Wounds In Children Research Articles

Lesiones atendidas en atención primaria en la Comunidad de Madrid: análisis de los registros en la historia clínica electrónica

ObjectiveTo describe the incidence of injuries treated in primary care by type of injury, age groups, and sex in the publicly-funded health system of the region of Madrid in Spain. MethodsA descriptive cross sectional study was performed of injury episodes registered in the primary care electronic medical records of the health system of Madrid in 2011. We calculated the global incidence of injuries, injury-specific rates for fractures, sprains, wounds, burns, foreign body injuries, poisoning and bruises, and their rate ratios with 95% confidence intervals, all of which were stratified by sex and age groups. ResultsIn 2011 there were 707,800 injury episodes (3.5% of all episodes treated in primary care). Most of the injuries occurred in women (54.0%) and in persons older than 34 years (58.0%). The most common injuries were wounds in men (35.3%) and bruises in women (30.6%). Overall, women had higher rates of injuries among the elderly and men had more injuries in the group younger than 15 years. By type of injury, the highest rates of fractures, burns and bruises were observed in the older population, foreign body injuries and wounds in children, sprains in youth, and poisonings in extreme ages. ConclusionsThe special vulnerability of boys younger than 5 years and elderly women suggests that intervention strategies should be targeted to the specific needs of these groups.

Use of acellular dermal regeneration template combined with NPWT to treat complicated extremity wounds in children

The treatment of open wounds with exposed bone, tendon, or nerve is a challenging reconstructive problem, especially in children. The purpose of this study is to evaluate the safety and effectiveness of using acellular dermal templates combined with negative pressure wound dressings in the treatment of complicated paediatric soft tissue extremity wounds. A retrospective review of eight patients treated with acellular dermal templates for closure of complicated extremity wounds was performed. After debridement, all patients were treated with a template and a negative pressure wound treatment (NPWT) system. The average age was 8.8 years with 4 females and 4 males. Four wounds were at the foot/ankle, with tendon exposed in all 4, nerve in 2, and bone in 3. There were 3 lower leg wounds, all with exposed bone. One patient had arm/hand wounds with exposed tendon. The size of the wounds and dermal graft averaged 86cm² and 57cm². The average time to wound closure was 65 days. The majority of the treatment was received as an outpatient, including NPWT. For inpatient and outpatient care, the average number of sponge system changes was 2.6 compared to 4.6, and time between changes was 3.5 compared to 6.8 days. Each patient had only one procedure each for application of the dermal substitute and later one skin grafting procedure. Complications were minimal, and all patients healed their wounds without the need of flaps. One patient required wound revision. Our study demonstrates that a dermal template combined with NPWT can safely and effectively be used to treat complicated wounds in children. Closure was obtained without flaps, the majority of the treatment time was spent in the outpatient setting, and the complication rate was low. There were no external sources of funding for this study. The authors have no conflicts of interest to declare.

Acute paediatric bite injuries treated on inpatient basis: A 10-year retrospective study and criteria for hospital admission

The aim of this study was to evaluate the acute bite wounds in children treated on an inpatient basis over a 10-year period and the criteria for inpatient treatment. This study comprised all acute mammalian bite injuries in relation to all paediatric bite injuries seen at the Emergency Surgical Department (ESD). Inclusion criteria were: aged between 0–18 years; acute human or animal bite injuries (presenting for the first time); and inpatient treatment. Exclusion criteria were: bite wounds treated elsewhere and referred for complications; bites treated on an outpatient basis referred for complications; and all insect bites. Over 10 years, 12,948 children were seen at the ESD. There were 167 children (0.77%) with mammalian bite wounds. Twelve of them responded to the inclusion criteria. They presented 7.18% of all mammalian bite injuries and 0.09% of all paediatric emergency visits at the ESD. The average age was 3.82 ± 1.63 years (from 1.3–7 years). The time elapsed between the accident to the wound debridement was 118.64 ± 101.39 minutes. There were 10 dogs, one horse, and one rabbit bite. Surgical treatment comprised debridement, saline irrigation, and primary closure or reconstruction. All patients received antibiotics in the postoperative period. The average hospital stay was 5.92 ± 2.39 days. In one case a partial distal flap necrosis occurred. Animal bite injuries treated on an inpatient basis are predominantly dog bites in young children under 10 years of age, with deep, extended, and commonly multiple injuries. Only 7% of paediatric bite injuries require inpatient treatment.

