Good antiseptic products cleanse wounds without further injuring tissue; the best tailor that to each individual’s needs.
How To Buy The Best Antiseptic For Treating An Open Wound
Wound care studies have found between ~5.6% and 26% of wounds become infected, a factor contributing to the chronic wound experienced by 13 million people worldwide each year.
Antiseptics can be used to treat or prevent infection of an open wound. But, it’s important to choose the right one for the job.
How Antiseptic Treatment Helps Open Wounds Heal
In Use of Wound Antiseptics In Practice, a best practices guide by Wounds International, medical professionals build on the International Wound Infection Institute’s concept of antiseptics:
“IWII (2022) has defined an antiseptic as a ‘topical agent with broad-spectrum activity that inhibits multiplication of, or sometimes kills, microorganisms’.
Antiseptics are generally applied to skin, mucous membranes and surface wounds, as well as other living tissues, with the aim of inhibiting microbial growth without necessarily killing microbes (Babalska et al, 2021).
Due to the emergence of new technologies…antiseptics can act beyond bacterial killing and without cytotoxicity (IWII, 2022).”
With this definition in mind, antiseptics fall into three categories. Each type helps wounds heal in a distinct way.
Bacteriostatic Antiseptics Prevent Microbial Growth
Bacteriostatic antiseptics are akin to disinfectants. They make the environment inhospitable for bacteria (among other microbes). These disrupt microbial reproduction.
Debriding Antiseptics Push Out Slough & Exudate
Debriding antiseptics cleanse through physical, mechanical action. Their molecules react to break up biofilms, dislodge microbial colonies, and push out slough, film, and wound exudate.
Surfactants are effective at forcing pathogens to release their “grip” on the surface of skin or a wound, making it easier to wash them away with normal irrigation.
Oxidizers can be both debriding and biocidal. These solutions trigger a redox reaction, which destabilizes the physical structure of certain microbes. It also generates bubbles, which can physically force debris, dead tissue, and pus out from a wound.
Biocidal Cleansers Kill Microbes
Biocidal cleansers kill microbes directly, typically on contact. Some are specifically designed to target certain types of pathogens (i.e. anti-fungals, antibiotics), while others affect a broad spectrum.
Most biocidal cleansers’ formulas trigger precise chemical reactions when they interact with infective microbes. These reactions target different processes or structures in the microbes’ cells, disrupting or destroying them.
Crucially, micro-organisms can develop resistances to certain targeted attacks. So, antiseptic formulas must be updated over time to address new resistances.
Key Features of the Best Antiseptic Wound Cleansers
When choosing an antiseptic to cleanse an open wound, look for certain beneficial traits. Five characteristics are key.
1. Biocompatibility
Biocompatibility is the degree to which a material interacts with the body harmoniously or antagonistically. According to the National Institute of Biomedical Imaging and Bioengineering (NIBIB) glossary:
“[Biocompatibility is] a measure of how a biomaterial interacts in the body with the surrounding cells, tissues and other factors.
A biomaterial is considered to have good biocompatibility if it does not generate a vigorous immune response, resists build-up of proteins and other substances on its surface that would hinder its function, and is resistant to infection.”
An antiseptic can be biocompatible in some ways and incompatible in others. A moderately biocompatible solution may resist infection and substance buildup, but simultaneously trigger an immune response in some people, or injure some healthy cells.
In contrast, a highly biocompatible antiseptic will kill infective pathogens without injuring healthy tissues or causing inflammation.
2. Wound Environment Appropriateness
Different wounds pose different risks. The best antiseptic for a given wound will not risk damaging the wound’s bed. Nor will it increase the likelihood of a wound drying out or over-hydrating (causing maceration).
3. Balanced pH
A solution’s pH tells you how acidic or alkaline it is.
Technically, a truly pH neutral fluid, like water, has a pH of 7. But, most “neutral” cleansers actually match the acidity of the protective mantle on the skin’s stratum corneum.
The mantle is a thin film on the outermost layer of skin, which shields deeper layers from germs and debris. This “acid mantle” has a pH of around 5.5. Neutral cleansers match this pH to prevent any damage to the mantle, reduce irritation, and enhance the solution’s biocidal effect.
