Wound cleansing is a fundamental component of wound bed preparation.^{159, 160} Wound cleansing is defined as actively removing surface contaminants, loose debris, non-attached non-viable tissue, microorganisms and/or remnants of previous dressings from the wound surface and its surrounding skin.²⁰ Therapeutic cleansing is rigorous cleansing of chronic or hard-to-heal wounds and is performed:

• To remove excessive wound exudate or debris from the wound bed in order to optimise visualisation and reliable assessment
  
• Prior to collection of a wound sample (swab or biopsy)
• To assist in hydrating a desiccated wound bed.^{155, 161}

Wound hygiene technique was referred to in the 2016 edition of this document and has been expanded by an expert panel as a term to remind clinicians that wound hygiene practices should be ‘repetitive, regular, frequent and necessary’.¹⁶² Wound hygiene involves cleansing, debridement of the wound bed and edge, and prevention of biofilm reformation.¹⁴⁸

Selecting And Using Wound Cleansing Solutions 

The ideal wound cleansing solution has not been established conclusively. Selection of a solution is based on:^{171, 172}

• Assessment of the wound (e.g. aetiology, anatomical location and visible structures)
  
•  The person’s risk of wound infection
•  Signs and symptoms indicative of local wound infection or spreading infection

• Colonisation with multi-drug-resistant organisms
•  Efficacy and organism sensitivities of solution
•  Goals of care
•  Local policies and resources. 

Wound cleansing solution options are outlined in Table 9. Inert substances are appropriate for cleansing most non-infected wounds.^{159, 161} Sterile normal saline or sterile water are inert solutions that are used in clinical situations requiring a sterile solution. Evidence from systematic reviews^163,173-176 and randomised controlled trials^177-179 has demonstrated that potable water¹⁷⁸ is a safe alternative to other wound cleansing solutions for both chronic and acute wounds. Potable water might be chosen in low-resource settings, community settings or for wounds with high levels of exudate or fistula effluent.¹⁶⁶ There is a role for judicious wound irrigation with an antiseptic solution, for example:

• To prevent surgical site infection when there is a high risk of infection (e.g. traumatic and contaminated wounds
•  In the presence of clinical signs and symptoms of local or spreading wound infection
•  In conjunction with surgical, sharp or conservative-sharp debridement as a component of biofilm-based wound care.^{166, 171}

Surfactants (surface active agents) are cleansing agents that contain a substance that lowers the surface tension between the wound bed and the fluid or between two liquids. The lowered surface tension facilitates the spread of the fluid across the wound bed. Surfactants assist separation of loose, non-viable tissue^{72, 168, 180} by breaking bonds between non-viable tissue/debris and the wound bed.¹⁶¹ These products might be chosen for cleansing wounds that require greater mechanical action when cleansing: for example, wounds with suspected biofilm.¹⁸⁰ Some topical antiseptic agents are manufactured in combination with a surfactant to capitalise on these properties and increase penetration of the antimicrobial agents across the wound bed.⁷² The manufacturers’ instructions for wound cleansing surfactants and antiseptic agents should be adhered to in regard to efficacy, recommended duration of each application and duration of consecutive treatments.¹⁷²