The Advantage of Using Clean Water over Saline in Cleansing Wounds - Research Proposal Example

What is the advantage of using clean water over saline in cleansing wounds? Initially, clinical management recognized only three principlesas the factors to aid in wound healing. These principles included; bacterial exposure and balance, debridement and moisture balance. The concept of wound bed preparation emphasizes on systematizing the healing of a chronic wound and its introduction officially into clinical medicine was in the year 2000. This process emphasizes on identifying why a wound could fail to heal in order to avoid all complications (Fleisher & Ludwig, 2010). The plan was formerly available only not as well defined as it is presently. Presently, this process has an initial integrated into the patients’ healthcare plan as opposed to previously when its application was because of an infection. Since the process was officially under inauguration, it has undergone several alterations that aid the science transferred to the bedside to aid in the healing intervention. The process use an acronym (TIME) which stands for tissue management, infection and inflammation, moisture control and balance and the final step is epithelial advancement. This process advances the art of wound healing without deviating from the base principles of moisture control, debridement and bacterial control. This framework is not a continuum and therefore is applicable in a large number of wounds (Fleisher & Ludwig, 2010). This framework is only applicable if the level of intervention is as thorough as the level of the assessment following it. The assessment helps identify how the wound is affecting the individual, cause of the wound and the effects of the individual on the wound. This aids in the determination of the healing process happening and the appropriate way to manage the wound. This process is also essential as the nurse in charge needs to collect data on how the wound’s management. The first step is debridement, which is a practice on empirical observation. Although this method has no proof of expediting healing, it is a clinical advice since it helps in striking a balance in the wound’s bio burden. After a wound, the body produces hormones and body enzymes form a corrosive compound on the surface of the wound. The control to this is simply making sure that a moisture balance is in place. Dressing and elevating it helps in minimizing this exudate therefore giving the wound an atmosphere for healing (Kifer, 2012). The most important step in wound healing, is balancing the bacteria on the wound. A wound contains microorganisms and tissue debris and this can delay healing. Pathogens tend to be attracted to the wound due to enzymes present on the surface and if not fully removed can cause an infection worsening the wound. In order to control the microorganisms on a wound, one has to cleanse the wound. Opinionated views summarize that cleaning wounds reduces infection, especially immediately after the acquisition of the wound, when the exudate from the wound is in excess, in case an infected exudate is present and if the wound has been under contamination. Wound cleaning is the act of removing contamination from a wound through application of fluids. There are many cleaning agents involved, but the main problem is when comparing how water helps in a wound healing as opposed to saline and other antiseptics. This debate gained very huge audiences all around the world and several studies carried out to prove this (Cook, Sankaran & Wasunna, 1988). The reason why saline is under recommendation is because it is an isotonic solution that does not affect the healing of the wound, but removes the bacterial contamination to the wound. The discussion ranges on to state that boiled drinking water would accomplish this in a more sure way in addition to the fact that it is accessible to everyone and cost effective electronic searches for Cochrane wound groups carried out and a review started to show which agent is more suitable. Two independent authors had the job of selecting the trials and extracting data. They also evaluated whether the included studies were viable. A third author checked that all the procedures were uniform whereby a difference was under discussion by the tea and settled. The data from these trials pooled into a model comparing all the experiments was underway. Seven experiments out of the eleven carried out where the rate of healing after cleaning with water as opposed to saline. Three trials were control experiments, which compared cleaning versus no cleaning at all. The last experiment compared procaine spirit versus water cleansing. Collecting the data was hard due to lack of standard criteria for determining the wound infection. Tap water was more adept at reducing the infection rate in chronic wounds as opposed to normal saline whereby while using tap water the risk rate was 0.16. Tap water is more effective than saline in cleaning chronic wounds in adults but in children there was no significant statistical difference. When wounds were cleaned with tap water or not cleaned at all they showed no relative significant difference. In the same manner, wounds cleaned with procaine spirit and those cleaned with water did not significantly differ in infection rate. According to this study, it is correct to state that cleaning wounds with tap water in adults helps in infection reduction. However, the control experiment also gives the opinion that cleaning the wound does not reduce or increase the rate of infection to the wound. In order for one to decide to use water as a wound-cleansing agent, one has to consider the nature of the water, nature of the wound and the nature of the patient. If tap water is unavailable, use of boiled water or distilled water is also as efficient. The preference for a particular wound cleaner over another depends on the clinical setting (American Medical Association, 1960). Most people prefer warm tap water because it is traditionally acceptable in the community and thought of change scares people. Over cleaning, a wound could cause the scrubbing off the already formed film hence prolonging the healing process. Certain articles published daily state that wound cleaning should be under operation without factory made antiseptics. According to these articles, antiseptics are too subtle for the wound unlike tap water, which is neutral, and saline, which is isotonic. In wound, cleaning water has been under use for centuries without ill effect. Under osmotic pressure, water is hypotonic therefore; it can form a cellular oedema before it ruptures. A wound if exposed to water for too long, it absorbs the fluid and the exudate production from the wound increases. Irrigation of water to a raw wound is painful to the patient, in addition it absorbs the useful nutrients in the blood even those that aid in healing. Water if introduced to red blood cells can cause them to burst or even to lyse. Saline on the other hand is isotonic; it has very little effect on blood flow or no effect at all. It does not have any effect on collagen or synthesis of DNA as proved from animal experiments. If a patient has immunity issues, the best cleanser to use would be saline. The experiments on saline have been animal experiments; therefore, caution has to be when applying them to humans. In this case and using the data and experiments as prove, the rate of healing would not be under effect by the use of neither saline nor water. It is however wise for the patient to consider the limitations of each method. The risk in using home water, especially if it is from a tank is danger of further infection. Several classes of bacteria exist in stagnant water; therefore, if the home water is not boiled or distilled it should not be under use for cleaning. The limitations of using saline in such a setting are the financial implications to the patient. Saline is unavailable and quite expensive for the patient to handle in a period of one month. The only hassle in using water would be boiling it whereby it becomes safe for such a sensitive cleansing. The experimental trial showed that in adults clean water has no effect on the infection rate of the wound and so does the saline (Fife, 2002). In conclusion, water and saline are both effective cleansers for wounds. The cleansers should be at body temperature in order not to mess with the healing time therefore prolonging the healing process. That should be the major consideration whenever treating a wound. The nurse should not make a mistake that prolongs the time the patient spends in the hospital. Over cleaning of the wound should not be at all times. The wound should receive cleaning when it is necessary. The research proves that over scrubbing may remove the healing films therefore prolonging the healing time. If water is to be under use as a cleanser, it should be under clinical application in order to avoid use of contaminated water. If saline is under use, then the patient must know about the option to use water and the cheaper it is to them. In the question a hand, it is impossible to tell who would heal faster since the body immune system reacts differently in different people. However, according to the research the woman cleaned with water would heal faster. References Fleisher, G. R., & Ludwig, S. (2010). Textbook of pediatric emergency medicine. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins Health. Cook, J., Sankaran, B., & Wasunna, A. E. O. (1988). General surgery at the district hosptial. Geneva: World Health Organization ; Albany, NY : WHO Publications Center USA [distributor. Fife, B. (2002). The healing crisis. Colorado Springs, Colo: Piccadilly. American Medical Association. (1960). JAMA: The journal of the American Medical Association. Chicago: American Medical Association. Kifer, Z. A. (2012). Fast facts for wound care nursing: Practical wound management in a nutshell. New York: Springer Pub. Read More