We’ve launched two new products today for those of you who like hatchets – and sometimes need to clean up the blood they leave behind….
“Video: Make a Chair from Green Wood with Rudy Everts” is a fun and informative video on how to build Rudy’s armchairs with green woodworking techniques. Rudy has been building these chairs for years and has come up with ways to handle all the angles in the chair using… a folded piece of paper. This video is about woodworking at its most essential. Basic tools. Simple techniques. And stealing the wood from a cemetery. The video is just $25 for the first 30 days. That’s 50 percent off the retail price. Read more about the video here. Rudy and I had a great time shooting this video in November, and I’m so happy we finally are letting it out into the world. Also, Rudy composed all the music for the video (under the name Tongues & Grooves”).
“Special Bundle: ‘Wound Care’ book + Slipcase + Our Favorite Shop Bandages.” Every workshop needs a way to take care of cuts, bruises and more serious injuries. “Workshop Wound Care” by Dr. Jeffrey Hill (an ER doctor and woodworker) gives you exactly that. To make the book easy to find in an emergency, we’ve paired it with this US-made slipcase in red canvas that has been hand painted with a white cross so you can see it across the room. The slipcase can be hung almost anywhere thanks to its brass grommets and screws (included). And, because cheap bandages stink, we include a collection of 20 of our favorite brand of bandages in the shapes and sizes most woodworkers need. We’re offering this bundle for just $43. We have only 99 of these, so act fact if you want one.
The following is excerpted from Dr. Jeffery Hill’s “Workshop Wound Care.” The book delves right to the heart of what you need to know when faced with common workshop injuries, from lacerations, to puncture wounds to material in the eye. Dr. Hill is an emergency room physician and an active woodworker. So he knows exactly the information a woodworker needs to know when it comes to injuries. And he presents information in a way that a non-medical professional can easily understand it.
There are a number of diseases that, due to their being very uncommonly encountered in the modern world, seem like quaint relics of antiquity. Diphtheria? Rubella? Mumps? Rabies? What even are those? There are a few diseases that have been completely eradicated (smallpox) or nearly completely eradicated (polio) thanks to sustained vaccination efforts. Tetanus, however, is here to stay on this earth through all of eternity regardless of our efforts at vaccination.
Why? Spores, that’s why
What is Tetanus?
Tetanus is a clinical condition caused by the tetanus toxin which produced by the bacteria Clostridium tetani. Clostridium tetani possesses the relatively uncommon ability to form spores (examples of other spore-forming bacteria include Clostridium botulinum, a.k.a. botulism, and Bacillus anthracis, a.k.a. anthrax).
Spores are exceptionally hardy bits of microbiology. Composed of a hard shell and just enough reproductive matter, they are typically produced when the bacteria run into rough times. A lack of nutrients, which would typically just kill off less fastidious bacteria, triggers C. tetani to produce these spores that can survive a lack of water, nutrients, presence of high amounts of radiation, freezing weather, boiling temps and even chemical disinfectants. Spores can remain viable in inhospitable environments for tens of thousands of years. C. tetani spores are most commonly found in soil, dust and manure, but can be found anywhere in the environment.
When tetanus spores find their way back to a hospitable environment they come alive and start to replicate, along the way producing tetanus toxin (awesomely named tetanospasmin). The tetanus toxin is taken up by the nervous system, ultimately ending up in the spinal cord and brain where it acts to block inhibitory signaling pathways. Because two negatives make a positive, the end result of this action is an excess of electrical transmission from the central nervous system to the muscles and severe muscle spasms.
Opisthotonus, which can be caused by tetanus, is a spasm of the muscles causing the head, neck and spine to arch backward.
These unopposed muscle contractions lead to the characteristic clinical manifestations of tetanus. “Lock jaw” is due to contraction of the jaw muscles. Contraction of the facial muscles results in “risus sardonicus,” a fixed smile/facial expression. And contraction of the back muscles results in severe arching of the back. But the neurotoxin doesn’t limit itself to the motor system; it can also lead to seizures and uncontrolledblood pressure (both high and low) and heart rate (also high and low).
