A systematic review of wound cleansing for pressure ulcers.
OBJECTIVE
The aim of this study was to use a Cochrane systematic review process to explore the effect of wound cleansing solutions and techniques on pressure ulcer healing.


BACKGROUND
Pressure ulcers impose a significant financial burden on health care systems and negatively affect the quality of life. Wound cleansing is an important component of pressure ulcer care; however, there is uncertainty regarding best practice.


METHODS
Systematic review.


METHODS
The Specialised Trials Register of the Cochrane Wounds Group, the Cochrane Central Register of Controlled Trials and bibliographies of relevant publications were searched. Drug companies and experts in the field were also contacted. Randomized controlled trials (RCTs) comparing wound cleansing with no wound cleansing, or different wound cleansing solutions, or different cleansing techniques, were eligible for inclusion. For dichotomous outcomes, relative risk (RR) plus 95% confidence intervals (CI) were calculated; for continuous outcomes, weighted mean difference plus 95% CI were calculated. Meta analysis was not conducted because of the small number of diverse RCTs identified.


RESULTS
No studies compared cleansing with no cleansing. A statistically significant improvement in healing occurred for wounds cleansed with saline spray containing Aloe vera, silver chloride and decyl glucoside (Vulnopur) compared with isotonic saline (p = 0.025). No statistically significant change in healing was seen when water was compared with saline (RR 3.00, 95% CI 0.21, 41.89). No statistically significant change in healing was seen for ulcers cleansed with, or without, a whirlpool (RR 2.10, 95% CI 0.93-4.76).


CONCLUSIONS
There is little trial evidence to support the use of any particular wound cleansing solution or technique for pressure ulcers. Relevance to clinical practice. No firm recommendations for ways of cleansing pressure ulcers in clinical practice can be made, the lack of RCT evidence should be a concern for health care providers.
Moore
Zena
Z
Health Research Board of Ireland Clinical Nursing & Faculty of Nursing & Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland. zmoore@rcsi.ie
Cowman
Seamus
S
D000504:Aloe; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use; D015400:Clinical Nursing Research; D003625:Data Collection; D003627:Data Interpretation, Statistical; D003902:Detergents / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D005960:Glucosides / Q000627:therapeutic use; D006801:Humans; D006875:Hydrotherapy; D017053:Infection Control / Q000379:methods; D008517:Phytotherapy; D003668:Pressure Ulcer / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D018030:Silver Compounds / Q000627:therapeutic use; D017592:Skin Care / Q000379:methods* / Q000451:nursing; D012965:Sodium Chloride / Q000627:therapeutic use; D012973:Sodium Hypochlorite / Q000627:therapeutic use; D007507:Therapeutic Irrigation / Q000379:methods* / Q000451:nursing; D016896:Treatment Outcome; D014945:Wound Healing
D000891:Anti-Infective Agents, Local; D003902:Detergents; D005960:Glucosides; D018030:Silver Compounds; D012965:Sodium Chloride; D012973:Sodium Hypochlorite; C037548:silver chloride; C504907:decyl glucoside