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Guide to Evaluating Irrigation Products

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Surgery Blog Post

Surgical wound irrigation is widely used during procedures to help cleanse the surgical site by flushing away debris and reducing contaminants. While leading healthcare organizations have published recommendations related to surgical irrigation practices, approaches to product selection and use continue to vary across facilities. This variability can make it difficult for hospitals to establish standardized irrigation protocols.

Not all irrigation products are the same. Product evaluation often extends beyond the solution itself to include factors such as delivery method, preparation requirements and sterility. Understanding these considerations can help facilities make more informed decisions when assessing irrigation options.

The right irrigation product should address what matters most:
supporting safe, efficient and consistent practices across the perioperative environment.

Why Surgical Wound Irrigation Evaluation Matters

Surgical wound irrigation helps alleviate potential risks and their associated costs. There are many potential risks in the operating room (OR). One of the greater risks is a surgical site infection (SSI)—a common type of healthcare-associated infection (HAI) that can place patients and healthcare facilities at risk.

Here are some of the costs to patients and the healthcare facility:

Health organizations have proposed using care bundles to minimize the risk of SSIs.

Evidence-based strategies and care bundles include4

  • Parenteral antimicrobial prophylaxis
  • Non-parenteral antimicrobial prophylaxis
  • Glycemic control
  • Normothermia
  • Antiseptic prophylaxis
  • Skin antiseptics
  • Surgical wound irrigation


Surgical Wound Irrigation is recommended in guidelines and standards by multiple health organizations. Since early surgical debridement is a standard in wound management,5 its effectiveness hinges on the choice of solution and how it's administered.

Not All Irrigation Products Are the Same

Your choice of wound irrigation product extends far more than the solution itself. APIC's 2026 overview of surgical irrigation guidance highlights that product formulation, preparation, sterility requirements, and delivery methods all play important roles in infection prevention efforts.6

Understanding the key differences across four critical areas can help your facility standardize to a safer, more consistent practice.

Solution

Active ingredients vary widely across available irrigation products—including antiseptics, antibiotics, surfactants and saline. Formulation and concentration can affect a solution's antimicrobial efficacy, safety profile and alignment with current surgical site infection prevention guidelines from the CDC, WHO and SHEA. 

Preparation

Some irrigation solutions require manual mixing or compounding at the back table before use. This introduces variability in concentration, labeling and sterile technique that can differ from procedure to procedure and team to team. 

Delivery

Available delivery methods include manual squeeze bottles, gravity feed with arthroscopy tubing, bulb syringes, pouring and powered irrigation devices.

The delivery method affects both the mechanical effectiveness of irrigation and how consistently it can be applied across procedures and surgical teams.

Sterility

Some irrigation products are not labeled as sterile. Sterility assurance can vary significantly depending on the sterilization method used during manufacturing and whether a validated sterility assurance level  can be established.

CDC: Centers for Disease Control and Prevention; SHEA: The Society for Healthcare Epidemiology of America; WHO: World Health Organization

Robust Evidence Establishing Povidone-Iodine for Irrigation

More than 50 years of clinical use* and extensive peer-reviewed literature support the use of povidone-iodine (PVP-I) for wound irrigation.

5 clinical practice guidelines recommend dilute PVP-I: CDC, WHO, SHEA, AAOS, ICM

AAOS: American Academy of Orthopaedic Surgeons; ICM: International Consensus Meeting for Musculoskeletal Infection
** Covers all concentrations of PVP-I used for irrigation in the past 50 years.

 

Compounded Irrigation Products May Introduce Additional Risk

Surgical wound irrigation solutions are often mixed on the back table of ORs. The FDA,7 the Joint Commission8 and the USP 7979 discourage manual compounding because of the numerous risks involved with manual preparation.

Unintended implications of manual compounding:

Potential risks:

Non-sterile formulations
Per USP 797, all components used must be evaluated for use in sterile drug preparation.9 Components labeled with "not for pharmaceutical use," "not for injectable use," or an equivalent label must not be used for irrigation. Since compounded or mixed products are not FDA-approved,7 they pose a high risk of contamination.

Bacterial contamination
Bacterial contamination may occur through re-use of skin antiseptic bottles.9

Medical errors
Unless the container in the sterile field is labeled as a multiuse container, it should be discarded after a single use.10 Unless immediately used, unlabeled containers are required to be discarded safely, as per the USP 7979 and the NPSG guidelines.8

Inconsistent application of aseptic technique
Inconsistencies rising from different practitioners' variations can result in contact with non-sterile surfaces, introduction of particulate matter or mix-ups with other CSPs.9

Non-sterile and non-standard irrigation solutions
Non-compliance with local and international standards like USP 797, to prepare and administer wound irrigation solutions using sterile components and aseptic technique results in non-standard solutions.11

Non-standard irrigation concentrations
Variations in manual measuring and mixing can result in non-standard irrigation concentrations.11

Lower effectiveness
Inconsistent irrigation pressure (being too much, or too low) arising from variations in the operators' selection of irrigation device and application pressure.12