If you have ever had a charley horse where your legs cramp up, you have a little taste of how terrifically painful muscle spasms can be. Now imagine that affecting your entire body. Also, because the tetanus toxin irreversibly binds with nerve cells, the uncontrolled nerve signals and muscle spasms continue until the body can grow new nerve endings (a process that is weeks to months long). Generalized tetanus can lead to broken bones, spasm of the respiratory muscles, and aspiration of stomach contents and food into the lungs. Ten to 20 percent of patients still die of tetanus despite modern medical therapies.
What Wounds are at High Risk for Tetanus Infection?
Tetanus infections don’t just come from rusty nails. In fact, all wounds – cuts, abrasions (both to the skin and eyes) and burns – are susceptible to tetanus infection. There are certain wounds, however, that are more prone to tetanus infection and create an environment where the tetanus bacteria will produce the tetanus toxin. Wounds that are dirty, puncture-type wounds and crush injuries are most at risk.
Logically, the more tetanus bacteria present in a wound, the higher the risk of infection. As such, injuries with significant contamination with soil are more likely to result in infection.
If the tetanus bacteria is pushed deep into the tissue, infection is more likely. Puncture wounds, in general, carry a higher risk of all types of wound infection. The narrow tract of a puncture wound is apt to quickly close over bacteria and other matter pushed deeply into the tissues. And, it is much more difficult to adequately clean at the time of injury, meaning it is much more difficult to use irrigation to decrease the number of bacteria present.
Because tetanus bacteria are more likely to grow and produce toxin in “devitalized” tissue, crush injuries are also highly susceptible to infection.
How does this translate to you, the woodworker? A scratch or minor cut from a chisel or knife is less risky. A injury from an axe or froe while breaking down green wood is more risky. (Though to reiterate: Any break in the skin carries a risk of tetanus infection.)
What About the Tetanus Vaccine?
The tetanus vaccine includes a component of the tetanus toxin called a toxoid. This toxoid is coupled with a diphtheria toxoid (Td) and often an acellular version of pertussis (TdaP).
As a side note, the risks of contracting diphtheria and pertussis in adulthood are sufficient enough that the administration of the whole package of TdaP is recommended by the CDC. Pertussis (whooping cough) can be common in older adults (often presenting as mild illness) and easily spread to incompletely vaccinated infants (often presenting as a severe respiratory illness). For this reason, if you are going to be around a new baby in the family (e.g. new grandparents), you’ll likely be asked to get a “tetanus booster” (though really you are boosting your pertussis immunity). Back to tetanus…
As with other vaccines, introducing the tetanus toxoid gives the body’s immune system a “wanted” poster of what the real toxin looks like, allowing the body to create neutralizing antibodies to the toxin. The typical vaccination schedule is for three doses of the vaccine to be administered at two months, four months, and six months of age, with boosters given around six to 12 months after the third dose, and again before entering kindergarten. Following that, boosters are recommended every 10 years. In the developed world, adherence to the recommended vaccination schedule is (thankfully) high, meaning that most people are “fully vaccinated” for tetanus through their childhood. It is not uncommon, however, for adults to miss out on their regular boosters. As a result of this, most cases of tetanus are reported in patients 50 years of age and older.
When Chris Williams was visiting from Wales, he extolled the virtues of “drawing salve” – an ointment that pulls splinters out of one’s hand or what have you. And I’ve heard the same praise from other friends from across the Atlantic – the stuff is certainly more popular there than here. So what is this stuff, and does it actually work?
Christopher Schwarz bought some, got himself a splinter (possibly on purpose?) to find out. He reports that it did indeed help to express the bit of wood that was lodged too far beneath his skin to remove it with tweezers. What I don‘t know is how long it took for that to happen – and might it have happened in the same time span without the salve application?
