To Örebro University

PURPOSE: To systematically summarize and review the existing literature to determine the difference between wound cleansing techniques, irrigation and swabbing, in relation to bleeding, pain, infection, necrotic tissue and exudate in non-infected chronic wounds including pressure injuries, venous and arterial leg ulcers and diabetic foot ulcers.

METHODS: A systematic search of the electronic databases Ovid Medline, Cochrane Database of Systematic Reviews, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and EMBASE was performed to identify all relevant literature in English. The search also included systematic reviews as a method to obtain additional potential citations by manually searching the reference lists. Included studies were assessed for methodological quality using the Cochrane Risk of Bias Tool.

RESULTS: One study met eligibility criteria. Two hundred fifty six patients with wounds healing via secondary intention (n = 256) were included. Wound cleansing via swabbing technique was associated with increased perception of pain and increased rates of infection when compared to the irrigation group (93.4% versus 84.2% p = 0.02 and 5.2% versus 3.3% p = 0.44, respectively). Only a small proportion of this sample met the inclusion criteria, so the results are not considered externally valid.

CONCLUSION: Wound cleansing remains a controversial topic. Despite calls for further research, there continues to remain a large gap in evidence to guide practice. Irrigation continues to replace swabbing in the management of chronic wounds, although evidence of improved outcomes is virtually nonexistent. Although the one study identified was of sound methodological quality, chronic wounds accounted for only a small percentage of the sample. Therefore, results are not generalizable to those with chronic wounds. Further research is needed to determine the effectiveness of basic wound cleansing techniques before considering more costly products.

BACKGROUND: Wound cleansing is a fundamental component of chronic wound management; yet, high-quality evidence to guide practice is limited. Understanding nurses' knowledge, attitudes, and practices (KAP) is essential, but no instrument with published evidence of acceptable measurement properties exists.

OBJECTIVE: To develop a KAP questionnaire on wound cleansing for community nurses and evaluate its measurement properties.

METHODS: A multi-phase study was conducted, including literature/consensus item generation; a two-round international Delphi process; pilot cognitive interviews; and field testing in Canada. Knowledge was assessed for item and construct validity; attitude for internal consistency (Cronbach's α); and all KAP items for stability using test-retest reliability.

RESULTS: 26 experts supported content relevance; feedback led to targeted revisions. Field testing involved 130 nurses (83.1 % homecare; >80 % with ≥5 years of wound care experience). Several knowledge items were too easy (≥.90); none negatively discriminated. Exploratory principal components analysis of attitudes yielded three components (63 % of variance); internal consistency ranged from α = 0.41 to α = 0.76. In the subsample (n = 30), knowledge κ values ranged from slight/fair to substantial; some items showed ceiling effects (uniform responses, κ undefined). Attitude and practice item-level intraclass correlation coefficients varied (.07-.95), with several ≥.75 and others <.60. Known-groups comparison supported higher knowledge among formally educated nurses.

CONCLUSION: Evidence supports content validity and a clarified attitudes structure; internal consistency and stability were acceptable for some elements but below the threshold for others. Future refinement and confirmatory testing are warranted.