A cleanser doesn’t have to be neutral to be the right choice. But, antiseptics that are too caustic (or too acidic) can cause problems.
4. Soothing Ingredients
The best antiseptics for open wounds often include ingredients which alleviate pain, itchiness, dryness, or inflammation. These inclusions can feel comforting in the moment of application, and many also help wounds heal faster—with fewer complications.
5. Hypoallergenic Formula
Patients with known allergies should avoid any product containing that allergen. Beyond that, hypoallergenic solutions are less likely to induce allergic or inflammatory responses in people, even those who aren’t aware of their allergy status.
Understanding 8 Key Antiseptics For Open Wounds
There is no single best antiseptic for open wounds. Instead, studies and clinical practice experiences support differentiating antiseptics in distinct categories.
There are eight types of antiseptic solutions widely used on wounds today.
Not all are equally effective. This sections answers key questions about each antiseptic type, including:
- The antiseptic category’s definition
- How it works to kill germs
- What type of wounds it’s best used for
- Risks of using this type of antiseptic
- When to avoid antiseptics in this category
- Which antiseptic products of each type wound care professionals recommend
1. Antibiotics (Polypeptide & Aminoglycoside)
Good for: acute, minor cuts and burns
What Are Antibiotic Antiseptic Solutions?
Antibiotic antiseptic cleansers incorporate ingredients with known bactericidal effects. The most common effect is interference with—and destruction of—the cell walls of bacteria.
Many antibiotic ingredients are naturally occurring, bioactive compounds. They’re produced by different species of molds or lichens.
Aminoglycosides (e.g. neomycin) and polypeptides (e.g. bacitracin) are common antibiotic inclusion in these antiseptics.
When To Use This Type of Antiseptic
Use an over-the-counter antibiotic antiseptic to cleanse minor acute wounds, like scrapes, cuts, or first-degree burns. It can also be used prophylatically, if there’s a risk of contamination.
How Do Neomycin/Bactracin Antiseptic Cleansers Work?
Most topical antibiotic cleansers are labeled “triple antibiotics,” matching the formula of brands like Neosporin. The vast majority of these antiseptics use three specific antibiotic ingredients: neomycin, bacitracin, and polymyxin B.
The National Library of Medicine’s reference guide, StatPearls, describes the first ingredient’s mechanism of action its “Neomycin” resource page:
”Neomycin belongs to the aminoglycosides group of antibiotics, which functions by inhibiting bacterial protein synthesis, resulting in a bactericidal effect primarily against gram-negative bacteria.”
Batritracin and polymyxin B are both polypeptide antibiotics. The National Cancer Institute’s Drug Dictionary describes how these kinds of antibiotics work in its Bacitracin entry:
“…cyclic polypeptide antibiotics…bind to C55-isoprenyl pyrophosphate, a biphosphate lipid transport molecule that carries the building blocks of the peptidoglycan bacterial cell wall. The binding interferes with the enzymatic dephosphorylation of the C55-isoprenyl pyrophosphate and prevents peptidoglycan synthesis, thereby inhibiting bacterial cell growth.”
Though they target different components of the bacteria, they both ultimately disrupt, and destroy, bacteria cells’ walls.
Risks & Contraindications
Over-the-counter antibiotic antiseptic cleansers are contraindicated for inflamed minor wounds, like excoriated acne papules or cysts. Instead, prescription topical antibiotics targeting those conditions may be necessary.
Allergies to certain antibiotics are not uncommon. A person who has had an allergic reaction to an antibiotic should get allergy testing to determine which types of antibiotics to avoid. Do not use antibiotic antiseptics if you are allergic to aminoglycosides or polypeptides.
Certain health organizations recommend against antibiotic antiseptics due to the risk of antibiotic resistance.
Recommended Antibiotic Antiseptic Products
For minor cuts and burns in a contaminant-prone space, it’s a decent idea to use an antibiotic cleanser proactively. One good option is Waterjel Bacitracin Ointment. It’s an ointment that prevents bacterial infections on minor cuts and abrasions.
2. Alcohol-Based Antiseptics
Good for: scrapes and skin abrasions
What Are Alcohol-Based Antiseptic Solutions?
