Cleansing solutions

Ideally, use sterile solutions (eg 0.9% sodium chloride, Hartmann solution or Ringer lactate) for standard wound cleansing. Alternatively, potable water can be used if sterile solutions are not readily available.

Antiseptic solutions can be used if the wound is dirty or clinically infected. Aqueous-based chlorhexidine, or povidone-iodine solution, are preferred due to efficacy. After 5 minutes, wash off the chlorhexidine or povidone-iodine. Avoid dripping and pooling of povidone-iodine. Additionally, do not apply povidone-iodine under an occlusive dressing or device.

Noncytotoxic antiseptic solutions, for example polyhexamethylene biguanide (PHMB, Prontosan), octenidine dihydrochloride (Octenilin), and hypochlorous acid and sodium hypochlorite (Microdacyn) are available, though there is limited clinical evidence to support routine use. Noncytotoxic antiseptics should not be washed off because the onset of action is slower and cytotoxicity is not a concern.

Cytotoxic antiseptics (eg hydrogen peroxide and sodium hypochlorite [including EUSOL]) are not recommended.

For venous leg ulcers that are progressing as expected, there is no high-level evidence to support routine use of povidone-iodine, chlorhexidine, sodium hypochlorite (including dilute solutions), peroxide-based preparations, ethacridine lactate, chloramphenicol, framycetin or mupirocin.

In general, topical antibiotics are not recommended because they have no demonstrated effect on healing and can promote antimicrobial resistance; see Ulcer and wound infection.