The management of bite wounds in children—A retrospective analysis at a level I trauma centre

IntroductionAnimal bite wounds are a significant problem, which have caused several preventable child deaths in clinical practice in the past. The majority of bite wounds is caused by dogs and cats, and also humans have to be considered to lead to those extreme complicated diagnosis in the paediatric patient population. Early estimation of infection risk, adequate antibiotic therapy and, if indicated, surgical treatment, are cornerstones of successful cures of bite wounds. However, antibiotic prophylaxis and wound management are discussed controversially in the current literature. In our study, we retrospectively investigated the bite source, infection risk and treatment options of paediatric bite wounds. MethodsA total of 1592 paediatric trauma patients were analysed over a period of 19 years in this retrospective study at a level I trauma centre, Department of Trauma Surgery, Medical University of Vienna, Austria. Data for this study were obtained from our electronic patient records and follow-up visits. In our database, all paediatric patients triaged to our major urban trauma centre have been entered retrospectively. ResultsDuring the 19-year study period, 1592 paediatric trauma patients met the inclusion criteria. The mean age was 7.7years (range 0–18.9), 878 (55.2%) were males and 714 (44.8%) were females. In our study population, a total of 698 dog bites (43.8%), 694 human bites (43.6%), 138 other bites (8.7%) and 62 cat bites (3.9%) have been observed. A total of 171 wounds (10.7%) have been infected. Surgical intervention was done in 27 wounds (1.7%). ConclusionGender-related incidence in bite wounds for dog and cat could be detected. Second, our findings for originator of bite wounds reflect the findings in the published literature. Total infection rate reached 10.7%, primary antibiotic therapy was administered in 221 cases (13.9%) and secondary antibiotic therapy in 20 (1.3%) cases. Observed infection rate of punctured wounds and wounds greater than 3cm was 3 times higher than for all other wounds.Our findings need to be proven in further prospective clinical trials.

Advanced skin, scar and wound care centre for children: A new era of care

Advanced wound care centres are now a well established response to the growing epidemic of chronic wounds in the adult population. Is the concept transferable to children? Whilst there is not the same prevalence of chronic wounds in children there are conditions affecting the integumentary system that do have a profound effect on the quality of life of both children and their families. We have identified conditions involving the skin, scars and wounds which contribute to a critical number of potential patients that can justify the setting up of an advanced skin, scar and wound care centre for children. The management of conditions such as giant naevi, extensive scarring and epidermolysis bullosa challenge medical professionals and lead to new and novel treatments to be developed. The variation between and within such conditions calls for a customizing of individual patient care that involves a close relationship between research scientists and clinicians. This is translational medicine of its best and we predict that this is the future of wound care particularly and specifically in children.

