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The effectiveness of cleansing solutions for wound treatment: a systematic review

2014; Volume: 12; Issue: 10 Linguagem: Inglês

10.11124/jbisrir-2014-1746

2202-4433

Paulo Joaquím Pina Queirós, Eduardo Santos, João Apóstolo, Daniela Cardoso, Madalena Cunha, Manuel Alves Rodrígues,

Pressure Ulcer Prevention and Management

Background The management of chronic and acute wounds has changed significantly over the last decade. The practice of wound cleansing or antiseptic management has a dichotomous history anchored in tradition and science. Although there is a consensus that wound cleansing reduces infection rates, there is, however, some debate in clinical circles about the potential advantages and disadvantages of cleansing wounds. This practice may not always be necessary as the exudate itself may contain growth factors and chemokines which contribute to wound healing. Objectives The objective of this review is to identify and synthesize the best available evidence on the effectiveness of cleansing solutions for wound treatment in clinical practice and compare the effectiveness of different cleansing solutions in infection and wound healing rates. Inclusion criteria Types of participants This review considered studies that included patients with chronic and acute wounds (of any etiology), with the exception of obstetric wounds. Patients aged 18 years or more in any setting (hospital, community and general practice) were included, with the exception of malnourished patients. Types of intervention(s) This review considered studies that used any cleansing solution or chemicals as cleansing solutions other than antiseptic solutions in wound treatment. Types of studies This review considered experimental study designs including randomized controlled trials (RCTs), non-randomized controlled trials, or other quasi-experimental studies, including before and after studies. Types of outcomes This review focused on two types of outcomes: primary outcome (infection rate) and secondary outcome (healing rate). Search strategy An initial search of MEDLINE and CINAHL was undertaken, followed by a second search for published and unpublished studies from January 1990 to January 2013 in major healthcare-related electronic databases. Studies in English, Spanish and Portuguese were included. Methodological quality Methodological quality was assessed by two independent reviewers using the standardized critical appraisal instrument from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument. Two independent reviewers assessed seven studies. There was general consensus among the reviewers to include the three final studies in this review. Data collection Data were extracted using the JBI data extraction form for experimental studies and included participant characteristics, intervention characteristics and study methods. Data synthesis The impact of interventions on infection and healing rates was described in a narrative format within each intervention. Data from two studies were pooled in a meta-analysis. Results Eight studies met the inclusion criteria. From those, five studies were excluded after assessment of methodological quality. The remaining three original articles, which consisted of 718 patients, were included in this review. The three studies were randomized clinical trials. The interventions included in this systematic review were: Tap water versus Sterile saline and Povidone-iodine-soaked gauze versus Saline-soaked gauze. Data from two studies reporting the effectiveness of Tap Water versus Sterile Saline and respective wound infection rates were pooled in a meta-analysis. The meta-analysis showed a low heterogeneity (Heterogeneity Chi squared=1.45, p=0.23; I2 =31.1%). No statistically significant differences were found (z=0.59; p=0.55). Nevertheless, a positive effect in the prevention of infection rates was observed in the tap water group (OR=0.79; 95% Cl: 0.36, 1.72). For acute wounds, the odds ratio of developing an infection when cleansing with tap water compared with saline was 0.98 (95% CI: 0.43, 2.25). Conclusions There is no evidence that using tap water to cleanse acute and chronic wounds in adults increases infection or healing rates. There is some evidence that it reduces infection when compared to saline. There may be a trend towards a lower wound infection rate when povidone-iodine is used in surgical wounds, but this was not significant for varicose vein surgery. However, due to the small number of studies by interventions (few cleansing solutions), the evidence is not strong enough to produce a best practice.