can cause pain and discomfort, and may adversely affect a patient’s quality of life [Lawton, 2009]. This emphasises the importance of not just caring for the wound itself but also the skin surrounding the wound.
Periwound management is an important but sometimes overlooked area, despite the impact it has on wound bed preparation and wound healing. Any patient with a wound is potentially at risk of periwound complications, but there are a number of factors which may increase the risk, including medications that can adversely affect the skin such as corticosteroids, chemotherapy agents, radiation therapy and antibiotics. Skin inflammation as found in eczema and psoriasis, skin frailty, diabetes and vascular changes and reduced mobility are all risk factors for periwound complications [Beeckman, 2020, Cowdell, 2020].
Poor skin hygiene may also have an adverse impact on the periwound area, through changing the skin pH [Beeckman, 2020, Cowdell, 2020]. Therefore, consideration should be given to the type of periwound skin cleanser selected. Gentle but effective cleansers that do not strip, dehydrate, or inflame the skin are preferred as they help minimise damage to the skin. Detergents, soaps, and cleansers containing high concentrations of sodium lauryl sulfate or ammonium laureth sulfate, which may irritate and strip skin lipids and lead to skin dehydration should be avoided. Ideally, cleaning agents should be in the lowest pH (4-5.8) range. [Mrdjenovich, 2011]
It is recommended that healthcare professionals should ‘think beyond soap and water’ [Mrdjenovich, 2011] and octenidine-containing wash mitts are increasingly being recognised as an effective alternative for cleansing the periwound area [Dhoonmoon, 2020]. Octenidine is a broad spectrum antimicrobial and to date, has not shown any decrease in antimicrobial efficacy to multi-resistant bacteria [Siebert, 2010]. There have been no reports of the development of resistance to octenidine and no side effects have been described [Lachapelle, 2014]. Octenidine has a residual antimicrobial effect on the skin, which lasts for at least 24 hours, which may result in a better preventative outcome [Brill, 2015].
Patient and staff feedback about the wash mitts has been highly positive [Dhoonmoon, 2020]. If a patient prefers a warmer mitt, there is a warming container which can be used for the mitts prior to use. Unlike washing solutions, which require a leave-on period and then rinsing, the mitts do not need to be rinsed and the skin dries quickly. Also, they are gentle on the skin. A community study using wash mitts to clean the periwound area around venous leg ulcers reported a real reduction in the prescription of antibiotics for wound infections and also reported no cases of Pseudomonas in patients over a 12 month period.
“The wash mitt has met both service user and clinician expectations by promoting good skin care, reducing unwarranted infections, and improving the quality of care delivered to service users in the community.” [Dhoonmoon, 2020]
To find out more, email: mail.uk@schuelke.com
Or watch the videos here schuelke.com/gb-en/Our-knowledge/Wound-management/Leg-cleansing.php
References
Beeckman D, Campbell K, LeBlanc K et al (2020) Best practice recommendations for holistic strategies to promote and maintain skin integrity. Wounds International. Available at: www.woundsinternational.com
Bianchi J (2012) Protecting the integrity of the periwound skin. Wound Essentials 1: 58-64
Brill FHH, Radischat N, Goroncy-Bermes P, Siebert J. Residual antiseptic efficacy of octenidine dihydrochloride versus chlorhexidine gluconate in alcoholic solutions. Antimicrob Resist Infect Control. 2015;4(Suppl 1):P33. Published 2015 Jun 16. doi:10.1186/2047-2994-4-S1-P33
Cowdell F, Jadotte YT, Ersser SJ et al (2020) Hygiene and emollient interventions for maintaining skin integrity in older people in hospital and residential care settings. Cochrane Database of Systematic Reviews 1. Art. No.: CD011377
Dhoonmoon L, Dyer M (2020) Improving leg ulcer care in the community. Journal of Community Nursing, vol. 34, no. 6
Guest JF, Fuller GW, Vowden P (2020) Cohort study evaluating the burden of wounds to the UK’s National Health Service in 2017/2018: update from 2012/2013. BMJ Open;10:e045253. doi:10.1136/ bmjopen-2020-045253
Lachapelle JM. A comparison of the irritant and allergenic properties of antiseptics. Eur J Dermatol 2014;24:3–9.
Lawton J (2009) Assessing and managing vulnerable periwound skin. World Wide Wounds http://www.worldwidewounds.com/2009/October/Lawton-Langoen/vulnerable-skin-2.html
Mrdjenovich DE, Fleck CA (2011) Consider skin hygiene and care beyond the wound. J Am Col Certif Wound Spec. 3(2):45-47
Siebert J. octenidine – a new topical antimicrobial agent for wound antisepsis. J Wound Technology. 2010;7: 66-68