Water for wound cleansing

Although various solutions have been recommended for cleansing wounds, normal saline is favoured as it is an isotonic solution and does not interfere with the normal healing process. Tap water is commonly used in the community for cleansing wounds because it is easily accessible, efficient and cost effective; however, there is an unresolved debate about its use. The objective of this review was to assess the effects of water compared with other solutions for wound cleansing. For this fourth update we searched the Cochrane Wounds Group Specialised Register (searched 9 November 2011); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 4); Ovid MEDLINE (2010 to October Week 4 2011); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, November 8, 2011); Ovid EMBASE (2010 to 2011 Week 44); and EBSCO CINAHL (2010 to 4 November 2011). Randomised and quasi randomised controlled trials that compared the use of water with other solutions for wound cleansing were eligible for inclusion. Additional criteria were outcomes that included objective or subjective measures of wound infection or healing. Two review authors independently carried out trial selection, data extraction and quality assessment. We settled differences in opinion by discussion. We pooled some data using a random-effects model. We included 11 trials in this review. We identified seven trials that compared rates of infection and healing in wounds cleansed with water and normal saline; three trials compared cleansing with no cleansing and one trial compared procaine spirit with water. There were no standard criteria for assessing wound infection across the trials, which limited the ability to pool the data. The major comparisons were water with normal saline, and tap water with no cleansing. For chronic wounds, the relative risk of developing an infection when cleansed with tap water compared with normal saline was 0.16, (95% CI 0.01 to 2.96). Tap water was more effective than saline in reducing the infection rate in adults with acute wounds (RR 0.63, 95% CI 0.40 to 0.99). The use of tap water to cleanse acute wounds in children was not associated with a statistically significant difference in infection when compared to saline (RR 1.07, 95% CI 0.43 to 2.64). We identified no statistically significant differences in infection rates when wounds were cleansed with tap water or not cleansed at all (RR 1.06, 95% CI 0.07 to 16.50). Likewise, there was no difference in the infection rate in episiotomy wounds cleansed with water or procaine spirit. The use of isotonic saline, distilled water and boiled water for cleansing open fractures also did not demonstrate a statistically significant difference in the number of fractures that were infected. There is no evidence that using tap water to cleanse acute wounds in adults increases infection and some evidence that it reduces it. However there is not strong evidence that cleansing wounds per se increases healing or reduces infection. In the absence of potable tap water, boiled and cooled water as well as distilled water can be used as wound cleansing agents.

A case of gunshot wound presenting with atypical cardiorespiratory findings

It is well known that a significant increase has occurred in the incidence of thoracic gunshot wounds in children over the last 15 years. Gunshot wounds have been defined as an a€A“epidemica€, a€A“a diseasea€, and a€A“a preventable public health problema€ all over the world. Gunshot wounds in children lead to more lethal or morbid outcomes due to the relatively small area in which their vital organs exist. Gunshot wounds are an increasingly more important problem in present communities with both their morbidities leading to significant impairment in quality of life and significant mortality. In this article, a case with various clinical outcomes following a gunshot wound is presented.

Comparisons of the Effects of Biological Membrane (Amnion) and Silver Sulfadiazine in the Management of Burn Wounds in Children

This prospective study was conducted on 102 children with second-degree thermal burns to assess qualitative differences between topical silver sulfadiazine (SD) and oven-dried, radiation-sterilized human amnion as wound dressing. The patients were divided into silver SD and amniotic membrane (AM) group by random sampling technique. The variables compared 1) the number of days admitted in the hospital, 2) the number of dressing changes, 3) time needed for epithelialization, 4) comfort and pain of the patients during dressing, 5) comfort and pain of the patients between dressings, 6) activities during treatment, 7) acceptability of the modules by the patients or attending guardians, and 8) comfort of the doctor during application. Patients' ages ranging from 1 day to 12 years and admitted to inpatient burn unit within 72 hours of occurrence were included in this study. Fifty-one burned children enrolled in each group. The mean hospital stay is significantly lower in AM group (P < .01). The number of dressing changes in AM group was significantly low (P < .001). The mean time taken for epithelial coverage of superficial second-degree burns is significantly lower in AM than in SD group (P < .001) and also those of deep second-degree burns (P < .001). Application was painless in AM than SD group (P < .001). State of pain in-between application shows significant difference (P < .001). Application of AM was comfortable to the attending doctor (P < .001). Significant activity of the patients was observed during treatment (P < .01) with AM. AM was accepted by the patients or parents (P < .001). This study indicates that radiation-sterilized, oven-dried AM is a better treatment option because its use reduces hospital stay and the number of dressing changes. Epithelialization of the wound is quicker. The use of AM is painless and odorless. The procedure is easy and comfortable to the doctor, and it is well accepted. Most of the patients remain ambulatory during treatment.

