Page 212 - HA Convention 2016 [Full Version]

HOSPITAL AUTHORITY CONVENTION 2016 Service Enhancement Presentations

F5.5 Healthcare Advances, Research and Innovations 09:00 Room 421

Pressurised Irrigation versus Swabbing Method in Cleansing Wounds Healed by Secondary Intention: A

Randomised Controlled Trial with Cost-effectiveness Analysis
Mak SS 1,2, Lee MY 1,3, Cheung SS 1,4, Lam KY 1,5, Choi KC 6, Chung TK 1,7, Wong TW 1,8, Lee TF 6
1New Territories East Cluster Nursing Research and Evidence Based Practice Workgroup, Central Nursing Division, New
Territories East Cluster, 2Department of Clinical Oncology, Prince of Wales Hospital, 3Medicine, North District Hospital,
4Department of Paediatrics, Prince of Wales Hospital, 5Department of Obstetrics and Gynaecology, Prince of Wales Hospital,
6The Nethersole School of Nursing, The Chinese University of Hong Kong, 7Central Nursing Department, Prince of Wales
Hospital, 8Department of Surgery, Prince of Wales Hospital, Hong Kong

Wednesday, 4 May Introduction

Wound cleansing should create an optimal healing environment by removing excess debris, exudates, foreign and necrotic
material which are commonly present in wounds that healed by secondary intention. At present, there is no research evidence
on whether pressurised irrigation provides better wound healing outcomes when compared with conventional swabbing
practice in cleansing wound.

Objectives

This study tried to find out 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.

Methodology

The study design was a multicentre, prospective, randomised controlled trial that took place in four General Outpatient
Clinics in Hong Kong. 256 patients with wound healing by secondary intention were randomly assigned by staff independent
of the study. A serially numbered, opaque and sealed envelope on either pressurised irrigation (n=122) or swabbing (n=134)
was distributed and chosen by patients. Staff undertaking study-related assessments was blinded to treatment assignment.
Patients’ wounds were followed up for six weeks or earlier 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 with 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). Patients in pressurised
irrigation group were significantly more in 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 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 saved HK$ 110 (95% CI -33 to 308) per patient when compared to swabbing, and was a cost-effective cleansing
method at no extra direct medical cost with a probability of 90%.

Conclusion

This is the first randomised controlled trial to compare pressurised irrigation and swabbing. Pressurised irrigation is more
cost-effective in shortening would healing time by secondary intention than swabbing with better patient tolerance. Use of
pressurised irrigation for wound cleansing is supported by this trial.

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