Alcohol-based antiseptic cleansers are typically sanitizers. They use molecules and compounds categorized as alcohols to kill germs. Ethanol, isopropyl alcohol, and propylene glycol are the most common options.
Most alcohol-based sanitizers are designed for use on intact skin, not to cleanse open wounds. There are some exceptions.
When To Use This Type of Antiseptic
Alcohol-based cleansers can be used as an acute wound rinse, if they’re not otherwise contraindicated. They’re better than nothing if there’s a risk of contamination or infection.
However, alcohol-based cleansers can be harmful to the body’s healthy tissues, and they don’t effectively kill spores or certain viruses. Thus, these cleansers shouldn’t be your first choice.
How Do Alcohol-Based Cleansers Work?
Alcohol kills pathogens by “denaturation.” The alcohol’s molecules break apart structural proteins in most microbes. This causes these single-celled organisms’ membranes to collapse. Without their membranes, most germs quickly dry up and die.
Notably, while alcohol-based cleansers are effectively biocidal “against most gram‐positive and gram‐negative bacteria,” as well as certain fungi and enveloped viruses, they have a few weaknesses. They can’t kill any pathogen without a membrane, including those with “spore” structures.
The alcohols most commonly used in antiseptic solutions are ethanol, isopropyl alcohol, and propylene glycol. Ethanol and isopropyl alcohol are most effective in concentrations of 70% or higher.
Propylene glycol is biocidal in concentrations of 25%-50%, depending on the specific microbe targeted. Note that propylene glycol based cleansers are safer to use on mucous membranes and bleeding wounds than isopropyl alcohol based antiseptics.
Risks & Contraindications
No alcohol solutions should not be used on burns, nor any wounds that require moisturization. These antiseptics are also highly flammable, so they shouldn’t be used with electrocautery.
Alcohol antiseptics don’t affect certain viruses, including norovirus, enterovirus, adenovirus, and rhinovirus. If these viruses are a potential contamination risk, choose a different cleanser.
Isopropyl Alcohol Vs. Propylene Glycol (Distinctions)
Isopropyl alcohol antiseptics pose a high risk of tissue injury. They often induce irritant contact dermatitis, causing stinging, inflammation, or itchiness. Do not use isopropyl alcohol on mucous membranes or on actively bleeding wounds.
Propylene glycol-based antiseptic cleansers are far less harmful and destructive to tissues. These can be used to clean open wounds in controlled concentrations.
Recommended Alcohol-Based Antiseptic Products
The most widely used alcohol-based antiseptic is isopropyl alcohol. Solutions like MedPride 70% Isopropyl Rubbing Alcohol are relatively safe to use to decontaminate shallow wounds and scrapes.
However, propylene glycol based antiseptic solutions, like CleanLife No Rinse Body Wash, are much safer. While it still should not be used on burns, it’s a good antiseptic choice to cleanse excoriated skin or abrasions.
3. PVP Iodine
Best for: puncture wounds, contaminated wounds
What Are PVP-Iodine Antiseptic Solutions?
Polyvinylpyrrolidone-iodine, also called (PVP)-iodine, is a unique form of the iodine molecule. Iodine demonstrates broad bacteriostatic and micro-biocidal properties.
When To Use This Type of Antiseptic
The document “Consensus For Wound Antisepsis” is the official guideline for antiseptic treatment among dermatologists and pharmacologists. It names (PVP)-iodine the “first choice” antiseptic treatment for “bites, stab/puncture, and gunshot wounds.”
Likewise, “Wound Antiseptics and European Guidelines for Antiseptic Application in Wound Treatment,” an official medical standards document of Europe, highlights similar benefits:
“The PVP-I solution is used as a medicinal product for antiseptic treatment of small superficial wounds of the skin and mucous membranes. It is the agent of choice for gunshot wounds, stab wounds and bites.”
Thus, PVP-iodine is a wise choice for puncture wounds and mucous membrane injuries.
How Do Polyvinylpyrrolidone Iodine Antiseptic Cleansers Work?
Free iodine molecules are like microbe-targeting bullets: shooting straight through microbial cells to destroy vital proteins, acids, and nucleotides.
