From preoperative planning to postoperative recovery, a surgeon’s role involves continuous decision-making that extends well beyond the confines of the operating room.
They navigate a constant risk-versus-reward balance, identifying opportunities to prevent complications throughout the care journey. Often, they must weigh variables both within and beyond their control — such as patient optimization and compliance, along with decisions around product selection, technique and overall cost. These are just some of the challenges they evaluate while staying focused on delivering the best possible outcomes, which is always their top priority.
To explore best practices in approaching these challenges, Becker’s Healthcare spoke with three leading surgeons who share common threads in their wound irrigation strategies.
Antonia Chen, MD (Dallas, Texas), Edward Karpman, MD, of El Camino Health (Mountain View, Calif.) and Ian Weber, MD, of the Joint Replacement Center (Westminster, Colo.) collectively perform over 1,000 procedures annually and have each engaged in and followed wound irrigation research for decades. They shared insights, strategies, and firsthand experience on optimizing wound irrigation to support successful outcomes, including shared perspectives on the complexities of wound irrigation and the role of Irrisept® Antimicrobial Wound Lavage in modern wound care protocols.
A physician can look to reduce complications before entering the OR
Patient selection and optimization challenges can present several pitfalls in wound management. Dr. Weber emphasizes the importance of this assessment, a task that takes place even before setting foot in the OR and believes this is an area that deserves more attention. Although there are limits to a surgeon’s control over patient readiness, Dr. Weber believes there are opportunities to mitigate risk by understanding medical conditions or comorbidities that can impede the healing process. Focusing on nutrition and reducing or removing harmful behaviors like smoking can reduce the chances of unfavorable outcomes.
“You’ve got to create a good host. You’ve got to create a situation where you can encourage or facilitate good wound healing. Making sure protein levels are up, not only for wound healing, but to prevent atrophy after surgery,” Dr. Weber said.
Proactive assessments and targeted optimization strategies can meaningfully reduce the likelihood of complications.
While no gold standard exists, evidence based solutions do
As Dr. Chen notes, there’s no single protocol that guarantees a complication-free outcome. “There is no holy grail that is going to prevent wound complications,” she said. “There is no one gold standard telling surgeons, ‘If you do this, then you won’t get a wound complication.’ It doesn’t exist.”
However, in addition to patient readiness, there are intervention techniques and specific products that do make a difference. Use of specific products, and the research that supports their use, can be evaluated. For wound management, preventing wounds from becoming problems for patients requires consideration of various products for suturing, dressings and, very critically, wound irrigation.
Evidence for wound irrigation
Although there are many solutions available, not all are created equally or have the evidence to back their use. These surgeons found that a chlorhexidine gluconate (CHG)-based option provided added benefits that historic irrigation solutions didn’t offer.
“I could have switched to saline, which is a more cost effective solution and readily available. But I wanted something more for my patients,” Dr. Chen said.
When she moved from a povidone-iodine-based irrigation to Irrisept, a low-concentration CHG based wound irrigation, it was because of extensive research, including her own. “I like seeing evidence before I use something on my patients,” she said. “The data [for Irrisept/chlorhexidine] is pretty compelling.” The combination of bench-top testing, in vivo testing and independent testing providing real-world evidence was enough to convince her to switch.
Dr. Weber applied the same evidence-based approach across all aspects of wound care, from closure techniques to dressing selection, illustrating a consistent approach grounded in research and real-world outcomes. This rigor also guided his selection of Irrisept. He values the consistency it brings to his practice, eliminating the need to select different irrigation solutions in different cases. “For me, it’s about having a product that’s safe, that’s nontoxic, that has the data to support it, and I can streamline — use it in every case for the day.”
Always considering costs, but not at the expense of the patient
Cost is always a key consideration, yet the full cost of wound management includes the price of products, as well as the time in the OR; the time of the clinicians and pharmacy; and the costs incurred if a patient experiences complications.
“The cost of everything is a consideration,” Dr. Karpman said. Products and processes that require additional time, money or resources may be cost-prohibitive to incorporate into the protocol. Surgeons in the OR need solutions that are fast and easy to use and don’t have a significant impact on the clinical workload. In the case of antibiotic irrigation, coordination with the hospital pharmacy, delivery of the antibiotics to nurses and sometimes having to wait for more to be brought up and mixed if the supply doesn’t last, adds a lot of time and inconvenience.
For these three physicians, patient safety remains the foremost concern. In line with the World Health Organization’s guidance, they find the evidence supporting continued antibiotic irrigation unconvincing.
“The World Health Organization recommends against using any kind of antibiotic irrigation during wound irrigation, because it’s been shown not to be effective, and we have an antibiotic resistance problem in this world,” Dr. Karpman said. His global perspective and concerns about long-term patient safety have led him to re-evaluate both products and protocols, concluding that an irrigation containing an antimicrobial as a preservative in the solution, like Irrisept, represents a safer and more evidence-aligned approach.
Safety, evidence and efficiency in wound management
Clinical protocol decisions consistently come down to weighing risk against reward. Complications are not only costly but also dangerous and complex to manage. All three surgeons interviewed emphasized the importance of relying on evidence that demonstrates safety and drives improved outcomes. While a universal gold standard for wound management has yet to be established, their perspectives highlight best practices focused on patient optimization, evidence-based product selection, operational efficiency, safety, and thoughtful cost management.
The convincing evidence for Irrisept
Irrisept Antimicrobial Wound Lavage delivers a critical balance, aligning with both clinical and economic imperatives. Providing broad-spectrum antimicrobial effectiveness as a preservative in the bottled solution, ease of use, safety, and operational efficiencies that physicians trust, it has become a key part of modern wound care protocols.
Irrisept contains 0.05% Chlorhexidine Gluconate in 99.95% Sterile Water for Irrigation, USP. It is a single use, self-contained wound lavage that delivers low pressure irrigation. Irrisept is indicated for mechanical cleansing and removal of debris, dirt, and foreign materials, including microorganisms from wounds.
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