H2O2 and wound care in the field

[berkeman]

Hydrogen peroxide is routinely used for cleaning abrasions and lacerations at athletic events where I work or volunteer. We use 3% H2O2 to help clean and debride the wounds, prior to dressing and bandaging (typically with Telfa non-stick pads and triple-antibiotic ointment).

But I've heard some nurses comment that they don't like using H2O2 on wounds, since it is toxic to cells involved in the wound-healing process, and delays healing. They would prefer to use saline for the cleaning chores.

I did some googling, and found some good articles. This is one (I haven't read the whole article yet):

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1318349/"

I also got an interesting question from a spectator at an event yesterday where I volunteered as an EMT -- "If you had a person with a laceration that was going to be sutured, would you clean it with hydrogen peroxide before suturing?" I think their question came from the cell damage issue raised in the link. Does anybody know the answer? Thanks.

 

[Studiot]

There was a time when chlorophenols (Dettol etc) were used, but recent work suggests these chemicals may be carcinogenic, so general use has been discontinued/discouraged. Peroxide is a substitute antiseptic.

Another currently favoured practice is the use of iodine based dressings, such as Inadine.

 

[bobze]

Hydrogen peroxide is routinely used for cleaning abrasions and lacerations at athletic events where I work or volunteer. We use 3% H2O2 to help clean and debride the wounds, prior to dressing and bandaging (typically with Telfa non-stick pads and triple-antibiotic ointment).

But I've heard some nurses comment that they don't like using H2O2 on wounds, since it is toxic to cells involved in the wound-healing process, and delays healing. They would prefer to use saline for the cleaning chores.

I did some googling, and found some good articles. This is one (I haven't read the whole article yet):

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1318349/"

I also got an interesting question from a spectator at an event yesterday where I volunteered as an EMT -- "If you had a person with a laceration that was going to be sutured, would you clean it with hydrogen peroxide before suturing?" I think their question came from the cell damage issue raised in the link. Does anybody know the answer? Thanks.

As you pointed out HP is good for superficial wounds and abrasions. It works on bacteria in a similar method to how our own neutrophils kill them (through a respiratory burst).

Yes, oxidizing agents are damaging to cells, but your cells have many proteins and methods to mitigate damage. Which is why a low percent HP topical solution is so effective at killing bacteria and not your own cells in mass quantities.

Deep lacerations which require sutures are normally cleaned around the wound with stronger topicals such as providone iodine (Inadine for example). The wound itself is cleaned through irrigation with sterile saline (normally through syringe profusion below the level of the wound) and then sutures are administered. Depending on location and severity of the wound prophylactic antibiotics or topical antibiotics/bactericidals can be used to further prevent wound infection.