Therapeutic wound cleansing: a paradigm shift from ancillary procedure to core therapy—an interpretation based on the International Wound Infection Institute consensus_West China Medical Journal

Authors：

LEI Changbin , HE Lingxiao , NING Qian ,  LIAO Dengbin

Trauma Center, West China Hospital, Sichuan University / West China School of Nursing, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

LIAO Dengbin, Email: jiuyou2003@163.com

Keywords：

Wound cleansing; expert consensus; biofilm; evidence-based practice

DOI：

10.7507/1002-0179.202509321

Video：

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This article interprets the 2025 International Wound Infection Institute consensus Therapeutic Wound and Skin Cleansing: Clinical Evidence and Recommendations, which marks a paradigm shift in viewing wound cleansing as a “core therapy” rather than an “ancillary procedure”. It systematically analyzes the definition of “therapeutic wound cleansing”, clarifies its distinction from debridement, and explains the proposed “optimal wound care” theoretical model. The core content involves an evidence-based interpretation and comparative analysis of the 14 recommendations across 5 dimensions: timing/frequency, scope, technique/operational standards, solution selection, and pain management. Finally, considering the current state of clinical practice in China, the article discusses the consensus’s implications for promoting standardized and precise wound care, and suggests directions for future research.

1.	J?rbrink K, Ni G, S?nnergren H, et al. The humanistic and economic burden of chronic wounds: a protocol for a systematic review. Syst Rev, 2017, 6(1): 15.
2.	Alam W, Hasson J, Reed M. Clinical approach to chronic wound management in older adults. J Am Geriatr Soc, 2021, 69(8): 2327-2334.
3.	Nussbaum SR, Carter MJ, Fife CE, et al. An economic evaluation of the impact, cost, and medicare policy implications of chronic nonhealing wounds. Value Health, 2018, 21(1): 27-32.
4.	Posnett J, Gottrup F, Lundgren H, et al. The resource impact of wounds on health-care providers in Europe. J Wound Care, 2009, 18(4): 154-161.
5.	Schneider RE, Hamdan JV, Rumbaugh KP. Biofilm dispersal and wound infection clearance with preclinical debridement agents. Int Wound J, 2025, 22(3): e70145.
6.	Blunt J. Wound cleansing: ritualistic or research-based practice?. Nurs Stand, 2001, 16(1): 33-36.
7.	International Wound Infection Institute (IWII). Therapeutic wound and skin cleansing: clinical evidence and recommendations. London: Wounds International, 2025.
8.	Swanson T, Ousey K, Haesler E, et al. IWII Wound Infection in Clinical Practice consensus document: 2022 update. J Wound Care, 2022, 31(Sup12): S10-S21.
9.	Munn Z, Lockwood C, Moola S. The development and use of evidence summaries for point of care information systems: a streamlined rapid review approach. Worldviews Evid Based Nurs, 2015, 12(3): 131-138.
10.	Murphy C, Atkin L, Swanson T, et al. Defying hard-to-heal wounds with an early antibiofilm intervention strategy: wound hygiene. J Wound Care, 2020, 29(Sup3b): S1-S26.
11.	Murphy C, Atkin L, Vega de Ceniga M, et al. Embedding Wound Hygiene into a proactive wound healing strategy. J Wound Care, 2022, 31(Sup4a): S1-S19.
12.	Mayer DO, Tettelbach WH, Ciprandi G, et al. Best practice for wound debridement. J Wound Care, 2024, 33(Sup6b): S1-S32.
13.	Rajhathy EM, Hill MC, Tran DL, et al. Evidence-informed nursing clinical practices for wound debridement. Am J Nurs, 2024, 124(12): 26-34.
14.	Goswami AG, Basu S, Banerjee T, et al. Biofilm and wound healing: from bench to bedside. Eur J Med Res, 2023, 28(1): 157.
15.	Eriksson E, Liu PY, Schultz GS, et al. Chronic wounds: treatment consensus. Wound Repair Regen, 2022, 30(2): 156-171.
16.	Visconti AJ, Sola OI, Raghavan PV. Pressure injuries: prevention, evaluation, and management. Am Fam Physician, 2023, 108(2): 166-174.
17.	Purssell E, Gallagher R, Gould D. Aseptic versus clean technique during wound management? Systematic review with meta-analysis. Int J Environ Health Res, 2024, 34(3): 1580-1591.
18.	Lam SC. Validation and cross-cultural pilot testing of compliance with standard precautions scale: self-administered instrument for clinical nurses. Infect Control Hosp Epidemiol, 2014, 35(5): 547-555.
19.	Lotfinejad N, Peters A, Tartari E, et al. Hand hygiene in health care: 20 years of ongoing advances and perspectives. Lancet Infect Dis, 2021, 21(8): e209-e221.
20.	Ren Y, Yu H, Wang Z, et al. Does earlier bathing increase the risk of surgical site infection? A meta-analysis of 11 randomized controlled trials. EFORT Open Rev, 2024, 9(6): 458-466.
21.	McGuiness W, Vella E, Harrison D. Influence of dressing changes on wound temperature. J Wound Care, 2004, 13(9): 383-385.
22.	Gannon R. Wound cleansing: sterile water or saline?. Nurs Times, 2007, 103(9): 44-46.
23.	Sim P, Strudwick XL, Song Y, et al. Influence of acidic pH on wound healing in vivo: a novel perspective for wound treatment. Int J Mol Sci, 2022, 23(21): 13655.
24.	Wei M, Zheng H, Xu X, et al. Assessment of wound-related pain experiences of patients with chronic wounds: a multicenter cross-sectional study in Eastern China. J Wound Ostomy Continence Nurs, 2024, 51(2): 111-116.
25.	GBD 2019 Antimicrobial Resistance Collaborators. Global mortality associated with 33 bacterial pathogens in 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet, 2022, 400(10369): 2221-2248.