Studies show that “iodine and iodophors have a wide range of activity against Gram‐positive and Gram‐negative bacteria, tubercle bacilli, fungi, protozoa and viruses, as well as some activity against bacterial spores.”
Composing iodine as PVP-I increases its “antimicrobial efficiency.” This version of iodine has an affinity for pathogen cell membranes, allowing it to “rapidly penetrate” targeted microbes.
Once inside the target cells, the iodine impacts structures by inactivating them. It affects “key groups of proteins, nucleotides and fatty acids in the cytoplasm and cytoplasmic membrane. Molecules required for survival are inactivated, resulting in cell death within a matter of seconds.”
Moreover, while iodine has a stronger biocidal impact on lipid‐enveloped viruses, it can also affect parvovirus. Currently, researchers do not understand how iodine injures or inhibits non-enveloped viruses, though they can confirm the effect.
Notably, iodine’s destructive effects are “rapidly neutralized” by blood and sputum, preventing it from injuring healthy tissues in a wound.
Risks & Contraindications
Despite iodine’s benefits, it poses some risks, and it shouldn’t be used in certain cases. Infants should not come into contact with iodine in any form.
A person taking Potassium Iodide (KI) or iodide solutions, Sodium Iodide I-131, Amiodarone, or any other medications containing iodides, should not use PVP-iodine as an antiseptic cleanser.
Likewise, PVP-iodine shouldn’t be used for wound care on a person with radiopaque iodine contrast (for medical scans) in their system.
Risks of PVP-iodine use for wounds include irritant contact dermatitis, stains (on skin, clothes, etc.), and hypothyroidism in infants.
Recommended PVP Iodine Antiseptic Products
Wound care professionals recommend treating bites and puncture wounds with Aplicare Povidone-Iodine Solution. Its broad-spectrum antimicrobial effect works fast, making it a great antiseptic for acute injuries.
The Aplicare formulation is far less likely to stain clothes and skin than conventional iodine solutions, while remaining just as strong.
4. Benzalkonium Chloride (BKC)
Good for: fighting multi-drug-resistant pathogens, necrosis prevention
What Are Benzalkonium Chloride Antiseptic Solutions?
Benzalkonium chloride (BKC) is an ammonia compound with broad antiseptic and disinfectant properties.
It’s used in topical antiseptic cleansers shown to promote rapid epithelialization and prevent wound de-vascularization.
When To Use This Type of Antiseptic
BKC antiseptics are useful in treating wounds at risk of certain types of infections, like Staphylococcus. They halt these infections’ spread and prevent contamination.
How Do BKC Antiseptic Cleansers Work?
Benzalkonium chloride is a “cationic surfactant.” It effectively dissociates positively charged salts in itself or its environment. These “bind to the negatively charged cell walls of bacteria, causing membrane disorganization, leakage, and cell lysis.”
This binding effect empowers it to destroy certain bacteria cells–as well as certain other pathogens.
BKC antiseptics also heighten the body’s immune response at the wound site. Certain heightened responses, like inflammation and white blood cell targeting, physically force colonizing pathogens out of the wound.
Risks & Contraindications
The heightened immune response of BKC can be a double-edged sword. Benzalkonium chloride antiseptic products shouldn’t be used by people with asthma, allergies, or eczema, as it is likely to trigger a flare or attack.
It’s also contraindicated for people with pulmonary conditions like COPD.
BKC can slow wound healing, and increased inflammation can be painful.
Due to these drawbacks, BKC is typically only recommended if first-choice antiseptics are unavailable.
Recommended BKC Antiseptic Cleansers
In the right circumstances, Blast X Antimicrobial Wound Gel is a helpful, Benzalkonium chloride-based wound cleanser. Its formula also incorporates citric acid, which studies show inhibits bacterial growth
A slight variant on BKC is BEC: Benzethonium chloride. This quaternary ammonium compound has antimicrobial effects similar to BKC’s, but its composition makes it less likely to trigger contact dermatitis and asthma attacks.
BEC antiseptics like Secura Total Body Foam Cleanser can clean mild abrasions, while posing a lower risk than BKCs.
