Chlorhexidine diacetate
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The preferred wound lavage and wetting solution is 0.05% chlorhexidine diacetate because of its wide spectrum of antimicrobial activity and sustained residual activity.
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It has antibacterial activity in the presence of blood and other organic debris, has minimal systemic absorption and toxicity, and promotes rapid healing. Residual activity may last as long as 2nd day, and effectiveness increases with repeated applications.
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Potential drawbacks of chlorhexidine include resistance to Proteus, Pseudomonas, and Candida, and corneal toxicity.
Povidone-iodine
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A 1% or 0.1% povidone-iodine is used frequently for wound lavage because of its wide spectrum of antimicrobial activity. Iodine compounds are active against vegetative and sporulated bacteria, fungi, viruses, protozoa, and yeasts.
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A 0.1% solution is recommended. This concentration kills bacteria within 15 seconds, and there is no known bacterial resistance. Residual activity lasts only 4 to 8 hours and organic matter inactivates the free iodine in povidone-iodine.
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It is absorbed to the system through the skin and mucous thus excess systemic concentration causes transient thyroid dysfunction. Its low pH can cause or intensify metabolic acidosis when it is absorbed.
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Scrubbing wounds with povidone-iodine detergents damages tissues and potentiate infection.
Other Solutions
a) Hydrogen peroxide, even in low concentrations, damages tissue and is poor antiseptic. It is an effective sporicide.
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Hydrogen peroxide when applied as lavage is converted into foam and oxygen by tissue catalases when it contacts wound tissue.
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It has a brief period of antimicrobial action, and it does not penetrate the tissues.
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Hydrogen peroxide should be used to irrigate wounds out should not be delivered to wounds under pressure. It should not be delivered to wounds under pressure.
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It does not require any special after care. The foaming action of hydrogen peroxide may be beneficial in removing dirt and debris from deep wounds when used in initial wound management.
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It may also be beneficial for removing clots from the wound and in obtaining hemostasis.
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It has minimal bactericidal potency, but more sporicide action .At 3% concentration it injures tissues.
b) Dakin’s solution is a 5% solution of sodium hypochlorite (1:10 dilution of laundry bleach). It is detrimental to neutrophils, fibroblasts, and endothelial cells and therefore should not be used as a wound lavage solution.
c) Sterile normal saline 0.9% - used for irrigation
d) Hyper tonic saline 2.5% - Cleaning & antibacterial activity
e) Isotonic saline, lactated ringers (or) Ringers Lactate
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