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.

We need to reframe the way we talk about wounds

Learn more about biofilm and hard-to-heal wounds

Wound Hygiene, 4 simple steps

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 devitalised tissue, debris and biofilm^{1, 2}

2. Debride

Definition:  
Physically removing biofilm, devitalised 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:
Devitalised tissue, callus, hyperkeratotic debris and senescent cells at the wound edges may be harbouring biofilm. Removal is necessary to facilitate epithelialisation and wound contraction ^1,2

4. Dress

Definition:
Applying a dressing to address any residual biofilm and prevent contamination and recolonisation, and therefore biofilm re-formation^1,2

Rationale:
Biofilm can re-form 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

Read Wound Hygiene Consensus document 1

Embedding Wound Hygiene into a Proactive Wound Healing strategy²

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.
- Implementing Wound Hygiene at every dressing change until healing occurs
- Recognising the crucial 5 stages of the healing trajectory:
    1. Necrotic tissue
    2. Sloughy tissue
    3. Unhealthy granulating tissue  
    4. Healthy granulating tissue  
    5. Epithilialising tissue  

Read Wound Hygiene Consensus document 2

Wound Hygiene Resources

Defying hard-to-heal wounds with an early antibiofilm intervention strategy

The first wound hygiene consensus document defining the 4 key anti-biofilm steps

Embedding Wound Hygiene into a proactive wound healing strategy

The second Wound Hygiene consensus document embedding the 4 steps throughout the wound healing trajectory

Expert Opinion Document

Early use of an antibiofilm strategy promotes positive patient outcomes

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