5. Hydrogen Peroxide
Not recommended
What Are Hydrogen Peroxide Antiseptic Solutions?
Hydrogen peroxide solutions are typically 3% H₂O₂ dissolved in water. They’re oxidizing antimicrobial (biocidal) agents.
When To Use This Type of Antiseptic
This is not recommended as an antiseptic for cleansing skin, nor any type of injury. Do not use hydrogen peroxide as an antiseptic on open wounds.
How Do Hydrogen Peroxide Antiseptic Cleansers Work?
Hydrogen peroxide products are diluted H₂O₂ solutions. They work as cleansers because they’re oxidizers. In our resource, “Is Hydrogen Peroxide On Wounds Safe? H₂O₂ FAQs” the Medical Monks team explores how it works in more detail. Here’s an excerpt:
H₂O₂, like most oxidizers, has antiseptic properties.
Oxidizing agents can kill germs and clear away stains through an oxidation–reduction (redox) reaction.
A redox reaction is a molecular transformation. It’s caused by the interaction of the “extra” oxygen atoms in the cleanser’s molecules and certain other molecules (like those in many bacteria or coffee stains).
The interaction causes an instant chemical change, pulling electrons away from the molecules in the stain or germ.
Losing these electrons changes the “oxidation state” of the molecules. This, in turn, destabilizes the entire structure of the pathogen / stain.
In many cases, that destabilization alone is enough to cause the substance to wholly disintegrate. Disintegration dissolves the stain and kills the bacteria.
Unfortunately, while oxidizers are great at killing microbes, they aren’t really safe to apply to wounds. They’re too destructive towards healthy cells. Moreover, using H₂O₂ to clean wounds risks dangerous—even lethal—side effects.
Risks & Contraindications
Hydrogen peroxide is too dangerous to use as an antiseptic on open wounds. Risks include:
- Harm or destruction of healthy granulation tissue
- Damage of necessary fibrin
- Delayed or prolonged wound healing
- Skin irritation
- Inflammation
- Air-gas embolism
- Lipid peroxidation (can damage red blood cells)
Recommended H₂O₂ Antiseptic Products
No hydrogen peroxide products are recommended for wound care.
6. Polyhexamethylene hydrochloride biguanide (PHMB)
Best for: chemical burns, colonized wounds
What Are PHMB Antiseptic Solutions?
PHMB is a biaguanide polymer. Its molecules carry a positive electron charge, and it has powerful biocidal effects. Studies show PHMB kills bacteria and fungi in 15-30 minutes by destroying microbial cell membranes.
When To Use This Type of Antiseptic
In the official medical standards document “Wound Antiseptics and European Guidelines for Antiseptic Application in Wound Treatment,” PHMB is “recommended in the treatment of epithelial lesions and second-degree burns.”
The recommendation is made after their analyses showed PHMB treatments for open wounds “completely eliminate Staphylococcus epidermidis strains” in less than a day, and effectively combat both MRSA and VRE.
Moreover, the review board found polyhexamethylene hydrochloride biguanide supported certain types of wound healing better than PVP-I. Antiseptic PVP-I solutions inhibit the reepithelialization process, while PHMB lets it proceed freely.
PHMB solutions are formulated to match the pH of skin and mucous membranes. As such, they’ve become a promising treatment for certain oral lesions and bacterial vaginosis.
How Does PHMB Work In Antiseptic Cleansers?
The European wound treatment guidelines detail how PHMB solutions work to kill pathogens. The solutions use three mechanisms to mount their attacks.
First, “PHMB binds to negatively charged phosphate phospholipid groups that are a component of the bacterial cell wall. By sinking non-polar segments of the molecule into the hydrophobic interior of the cell membrane, it results in membrane dysfunction.”
At the same time, “PHMB increases the distance between the lipid molecules of the membrane,” an act which “affects the proper functioning of ion pumps, various enzymes and bacterial cell receptors.”
Finally, the compound “stiffens the [microbe’s] liquid bilayer membrane, leading to an increase in its permeability. The accumulation of adverse effects induced by PHMB ultimately leads to the disruption of the cell wall and membrane and the death of microorganisms exposed to the antiseptic.”
