Sterile Vs. Clean In Survival Situations

Hey Prepper Nation,

A significant factor in the quality of medical care given in a survival situation is the level of cleanliness of the equipment used.  In primitive conditions, it will be a challenge to make an environment that guarantees the best chance of avoiding infection in a wound.  It will be harder still to sterilize all of your equipment. Now, you may have heard of the terms “sterile” and “clean”, but do you have more than a vague idea of what they mean?

What Does Sterile Mean?

When it comes to medical protection, “sterility” means the complete absence of microbes.  To guarantee the elimination of all organisms, a type of pressure cooker called an “autoclave” is used for instruments, towels, and other items that could come in contact with the patient.  Interestingly, some things can be “dirty” and “sterile” at the same time.  If I put a handful of dirt in a container in a pressure cooker, I would render the dirt sterile by killing all the microbes in it.  It would still be dirt, however.

There is considerable debate, even now, as to what truly constitutes “sterile technique” and what is to be considered “clean technique”.  There is even some disagreement with regard to which technique is best in which scenario.  Although this is a discussion for a much longer article, suffice it to say that initial wound care, especially with deep wounds in the first 48 hours, should be sterile if possible.  As it becomes clear that the wound is not infected, clean technique may be acceptable (indeed, it may be all you have).  An infected wound will appear red, swollen, and feel hot to the touch (see image below).

Clean Vs. Sterile

Here are common characteristics of clean vs. sterile methods:

Sterile technique involves hand washing with special solutions and the use of sterile instruments, gloves, towels, and dressings.  When used on a patient, the area immediately around them is referred to as a “sterile field”.  In order to say that sterile technique was used, you would have to assure that only sterile items were used, and were only touched by other sterile items.  This is not impossible, but requires extra diligence (and expense) to achieve.  For example:  Clean, non-sterile gloves come 100 to a carton, while each pair of sterile gloves must be individually packaged.

Clean technique concentrates on reducing the number of microorganisms that could be transferred from one person to another by medical instruments, or other medical supplies. Meticulous washing of hands and instruments with soap and hot water is important, as is the wearing of clean gloves.  Attention is given to making sure that dressings are made of clean cloth or gauze.  In most survival settings, this may be as good as it gets, but is that so bad?

There is very little research that compares clean vs. sterile technique for wound care.   In one study, an experiment was conducted in which one group of patients with traumatic wounds were cleaned with sterile saline solution, the other group with tap water.  Amazingly, the infection rate was 5.4% in the tap water group as opposed to 10.3% in the sterile saline group.  Another study revealed no difference in infection rates in wounds treated in a sterile fashion as opposed to clean technique.

Therefore, I usually recommend clean water to irrigate wounds (see image below), although sterile saline is also fine.  If you use Betadine, make sure it is very dilute.  Betadine is cytotoxic (harmful to new cells) in deep wounds, so is best in the initial cleansing or in situations where infection is suspected. The same goes for Hydrogen Peroxide.

Let’s talk for a second about sterile vs. non-sterile dressings.  I usually recommend a moist sterile gauze in deep wounds covered by a less moist or dry dressing on top (“wet-to-dry dressing”).  However, consider this: A 2006 study in the Canadian Journal of Plastic Surgery took 2 x 2 inch squares of the following items and submitted them for tests to see if there were bacterial organisms on them:

  • 20 Sterile Gauze
  • 20 Panty Liners
  • 20 Sanitary Feminine Napkins
  • 20 Diapers

The results:

  • None of the 20 sanitary napkins grew out bacteria
  • 1 of the 20 panty liners grew out bacteria (Staphylococcus)
  • 2 of the 20 sterile dressings grew out bacteria (1 Staph. And 1 Streptococcus)
  • 15 of the 20 diapers grew out bacteria (all bacillus)

Surprised that the sterile dressings came in third?  I was.  In any case, this doesn’t prove that you shouldn’t use sterile dressings where possible; it just means that, for survival purposes, we might want to conduct further research (which is what the Canadian study recommended).

                                            The Winner!