1. J?rbrink K, Ni G, S?nnergren H, et al. The humanistic and economic burden of chronic wounds: a protocol for a systematic review. Syst Rev, 2017, 6(1): 15.
2. Alam W, Hasson J, Reed M. Clinical approach to chronic wound management in older adults. J Am Geriatr Soc, 2021, 69(8): 2327-2334.
3. Nussbaum SR, Carter MJ, Fife CE, et al. An economic evaluation of the impact, cost, and medicare policy implications of chronic nonhealing wounds. Value Health, 2018, 21(1): 27-32.
4. Posnett J, Gottrup F, Lundgren H, et al. The resource impact of wounds on health-care providers in Europe. J Wound Care, 2009, 18(4): 154-161.
5. Schneider RE, Hamdan JV, Rumbaugh KP. Biofilm dispersal and wound infection clearance with preclinical debridement agents. Int Wound J, 2025, 22(3): e70145.
6. Blunt J. Wound cleansing: ritualistic or research-based practice?. Nurs Stand, 2001, 16(1): 33-36.
7. International Wound Infection Institute (IWII). Therapeutic wound and skin cleansing: clinical evidence and recommendations. London: Wounds International, 2025.
8. Swanson T, Ousey K, Haesler E, et al. IWII Wound Infection in Clinical Practice consensus document: 2022 update. J Wound Care, 2022, 31(Sup12): S10-S21.
9. Munn Z, Lockwood C, Moola S. The development and use of evidence summaries for point of care information systems: a streamlined rapid review approach. Worldviews Evid Based Nurs, 2015, 12(3): 131-138.
10. Murphy C, Atkin L, Swanson T, et al. Defying hard-to-heal wounds with an early antibiofilm intervention strategy: wound hygiene. J Wound Care, 2020, 29(Sup3b): S1-S26.
11. Murphy C, Atkin L, Vega de Ceniga M, et al. Embedding Wound Hygiene into a proactive wound healing strategy. J Wound Care, 2022, 31(Sup4a): S1-S19.
12. Mayer DO, Tettelbach WH, Ciprandi G, et al. Best practice for wound debridement. J Wound Care, 2024, 33(Sup6b): S1-S32.
13. Rajhathy EM, Hill MC, Tran DL, et al. Evidence-informed nursing clinical practices for wound debridement. Am J Nurs, 2024, 124(12): 26-34.
14. Goswami AG, Basu S, Banerjee T, et al. Biofilm and wound healing: from bench to bedside. Eur J Med Res, 2023, 28(1): 157.
15. Eriksson E, Liu PY, Schultz GS, et al. Chronic wounds: treatment consensus. Wound Repair Regen, 2022, 30(2): 156-171.
16. Visconti AJ, Sola OI, Raghavan PV. Pressure injuries: prevention, evaluation, and management. Am Fam Physician, 2023, 108(2): 166-174.
17. Purssell E, Gallagher R, Gould D. Aseptic versus clean technique during wound management? Systematic review with meta-analysis. Int J Environ Health Res, 2024, 34(3): 1580-1591.
18. Lam SC. Validation and cross-cultural pilot testing of compliance with standard precautions scale: self-administered instrument for clinical nurses. Infect Control Hosp Epidemiol, 2014, 35(5): 547-555.
19. Lotfinejad N, Peters A, Tartari E, et al. Hand hygiene in health care: 20 years of ongoing advances and perspectives. Lancet Infect Dis, 2021, 21(8): e209-e221.
20. Ren Y, Yu H, Wang Z, et al. Does earlier bathing increase the risk of surgical site infection? A meta-analysis of 11 randomized controlled trials. EFORT Open Rev, 2024, 9(6): 458-466.
21. McGuiness W, Vella E, Harrison D. Influence of dressing changes on wound temperature. J Wound Care, 2004, 13(9): 383-385.
22. Gannon R. Wound cleansing: sterile water or saline?. Nurs Times, 2007, 103(9): 44-46.
23. Sim P, Strudwick XL, Song Y, et al. Influence of acidic pH on wound healing in vivo: a novel perspective for wound treatment. Int J Mol Sci, 2022, 23(21): 13655.
24. Wei M, Zheng H, Xu X, et al. Assessment of wound-related pain experiences of patients with chronic wounds: a multicenter cross-sectional study in Eastern China. J Wound Ostomy Continence Nurs, 2024, 51(2): 111-116.
25. GBD 2019 Antimicrobial Resistance Collaborators. Global mortality associated with 33 bacterial pathogens in 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet, 2022, 400(10369): 2221-2248.

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