Fortunately, despite its multifaceted attack on germs, PHMB rarely imposes any negative effects on human tissues.
Risks & Contraindications
Scientific reviews describe PHMB as largely safe for short-term use on open wounds:
“Despite the high affinity of PHMB with microbial cells, this substance has limited effects on human and animal cells. Polihexinide has a large margin of safety in clinical use.”
Allergic reactions to PHMB are rare. However, “Allergy to PHMB is associated with dermatitis, old age and occupational exposure.” While these are minority circumstances, they are not rare.
Moreover, PHMB’s tissue affinity makes it a poor candidate for long-term use.
Fortunately, that’s not an issue with its application as an open wound cleanser
Recommended PHMB Antiseptic Products
Wound care professionals recommend gentle PHMB solutions as open wound antiseptics. One well-reputed option is Prontosan Wound Irrigation Solution.
Prontosan combines PHMB with a surfactant. Together, the two ingredients can remove debris from the wound with simple irrigation, while preventing (or treating) infections inhibiting healing.
The Prontosan solution affects the body’s enzymes in the wound, encouraging them to help push out dead or infected tissue. This process is called “autolytic debridement.” It’s one key way to prevent tissue necrosis.
Another PHMB antiseptic recommended by professionals is BIAKŌS. The BIAKŌS® Antimicrobial Skin and Wound Irrigation Solution blends the biaguanide polymer with citric acid.
In a recent study, “Citric acid ointment was found effective in controlling infections. Out of 259 cases [treated with citric acid] 244 (around 95%) were healed.” Given its bactericidal effect, the study’s lead researchers concluded that it’s, “the best alternative for the treatment of traumatic wounds. Besides these properties, citric acid has no adverse effects and it is a good dressing agent.”
By bringing these two antimicrobial agents together, the highly biocompatible BIAKŌS® solution creates a safe wound healing environment. It protects against bacteria, viruses, fungi, and spores while keeping the wound appropriately hydrated and the wound’s pH stable.
7. Hypochlorous acid (HOCl)
Best for: chronic wounds, ulcers
What Are Hypochlorous Acid Antiseptic Solutions?
HOCl is an endogenous substance found naturally in mammals. It’s an oxidizing agent, and its antimicrobial action is effective against a broad range of microorganisms.
HOCl solutions utilize these antimicrobial effects for wound treatment.
Hypochlorous antiseptics are simultaneously so powerful, yet so non-toxic to humans, the World Health Organization added them to its official, global List of Essential Medicines in 2021.
When To Use This Type of Antiseptic
HOCl antiseptics can be used in almost all circumstances. However, they’re particularly effective when treating chronic wounds, including lesions and ulcers.
How Do HOCl Antiseptic Cleansers Work?
As a natural product of the human immune system, HOCl has been thoroughly studied as a potential antiseptic. Given its source, the compound is highly biocompatible with the human body. Moreover, its enzymes have a truly wide spectrum of effect.
In Hypochlorous Acid: A Review, biochemists summarize the mechanisms of the substance’s antimicrobial action:
Neutrophils, eosinophils, mononuclear phagocytes, and B lymphocytes produce HOCl in response to injury and infection through the mitochondrial membrane–bound enzyme known as ‘respiratory burst nicotinamide adenine dinucleotide phosphate oxidase.’
HOCl selectively binds with the unsaturated lipid layer and subsequently disrupts cellular integrity. Between pH levels of 3 and 6, the predominant species is HOCl that has maximal antimicrobial properties.
HOCl is a powerful oxidizing agent. In aqueous solution, it dissociates into H+ and OCl–, denaturing and aggregating proteins.
HOCl also destroys viruses by chlorination by forming chloramines and nitrogen-centered radicals, resulting in single- as well as double-stranded DNA breaks, rendering the nucleic acid useless and the virus harmless.
Risks & Contraindications
HOCl antiseptics are the lowest-risk open wound cleansing solutions. They’re entirely non-cytotoxic and broadly biocompatible.
Recommended HOCl Antiseptic Products
For people seeking an HOCl-based antiseptic, the professionals recommend Vashe Wound Cleanser.
It’s one of the safest cleansing solutions for open-wound care. Not only is it completely biocompatible and non-cytotoxic, but it also matches skin’s pH (5.5).