Align Your Irrigation Approach with Current Best Practice Guidance

  1. Use of dilute PVP-I for wound irrigation†
    Use dilute PVP-I solution and not antibiotics for wound irrigation: WHO,13 CDC14 and SHEA15

  2. Label the container to avoid errors and ensure patient safety
    Label solutions in various procedural settings both on and off the sterile field: Joint Commission7, USP Standards9

  3. Apply adequate pressure when irrigating
    Within the recommended range of 4 to 15 PSI by AHRQ12

  4. Align with USP standards for sterile preparations9
  •  Compound using no more than three sterile packages
  •  Bear a label listing names and amounts of ingredients
  • Use within 4 hours
  • Discard if not used within recommended time
  • Demonstrate competence in following standard operating procedures for compatibility testing

†PVP-I is an antimicrobial preservative contained within the bottled solution. 

 

Choosing an Irrigation Product: Questions to Ask

When evaluating irrigation products, consider:

  • Does the solution align with current guideline recommendations?
  • Is the product supplied sterile?
  • Is dilution or compounding required before use?
  • How is sterility maintained throughout preparation and delivery?
  • Does the delivery method support consistent application?
  • Can the product help standardize practice across surgical teams?
  • Is the solution cleared by the FDA for intraoperative irrigation?

 

Evaluating preparation, delivery and sterility together can help facilities make more informed irrigation decisions while supporting consistency, efficiency and patient safety.

Get in touch with a BD representative

References
  1. Ban KA,Minei JP, Laronga C, et al. American College of Surgeons and Surgical Infection Society: surgical site infection guidelines, 2016 update. J Am Coll Surg. 2017;224(1):59-74. doi:10.1016/j.jamcollsurg.2016.10.029
  2. Scott RD. The Direct Medical Costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention. Centers for Disease Control and Prevention; 2009. Accessed January 2023. https://stacks.cdc.gov/view/cdc/11550
  3. Anderson DJ, Podgorny K, Berríos-Torres SI, et al. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35(6):605-627. doi:10.1086/676022
  4. Berríos-Torres SI, Umscheid CA, Bratzler DW, et al. Centers for Disease Control and Prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg. 2017;152(8):784-791. doi:10.1001/jamasurg.2017.0904
    5. Manna B, Nahirniak P, Morrison CA. Wound debridement. StatPearls Publishing; updated April 19, 2023. Accessed May 2026. https://www.ncbi.nlm.nih.gov/books/NBK507882/
  5. Association for Professionals in Infection Control and Epidemiology (APIC). An Overview of Surgical Irrigation: Evidence-Based Guidelines for Reducing Risk of Surgical Site Infections. Arlington, VA: APIC; 2026
  6. Food and Drug Administration. Compounding and the FDA: questions and answers. Accessed November 17, 2022.https://www.fda.gov/drugs/human-drug-compounding/compounding-and-fda-questions-and-answers
  7. The Joint Commission. National Patient Safety Goals Effective January 2023 for the Hospital Program. Published January 2023. Accessed January 26, 2023. https://www.jointcommission.org/ /media/tjc/documents/standards/national-patient-safety-goals/2023/npsg_chapter_hap_jan2023.pdf
  8. United States Pharmacopeia. GeneralChapter <797> Pharmaceutical compounding—sterile preparations. In: USP-NF. United States Pharmacopeia; 2023. Accessed May 2026.https://doi.org/10.31003/USPNF_M99925_07_01
  9. Food and Drug Administration. FDA Drug Safety Communication: FDA requests label changes and single-
    use packaging for some over-the-counter topical antiseptic products to decrease risk of infection. Published 2019. Accessed October 1, 2022. https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-requests-label-changes-and-single-use-packaging-some-over-counter
  10. Barnes S, Spencer M, Graham D, Johnson HB. Surgical wound irrigation: a call for evidence-based standardization of practice. Am J Infect Control. 2014;42(5):525-529. doi:10.1016/j.ajic.2014.01.012
  11. Mak SS, Lee MY, Cheung JS, et al. Pressurised irrigation versus swabbing method in cleansing wounds healed by secondary intention: a randomised controlled trial with cost-effectiveness analysis. Int J Nurs Stud. 2015;52(1):88-101. doi:10.1016/j.ijnurstu.2014.08.005
  12. World Health Organization. Global guidelines for the prevention of surgical site infection. World Health
    Organization; 2018. Accessed September 2022. https://apps.who.int/iris/handle/10665/277399
  13. Berríos-Torres SI, Umscheid CA, Bratzler DW, et al. Centers for Disease Control and Prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg. 2017;152(8):784-791. doi:10.1001/jamasurg.2017.0904
  14. Calderwood MS, Anderson DJ, Bratzler DW, et al.Strategies to prevent surgical site infections in acute-care hospitals: 2022 update. Infect Control Hosp Epidemiol. 2023;44(5):695-720. doi:10.1017/ice.2023.67 
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