the splash guard just above the skin surface, the clinician should apply firm pressure to the plunger This technique is usually capable of generating to lb/psi which is considered ideal pressure for wound irrigation Some institutions may have splash guards that attach directly to the bottle of saline Consider warming the saline before irrigation because this may be more comfortable Tap water is equally effective at irrigating wounds without increasing risk for infection Soaking the injured body part should be avoided because this may lead to maceration of the wound and edema Scrubbing the wound should be reserved for particularly “dirty” wounds in which contaminants are not effectively removed with irrigation alone Use topical or infiltrative anesthetics for pain control before scrubbing It may be necessary to extract some foreign material with fine forceps if it remains adherent after copious irrigation This will avoid tattooing of the skin and reduce the risk of infection In rare cases, the wound must be extended with a scalpel to allow proper exploration and cleaning The provider should consider trimming small amounts of tissue in irregular lacerations and excising necrotic skin but should not make dramatic changes in the wound Devitalized tissue should be removed only if it looks ischemic or is otherwise clearly indicated If more extensive debridement is deemed necessary, consultation with a surgical specialist is recommended Subcutaneous fat can be safely and easily removed if it interferes with wound closure It is wise to remove such fat carefully, in small quantities, to avoid disruption of small vessels and cutaneous nerve branches Avoid removal of facial fat because this may leave an unsightly depression Debridement is advantageous because it creates well-defined wound edges that can be more easily opposed However, excessive removal of tissue can create a defect that is difficult to close or may increase tension at the wound margin such that scarring is more likely Examine the wound further after cleansing and debridement After exploration, it is wise to reevaluate the decision to close the wound primarily When proceeding further, emergency providers should wash their hands before donning gloves Sterile gloves are still commonly utilized, although some studies report no increased risk of infection with nonsterile gloves Sterile masks not reduce the risk of wound infections, but a facial splash shield is useful to protect the clinician The area surrounding the wound should be appropriately draped before wound repair However, if a young child is particularly upset by facial drapes, they can be omitted Proper cleaning of the wound is more important to uncomplicated healing than meticulous attempts to avoid introduction of small numbers of bacteria by preserving a sterile field