Nettoyage des plaies. Connaissances et pratiques des infirmiers

Abstract

Wound management constitutes an important public health issue. Health authorities have published numerous recommendations on wound cleansing and dressing. The French law currently authorizes nurses to prescribe wound care with a doctor's agreement. Further, they have an essential role in wound management. In this study, we evaluate nurses' behavior in wound cleansing in outpatients and in hospital settings. The survey was conducted from 4/1/11 to 5/6/11 in 111 nurses working at Argenteuil Hospital and in 299 nurses with outpatient activity within two administrative departments (Hauts-de-Seines and Val-d'Oise) in the suburbs of Paris, France. The questionnaire included items relating to the use of antiseptics during cleansing of various types of wounds, with or without signs of super-infection, and with or without medical prescription. The results were compared with French references. One hundred and ninety-one answers were obtained: 111 (100%) from the hospital and 80 (27%) from nurses with outpatient activity (women: 88%, mean age=36 years). The mean number of wounds seen per week was 18 (0-135). In the absence of a prescription, antiseptics were used by less than 35% of the nurses for chronic wounds and burns but by more than 50% for operative and traumatic wounds. When water or physiological serum was prescribed for wound cleansing, these figures were slightly lower. Conversely, if an antiseptic was prescribed, more than 50% of the nurses used antiseptics. Where nurses disagreed with the medical prescription, more than 60% of the hospital nurses discussed this with the doctor, compared to less than 40% of private nurses. In the event of signs of super-infection, more than 85% of the nurses used antiseptics, with or without medical prescription, and in the case of disagreement, more than 90% called the doctor, whether working in a hospital setting or among outpatients. The alternative to an antiseptic was physiological saline for 60 to 80% of the nurses, with sterile water or tap water being used by less than 45%. Antiseptics continue to be used in situations in which they are no longer recommended (e.g. chronic wounds, operative wounds, super-infected wounds) whereas they are used very little for burns, where they are in fact recommended during the acute phase. This is true both with and without medical prescription. Prescriptions are not always followed in practice and prescriptions of antiseptics are more often respected than prescriptions of water or physiological saline solution. Discussion with the prescribing doctor is more frequent among hospital nurses than among private nurses.