wound workshop

interesting workshop. but i wonder why only S&N doing such talks? it seems the other companies aren't very interested in getting out business? we are talking of MASsIVe amount of $$, why aren't they doing the much needed marketing and advertisement? perhaps they don't have enough $ to start the money rolling in or the lack of expert? hmm,....

i found 1 area particularly interesting to me. flushing the wound with solution vs the traditional cleansing with guaze/ cotton dipped in solution. i remembered being taught by someone (wonder who...hmm..) that if we cleansed with the guaze/ cotton we can mechanically "wipe" off the 'dirt' or whatever that is sitting on the surface of the wound but if we flush the wound the 'dirt' would not be totally cleared out. so i had always support the traditional method of cleansing the wound unless left with no choice (deep but with narrow entrance wound) then i will have to flush. yet i still disapproved flushing cuz not all of the 'dirty solution' will be flushed out... err... hard to explain maybe let me draw an example...

-> the patient's wound cavity is 4 cm deep and 5 x 7 cm wide. slough covered the surface of the wound and the exudate is moderate. let says we flush the wound with N/S and by means of gravity, the top of the wound is adequately cleansed via the flushing method but... the top of the wound kept having a pool of 'used solution' building up. the area in my view is thus not totally or thoroughly cleansed. although we will end our cleansing with drying the wound with gauze but... the bottom was still not cleansed. instead of saying it was flushed clean, i would think of it as soaked. (get me point?)

so when the Sis said we should FLUSH the wound, i was a bit err... in doubt. but my co-workers all agreed that it should be the way to go. hmm... o_O?? i wondered. so i got on to curtin univ. library online to search for research paper to support my view. this is what i found...

13psi irrigation using a 30-60ml syringe with a 18-20G needle versus cleansing with gauze Infection One controlled trial without randomisation (Hollander et al 1998) compared wound infections and cosmetic appearance in wounds (non-bite, non-contaminated, facial and scalp lacerations) that were irrigated with normal saline and those that were cleansed with gauze and normal saline. No difference in infection rates between the groups was noted however, optimal cosmetic appearance at the time of suture removal was higher in the non-irrigation group.

but the situation above is on clean wound (which should heal regardless of lor) and i also saw this...

Healing One trial (Griffiths et al 2001 ), undertaken on chronic wounds, reported that there was no statistically significant difference in the number of wounds that healed after cleansing with tap water or normal saline. However, it should be noted that this trial was of a low power to detect a clinically important difference as statistically significant (49 wounds and only three infections).

Cost analysis The use of tap water was reported to be inexpensive compared to the use of normal saline in the only RCT that reported this outcome (Griffiths et al2001). In 2001, the estimated cost per dressing using normal saline was AUD$1.43 plus the cost of the dressing, compared to AUD$1.16 using tap water. The trial also indicated that if the wound was cleansed during showering, the only cost would be the dressing. Additional costs for the saline group included staff time, and materials and equipment used for the dressings.

interesting....