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

doi:10.1016/j.surg.2018.01.013

The gap between currently available evidence and awareness in clinical practice of wound care: It is the time to shower earlier

Surgery. 2018 Mar 1:S0039-6060(18)30029-1. doi: 10.1016/j.surg.2018.01.013. Online ahead of print.

Authors

Ya-Hsuan Yu¹, Sylvia Chao¹, Yen-Kuang Lin², Yun-Yun Chou³, Hsun-Hsiang Liao⁴, El-Wui Loh⁵, Chung-Shun Wong⁶, Ka-Wai Tam⁷

Affiliations

¹ School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, China.
² Biostatistics Center, Taipei Medical University, Taipei, Taiwan, China.
³ Shared Decision Making Resource Center, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan, China.
⁴ Joint Commission of Taiwan, Taiwan, China.
⁵ Shared Decision Making Resource Center, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan, China; Center for Evidence-based Health Care, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan, China.
⁶ Department of Emergency Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan, China; Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, China.
⁷ Shared Decision Making Resource Center, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan, China; Center for Evidence-based Health Care, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan, China; Division of General Surgery, Department of Surgery, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan, China; Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, China; Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan, China. Electronic address: kelvintam@h.tmu.edu.tw.

PMID: 29502871
DOI: 10.1016/j.surg.2018.01.013

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.