Dear list
Some weeks ago, Adrian Roberts asked about the use of antispetics in wounds. I
passed it on to colleagues for their comments. Here they are.
Patrick Crookes
Department of Nursing
University of Wollongong
Annette Hoskins wrote:
>
> Message /answer
> In response to Adrian Roberts enquiry re the use of different protocols for
> Emergency Department wound management. I think clinicians are becoming
> bogged down by the term EBP. There may not be valid evidence for every
> situation & EBP should compliment sound clinical expertise & judgement. eg
> there is a plethora of information on antiseptic use in the literature BUT
> this may not necessarily be a body of valid evidence (I have searched
> Cochrane & there does not appear to be a systematic review on antiseptic
> use, which is interesting considering the passion concerning the use of
> antiseptics in wound healing in the last 10 years!!) We should contact The
> NHS Centre for reviews & dissemination, University of York to see if they
> have performed any systematic reviews on this subject & ask them if their
> reviews make their way onto the Cochrane database! But in response to
> Adrians question more specifically, a commonsense approach should be taken
> in respect to Emergency Department wound management ie the physical removal
> of dirt & foreign bodies from a wound is the most important goal for the
> Emergency Department, dirt is more easily removed with the use of a
> surfactant eg Chlorhexidine & Cetrimide (Savlon) & the use of soft porous
> sponges (Chisolm 1992, Emergency Clinics of North America)to decrease tissue
> trauma, if a one off application of an antiseptic eg Povidone Iodine, is
> used to decrease the potential for latent wound infection then it is used as
> per manufacturers instructions eg 3-5 minutes contact time, then flushed
> from the wound with warm Normal Saline or tapwater. The manufacturers of
> "Betadine" have produced an Australian consensus statement (with clinician
> input) on the use of "Betadine" in Australian hospitals & it states that
> "there is no proven evidence of benefit or detriment for the continuing use
> of "Betadine" in the acute traumatic wound"....the goal for the
> decontamination of an acute traumatic wound is different to the ongoing
> management of this wound whereby normal saline & tapwater then become the
> solutions of choice. Clinicians need to be aware of their goals of
> management & not to blindly following excerpts from the literature eg
> "antiseptics delay wound healing & normal saline is the solution of
> choice"...well not for every wound care situation eg central line management
> requires antiseptics but I have witnessed clinicians using normal saline
> which is ludicrous, it is a different wound care situation involving intact
> skin & foreign bodies (the central line) & antiseptics are MOST
> APPROPRIATE!! Emergency Department wound care is again a different situation
> to the ongoing managment of a wound & the goals should be specific ie to
> debride a wound of foreign matter (gentle scrubbing & sharp debridement), to
> reduce the potential for latent wound infection due to the likelihood of the
> patient encountering a large dose of bacteria at the time of the trauma (use
> of antiseptics following contact time recommendations & flushing with normal
> saline post use)...LET COMMONSENSE & SIMPLE PROTOCOLS PREVAIL!! The
> Emergency Department & the management of acute traumatic wounds is a
> specific field of wound managment requiring it's own logical procedures!!
>
> Brenda Ramstadius & Annette Hoskins
> Wollongong Hospital and University of Wollongong, Nursing Dept.
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