Professional Documents
Culture Documents
13
Although there is evidence to suggest that wound
cleansing is not always necessari
4
, there is no diagnostic
test that would allow healthcare professionals to identify
the bacterial load in the wound capable of causing wound
infection". The situation is further complicated by studies
showing that bacterial colonisation of the wound does not
necessarily indicate infection and there is no need to
remove the bacteria in the absence of clinical signs of
infection'6.".
Antiseptics
The use of antiseptics, particularly povidone iodine, in the
management of acute traumatic wounds has remained a
controversial issue over the last two decades. It is also
important to realise that the term iodine has sometimes
been used to describe all formulations including povidone
iodine, cadexomer iodine and others. These preparations
have different iodine concentrations and different
characteristics of their component parts. This raises the
question of whether they should be grouped and studied
separately.
The term antiseptic was first used by Pringle in 1750'"'
An antiseptic is a substance that inhibits the growth and
development of micro-organisms causing sepsis in
wounds'9. They may be either bactericidal or
bacteriostatic. Commonly used antiseptics for wound
cleansing include chlorhexidine, iodine compounds,
alcohol, benzalkonium chloride and hydrogen peroxide.
The use of antiseptics in wound care is controversial.
The debate started after Fleming's lecture in 1919 about
his work on antiseptics in septic wounds. The use of
antiseptics began to decrease in 1929 after the discovery
of penicillin. Stringer et al showed that antiseptics confer
no benefit as compared to sahne in cleansing wounds'o In
vitro experiments by Brennan and Leaper
2
' demonstrated
antiseptics were detrimental to the production of
collagen, impairing epithehal migration and inhibiting
microcirculation. Furthermore antiseptics are inactivated
by contact with body fluids, blood, and proteins'
However, they need to be in contact long enough to
reduce bacterial numbers
23
This evidence led to a decrease in the popularity of
antiseptics for wound cleansing and there was a decline in
their use with more emphasis on antibiotics in the
treatment of contaminated/infected wounds. However,
with the emergence of bacterial resistance to antibiotics,
there has been a reappraisal in the use of antiseptics, and
especially iodine compounds.
VOL 16 NO.4 NOVEMBER 2006
Iodine is one of the long established antiseptics. Early
preparations caused local pain and tissue reaction.
Povidine iodine was introduced 40 years ago. It contains
polyvinylpyrrolidone iodine, which is a water soluble
complex of elemental iodine with a synthetic polymer.
10% solution in water is the most commonly
manufactured form.
It has a bactericidal action and is effective against a
wide range of bacteria, fungi and even spores
24
. The killing
action occurs in seconds and is thought to be from
inactivation of vital cytoplasmic substrates, which are
necessary for bacterial viability25. l s m ~ proteins can bind
up to 80% of free iodine'6
The presence of organic matter has a marked
depressant effect on the minimum lethal concentrations
of iodine. In the absence of inhibitors the disinfection is
rapid, probably less than 10 seconds
27