Remember that your entire sick room should be kept disinfected, so as not to spread infection. Disinfectants are substances that are applied to non-living surfaces to destroy microbes. This would include areas where you would treat patients or prepare food.  Disinfection does not necessarily kill all germs and, as such, is not as effective as sterilization.

A disinfectant is different from an antiseptic, which removes micro-organisms from the surfaces of LIVING tissue.  An antiseptic differs from an antibiotic in that an antibiotic can kill harmful bugs INSIDE a living organism.

Examples of Disinfectants include:

  • Bleach
  • Alcohol
  • Vinegar

Examples of Antiseptics include:

  • Chlorhexidine (Hibiclens)
  • Betadine
  • Hydrogen Peroxide
  • BZK (Benzalkonium Chloride)

Examples of Antibiotics include:

  • Amoxicillin
  • Tetracycline
  • Ciprofloxacin

Some mistakenly consider disinfection to be the same as “decontamination”. The latter, however, may include the elimination of toxic chemicals or radiation.  The removal of radioactive dust from a surface would, therefore, not be called disinfection, but decontamination.

Dr. Bones

Reference:  Can J Plast Surg. 2006 Spring; 14(1): 25–27.

Reference:  Journal of Wound, Ostomy, and Continence Nursing- March/April 2012

Are you prepared to deal with medical issues in disaster situations?  If you have the #1 Amazon Survival Skills Bestseller “The Doom and Bloom Survival Medicine Handbook”, you will be!   Here’s the trailer:

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  1. Ken Lowder, 15 July, 2012

    Very interesting article. During our work in new Orleans after Katrina cleanliness was difficult to say the least. We bought a large amount of baby wipes and bathing wipes to clean arms prior to starting iv’s. wounds were flushed with sterile water after washing the surrounding area. We also washed ourselves to with them before handling patients. I keep sealed boxes of them in my kit and in the car too. I think in an emergency flushing dirty wounds with clean water to get the dirt out is much better than nothing prior to bandaging. The results on women’s products are not surprising after the toxic shock problem a few years ago. I already have tampons in my kit for deep puncture wounds I think I’ll add a few napkins to cover wounds before covering with kerlex!

    See you in Arlington!


  2. Sterile vs. Clean in a Survival Situation « Bibles and Barbells, 15 July, 2012

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  3. Dr. Bones, 16 July, 2012

    Hi Ken,

    I agree completely.  Make sure to say hi in Arlington!

    Dr. Bones

  4. SophiaScholar, 17 July, 2012

    Just now getting into the content of your web site. Good stuff here. Thank you. Kudos.

  5. Millenniumfly, 18 July, 2012

    Any good sources for acquiring bulk sterile gauze? I know you can buy bulk non-sterile gauze on Amazon and elsewhere but have never found a good source for sterile (without spending a fortune).

  6. Lcgadston, 19 July, 2012

    I’m not suprised at all that sterile saline had a higher infection rate than tap water and that sterile gauze came in third in that study. Hospitals are supposed to be clean and sterile and thats where drug resistant staph mostly hangs out. If one trains their body to fight bacteria and strengthens their immune system, you don’t need anything more than ‘clean’, exept maybe sterilize the tools such as scalpels. When I get cut, the wound gets a band aid and some bagbalm IF its bleeding for more than just a few drops. Where I work I have a tendancy to get burned. I have had grease burned right into my skin leaving a dirty 1st or 2nd degree singe (though not usually any larger than a quarter) and it heals just fine without any fancy treatments, not even aloe. If one does contract an infection, a paste made from an oral myacin antibiotic works very well and is very cheap, sold at livestock supply stores.

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  8. Dr Bones, 20 July, 2012

    Hi Millenium,

    Funny you should mention it, it’s the next item that’s going up on our store! Boss Amy hasn’t figured out the price yet, though…

    Dr. Bones

  9. Dr Bones, 20 July, 2012

    Thanks, Sophia!

  10. Dr Bones, 20 July, 2012

    Hi Ken,

    Packing our bags! lol

    Dr. Bones

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  14. Andy, 04 October, 2012

    Wow, great article. I just posted your suture video on my website,, but I got to thinking: How can we be sterile in a survival situation?

    Would bleaching (soaking in bleach) all of our medical instruments directly before use lead to a sterile medical instrument?

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