Under Pressure: The Crucial Role of PSI in Wound Irrigation

Author Ryan Hanes

Published Mar 08, 2023

Discover why PSI (Pounds per Square Inch) is important for pressurized wound irrigation and how it promotes healing, prevents infection, and aids visual inspection. Learn about the benefits of pressurized irrigation and how to choose the right delivery device for optimal wound care.

Perhaps now more than ever, wound care is an essential aspect of the healthcare spectrum and it involves a variety of processes and procedures aimed at promoting healing and preventing infection.

In recent years, there’s been an increased emphasis on the use of pressurized wound irrigation through mechanical hydrotherapy devices which offer higher levels of pressure for wound bed cleansing. Indications regarding pressure levels, or PSI (Pounds per Square Inch), have become effective protocols in achieving improved patient outcomes and advanced wound healing. In this article, we’ll explore the critical nature of PSI when it comes to wound irrigation.

Let’s Talk Irrigation

Wound irrigation is a cleansing process involving the constant flow of a solution across an open wound surface in order to achieve wound hydration, remove foreign debris, and aid in the physician’s visual inspection of the wound. Proper irrigation is indicated in the management of both acute and chronic wounds—especially those that will undergo suturing, surgical repair, or debridement⁵.

In comparison to other wound care cleansing practices—such as swabbing or bathing—wound irrigation is considered to be the most consistent and effective method¹.

The Benefits of Pressurized Irrigation

1. Removes Pathogens

PSI plays a crucial role in the removal of bacteria and other contaminants from the wound. Through appropriate use of pressurized cleansing, it’s easier to dislodge debris and bacteria from the wound bed¹⁻⁷. This can be particularly important in cases of infected wounds, where the presence of bacteria in the wound can significantly impede healing. In fact, pressurized cleansing ensures that pathogens are effectively removed from the wound site, reducing the risk of infection and aiding visual inspection⁸.

2. Promotes Granulation Tissue Formation

Some existing clinical research suggests that pressurized hydromechanical wound therapy can promote granulation tissue formation, a vital aspect of wound healing⁸. Granulation tissue is essential for wound healing as it contains blood vessels, fibroblasts, and other cells that produce collagen, a crucial component of the extracellular matrix. The wound bed is effectively stimulated through the use of pressurized cleansing, promoting the formation of granulation tissue, leading to improved wound healing outcomes.

3. Safe & Effective

Mechanical irrigation and other pressurized cleansing devices are a safe and effective means of wound cleansing, particularly in comparison to other forms of wound cleansing, such as scrubbing or soaking¹. Mechanical irrigation is gentle on the wound bed, ensuring that healthy tissue is not damaged in the process.

PSI in Practice

Delivery Device Decisions

Clinical literature supports the use of both low-pressure and high-pressure irrigation methods. While bulb syringe irrigation has persisted as a popular means of wound irrigation, current literature suggests pulsed lavage irrigation is more effective in decontamination of wounds². A 2006 study showed that pulsed lavage irrigation with 3 L of saline solution resulted in a reduction of approximately the same amount of bacteria as did irrigation with 9 L with use of a bulb syringe². This means that pulsed lavage irrigation allows for more effective decontamination of wounds in less time with respectively less cleansing solution.

When choosing a delivery method for wound irrigation is it vital to choose a tool that can deliver a consistent stream of solution across the wound bed, this allows for optimal clearing of debris present in the wound and decontamination. The Agency for Health Care Policy and Research (AHCPR) recommended a pressure of 4 -15 pound per square inch (PSI) to be ideal for wound irrigation⁶.

Selecting the Right Solution

Selecting the right solution for wound irrigation is just as important as selecting the optimal delivery device. Since its emergence during World War I, hypochlorous acid (HOCl) has risen as a highly regarded wound irrigation solution due to its unique combination of safety and efficacy—a profile not seen in essentially any other wound care product on the market.

As a direct replacement for saline in many applications, HOCl can be used in combination with pressurized wound irrigation, like the innovative BIHOCL Probe and Shield, to promote wound healing, remove biofilm and microorganisms, and prevent infection.

A demonstration of the BIHOCL PureCleanse solution being applied using the shield applicator.

HOCl is a natural substance produced by the body's immune system to fight infection and has been shown to be highly effective in killing bacteria, viruses, and fungi while being gentle on healthy tissue. Additionally, HOCl has a neutral pH and does not cause stinging or burning sensations, making it more comfortable for patients. In comparison to other wound irrigation solutions, such as povidone-iodine, which can cause skin irritation and allergic reactions, HOCl is an optimal solution for wound irrigation.

BIHOCL PureCleanse offers an advanced hypochlorous solution that easily accepts the BIHOCL Probe and/or Shield attachment—a combination that is welcomed innovation in a field that needs it most. Visit our Advanced Wound Care page, or contact us to learn more!

References

Ennis WJ, Valdes W, Salzman S, Fishman D, Meneses P. Trauma and wound care. 2004. 291-307.
Svoboda, M. S. J., Bice, T. G., Gooden, H. A., Brooks, D. E., Thomas, D. B., & Wenke, J. C. (2006). Comparison of bulb syringe and pulsed lavage irrigation with use of a bioluminescent musculoskeletal wound model. JBJS, 88(10), 2167-2174.
Gabriel, A. (2015). Wound irrigation: overview, preparation, technique.
Hiebert, J. M., & Robson, M. C. (2016). The immediate and delayed post-debridement effects on tissue bacterial wound counts of hypochlorous acid versus saline irrigation in chronic wounds. Eplasty, 16.
Lewis, K., & Pay, J. L. (2022). Wound Irrigation. In StatPearls [Internet]. StatPearls Publishing.
Luedtke-Hoffmann, K. A., & Schafer, D. S. (2000). Pulsed lavage in wound cleansing. Physical Therapy, 80(3), 292-300.
Grade, A., Grade, B., Grade, C., & Grade, D. Solutions, techniques and pressure in wound cleansing.
Desjardins, H., & Guo, L. (2018). An overlooked but effective wound care methodology: hydromechanical therapy revisited. Plastic and Reconstructive Surgery Global Open, 6(8).