Prospective, Randomized, Controlled Trial Comparing a Tissue Adhesive (Dermabond™) with Adhesive Strips (Steri-Strips™) for the Closure of Laparoscopic Trocar Wounds in Children

4 methods are used in pediatric laparoscopic surgery to close trocar wounds. While tissue adhesives or adhesive strips have been shown to produce fewer wound complications and a better cosmetic result compared to trans- or only subcutaneous sutures, the choice of technique is still often based on the surgeon's personal experience. Thus, the objective of this trial was to assess the impact of tissue adhesives (Dermabond™) compared to adhesive strips (Steri-Strip™) on potential complications of wound healing, wound pain, cosmetic outcome, and patient satisfaction after laparoscopic appendectomy in children. 49 patients undergoing laparoscopic appendectomy were enrolled in this prospective randomized trial. In every patient, two 5-mm and one 10-mm port-site incision was closed either with Dermabond™ or Steri-Strip™ after placing subcuticular absorbable sutures (4-0 Vicryl™). Postoperative complications, pain, and patient satisfaction with scars were evaluated at follow-up on day 10 and day 90 after the operation using a questionnaire and a visual analogue scale (VAS). Photographs of scars taken on day 90 were evaluated on a VAS by 2 pediatric surgeons blinded to the closure method used. According to the surgeons' evaluation of the cosmetic outcome, a significant difference between the 2 groups with regard to the cosmetic score was found on day 90 of follow-up, favoring Steri-Strip™ wound closure (p < 0.05). On day 10 and 90 there were no statistical differences between the 2 methods as regards the result of patient evaluations (p > 0.05). Only one wound infection (4%) was observed in the Steri-Strip™ group (n = 25) on day 10. At follow-up on day 90 two patients (9.1%) in the Dermabond™ group and one (4.8%) in the Steri-strip™ group complained of wound pain (p = 0.52). Both tissue adhesives and adhesive strips are excellent "no needle" alternatives for the closure of laparoscopic port-site incisions in children. As regards cosmetic outcome, Steri-Strip™ wound closure seems to be the most suitable and is also the less expensive technique.

Non-Absorbable Interrupted versus Absorbable Continuous Skin Closure in Pediatric Appendectomies

appendectomy wounds are still commonly closed with non-absorbable sutures. Stitch removal has financial costs and causes anxiety in children. Our aim was to compare interrupted non-absorbable (NA) and continuous intradermal absorbable (A) sutures in appendectomy wounds to evaluate whether absorbable suturing increases the risk of complications. 198 children (age 4-18 years) including perforated cases were prospectively randomized into two groups (NA and A skin closure). The wounds and inflammatory markers were evaluated on the first two postoperative days. The appearance of the wound was evaluated one week postoperatively by a district nurse. Follow-up data were obtained from 166 patients (87 in NA group and 79 in A group). in NA group 86 % and in A group 81 % had appendicitis (8 % and 15.6 % perforated and 9.3 % and 25 % gangrenous cases in NA and A groups, respectively). The total wound infection rate was low, 1.8 % (2.3 % in NA Group and 1.3% in A Group). No differences in the inflammatory markers or the appearance of the wound were noted between the groups, but nine children in NA Group (10.3 %) had a partial wound dehiscence after stitch removal. appendectomy wounds in children can be closed with continuous, absorbable sutures, even in complicated cases.

Topical anaesthesia in children: reducing the need for specialty referral

The management of wounds in children is stressful, not only for the child, but also for parents and staff. In our Emergency Department (ED), we currently do not have a paediatric sedation policy, and thus children requiring suturing, not amenable to distraction and infiltrative anaesthesia, are referred to specialty teams for general anaesthesia. We proposed that the introduction of a topical anaesthetic gel (lidocaine, adrenaline, tetracaine - LAT) might help to reduce the number of referrals, by allowing the ED staff to perform the procedures, in combination with nonpharmacological approaches. We carried out a retrospective review of ED records of all children aged 14 years or less attending with wounds, over an 8-month period, from 01 May 2007 to 31 January 2008. Two hundred and one (50.6%) patients presented before the introduction of LAT gel, whereas 196 (49.3%) patients presented afterwards. A total of 39 (19.4%) patients were referred for specialty review pre-LAT, whereas only 19 (9.7%) patients were referred in the LAT group. Of these, 31 (15.4%) pre-LAT and 15 (7.7%) LAT group required general anaesthesia. There is a significant difference between these two groups, using Fischer's exact test, P=0.018. We have found that the introduction of topical anaesthetic gel in ED has significantly reduced the number of children with wounds referred to specialty teams for general anaesthesia. This has important implications for patient safety and hospital resources.