Studies show Vashe Wound Cleanser is safe for use on burns (including most chemical burns), and it reliably kills infectious pathogens—without damaging skin.
Clear away odor-causing microbes and speed wound healing—naturally.
8. Sodium Hypochlorite (NaOCl) Solutions
Best for: decontamination of acute wounds, good for puncture wounds
What Are (NaOCl) Antiseptic Solutions?
Aqueous sodium hypochlorite solutions, or (NaOCl), release active chlorine. When it’s dissolved in water, NaOCl “hydrolyses,” transforming into hypochlorous acid.
This action gives NaOCl solutions many of the same antiseptic properties as HOCl.
When To Use This Type of Antiseptic
The “Wound Antiseptics and European Guidelines for Antiseptic Application in Wound Treatment” recommends using sodium hypochlorite as a first-line Antiseptics option when:
- Decontaminating acute and chronic wounds
- Rinsing the peritoneal cavity
- Cleansing wound with no drainage
The standard also ranks sodium hypochlorite as the next-best-choice for antiseptic treatment of open bite, puncture, or gunshot wounds.
How Do NaOCl Antiseptic Cleansers Work?
NaOCl solutions often transform sodium hypochlorite into HCOl, then attack pathogens using similar means.
Risks & Contraindications
Concentration is key to managing risks. In concentrations below 5%, no systematic harms have been observed through application.
However, allergic reactions, dermatitis, and skin necrosis are known risks at certain higher concentrations.
Recommended Sodium Hypochlorite (NaOCl) Antiseptic Products
One of the most reliable (NaOCl) antiseptics is Dakin’s Solution. It’s a broad-spectrum antimicrobial solution of 0.125% sodium hypochlorite.
Longitudinal studies show Dakin’s solution is a good tool for addressing chronic wounds, as it targets the bacteria and fungi which often creates long lasting barriers to wound healing.
A gentler alternative is Microcyn. It combines Sodium Hypochlorite with HOCl, offering a sting-free wound care solution.
Its formula excludes steroids and antibiotics, so it’s often an effective treatment option for multi-drug-resistant infections.
How To Treat An Open Wound With Antiseptic Cleanser
The best practices for antiseptic wound care and treatment vary, depending on the type of wound you’re dealing with.
If a wound’s bleeding is not under control, or if the wound is minor and the patient faces a significant risk of poor tissue response (allergic reaction, etc.), don’t use an antiseptic at all.
Otherwise, apply antiseptic in accordance with best practices, detailed below.
1. Identify Wound Type
Different types of wounds require different modes of care. A very minor, shallow wound, like a papercut, may only require a rinse with clean water and a flexible bandage.
Before applying antiseptic, identify whether the wound is a:
- puncture wound
- surgical wound
- burn
- thermal
- chemical
- degree of severity____
- chronic ulcer or lesion
- peristomal / perineal skin excoriation
- laceration
- with debris / contaminants
- shearing
- skin tear
- friction / chafing
- abrasion
- with debris / contaminants
After determining wound type, that can guide your next steps. Wounds that do not stop bleeding after applying pressure, puncture wounds, wounds with embedded debris, and wounds injuring organs or amputating extremities are emergencies.
The non-profit American College of Emergency Physicians offers a free, useful guide to assessing wound severity. It makes clear which wounds require a trip to Urgent Care, which can be treated at home, and when calling 911 is mandatory.
2. Infection Risk Assessment & Diagnostic Swab
Once you know the type of wound you’re treating, assess the risk of infection. This may mean taking a diagnostic swab or biopsy, or it may mean a simple visual assessment and evaluation via questionnaire.
Wound International recommends taking “a whole person approach.” This means using an assessment method that takes the individual’s unique medical condition into account.
For example, “clinical signs and symptoms of wound infection are often missing in patients with arterial, or venous, insufficiency and diabetes neuropathy. Therefore, clinicians should…consider the patient’s disease status to decide which treatment option is most appropriate.”
If any infection is present, an antiseptic needs to be able to address that particular colonizing pathogen. If there is no infection, the antiseptic should still be chosen with the individual’s condition in mind.
