title: Pressurised irrigation versus swabbing method in cleansing wounds healed by secondary intention: a randomised controlled trial with cost-effectiveness analysis.
abstract: BACKGROUND
  Wound cleansing should create an optimal healing environment by removing excess debris, exudates, foreign and necrotic material which are commonly present in the wounds that heal by secondary intention. At present, there is no research evidence for whether pressurised irrigation has better wound healing outcomes compared with conventional swabbing practice in cleansing wound.
  
  
  OBJECTIVE
  This study investigated the differences between pressurised irrigation and swabbing method in cleansing wounds that healed by secondary intention in relation to wound healing outcomes and cost-effectiveness.
  
  
  METHODS
  Multicentre, prospective, randomised controlled trial.
  
  
  METHODS
  The study took place in four General Outpatient Clinics in Hong Kong.
  
  
  METHODS
  Two hundred and fifty six patients with wounds healing by secondary intention were randomly assigned by having a staff independent of the study opening a serially numbered, opaque and sealed envelope to either pressurised irrigation (n=122) or swabbing (n=134). Staff undertaking study-related assessments was blinded to treatment assignment. Patients' wounds were followed up for 6 weeks or earlier if wounds had healed to determine wound healing, infection, symptoms, satisfaction, and cost effectiveness. The primary outcome was time-to-wound healing. Patients were analysed according to their treatment allocation. This trial is registered with ClinicalTrials.gov, number NCT01885273.
  
  
  RESULTS
  Intention-to-treat analysis showed that pressurised irrigation group was associated with a shorter median time-to-wound healing than swabbing group [9.0 days (95% CI: 7.4-13.8) vs. 12.0 (95% CI: 10.2-13.8); p=0.007]. Pressurised irrigation group has significantly more patients experiencing lower grade of pain during wound cleansing (93.4% vs. 84.2%; p=0.02), and significantly higher median satisfaction with either comfort or cleansing method (MD 1 [95% CI: 5-6]; p=0.002; MD 1 [95% CI: 5-6]; p<0.001) than did swabbing group. Wound infection was reported in 4 (3.3%) patients in pressurised irrigation group and in 7 (5.2%) patients in swabbing group (p=0.44). Cost-effectiveness analysis indicated that pressurised irrigation in comparison with swabbing saved per patient HK$ 110 (95% CI: -33 to 308) and was a cost-effective cleansing method at no extra direct medical cost with a probability of 90%.
  
  
  CONCLUSIONS
  This is the first randomised controlled trial to compare the pressurised irrigation and swabbing. Pressurised irrigation is more cost-effective than swabbing in shortening time that wound heals by secondary intention with better patient tolerance. Use of pressurised irrigation for wound cleansing is supported by this trial.
authors.affiliation: Department of Clinical Oncology, Prince of Wales Hospital, Hong Kong. Electronic address: mss692@ha.org.hk.
authors.forename: Suzanne So-Shan
authors.initials: SS
authors.lastname: Mak
authors.affiliation: Department of Medicine, North District Hospital, Hong Kong.
authors.forename: Man-Ying
authors.initials: MY
authors.lastname: Lee
authors.affiliation: Department of Pediatrics, Prince of Wales Hospital, Hong Kong.
authors.forename: Jeanny Sui-Sum
authors.initials: JS
authors.lastname: Cheung
authors.affiliation: The Nethersole School of Nursing, the Chinese University of Hong Kong, Hong Kong.
authors.forename: Kai-Chow
authors.initials: KC
authors.lastname: Choi
authors.affiliation: Central Nursing Department, Prince of Wales Hospital, Hong Kong.
authors.forename: Tak-Ki
authors.initials: TK
authors.lastname: Chung
authors.affiliation: Department of Surgery, Prince of Wales Hospital, Hong Kong.
authors.forename: Tze-Wing
authors.initials: TW
authors.lastname: Wong
authors.affiliation: Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Hong Kong.
authors.forename: Kit-Yee
authors.initials: KY
authors.lastname: Lam
authors.affiliation: The Nethersole School of Nursing, the Chinese University of Hong Kong, Hong Kong.
authors.forename: Diana Tze-fan
authors.initials: DT
authors.lastname: Lee
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D007507:Therapeutic Irrigation; D014945:Wound Healing
keywords: Cleansing techniques; Healing time; Pressurised irrigation; Randomised controlled trial; Swabbing; Wound cleansing; Wound irrigation