I find it impossible to understand that none of the guidelines includes as the basis for hygienic wound care soap baths or showers, which should precede any other measures. Water, even sterile saline solution would not have yielded any evidence. These would counteract any surgical hand scrubbing and any recommendation of hygiene committees for healthcare staff to wash their hands after any contact with patients.
What do colleagues do in case of filthy and grossly malodorous wounds, in case the hair on the head is glued together by blood, in case of in grown stockings, or in case of maggot or insect infestation?
The point of any lavage is to reduce any massive contamination of body cavities and skin by bacteria, fungi, or insects to a minimum. Because of the environment it is impossible to make wounds completely sterile.
By eliminating protein, fat, and detritus, the breeding ground for any pathogensis removed. Further therapies should be undertaken only after this initial step.
It is then of no crucial relevance how the wound is dressed, unless the patient has allergies. Sterile dressings and daily changes of dressings, wherever possible, are what is needed.
For this reason we do not allow hydrogel dressings in our clinic for homeless people. Some 24 hours later, specimens almost always show massive growth of mostly Staphylococcusaureus. In patients with venous-lymphatic stasis, compression therapy is essential (Author).