Retained Hawthorn Fragment in a Child's Foot Complicated by Infection: Diagnosis and Excision Aided by Localization with Ultrasound

Puncture wounds in children are very common and often result in foreign body retention. Organic materials in the form of plant thorns present problems in identification and localization because they are not visualized with plain radiographs. A case of a 10-year-old girl with a small piece of retained hawthorn is presented. Correct diagnosis and treatment were delayed because of misinterpretation of magnetic resonance image studies. Ultrasound ultimately located the foreign body, and assisted in its excision. Plant thorns may be toxic and produce an intense local inflammatory response. In the case described in this article, deep infection caused by Enterobacter cloacae and Pantoea agglomerans was associated with the retained thorn. The small size of the foreign body, misinterpretation of diagnostic images, and the deep infection highlight the challenges that can be encountered by physicians managing puncture wounds in children.

Schwere Nebenwirkungen nach Octenisept®-Spülung von Perforationswunden im Kindesalter

Deep penetrating wounds in children's hands are repeatedly treated in emergency wards conservatively through irrigation, antibiotic therapy and splint immobilisation. After we had seen severest phlegmonous reactions after irrigation with Octenisept followed by long troublesome histories we would like to warn against using this antiseptic agent for irrigation of wounds. We give an overview about the significance of antiseptics and the use of antibiotics in the treatment of deeper contaminated wounds. Between 2003 and 2007, 5 children (aged 2 to 8 years) were treated for sequelae of local wound irrigation with Octenisept in perforating hand injuries. We describe the early and medium-term aspects after irrigation, the further development, therapeutic measures, long-term damages and necessary reconstructions. We present the results of bacteriological smear tests, laboratory reports and histological examinations as well as allergy tests. All children showed more or less identical hand appearances. Hands were swollen caused by an interstitial oedema, compartment pressures were increased and hand function was completely suspended. The oedemas persisted for weeks and were hardly controllable. Especially serious were injuries at thenar level and in the first web space. Long-term sequelae were contractures caused by fibrotic muscle changes. Neither through bacteriological nor histological analysis were hints of bacterial or viral infections found. An allergic reaction to Octenisept could be excluded in the 3 most heavily affected children by an ROAT test. To prevent damage, contaminated wounds should be operatively debrided and not be irrigated with an antiseptic liquid. Octenisept seems to have a toxic effect in non-distinguished tissue. Because of a slow resorption it remains for a long time in the tissue. For therapy we recommend fasciotomy of the mid-hand and probably finger compartments, followed by compression treatment, physiotherapy with lymphatic drainage, dynamic and static splints.

Body wall thickness in adults and children—Relevance to penetrating trauma

Aim Although uncommon in children, penetrating trauma may be associated with considerable risk of morbidity and mortality. In part this reflects the child's thinner body wall. No data exists on the difference in body wall thickness in children as compared to adults. Method Computer tomography (CT) scans (23 adults and 17 children) selected at random were reviewed. Measurements of the thickness of the skin and subcutaneous tissue were taken from anatomically defined regions on the thoracic and abdominal wall. The differences between adults and children were compared and analysed statistically. Results The mean ages were 51.3 years for an adult and 8.9 years for a child. Indications for the CT scans included malignancy, inflammatory conditions and blunt trauma. Statistically significant differences in the median thicknesses of adult and paediatric thoraco-abdominal wall were found in all of the regions measured. This difference ranged from 7 mm at the xiphisternum to 14 mm in the right and left axillary lines at the level of the iliac crests. Conclusions The demonstrated difference in thickness of the thoraco-abdominal wall of an adult as compared to a child means that for a penetrating injury of equal depth, the body wall will be more easily breached and more organs potentially damaged in a child, particularly if the injury is sustained in the flanks. This supports the principle that all penetrating thoraco-abdominal wounds in children should be explored in the operating theatre under general anaesthesia to reduce the risk of a missed injury.