We also don’t know is if there is any scientific proof that this stuff works, so we asked our friendly medical expert, Dr. Jeffrey Hill, to weigh in. He’s the author of “Workshop Wound Care,” an emergency room physician and an avid woodworker (and gardener). I’m sure he’s had plenty of his own splinters (almost certainly not on purpose), and removed more splinters from others than most of the people reading this. Below are his thoughts on drawing salve.
The term “drawing salve” somehow conjures impressions of both comfort and trepidation. Is it a soothing medicinal ointment that has been healing boo-boos since the times of Galen and Hippocrates, and is still around due to centuries of successfully treated patients? Or is it snake oil, still around because someone can make a buck or two off it? As with most things in life, the answer is probably: it depends.
A good first question might be: why is an article on medicinal ointments showing up in a woodworking blog? Well, working with sharp objects, we all tend to get nicks, scratches, and – often most maddeningly – splinters that seem to only get more painful as time goes on. In my book, “Workshop Wound Care,” I cover approaches to removing splinters. The basic approach is to first determine the direction in which the splinter fragment is oriented, take some sharp, pointed tweezers, grasp firmly, and pull with axial traction (pull in the direction the splinter is oriented).
Push the splinter in the same direction it traveled in, and there isn’t additional pain. Push it in the opposite direction, and you’ll feel it.
An 18-gauge needle can be used to enlarge the splinter opening. Then use tweezers to pull it out in the correct direction.
If this is successful, and the splinter is wholly removed, you’re likely in great shape. Just wash the wound, maybe cover it with a bandage, and move on with your day. If, however, some tiny bit of the splinter remains (maybe it was too small to grasp initially or it broke off under the skin surface), you might be in for a painful couple of days as your body reacts to the foreign invader that breached the protective shield of your skin. In response to the splinter, your body sends inflammatory cells to the site to try to wall it off and kill any bacteria or fungi that might have hitched a ride on the piece of oak.
If all goes well, the inflammatory cells stream in and destroy any bacteria and fungi. The splinter is, however, far too big for a macrophage’s mouth, so the body and this inflammatory process will slowly push the splinter out past the skin. If things don’t go well, the bacteria win the day, besting the inflammatory response, and forming an abscess (perhaps more commonly known as a boil) around the splinter that will eventually need to be incised and drained. Whether things go well or poorly, the inflammatory process a splinter causes is a painful one.
Enter the drawing salve.
Drawing salves (and salves in general) are not one monolithic thing. They are, at their base, an ointment (a thick viscous liquid) often supplemented with chemicals with varying degrees of real or purported medical benefits. One should use appropriate caution and reason in interpreting the stated medical benefits of these preparations. Because these salves often get classified as cosmetic products, they may not undergo the rigorous testing or standards required of medications (in the eyes of the Food and Drug Administration). The FDA, in fact, specifically cautionsagainst salves with potentially corrosive ingredients (graphic images warning at that link) or salves that claim to be able to treat or cure skin cancer, moles, warts or boils. Even salve preparations containing known medical benefits (such as the ichthammol discussed below) should be used with caution and careful attention to how your body is responding. Should your symptoms of pain and redness worsen, or should you develop fever, pus draining from the wound or streaking redness from the wound, you should, of course, seek the care of a medical professional.
The 10-percent ichthammol salve is the one Chris tried.
Ichthammol, or ammonium bituminosulfate, a common ingredient in drawing salve preparations, is derived from sulfur-rich shale oil and has theorized antibacterial, antifungal and anti-inflammatory properties. It has a weak recommendation by expert consensus for the treatment of the terrible skin condition Hidradenitis Suppurativa (subtext here is that this means there’s no good evidence of its benefit, but smart people suggest it, so we sometimes do it). There’s no direct evidence that it would help get a splinter out of your body more quickly. However, its inclusion in a drawing salve makes sense from a pathophysiological standpoint. It has a sticky, thick consistency ideal for inclusion in an ointment where the goal is to hydrate and soften the skin. Its likely antibacterial, antifungal and anti-inflammatory effects might lessen the pain associated with the process of expelling the splinter from the body and may lend a hand in the eternal battle of the human immune system vs. bacteria. If the skin is soft and hydrated, it should be easier for the body to push out the tiny splinter fragment. And, if the inflammatory response (which is often overly robust) is held slightly in check, it should lessen the pain associated with having a sliver of oak under your skin.
