Wound Cleansing Mistakes

Wound cleansing is one of the most familiar steps in wound care. It is also one that deserves regular reassessment.

For busy clinicians, the process can become routine: remove the dressing, cleanse the wound, apply a new dressing, and move on. Yet decisions made during cleansing can influence wound bed preparation, infection prevention and management, surrounding skin integrity, and the patient’s experience.

The International Wound Infection Institute (IWII) explored these considerations in its 2025 consensus document, Therapeutic Wound and Skin Cleansing: Clinical Evidence and Recommendations. The guidance frames cleansing as a therapeutic intervention that calls for thoughtful selection of solutions, techniques, and sequencing while considering the individual patient’s needs.

The IWII’s 2026 Wound Infection in Clinical Practice guidance provides additional context around infection risk, biofilm management, and antimicrobial stewardship.

Here are seven familiar wound cleansing practices worth reconsidering.

1. Cleansing only when the wound looks dirty

A wound may appear relatively clean while still containing exudate, dressing residue, debris, or microorganisms that are not readily visible. Waiting for obvious contamination can overlook cleansing’s role in wound bed preparation and infection prevention and management.

The IWII recommends therapeutic cleansing of the wound bed, wound edge, periwound, and surrounding skin whenever a wound dressing is changed or removed.

Importantly, this recommendation does not mean dressings should be changed more frequently solely for cleansing. Dressing-change frequency should remain individualized according to wound characteristics, dressing requirements, patient needs, and the established care plan.

What to reconsider: Incorporate appropriate cleansing into planned dressing changes rather than relying on visible debris as the only reason to cleanse.

2. Using the same cleansing solution for every wound

Normal saline is familiar and widely used, but familiarity alone should not determine solution selection. Wound characteristics, infection risk, tissue condition, patient factors, and treatment goals all influence which cleansing solution is appropriate.

The IWII’s therapeutic cleansing guidance highlights considerations such as antimicrobial activity, cytotoxicity, pH, and potential allergens. Its 2026 wound infection guidance also reinforces the importance of antimicrobial stewardship and thoughtful selection of antiseptic interventions.

Antimicrobial cleansing solutions may be appropriate when wound infection is suspected or confirmed, but their selection should be based on clinical assessment and incorporated into a comprehensive infection-management plan. An increased risk of infection does not automatically mean every wound requires an antimicrobial cleanser.

Product instructions for use, recommended contact times, local protocols, and the patient’s overall treatment plan should also guide selection.

What to reconsider: Reevaluate cleansing solutions as wound characteristics and infection risks change rather than maintaining the same solution throughout treatment without reassessment.

3. Assuming more cleansing pressure always means better results

Effective wound cleansing requires sufficient action to remove unwanted material without unnecessarily damaging viable tissue or increasing patient discomfort.

While therapeutic cleansing may sometimes require vigorous techniques, greater pressure does not inherently produce better results. The appropriate intensity depends on the wound’s presentation, tissue condition, microbial burden, clinical objectives, and patient tolerance.

The IWII supports an individualized approach, recognizing that cleansing intensity may range from gentle to vigorous depending on clinical assessment.

For wounds with fragile granulation tissue or significant discomfort, a gentler approach may be appropriate. Other wound presentations may require more deliberate mechanical cleansing to address debris or other material, with debridement considered separately when clinically indicated.

The objective is effective wound bed preparation while protecting viable tissue and respecting the patient’s pain experience.

What to reconsider: Select cleansing intensity based on wound assessment and patient tolerance rather than assuming maximum pressure or aggressive technique is necessary for effective cleansing.

4. Focusing exclusively on the wound bed

The wound bed naturally receives considerable attention, but effective cleansing extends beyond the open wound.

Exudate, moisture, adhesive residue, and debris can affect the periwound and surrounding skin. Changes in these areas may also provide important information about wound progression, infection concerns, and dressing performance.

The IWII identifies three therapeutic cleansing zones:

• Zone 1: Wound bed and wound edge
• Zone 2: Periwound skin
• Zone 3: Surrounding skin

Each zone requires assessment and an appropriate cleansing approach during a dressing procedure.

Protecting the skin around a wound is particularly important when managing moisture, preventing maceration, and supporting the integrity of tissue exposed to wound drainage and adhesives.

What to reconsider: Include the wound edge, periwound, and surrounding skin in routine assessment and cleansing rather than focusing exclusively on the wound bed.