Outcome of primary closure of abdominal wounds following typhoid perforation in children in Ile-Ife, Nigeria

Abdominal wounds following surgery for typhoid perforation are classified as dirty, with an infection rate of over 40%. To date, the optimal method for closure of these wounds remains controversial. Delayed primary closure which was conventionally recommended as standard practice, is now considered to be of no value in preventing surgical site infection (SSI). This study evaluates the outcome of primary closure of this class of wounds in children in Ile-Ife, Nigeria, and advocates a multidisciplinary wound management protocol. This is a retrospective study of children aged < 1-15 years who had had surgery for typhoid perforation in a teaching hospital in south western Nigeria, over a period of ten years. Thirty-two patients, 18 males and 14 females, in the ratio of 1.3:1 were managed for typhoid perforation during the ten year period. All 32 patients had primary closure of their abdominal wounds. There was primary wound healing in six (18.8%) patients, while 19 (59.4%) patients had surgical site infections. Wound dehiscence, intraabdominal abscess, and faecal fistulas were the other complications documented in the study. Abdominal wounds of typhoid perforation, though classified as being dirty, can be closed primarily with good healing outcomes. A multidisciplinary approach to wound management will reduce the incidence of wound sepsis and its associated morbidity and costs.

Gunshots wounds in children: Epidemiology and outcome

Gunshots wounds in children: Epidemiology and outcome

Enzymatic Wound Debridement

Clinical experience and existing research strongly support debridement as a necessary component of wound bed preparation when slough or eschar is present. Multiple techniques are available, but the indications for each technique and their efficacy are not clearly established. There is little evidence to guide the clinician in the selection of a safe, effective debridement method for the patient with a chronic wound. We sought to identify evidence related to the efficacy of enzymatic debriding agents collagenase and papain-urea in the removal of necrotic tissue from the wound bed and its impact on wound healing. A systematic review of electronic databases was undertaken using key words: (1) debridement, (2) enzymatic debridement, (3) collagenases, (4) papain, (5) urea, and (6) papain-urea. All prospective and retrospective studies that compared enzymatic debridement using collagenase or papain-urea (with and without chlorophyllin) on pressure ulcers, leg ulcers, or burn wounds were included in the review. All studies that met inclusion criteria and were published between January 1960 and February 2008 were included. Collagenase ointment is more effective than placebo (inactivated ointment or petrolatum ointment) for debridement of necrotic tissue from pressure ulcers, leg ulcers, and partial-thickness burn wounds. Limited evidence suggests that a papain-urea-based ointment removes necrotic material from pressure ulcers more rapidly than collagenase ointment, but progress toward wound healing appears to be equivocal. Limited evidence suggests that treatment of partial-thickness burn wounds in children with collagenase ointment may require an equivocal time to treatment with surgical excision and that combination treatment may reduce the need for surgical excision. Insufficient evidence was found to determine whether collagenase ointment removes necrotic tissue from leg ulcers more or less rapidly than autolytic debridement enhanced by a polyacrylate dressing. Enzymatic debriding agents are an effective alternative for removing necrotic material from pressure ulcers, leg ulcers, and partial-thickness wounds. They may be used to debride both adherent slough and eschar. Enzymatic agents may be used as the primary technique for debridement in certain cases, especially when alternative methods such as surgical or conservative sharp wound debridement (CSWD) are not feasible owing to bleeding disorders or other considerations. Many clinicians will select enzymes when CSWD is not an option. Clinical experience strongly suggests that combined therapy, such as initial surgical debridement followed by serial debridement using an enzymatic agent or enzymatic debridement along with serial CSWD, is effective for many patients with chronic, indolent, or nonhealing wounds.

Foreign body reaction after usage of tissue adhesives for skin closure: a case report and review of the literature

The usage of tissue adhesives such as 2-octyl cyanoacrylate is a standard tool for closure of superficial wounds of the body. The benefits using 2-octyl cyanoacrylate are well known and appreciated by surgeons world wide. Especially in superficial or small wounds in children where no surgical procedure is wanted this technique is commonly used. However, so far the risks and possible complications after using 2-octyl cyanoacrylate are not sufficiently published and discussed. We report a case of foreign body reaction after 3 weeks in a 39-year-old female patient after usage of 2-octyl cyanoacrylate treating a superficial wound of the right wrist. The use of 2-octyl cyanoacrylate for the closure of superficial and small wounds or lacerations is a simple, quick and comfortable method. However, there is clinical evidence that in some cases the use of this type of tissue adhesive may lead to foreign body reaction. We suggest that each patient who is treated by this type of wound closure technique should be mandatory informed on the potential risk of a foreign body reaction.

