Wound cleansing for pressure ulcers

 

Abstract

Background

Pressure ulcers (also called pressure sores, bed sores and decubitus ulcers) are areas of tissue damage that occur in the elderly, malnourished or acutely ill, who cannot reposition themselves. Pressure ulcers impose a significant financial burden on health care systems and negatively affect quality of life. Wound cleansing is considered an important component of pressure ulcer care.

Objectives

This systematic review seeks to answer the following question:
what is the effect of wound cleansing solutions and wound cleansing techniques on the rate of healing of pressure ulcers?

Search methods

For this second update, we searched the Cochrane Wounds Group Specialised Register (searched 26/3/10) The Cochrane Central Register of Controlled Trials (CENTRAL) - The Cochrane Library 2010, Issue 1, Ovid MEDLINE - 2007 to March Week 2 2010, Ovid EMBASE - 2007 to 2010 Week 9 and EBSCO CINAHL - 2007 to March 26 2010.

Selection criteria

Randomised controlled trials (RCTs) comparing wound cleansing with no wound cleansing, or different wound cleansing solutions, or different cleansing techniques, were eligible for inclusion if they reported an objective measure of pressure ulcer healing.

Data collection and analysis

Two review authors extracted data independently and resolved disagreements through discussion. A structured narrative summary of the included studies was conducted. For dichotomous outcomes, relative risk (RR), plus 95% confidence intervals (CI) were calculated; for continuous outcomes, mean difference (MD), plus 95% CI were calculated. Meta analysis was not conducted because of the small number of diverse RCTs identified. For the second update of this review, two review authors independently assessed each included study using the Cochrane Collaboration tool for assessing risk of bias.

Main results

No additional studies were identified from the updated search. Three studies met the inclusion criteria for the review. No studies compared cleansing with no cleansing. Two studies compared different wound cleansing solutions. A statistically significant improvement in Pressure Sore Status Tool scores occurred for wounds cleansed with saline spray containing Aloe vera, silver chloride and decyl glucoside (Vulnopur) compared to isotonic saline (P value = 0.025), but no statistically significant change in healing was seen when water was compared to saline (RR 3.00, 95% CI 0.21 to 41.89). One study compared cleansing techniques, but no statistically significant change in healing was seen for ulcers cleansed with, or without, a whirlpool (RR 2.10, 95% CI 0.93 to 4.76).

Authors' conclusions

We identified three small studies addressing cleansing of pressure ulcers. One noted a statistically significant improvement in pressure ulcer healing for wounds cleansed with saline spray containing Aloe vera, silver chloride and decyl glucoside (Vulnopur) when compared with isotonic saline solution. Overall, there is no good trial evidence to support use of any particular wound cleansing solution or technique for pressure ulcers.

 

Plain language summary

Wound cleansing to help pressure ulcers heal.

Pressure ulcers (also called pressure sores, bed sores and decubitus ulcers) are areas of tissue damage that occur in the elderly, malnourished or acutely ill, who cannot reposition themselves. The three trials identified found no good evidence that cleansing pressure ulcers (bed sores) using a particular technique, or cleansing with a particular solution, helps healing. Very little research has studied the cleansing of pressure ulcers and therefore we are unable to draw any firm conclusions.

 

摘要

背景

傷口清潔在褥瘡照料扮演之角色

年紀太大的老人，營養不良或罹患急性重症的病人，因為無法自行翻身所導致組織的損傷，就是所謂的褥瘡 (Pressure ulcers) 。褥瘡除了對健康照護系統造成很大的財務負擔，對生活的品質也具有負面的影響。傷口的清潔對褥瘡的照顧來說，是很重要的一環。

目標

這篇系統性的回顧是想了解，各項傷口清潔溶液與清潔方式對於褥瘡癒合速度的影響效應究竟為何?

搜尋策略

我們搜尋了Specialised Trials Register of the Cochrane Wounds Group (到2005年8月為止) ，以及Cochrane Central Register of Controlled Trials (The Cochrane Library中2005年第三期) 。我們同時搜尋了其他相關的出版作品，也連絡了一些藥廠，及這方面的專家，來挑選出先前搜尋過程中，被漏掉的一些相關研究。

選擇標準

我們檢視諸多隨機臨床對照試驗 (Randomised controlled trials (RCTs)) ，其內容涵括:接受傷口清潔處置與否的不同組別間比較，或使用不同的傷口清潔溶液的各組別間比較，或是使用不同的傷口清潔技巧的各組別間比較。只要這些臨床試驗有客觀評估褥瘡癒合速率的設計，都符合我們的納入標準。

資料收集與分析

由2位評論作家分別蒐集資料，並透過討論以及根據Cochrane Wounds Group的參考文獻達成共識。並將所有研究結果匯集成一篇結構嚴謹的敘述性摘要。我們對於2項式 (2分法，dichotomous) 的變項或結果，計算出它們的相對風險比率 (relative risk) (RR), 及95% 信賴區間 (95% confidence intervals) (CI) ，對連續性變項，則計算出其平均數 (weighted mean difference) (WMD), 及 95% 信賴區間 (CI) ，由於具差異性的隨機臨床試驗數量不多，沒辦法進行後設研究 (meta analysis) 。

主要結論

目前為止沒有任何研究是在 ‘進行傷口清潔’ 與 ‘不做傷口清潔’ 之間進行比對。但我們找到2個比對不同清潔傷口的溶液的研究，其中發現使用含有蘆薈 (Aloe vera) 氯化銀 (silver chloride) 以及癸基葡萄糖? (decyl glucoside) 的生理食鹽水來噴灑傷口，跟單純使用等張的生理食鹽水清潔傷口 (P value = 0.025) 比起來，以Pressure Sore Status Tool方式評估，前者是有統計學上顯著的優越性。但是若是比對食鹽水跟清水 (RR 3.00, 95% CI 0.21, 41.89) ，對傷口的癒合在統計學上就沒有顯著的差異了。有一個研究是比對不同的傷口清潔技巧，但是在傷口的癒合上，有沒有使用漩渦沖刷 (RR 2.10, 95% CI 0.93 to 4.76) 清潔，在統計學上都沒有顯著的差別。

作者結論

我們只確認了3個有關清潔褥瘡傷口的研究，其中一個研究指出，對照於利用等張的生理食鹽水來清潔褥瘡傷口的做法，使用含有蘆薈 (Aloe vera) 氯化銀 (silver chloride) 以及癸基葡萄糖? (decyl glucoside) 的生理食鹽水來噴灑清潔傷口，對褥瘡傷口癒合速度，有統計上顯著的助益。但整體來說，我們沒有找到足夠的證據來證明，使用任何特定的溶液或清潔傷口的方式，可以加快褥瘡傷口癒合的速度。

翻譯人

本摘要由成功大學附設醫院蔡佩蓉翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

在我們搜尋的資料中，並沒有足夠的證據可以證明，清潔褥瘡的傷口，或使用特定溶液來清潔傷口，對傷口的癒合有任何幫助。目前對於清潔褥瘡傷口方面的研究不足，導致我們無法做一個強而有力的結論。