So what’s the verdict on drawing salves? Are they snake oil or helpful, healing ointments? Should you slap them on every splinter you have and save yourself the pain that comes with pulling one out with a sharp pair of tweezers? They may have a benefit for those splinters too small to pull out, or those splinters that fracture and stay under the surface of the skin as you try to pull them free. In general, the best course of action is to get the splinter out as soon as possible, but if you can’t, a drawing salve (like ones that contain ichthammol) might help the body rid you of the splinter (and probably will make the process less painful).
This one smells nice. I might try it on my cuticles (the lid says its good for dry skin).
The spinning carbide took a chunk out of the metal jointer guard when it fell on the blades – now imagine the mess those blades can make of flesh. Or rather don’t – it’s not pretty.
The following is by Steve Latta. Steve makes contemporary and traditional furniture, and teaches woodworking at Thaddeus Stevens College of Technology and Millersville University in Lancaster County, Pa. He’s a contributing editor to Fine Woodworking magazine, and is working on a project for Lost Art Press.His Instagram is @steve_latta_woodworking.
About 30 years ago, I took a turning class from the late Rude Osolnik in Akron, Ohio. At that time, Rude was teaching at Berea College and was a master at his craft. It was my first turning class and I had never chucked anything on a lathe prior to it. As Rude was prepping for a demo on spindle turning, he pushed the blank into the tail stock and with the lathe running, he slowly engaged the drive center. With a little finesse of tightening and loosening the stock as it spun, he ended up with the blank humming nicely.
Feeling confident with what I’d observed, I went back to my station, attempted the same technique on the Powermatic #90 assigned to me and promptly launched my blank, leaving a divot in the ceiling. While rubbing the emerging bruise on my hand (not to mention on my ego), a classmate doing his best to suppress a laugh explained that Rude does it that way because he’s been doing it for 40 years. He recommended that I load my blank with the lathe turned off. Despite my stupidity, I survived the self-inflicted forces of natural selection.
That same experience occurred when I started teaching woodworking at a technical college in Lancaster, Penn. I had 16 years in the trade and was a pretty decent cabinetmaker at that point. I even considered myself a “safe” cabinetmaker – until I observed my bright-eyed and bushy-tailed students doing things on the table saw that made me turn white with fear. When asked “Where in the hell did you learn that!?”, the answer was more often than not, “From watching you.” Ouch! That hurt, but it impressed upon me the urgency and necessity of starting with the basics and the essential safe practices for operating a tool, whatever it is.
I love my students. I love their raw energy. Most are between 18 and 25 years of age, male, driven by hormones and with a brain that is far from fully developed. That is not a criticism, just a fact. Their typical solution to most problems is to push it or hit it harder. They do not fully grasp the consequences of a bad choice. They don’t know what the tools really do and certainly do not yet how to use them properly. At that age, most have yet to learn that they themselves are breakable.
Mishaps with hand and power tools can change a life or end a career in a millisecond. Back in the early ’80s, a fellow apprentice was ripping wide, heavy boards on a table saw while wearing gloves. In a blink of the eye, there were four leather fingers resting on the table detached from the glove. They weren’t empty and his career in woodworking was done. Over my 40 years in the trade, I have picked up, scraped up or cleaned up more human tissue than one should. The most recent incident involved small chunks of bone and flesh from the dust chute on a jointer. And, yes, it was gross.
“Bandosawrus” (used with permission of Chris Vesper, Vesper Tools).
Some folks name their tools. An acquaintance of mine named his 36” bandsaw “Bandosawrus” because of its size and power. I know of a 9-horsepower shaper named “Shredder.” I do not know of any named “Daisy.” Despite that sense of attachment we can get to our tools, I guarantee the emotional bond is strictly one way. There is not a part of my body, any part, that will make the power tools in my shop bog down even a single rpm. The edge of a sharp chisel will pay no mind to the calluses on my hands. The destruction these tools can cause to a body happens in an instance without love nor malice. Although it is easy to blame the tool, “operator error” is often the real problem expressing itself as a lack of diligence or understanding.
