Wound cleansing for pressure ulcers

Pressure ulcers (also called pressure sores, bed sores and decubitus ulcers) are areas of tissue damage that occur in the very old, malnourished or acutely ill, who cannot reposition themselves. Pressure ulcers impose a significant financial burden on health care systems and negatively affect quality of life. Wound cleansing is considered an important component of pressure ulcer care.

This systematic review seeks to answer the following question:What is the effect of wound cleansing solutions and wound cleansing techniques on the rate of healing of pressure ulcers?

We searched the Specialised Trials Register of the Cochrane Wounds Group (up to August 2005), and the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2005). We searched bibliographies of relevant publications retrieved. We contacted drug companies and experts in the field to identify studies missed by the primary search.

Randomised controlled trials (RCTs) comparing wound cleansing with no wound cleansing, or different wound cleansing solutions, or different cleansing techniques, were eligible for inclusion if they reported an objective measure of pressure ulcer healing.

Two authors extracted data independently and resolved disagreements through discussion and reference to the Cochrane Wounds Group editorial base. A structured narrative summary of the included studies was conducted. For dichotomous outcomes, relative risk (RR), plus 95% confidence intervals (CI) were calculated; for continuous outcomes, weighted mean difference (WMD), plus 95% CI were calculated. Meta analysis was not conducted, because of the small number of diverse RCTs identified.

No studies compared cleansing with no cleansing. Two studies compared different wound cleansing solutions: a statistically significant improvement in Pressure Sore Status Tool scores occurred for wounds cleansed with saline spray containing Aloe vera, silver chloride and decyl glucoside (Vulnopur) compared to isotonic saline (P value = 0.025), but no statistically significant change in healing was seen when water was compared to saline (RR 3.00, 95% CI 0.21, 41.89). One study compared cleansing techniques, but no statistically significant change in healing was seen for ulcers cleansed with, or without, a whirlpool (RR 2.10, 95% CI 0.93 to 4.76).

We identified only three studies addressing cleansing of pressure ulcers. One noted a statistically significant improvement in pressure ulcer healing for wounds cleansed with saline spray containing Aloe vera, silver chloride and decyl glucoside (Vulnopur) when compared with isotonic saline solution. Overall, there is no good trial evidence to support use of any particular wound cleansing solution or technique for pressure ulcers.