5. Following a cleansing sequence without considering contamination and tissue vulnerability

The order in which a wound and its surrounding tissues are cleansed can influence contamination risk and the effectiveness of the procedure.

Traditionally, many clinicians have been taught to cleanse from the center of the wound outward. The IWII’s 2025 guidance offers a more detailed framework that considers the different cleansing zones and the vulnerability of tissue within the wound.

The IWII recommends cleansing the surrounding skin and periwound first, followed by the wound bed, beginning with the most vulnerable regions and progressing toward the least vulnerable regions based on wound assessment.

This approach emphasizes preparing the surrounding tissues before addressing the wound bed and using techniques that minimize transfer of contaminants between areas.

Within the wound itself, however, the appropriate direction of cleansing is not always straightforward. The IWII acknowledges ongoing debate about inside-to-outside versus outside-to-inside methods.

Rather than prescribing one universal direction for every wound, the guidance emphasizes assessing tissue vulnerability, contamination, and wound characteristics when determining the appropriate sequence.

Clinicians should use appropriate techniques and materials to minimize cross-contamination between cleansing zones while following applicable protocols.

What to reconsider: Revisit traditional cleansing sequences in light of the IWII recommendations. Cleanse the surrounding skin and periwound before the wound bed, then tailor cleansing within the wound according to tissue vulnerability, contamination risk, and clinical assessment.

6. Treating patient discomfort as unavoidable

Pain can significantly affect the wound care experience. Tender tissue, adherent dressings, inflammation, and previous painful procedures can make even routine cleansing uncomfortable.

The IWII recognizes patient comfort and pain management as important considerations when selecting cleansing techniques and determining the intensity of treatment.

Before beginning, clinicians should assess pain, explain the procedure, and consider whether pain-management interventions are needed.

During cleansing, patient feedback should help guide technique, pressure, and adjustments to the care plan.

A more vigorous technique may be clinically appropriate in certain situations, but patient tolerance and the potential for tissue injury must remain part of that decision.

What to reconsider: Build pain assessment, communication, and appropriate comfort measures into the cleansing process. Adjust technique and intensity when clinically indicated rather than treating discomfort as an unavoidable part of wound care.

7. Keeping the original cleansing plan even as the wound changes

Wounds change throughout treatment. Exudate levels may increase or decrease, tissue characteristics evolve, and concerns related to infection or periwound integrity may emerge.

A cleansing solution or technique selected during the initial assessment may not remain the most appropriate choice as these conditions change.

The IWII’s 2025 and 2026 guidance reinforces the importance of ongoing assessment, wound infection recognition, and individualized treatment decisions.

This includes reassessing whether antimicrobial interventions remain appropriate, whether cleansing techniques are achieving their intended objectives, and whether the patient continues to tolerate the approach.

Planned dressing changes provide opportunities to evaluate the wound bed, wound edge, periwound, surrounding skin, and patient response.

Documenting these findings helps the care team understand when and why changes to the cleansing plan are necessary.

What to reconsider: Treat wound cleansing as an evolving clinical decision. Regularly reassess the solution, technique, intensity, and treatment objectives as the wound progresses.

Turning guidance into everyday practice

Effective wound cleansing requires more than selecting a solution and following a familiar routine.

It calls for thoughtful consideration of the wound bed, wound edge, periwound, surrounding skin, cleansing technique, and patient experience.

The IWII’s recommendations provide a framework for approaching these decisions, emphasizing wound-specific assessment, appropriate cleansing intensity, deliberate sequencing, and responsible antimicrobial use.

For clinicians, revisiting established practices offers an opportunity to align everyday wound care with evolving clinical guidance while remaining attentive to each patient’s individual needs.

For a broader summary, explore extriCARE’s related article, 10 Things to Know About the 2025 IWII Wound Cleansing Updates.

Clinical disclaimer

This article is intended for educational purposes and is not a substitute for clinical judgment, institutional protocols, product instructions for use, or applicable local and national guidance.

References

1. International Wound Infection Institute. (2025). Therapeutic wound and skin cleansing: Clinical evidence and recommendations. Wounds International. https://woundsinternational.com/consensus-documents/therapeutic-wound-and-skin-cleansing-clinical-evidence-and-recommendations/
2. International Wound Infection Institute. (2026). Wound infection in clinical practice: Principles of best practice (4th ed.). Wounds International. https://woundsinternational.com/consensus-documents/wound-infection-in-clinical-practice-principles-of-best-practice-fourth-edition/