These days I often bristle watching videos of various woodworking operations on Instagram or YouTube. I recall a well-known internet personality demonstrate how he cut the dovetailed slot on the bottom of the column for a three-leg pedestal table. Using a shaper with an industrial-size dovetail bit, he ran the first pass right down the center of the mortise, requiring an additional pass on each side of the first to obtain the proper width. He did not show the second cut but skipped to the final pass furthest from the fence. He finished his video sliding the dovetailed foot easily into the column. He was smiling ear-to-ear. I am quite certain that anyone who attempted what had been demonstrated did not smile. The omitted second cut was a climb cut, and a particularly dangerous one at that. I suspect the author discovered that little nightmare making his video. I also suspect that is why he left it out.
Sometimes the videographer even states, “this one will drive the safety police nuts!” In our “rugged sense of individualism” culture, we admire those who break the rules. But sometimes the outcome is ugly. If something isn’t safe, don’t post it. Take a look at your motives for making the video. Is the purpose to relay solid information or rather, out of vanity flavored with ignorance, say “Look at me. Look at me.” Does the number of “likes” and “followers” trump basic safety? Sure, it is possible to turn a short spindle on a table saw combined with a drill. The fact that it’s possible and may even look “cool” garnering thousands of hits does not make it a valid technique and certainly not a safe one. Just because something can be done doesn’t mean that it should be. In my mind, promoting such practices is a crime.
Deviating from accepted safety norms should only come after mastery. Stepping out of what is considered safe should be a conscious choice based on years of experience with a full understanding of what the negative consequences may be. The undefined nuances of what a tradesperson knows are rarely expressed in articles or videos. The subtleties are so ingrained that they are unwittingly taken for granted and hence are inaccessible to the observer. A certain technique might work 99 times out of 100 but the one time it doesn’t might be a bloodbath, literally. In this trade, we are not working with knitting needles but an endless assortment of sharp objects, some of them moving at incredible speeds. Out of respect and concern for viewers in our online ventures, safety rather than sensationalism, should be gold standard, not the number of likes.
– Steve Latta
Editor’s note: If you do get hurt (we sure hope you don’t), make sure you have a well-stocked first-aid kit at hand, and that you know how to use it. And that you know when to seek professional help. Reading “Workshop Wound Care,” by Dr. Jeffery Hill, is a good first step.
A syringe with splash guard is good to have on hand for deep wound if you live far away from a healthcare center.
The following is excerpted from Dr. Jefferey Hill’s “Workshop Wound Care.” The book – the newest offering in our pocket book series – delves right to the heart of what you need to know when faced with common workshop injuries, from lacerations, to puncture wounds to material in the eye. Dr. Hill is an emergency room physician and an active woodworker. So he knows exactly the information a woodworker needs to know when it comes to injuries. And he presents information in a way that a non-medical professional can easily understand it.
The initial steps of wound care are critically important to creating an environment that promotes healing with a quick return to normal function and (if it’s a concern of yours) good cosmetic outcomes. As we covered in Chapter 4, Wound Healing Primer, there are a number of factors that can affect the healing process.
Wounds that heal well have minimal tissue damage, don’t get infected and have tissue layers that line up well. The amount of tissue damage is, generally speaking, a function of the way the injury occurred (crush injuries mean more tissue destruction as opposed to lacerations, which have minimal destruction apart from the severed tissue layers). Sometimes, however, actions taken early in the wound care process can worsen some of the existing tissue damage, or, in the very least, can fight against creating the optimal healing environment.
Stopping ongoing bleeding is clearly the first step in addressing a fresh wound. But assuming the wound is small-ish and the bleeding is not severe enough to prompt you to seek care at your local urgent care or emergency department, your next steps should be focused on cleaning the wound to prevent infection.
