Prognosis and Harm of Wound Cleansing Using Tap Water - Research Proposal Example

Title

Author (date)

Study Design

Description

Validity

Results

Author's Conclusions

Reviewer's Comments

Water for Wound Cleansing

(From Cochrane Database of Systematic Reviews)

Fernandez, R.

and

Griffiths, R.

(2008)

A systematic review of randomized and quasi-randomized controlled trials

P:   People of all ages with a wound of any etiology, in any setting (hospital, community, nursing homes, general practice,

wound clinics)

I:   Wound cleansing using water

C:  Wound cleansing using normal saline

O:  Infection,  wound healing, and cost analysis

Trial selection, data extraction, and quality assessment were carried out independently by two authors and checked by a third author. Differences in opinion were settled by discussion. Some data were pooled using a random-effects model. Trials undertaken in any country, irrespective of the tap water quality were included and there was no restriction on the basis of the language in which the trial reports were written.

Valid and non-biased.

Results demonstrated a significant reduction in infection rates in wounds cleaned with tap water compared with normal saline (RR 0.63, 95%CI 0.40 to 0.99; p=0.05)

There was no statistically significant difference in the number of wounds that healed after cleansing with either tap water or normal saline

(RR 0.57, 95% CI 0.30 to 1.07)

For cost analysis, tap water was inexpensive compared with the use of normal saline.

There is no evidence that using tap water to cleanse acute wounds in adults increases infection and some evidence that it reduces it. However, there is no strong evidence that cleansing wounds per se increases healing or reduces infection. In the absence of potable tap water, boiled and cooled water, as well as distilled water, can be used as wound cleansing agents.

Where tap water is high quality (drinkable), it may be as good as other methods such as sterile water or saline water (and more cost-effective), but more research is needed.

PICO QUESTION: In postsurgical patients who are for hospital discharge with wounds that require regular cleansing and irrigation, does wound cleansing using tap water have significant effects compared with using 0.9% normal saline solution in terms of wound healing or infection?

DOMAIN:  This applies to both clinical and community settings specifically to the prognosis/harm of wound cleansing using tap water.

Title

Author (date)

Study Design

Description

Validity

Results

Author's Conclusions

Reviewer's Comments

Effectiveness of Solutions, Techniques and

Pressure in Wound Cleansing 

(From The New South Wales Centre for Evidence-Based Health Care - a collaborating center of The Joanna Briggs Institute)

Fernandez, R.

Griffiths, R.

and

Ussia, C.

(2004)

A systematic review of randomized and clinical controlled trials

P:   Adults and/or children with wounds

I:  Wounds were cleaned with commercial cleansers, normal saline, water, chlorhexidine, hydrogen peroxide or povidone-iodine

C: Effects comparison

O: Prevent infection and promote wound healing

Selection of potential articles, assessment of methodological quality, and data abstraction was conducted independently by two reviewers. Trials with similar patients, comparisons, and outcomes were pooled. The data were analyzed using Cochrane Review Manager 4.2. Where pooling was inappropriate, trials are discussed in a narrative review.

Valid and non-biased.

Fourteen randomized controlled trials were included that compared various solutions for wound cleansing. The evidence indicates that there is no difference in the infection and healing rates in acute and chronic wounds cleansed with either tap water or normal saline.

The evidence supports the use of potable tap water for cleansing lacerations in both adults and children and postoperative wounds in adults only. Potable tap water as well as boiled and cooled water is also an effective wound cleansing solution. This finding, however, is based on a trial that had a small sample size.

The evidence to support the use of potable tap water is limited (only one study with low power); therefore, further studies are required to confirm that assumption.

PICO QUESTION: In postsurgical patients who are for hospital discharge with wounds that require regular cleansing and irrigation, does wound cleansing using tap water have significant effects compared with using 0.9% normal saline solution in terms of wound healing or infection?

DOMAIN:  This applies to both clinical and community settings specifically to the prognosis/harm of wound cleansing using tap water.

Title

Author (date)

Study Design

Description

Validity

Results

Author's Conclusions

Reviewer's Comments

A Comparison Between Traumatic Wound Infections after

Irrigating Them with Tap Water and Normal Saline

(From World Journal of Medical Sciences )

Mirshamsi, M.H. Ayatollahi, J.

and

Dashti-R, M.H.

(2007)

Randomized and clinical controlled trials

P:  600 patients with fresh contaminated traumatic wounds

I:   Washed with tap water

C:  Washed with normal saline

O:  Rate of wound infection

In a clinical trial study fresh contaminated traumatic wounds of 600 patients referred to 2 emergency centers in Yazd, Iran was randomly washed perfectly with either normal saline or tap water and then sutured with a Nylon thread and left without any dressing. All wounds were followed for 1, 3, and 5 days and during each observation. Classic signs of infection such as erythema, swelling, warmth, purulent and bloody drainage, and Crepitation were recorded for each patient. The patients in 2 groups were matched according to age and sex.

Valid and non-biased.

In patients who were 30-60 years old, the incidence of wound infection in wounds washed with tap water was greater than those washed with normal saline (10% vs. 6% p=0.03), but in age ranges less than 30 and greater than 60 years there was no significant difference in wound infection between two groups (p=0.488 and p=0.402).

In wounds washed with tap water the incidence rate of wound infection in males was significantly greater than females (10.7% vs. 6.7% p= 0.03)

Findings as well as other mentioned reports appear to support the cost-effectiveness and ease of use of tap water in wound cleansing. However, tap water could be used for cleansing when produced from a supply of potable drinking water. Tap water of lesser quality than was used in our study may produce different effects.

Findings appear to support the safety and ease of use of tap water in wound cleansing, however, tap water could be used for cleansing when produced from a supply of potable drinking water. Tap water of lesser quality than was used in this study may produce different effects.

GUIDE

Author (date): include all authors and date of publication

Study design (level of evidence): include study design and level of evidence using JBI or NHMRC

Description: include patients, intervention, comparison, outcomes measured

Validity: include methodology, rigor, the potential for bias

Results: include generally favorable or unfavorable, specific outcomes of interest, the estimate of experimental effect if appropriate

Author's Conclusions: include limitations, the implication for practice and research) if appropriate

Reviewer's Comments: include the potential for bias, weaknesses, and strengths