Proposta de um algorítmo para seleção de coberturas, segundo o tipo de lesão aberta em crianças

OBJETIVOS: Este estudo descritivo teve por objetivos elaborar um algoritmo para apoiar a decisão da enfermeira na seleção de coberturas segundo o tipo de lesão aberta em crianças e avaliar sua aplicabilidade, segundo a opinião de enfermeiras pediátricas. MÉTODOS: O algoritmo desenvolvido é composto por determinantes relativos à avaliação do tecido e estágio de cicatrização, limpeza da ferida e tipo de cobertura primária e secundária utilizado. RESULTADOS: Entre as 24 enfermeiras que participaram da avaliação do algoritmo, o tempo de formadas e de trabalho em pediatria apresentou mediana de dois anos; 87,5% eram pós-graduandas e 100% cuidavam de uma a quatro crianças com feridas abertas por mês. Quanto a avaliação do algoritmo, na maioria das variáveis verificadas, o instrumento foi considerado ótimo. CONCLUSÃO: Após a utilização do algoritmo proposto, 95,8% das enfermeiras consideraram um importante instrumento para aplicação na prática assistencial.

Water for wound cleansing

Background Various solutions have been recommended for cleansing wounds, however, normal saline is favoured as it is an isotonic solution and is less likely to interfere with the normal healing process. Tap water is commonly used in the community for cleansing wounds because it is easily accessible, efficient and cost-effective; however, there is an unresolved debate about its use. Objectives The objective of this review was to assess the effects of water compared with other solutions for wound cleansing. Search strategy Randomised and quasi-randomised controlled trials were identified by electronic searches of Cochrane Wounds Group Specialised Register (June 2004), MEDLINE (1996-2004), EMBASE (1980-2004), CINAHL (1982-2004), and the Cochrane Controlled Trials Register (Issue 2, 2004). Primary authors, company representatives and content experts were contacted to identify eligible studies. Reference lists from included trials were also searched. Selection criteria Randomised and quasi-randomised controlled trials that compared the use of water with other solutions for wound cleansing were eligible for inclusion. Additional criteria were outcomes that included objective or subjective measures of wound infection or healing. Data collection and analysis Trial selection, data extraction and quality assessment were carried out independently by two reviewers and checked by a third reviewer. Differences in opinion were settled by discussion. Some data were pooled using a fixed effects model. Main results Five trials were identified that compared rates of infection and healing in wounds cleansed with water and normal saline; three compared cleansing with no cleansing and one compared cleansing with procaine spirit with water. There were no standard criteria for the assessment of wound infection across the trials which limited the ability to pool the data. The major comparisons were water versus normal saline, and tap water versus no cleansing. For chronic wounds, the relative risk of developing an infection when cleansed with tap water compared with normal saline was 0.16 (95% CI 0.01-2.96). Use of tap water to cleanse acute wounds in adults was associated with a lower rate of infection than saline (RR 0.55, 95% CI 0.31-0.97). The use of tap water to cleanse acute wounds in children was not associated with a statistically significant difference in infection, when compared with saline (RR 1.07, 95% CI 0.43-2.64). Similarly, no statistically significant differences in infection rates were seen when wounds were cleansed with tap water versus not cleansed at all (RR 0.81, 95% CI 0.31-2.12). Likewise, there was no difference in the infection rate in episiotomy wounds cleansed with water or procaine spirit. The use of isotonic saline, distilled water and boiled water for cleansing open fractures also did not demonstrate a statistically significant difference in the number of fractures that were infected. Conclusions Although the evidence is limited one trial has suggested that the use of tap water to cleanse acute wounds reduces the infection rate and other trials conclude that there is no difference in the infection and healing rates between wounds that were not cleansed and those cleansed with tap water and other solutions. In the absence of drinkable tap water, boiled and cooled water as well as distilled water can be used as cleansing agents.