In preventing wound infections, the single-most important step is thorough irrigation of the wound. Even a dump truck full of antibiotics won’t prevent an infection in a contaminated wound that wasn’t cleaned. Why? Exponential growth is the reason. A characteristic of exponential growth is that things seem fine until they aren’t and when things get bad, they get bad quickly (see the global COVID-19 pandemic).
Staphylococcus aureus, one of the more common bacteria on your skin and a frequent cause of wound infections, has a doubling time of about 90 minutes. So two bacteria become four in 90 minutes, four becomes eight in three hours, eight becomes 16 in four-and-a-half hours, 16 becomes 256 in six hours. Not too bad, honestly. By 24 hours you’re up to more than 130,000 bacteria in the wound. But, let’s say instead of starting with a wound with only two bacteria, you start in a wound that has 100 bacteria. This time, by 6 hours you’re at 1,600 bacteria. By 12 hours, 25,600. And by 24 hours, more than 6.5 million bacteria are in the wound.
Antibiotics are great and all, but by the time you get them prescribed, filled at the pharmacy, into your stomach, to the bloodstream and out to the wound, they would be greeted by a mass of hundreds of thousands to millions of bacteria.
This isn’t to say that antibiotics don’t have a role in preventing wound infections. They do, and are prescribed in certain circumstances based on the types of tissues injured, risk of infection and ability of the patient to fight off infections. But, the single-most important thing you can do to prevent a wound infection is to clean the wound thoroughly and decrease the bacteria cell counts in the wound. Get that number small enough, and the roving white blood cells that come to a healing wound will usually be able to take care of things.
‘Dilution is the Solution to Pollution’ Bacteria find their way into wounds in a number of ways. First, understand that bacteria are literally everywhere. They are on you, your skin, your chisel, your table saw blade, that nice piece of white oak that gave you a splinter while you were trying to rive out some leg stock. Everywhere. Bacteria can be forced from your skin into a wound by the chisel or whatever else caused your injury. They can catch a ride on a tiny sliver of wood or metal. Or they could be pressed into the wound as you try to hold a grimy rag to it attempting to stanch bleeding.
The goal of irrigation is to rid the wound of as many bacteria and as much bacteria-laden detritus as possible. As the old surgical maxim “dilution is the solution to pollution” suggests, the prime way that this is accomplished is through flowing a large volume of water over and through the wound. The surest way to clean the wound of bacteria and any foreign bodies is through a combination of volume and pressure.
The setup for this irrigation is shown in the photo [Above]. The splash guard is basically a fancy 19-gauge blunt plastic needle with a shield to keep water from spraying everywhere while you irrigate the wound. The combination of the syringe and this splash guard results in a flow of saline/water with pressures around 25 to 35 psi.
What About Tap Water? How much volume is enough volume? The general rule of thumb is that wounds should be irrigated with 500ml to 1L of fluid. But in practice, the real goal is to make sure the wounds are completely free of foreign bodies. Wounds that are clean in appearance to begin with might get away with smaller volumes of irrigation depending on location, depth of the wound and mechanism of injury.What About Tap Water?The type of irrigation just described is important for wounds that are relatively deep or fairly contaminated. Most of the wounds you’ll sustain in the workshop will be relatively small nicks, cuts and skin tears. For these minor wounds, thorough irrigation with tap water will do. In fact, there are a number of studies that show no difference in infection rates for wounds cleansed with tap water vs. saline, even for larger wounds. This of course assumes that the source of the tap water is clean – not really a concern for most municipal water sources, but could be a concern in developing nations or in underdeveloped and under-resourced pockets of the United States.
The process for irrigating a wound with tap water is quite simple (if a bit painful). Turn the tap to lukewarm/body temperature water (those newly exposed nerve fibers will be exceedingly sensitive to any stimuli). Let the water run over the wound for several minutes. Re-examine the wound to see if there is any debris remaining. If there is, you can try to irrigate again, or try to irrigate with the pressure irrigation setup described above, if you have a syringe with a splash guard. However, if the wound is that dirty you might need a more thorough irrigation in a healthcare setting.
