To Örebro University

Wound cleansing is widely regarded as a foundational component of chronic wound management; however, the empirical evidence supporting commonly recommended cleansing techniques remains limited. Much of the guidance informing current practice is derived from acute wound models, laboratory studies, and expert consensus rather than from comparative studies conducted in chronic wound populations.

The aim of this thesis was to examine the evidence base for wound cleansing practices in chronic wounds and to investigate nurses’ knowledge, attitudes, and practice related to wound cleansing.

The thesis comprises four studies. Study I systematically reviewed evidence comparing irrigation and swabbing techniques in chronic wounds. Study II developed and psychometrically evaluated a questionnaire measuring nurses’ knowledge, attitudes, and practices related to wound cleansing. Study III applied the instrument in an international cross-sectional survey. Study IV conducted confirmatory factor analysis to evaluate the internal structure of the attitudes subscale.

The review identified extremely limited chronic wound-specific evidence for commonly recommended cleansing techniques. The developed instrument demonstrated acceptable psychometric properties. Survey findings showed variation in clinician knowledge and practice, with higher knowledge associated with formal wound care education. Confirmatory analysis supported the multidimensional structure of nurses’ attitudes.

These findings highlight the need for stronger empirical evidence and structured education to support evidence-informed cleansing practices.