A Comparison Study on Chlorhexidine and Normal Saline for Perineal Wound Cleansing

Transcription

1 A Comparison Study on Chlorhexidine and Normal Saline for Perineal Wound Cleansing Department of Obstetrics & Gynaecology Kwong Wah Hospital Sin Ming TAI, Amy KM YEUNG, Karen KL YU, Pui I LOU, Alice SY SHAM & Mandy SF WONG

2 Perineal Cleansing Ante-partum vaginal examination Intrapartum labour preparation, episiotomy repair Post-partum perineal tear or episiotomy wound

3 Aim of Perineal Wound Care Relief of pain and discomfort Prevention of infection Promotion of healing

4 Cleansing Solution (1) Chlorhexidine Salvon Betadine Salt Normal Saline Water

5 Cleansing Solutions (2) Based on Wound Care Society s educational leaflets: Aqueous solutions should be used rather than alcoholic solutions as the latter fix skin cells and delay healing Traditional antiseptics may have a toxic effect on wound healing

6 Cleansing Solutions (3) Chlorhexidine (Hibitane) Recommended for use on wounds Effective against a wide range of gram-positive and gram-negative organisms and some fungi Ineffective against acid-fast bacilli, spores and viruses Inactivated by organic matter such as blood, pus and soap

7 Cleansing Solutions (4) Normal Saline The least harmful cleansing agent Similar osmotic pressure with living cells Does not cause chemical damage to wound No antiseptic properties Assist in the removal of wound debris Should be used at body temperature

8 Objective of the study To compare the effectiveness of traditionally used Hibitane solution (Chlorhexidine Acetate 0.05% in aqeuous solution) with Normal saline (0.9% sodium chloride) as a cleansing solution for perineal wound cleansing

9 Method (1) From May to December 2000 Conducted in one postnatal ward Vaginal delivery and perineal wound either episiotomy or perineal tear Women using same kind of cleansing solution were nursed in the same room Randomly assigned into 2 groups (Hibitane or Normal Saline) Solution were swapped on alternate month

10 Method (2) Initial wound care after delivery and daily cleansing of wound were performed by nursing staff as usual A wound healing checklist was kept to record the condition of perineal wound All records of those readmitted to Gynaecology ward for wound management would be traced back for review Hibitane solution would be used to combat infection

11 Result (1) 2148 postnatal women were included in the study Characteristics for each group: Hibitane Solution Normal Delivery Mode of Delivery Ventose Extraction Forceps Delivery Total 1016(47.3%) 68(3.2%) 6(0.3%) 1090(50.7%) Normal Saline 964(44.9%) 87(4.1%) 7(0.3%) 1058(49.3%) Total 1980(92.2%) 155(7.2%) 13(0.6%) 2148(100%)

12 Result (2) Wound Condition: Episiotomy Perineal Wound Perineal Tear Total Hibitane Solution 964(44.9%) 126(5.9%) 1090(50.7%) Normal Saline 928(43.8%) 130(6.1%) 1058(49.3%) Total 1892(88.1%) 256(11.9%) 2148(100%)

13 Result (3) Significant level of pregnancy, delivery characteristics and maternal outcomes between 2 groups p value Pregnancy Maternal age Parity Antenatal Complication Delivery Characteristics Infant birth weight First stage Second stage Rupture of membrane Liquor Mode of delivery Maternity Outcome Postpartum Pyrexia Postnatal Anaemia 0.561

14 Result (4) Wound Outcome: Wound Outcome Gapping Infection Total Hibitane Solution 9 (0.4%) 6(0.3%) 15(0.7%) Normal Saline 11(0.5%) 3 (0.1%) 14(0.6%) Total 20(0.9%) 9(0.4%) 29(1.3%)

15 Result (5) Significant level of wound outcome: p value Wound Condition Episiotomy Perineal Tear Wound Outcome Wound Gapping Wound Infection 0.339

16 Result (6) There was no significant difference in the wound infection or breakdown in either Hibitane solution or Normal Saline The effectiveness of wound cleansing of both solutions was similar

17 Discussion (1) Most perineal wounds are clean surgical wounds repaired by suturing with aseptic technique If the wound is clean with little exudate, and there is signs of healthy granulation, repeated cleaning may traumatize newly produced delicate tissues, reduce the surface temperature of the wound and remove exudate which itself may have bactericidal properties, thus delaying wound healing (Glide, 1992)

18 Discussion (2) For perineal cleansing, traditional swabbing with antiseptic is ineffective as it rapidly inactivated by lochia and body fluid Antiseptic agents are seldom warmed up and therefore cool down the surface temperature of the wound and delay wound healing (Lawrence, 1997)

19 Discussion (3) Normal saline is the least harmful cleansing agent and is now widely advocate as the fluid of choice for wound cleansing and irrigation (Glide, 1992, Murphy, 1995, & Trevelyan, 1996)

20 Implication for practice (1) Normal saline is an appropriate solution for perineal wound care Cleansing of wound should be considered only after adequate assessment The role of the midwife in perineal wound care is to identify the cleansing agent most appropriate to the job at hand

21 Implication for practice (2) If the wound is to be cleaned, the solution with the least toxic effect to the healing tissues is the most desirable According to previous literature review, saline or water is suitable for non-infected perineal wounds If the wound is infected and an antiseptic is needed, chlorhexidine is the choice

22 Significant Change in Nursing Practice The perineal wound infection rate from 1999 to 2001 in all postnatal wards Year Infection Rate Solution Use % Hibitane % Hibitane & Normal Saline % Normal Saline

23 Acknowledge Department of Obstetrics & Gynaecology All working group members All nursing staff of E9

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