Why not Hydrogen Peroxide, Iodine etc. Apart from water or saline, the only other thing that should be used to clean a wound is a mild soap and maybe a dilute iodine solution.
My experience while growing up in the United States Midwest was that every scrape, nick or cut should be cleaned out with hydrogen peroxide every day until the wound healed. And why not? It bubbles like mad, stings a bit and the wound looks a good deal cleaner afterward.
There are a number of problems with using hydrogen peroxide to clean wounds. For starters, it does a much better job of killing red blood cells than it does of killing bacteria. This can be helpful for wounds that have a lot of dried, caked-on blood as can often happen with wounds in hairy areas. It is far less helpful for your standard wound. For wounds that are a couple of days into healing, hydrogen peroxide has been shown to separate newly minted skin cells from the healing tissue at the base of wounds. And, in experimental conditions, hydrogen peroxide has been shown to delay wound healing. If you do choose to use hydrogen peroxide to clean dried blood off, be ready for some heat. The chemical degradation of hydrogen peroxide to water and oxygen is exothermic (it gives off heat). It’s not enough to cause any thermal burns to the area, but it is quite noticeable.
Iodine is frequently used to clean wounds and does have some advantages over saline irrigation alone in some situations. Iodine is sold in two formulations: a solution and a scrub. The scrub was designed for use on intact skin and for cleaning the skin surface prior to surgery. The detergent mixed into the scrub is toxic to tissues and shouldn’t be used in open wounds. Iodine solution is typically sold at a 10 percent concentration. When it is diluted to less than 1 percent, it is safe for use in open wounds and has excellent antibacterial, anti-viral and anti-fungal activity. In the emergency department, iodine-diluted solutions are typically used for irrigating wounds at high risk of infection (based on mechanism, contamination, location).
Iodine must be diluted to be used in open wounds.
Chlorhexadine is a surgical scrub soap that is also widely available. It was also designed for use primarily with intact skin. If you have had an elective surgery you may have been instructed to shower with it for several days/weeks prior to the surgery. The reason being that it builds up on the skin surface and has potent anti-bacterial properties (great for decreasing the risk of surgical site infection). It also has a detergent that can be toxic to the tissues in open wounds so its use in wound irrigation is discouraged.
Soaps work by liquefying fats and oils, making them soluble in water and able to be carried away by running water. Because bacterial cell walls are made of fat, soap is able to dissolve some of these cell membranes, killing the bacteria. Commercially available soaps are all generally quite mild in their fat-busting properties (they are fairly mild detergents) meaning that they should not be particularly toxic to open wounds.
Putting it all together, how should you clean your wound? First inspect the wound. Large, gaping wounds or wounds that have a lot of debris in them will likely need to be cleaned and repaired in a healthcare setting. Some initial irrigation of these wounds with running tap water may help you triage the wound and may help lightly clean it in preparation for a more thorough cleaning by a medical professional. After you irrigate under running tap water, cover the wound with sterile gauze that has been dampened with sterile saline and head to your local medical facility.
Smaller wounds, scrapes and lightly contaminated wounds that you feel can be dealt with at home should be first lightly cleaned with soap and water. Then allow lukewarm tap water to run over the wound for several minutes until it appears to be clean to your eye and no debris remains. If you still see some debris, you can try to use the aerosolized saline wound washes that are available in your local drugstore. It’s not clear how the pressures generated by these products compare to the pressure irrigation setup used in your local emergency department. As a general rule of thumb, if the wound still appears dirty, then you’ll need more aggressive cleaning by a healthcare professional and should seek care.
Do note that oftentimes the process of cleaning and irrigating the wound may cause it to start bleeding (you may have washed away the blood clots that stopped any previous bleeding). That’s OK. After you have finished cleaning the wound, you should be able to stop the bleeding again with a combination of direct pressure and maybe a pressure dressing.
After the wound is cleaned thoroughly and the bleeding has been stopped, you’re on to dressing the wound to keep it clean and promote healing.
