Winchester Laboratories' Saljet technology, a device used to irrigate and cleanse non-complex wounds, has appeared on the popular television medical drama Grey's Anatomy. More importantly, it has proven results in the world of non-fiction. Dr Harriett B Loehne, a certified wound specialist and the owner of an eponymous wound-management consulting company, shares her views on best practice in wound treatment and what differentiates Saljet from other treatments on the market.
Harriett B Loehne: Saljet is a disposable polymer vial with a twist-off top for single use containing 30ml of sterile normal saline (NS) 0.9%. It has no preservatives, surfactants or buffering. When firmly squeezed, it delivers 4-8psi of NS to the wound, with a maximum of 10psi. The vial and its top are recyclable or can be disposed of in regular waste.
The product is FDA-approved and licensed for use in dressing changes. It does not have to be dated or timed during a procedure. Saljet also has a CE mark. Licensed as a device and not a pharmaceutical, it does not have to be kept under lock and key and can be used whenever a physician has ordered saline for a dressing change. The MSDS indicates no hazard, no cytotoxicity and no carcinogenicity. The vials are packed four to a strip and each box contains ten strips, with six boxes in a shipping case. It has a 36-month shelf life.
Many wound and skin cleansers are cytotoxic: the dilution that is required to be non-cytotoxic renders their efficacy essentially nil. With few exceptions, NS should be used for cleansing and irrigation. For complex wounds requiring debridement, and those with deep tracts and tunnels, pulsed lavage is the intervention of choice. For all other wounds, NS can be delivered in several methods.
To be safe and efficacious, irrigation must be between 4-15psi. Pouring NS from a bottle does not provide the adequate psi, nor does a bulb syringe with impact pressure of 2psi. A syringe with a 19-gauge needle delivers 8psi, but requires a sterile basin and raises safety concerns for the patient and clinician. Aerosolisation spray cans, in addition to being cold, decrease in pressure during use. Saljet moistens dressings for easy removal to avoid damage to granulation tissue, and eliminates concern for the contamination of opened bottles being reused, or the danger and cost of syringes, needles and basins.
To prevent delayed healing, wounds should be irrigated with sterile NS to remove debris, necrotic tissue, purulent exudate and biofilm initially, and at each dressing change. It is important to warm the irrigant, which can be easily done by body heat in the clinician's lab coat or scrub pocket. It can also be placed in warm water or given to the gloved patient to hold while dressing changes are being prepared. Thermocline - the principle that the wound must remain at least at body temperature for optimal healing - is often overlooked by wound-management clinicians. It takes approximately four hours for a wound exposed to air, and longer when exposed to cold, to begin the healing process.
Pouring saline from a bottle is not efficacious and it often ends up wasted. Once the bottle is open, the saline is no longer sterile and should be discarded within 24 hours; and rarely is the bottle empty by that time. Saljet delivers a unit dose with no concern about storage or sterility, and subsequent waste with increased cost.
Saljet is appropriate for use in hospitals, home health, long-term care, nursing homes, urgent-care centres, emergency room and emergency services, workplace employee health departments, the military and veterinarian offices.
Saljet is an ideal method of cleansing all non-complex wounds and I would like to see it made available to the consumer over the counter. It has a place in the offices of school nurses, at camps and activity organisations and in homes.