The gap between currently available evidence and awareness in clinical practice of wound care

It is the time to shower earlier

Ya Hsuan Yu, Sylvia Chao, Yen Kuang Lin, Yun Yun Chou, Hsun Hsiang Liao, El Wui Loh, Chung Shun Wong, Ka Wai Tam

Research output: Contribution to journalArticle

Abstract

Background: A postoperative water-forbidden strategy has been used for many decades. However, evidence shows that early contact with water postoperatively does not increase the infection rate. Our study evaluated the gap between currently available evidence and awareness in clinical practice of postoperative wound care. Methods: We conducted a systematic review to compare the outcomes between postoperative water-contact and water-forbidden groups. PubMed, EMBASE, and Cochrane databases were searched. A meta-analysis was conducted to calculate a pooled effect size by using random-effects models. On the basis of pooling results, a questionnaire survey was conducted to evaluate the gap from systematic review to clinical practice by clinical staff and patients. Results: We reviewed 12 trials including 4,086 patients. Incidence of infection and wound complications did not differ significantly between water-contact and water-forbidden groups. Satisfaction was significantly higher in water-contact group than in water-forbidden group (risk ratio: 17.33; 95% confidence interval, 11.11–27.03). A survey of clinicians showed that awareness, acceptance of the evidence, and the current water-contact strategy differed among departments. However, many clinicians showed no willingness to apply the water-contact strategy for various reasons. A survey of patients showed low awareness of the issue and variety in willingness to contact water. Conclusion: Water-forbidden strategy causes inconvenience to patients. However, a majority of patients and clinicians still hesitated to apply the early water-contact strategy, even after viewing the results of the current review. Establishment of local clinical practice guidelines, advocacy from authorities, and promotion by social media for this strategy are warranted.

Original languageEnglish
JournalSurgery (United States)
DOIs
Publication statusAccepted/In press - Jan 1 2018

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Water
Wounds and Injuries
Social Media
Postoperative Care
Wound Infection
Practice Guidelines
PubMed
Meta-Analysis
Odds Ratio
Databases
Confidence Intervals
Incidence
Infection
Surveys and Questionnaires

ASJC Scopus subject areas

  • Surgery

Cite this

The gap between currently available evidence and awareness in clinical practice of wound care : It is the time to shower earlier. / Yu, Ya Hsuan; Chao, Sylvia; Lin, Yen Kuang; Chou, Yun Yun; Liao, Hsun Hsiang; Loh, El Wui; Wong, Chung Shun; Tam, Ka Wai.

In: Surgery (United States), 01.01.2018.

Research output: Contribution to journalArticle

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abstract = "Background: A postoperative water-forbidden strategy has been used for many decades. However, evidence shows that early contact with water postoperatively does not increase the infection rate. Our study evaluated the gap between currently available evidence and awareness in clinical practice of postoperative wound care. Methods: We conducted a systematic review to compare the outcomes between postoperative water-contact and water-forbidden groups. PubMed, EMBASE, and Cochrane databases were searched. A meta-analysis was conducted to calculate a pooled effect size by using random-effects models. On the basis of pooling results, a questionnaire survey was conducted to evaluate the gap from systematic review to clinical practice by clinical staff and patients. Results: We reviewed 12 trials including 4,086 patients. Incidence of infection and wound complications did not differ significantly between water-contact and water-forbidden groups. Satisfaction was significantly higher in water-contact group than in water-forbidden group (risk ratio: 17.33; 95{\%} confidence interval, 11.11–27.03). A survey of clinicians showed that awareness, acceptance of the evidence, and the current water-contact strategy differed among departments. However, many clinicians showed no willingness to apply the water-contact strategy for various reasons. A survey of patients showed low awareness of the issue and variety in willingness to contact water. Conclusion: Water-forbidden strategy causes inconvenience to patients. However, a majority of patients and clinicians still hesitated to apply the early water-contact strategy, even after viewing the results of the current review. Establishment of local clinical practice guidelines, advocacy from authorities, and promotion by social media for this strategy are warranted.",
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AU - Tam, Ka Wai

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