3. Choose The Right Antiseptic For This Specific Wound
Choose an antiseptic cleanser that reliably addresses the type of infection present (if any).
Then, list the wounded individual’s medical diagnoses, current prescriptions, and any supplements they take. Cross check the list with available antiseptic options, to eliminate any which are contraindicated.
Evaluate the antiseptic products for biocompatibility, and check the safety data sheet to ensure the product is free from any ingredients the individual is allergic to.
When choosing, prioritize highly biocompatible and non-cytotoxic options.
4. Clean Skin Around The Wound With Antiseptic
Before cleaning the wound itself, cleanse the skin around it. Use gentle disinfectant wipes, if possible. Do not touch the wound in this phase.
5. Wash Wound Surface (Saline / Cleanser Is Wound-Type Dependent)
Wash the wound’s surface by running sterile water or saline over it. Depending on the type of wound, a surfactant soap, antibiotic cleanser, or antibiotic-free antiseptic may be used for this process.
Prophylactic antibiotics are recommended when the wounded person is immunocompromised, the wound is contaminated, or the wound was exposed to a high-risk environment. In other cases, antibiotic cleansers are not recommended, due to the risk of antibiotic resistance.
Note that puncture wounds and bites should NOT be subject to irrigation with any pressurized fluid, including saline, except under the supervision of emergency medicine professionals.
Please seek guidance specific to puncture wounds, or seek emergency medical care.
6. Manage Pain Throughout Cleansing
Pain relief should be prioritized during cleansing. Pain is a warning sign. Note any painful sensations (if you’re cleansing your own wound) or reported pain (if you’re cleaning another individual’s wound). Stay alert for signs of irritation, inflammation, blistering, or atypical reactions to cleansers.
To manage pain, consider applying localized anesthetics, like lidocaine or benzocaine. Or, use anti-inflammatory agents (unless otherwise contraindicated). Certain antiseptic solutions incorporate pain-relieving ingredients.
7. If Needed, Cleanse Wound Depths In Debride-Clean Pattern
The World Health Organization (WHO) sets the international standard for wound cleansing procedures. Their standardized, evidence-based process is detailed in their free guide, “Wound Toilet and Surgical Debridement.”
“Toilet” is a slightly old-fashioned term for wound irrigation. The guide makes the procedure’s steps clear. It uses straightforward language and offers illustrations.
The core process is a cleansing-debridement cycle. It’s first performed at the wound’s surface. Then it’s repeated, cleaning out deeper layers of the wound.
As with step 5, an antiseptic or saline may be used at this stage, depending on wound type.
Related Antiseptic Cleansing Strategies
The WHO’s process is compatible with the procedure laid out in “Techniques for aseptic dressing and procedures. First published by the International Center for Eye Health, it was later reproduced and preserved in the National Library of Medicine.
Notably, these techniques emphasize preventing contamination with both the cleansing directions and careful use of sanitized materials. Recommended tactics include:
“Start from the dirty area and then move out to the clean area. Be very careful when doing this as the tissue or skin may be tender and there may also be sutures in place. Clean the area without causing further damage or distress to the patient.
Make sure you do not re-introduce dirt or ooze by ensuring that cleaning materials (i.e. gauze, cotton balls) are not over-used. Change them regularly (use once only if possible) and never re-introduce them to a clean area once they have been contaminated.”
8. Dress With Ointments, Bandages Appropriate To The Wound Type
After cleaning the wound, dress it appropriately. In its consensus document, Wounds International emphasizes that antiseptics should never be the sole tool for infection prevention or treatment.
Instead, appropriate dressings, and treatment of any underlying conditions, are key to healing.
Different types of wounds benefit from different types of care:
- Negative pressure wound therapy and compression therapy can help venous ulcers heal.
- Offloading or redistributing pressure, or adding barriers to prevent chafing from medical devices, can prevent the recurrence of pressure ulcers.
- Arterial restoration is key for isechemic wounds.
- Glycemic control is a vital treatment for diabetes-related ulcers or lesions.
Combining appropriate antiseptic cleansing with the right dressings and treatments improves the likelihood a wound heals successfully.
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Edited for content by JORDAN GAYSO.
