Dr Malcolm Franke¹, Dr Bishoy Soliman¹

¹Royal North Shore Hospital, St Leonards, Australia

Abstract:

Introduction

A number of solutions are available for the cleaning of burns, these include but are not limited to potable water, 0.9% sodium chloride, chlorhexidine, povidone-iodine and Prontosan. Whilst there is considerable variation across centres, there is a paucity of evidence regarding the optimal cleaning solution of burns.

Methods

We conducted a review of the evidence behind the most commonly used cleaning solutions in burns including tap water, chlorhexidine, 0.9% sodium chloride, Povidone-iodine solution and Prontosan.

Results

There was dearth of studies examining the efficacy and safety of the most commonly used cleaning solutions, with many results being extrapolated from general wound cleaning. Both chlorhexidine and povidone-iodine solutions were found to potentially inhibit metalloproteinases release from fibroblast cells.(Tatnall, Leigh & Gibson, 1990; Thomas et al., 2009). Studies also suggest no significant difference in infection rates with wounds cleaned with water compared with saline.(Fernandez & Griffiths, 2008) While the quality and number of studies were low, several studies suggested Prontosan may lead to improved wound outcomes in adults and children.(Ciprandi et al., 2018; Daeschlein et al., 2007; Kiefer et al., 2018)

Conclusion

Infection is the number one complication from burns wounds requiring hospitalization. All the available cleaning solutions appear to be safe in clinical practice with the available evidence suggests that Pronotsan may lead to better outcomes. However, its use must be weighed against other factors such as cost and availability. More studies are required to better understand the optimal burns cleaning solution.

References

Ciprandi, G, Ramsay, S, Budkevich, L, Strack, A, Van Capellen, P & Marathovouniotis, N 2018, ‘A retrospective systematic data review on the use of a polihexanide-containing product on burns in children’, Journal of tissue viability, vol. 27, no. 4, pp. 244-248.

Daeschlein, G, Assadian, O, Bruck, J, Meinl, C, Kramer, A & Koch, S 2007, ‘Feasibility and clinical applicability of polihexanide for treatment of second-degree burn wounds’, Skin pharmacology and physiology, vol. 20, no. 6, pp. 292-296.

Fernandez, R & Griffiths, R 2008, ‘Water for wound cleansing’, Cochrane database of systematic reviews, no. 1.

Kiefer, J, Harati, K, Müller-Seubert, W, Fischer, S, Ziegler, B, Behr, B, Gille, J, Kneser, U, Lehnhardt, M & Daigeler, A 2018, ‘Efficacy of a gel containing polihexanide and betaine in deep partial and full thickness burns requiring split-thickness skin grafts: a noncomparative clinical study’, Journal of Burn Care & Research, vol. 39, no. 5, pp. 685-693.

Tatnall, F, Leigh, I & Gibson, J 1990, ‘Comparative study of antiseptic toxicity on basal keratinocytes, transformed human keratinocytes and fibroblasts’, Skin Pharmacology and Physiology, vol. 3, no. 3, pp. 157-163.

Thomas, GW, Rael, LT, Bar-Or, R, Shimonkevitz, R, Mains, CW, Slone, DS, Craun, ML & Bar-Or, D 2009, ‘Mechanisms of delayed wound healing by commonly used antiseptics’, Journal of Trauma and Acute Care Surgery, vol. 66, no. 1, pp. 82-91.

Biography:

Unnaccredited Burns Registrar

Royal North Shore Hospital