| Objectives:1.The purpose of the multi-center current research was to understand the current status of whole body skin cleansing of chronic wound patients and analyze the influencing factors,which layed a foundation for the further analysis of the influence of whole body skin cleaning on the prognosis of chronic wounds in cohort study;2.The aim of the cohort study was to analyze t he effects of whole body skin cleaning on the prognostic indicators of wound healing and wound infection in patients with chronic wounds,so as to provide a clinical basis for selecting appropriate whole body skin cleaning methods for patients with chronic woundsMethods:1.This study was divided into two parts.The first part was a multi-center current survey of whole body skin cleansing of patients with chronic wounds.The patients with chronic wounds in wound care clinics and surgical wards of 7 hospitals were investigated.Among them,patients who met the inclusion and discharge criteria were selected as subjects.After obtaining the consent of the patients,the online questionnaire survey of"Survey on whole body Skin Cleansing of Patients with Chronic Wounds"can be completed through wjx on the mobile phone.Researchers exported the original survey data from wjx.Epidata3.0 software was used for double entry and established databases,and then SPSS 25.0 was used for data analysis.2.The second part was to conduct a cohort study on the impacts of skin cleansing on wound infection and healing of patients with chronic wounds based on the first part of the study.Patients with chronic wounds were selected as the screening population who went to the Wound Care Center of Jinling Hospital Affiliated to Medical College of Nanjing University from 2020 to 2021,and the subjects were selected according to the standards of intake and discharge.Patients who voluntarily participated in this study and signed the informed consent were included in the study cohort.A total of 212patients were included in the study cohort,among whom the patients who cleaned their whole body skin except the wound at home after injury were included in the observation cohort(n=106),and 106 patients who had never been cleaned after injury were included in the control cohort according to a 1:1 ratio.The observation period of this study was2 months or until the wound was healed.The main observation indicators were infection rate,healing time and wound healing rate.The auxiliary observation indicators were positive rate of bacterial culture,PUSH.In this study,SPSS 25.0 was used for statistical analysis of the data.Results:1.4 invalid questionnaires were excluded from the current multi-center survey,and a total of 409 valid questionnaires were received.There were 208 males(50.9%)and 201females(49.1%).The patients were 18-100 years old and the average age was 55.92±17.66 years old.72 cases were illiterate,accounting for 18.3%,163 cases were below junior high school(not including illiteracy),accounting for 39.9%,99 cases were high school or technical secondary school,accounting for 24.2%,and 72 cases were college or above,accounting for 17.6%.The limbs with the most wounds included 195 cases including hands and feet,accounting for 47.7%,followed by the chest and abdomen with 135 cases,accounting for 33.0%,the waist and hips with 56 cases,accounting for13.7%,and the least for the head,face and neck with 23 cases,accounting for 5.6%.There were 188 cases with wound duration of 30-50 days,accounting for 46%,and 221cases with wound duration of more than 50 days,accounting for 54%.There are many causes of injuries,the most common of which is postoperative wound infection with151cases(36.9%),the second is spontaneous ulceration with 84 cases(20.5%),and the least is incision injury with 8 case(2.0%).Mobility:289 cases(70.7%)of autonomous activities,61 cases(14.9%)of wheelchair activities,59 cases(14.4%)of bed rest.There were 113 patients who had never been cleaned after injury,accounting for 27.6%,and296 cases were cleaned,accounting for 72.4%.The main cleaning methods were partial bathing(70.6%),showering with wound protected(20.3%)and showering without wound protected(7.4%).The cleaning frequency was once a week,and the cleaning time was 15min each time.The main reason for 113 patients who did not wash:the doctor told that they could not touch water accounted for 70.8%(80 cases),followed by patients who worried about infection after washing accounted for 25.6%(29cases),lost their ability to take care of themselves accounted for 1.8%(2 cases),unable to withstand accounted for 0.9%(1 cases),unattended 0.9%accounted for(1cases).Univariate analysis found that the skin cleansing rate of chronic wound patients was significantly different in Level of education,self-care ability,wound pain,and wound duration(P<0.05);multivariate logistic regression analysis found that self-care ability(OR=1.888,[95%CI:1.146～3.111]),Previous treatment history([OR=0.264,95%CI:0.137～0.508]),wound pain(OR=0.443,[95%CI:0.223～0.883])and wound duration longer than 50d(OR=1.821,[95%CI:1.126～2.944])are the influencing factors of whole body skin cleansing in chronic wound patients.2.A total of 212 patients were enrolled in the cohort study,106 patients in the observation group and 106 patients in the control group,and there were no lost cases during the whole study.Comparison of baseline data between the two groups:there was no significant difference in general demographic data including gender,age,history of basic diseases,history of diabetes mellitus,history of malignant tumor,history of immune diseases,history of antibiotic use and nutritional status(P>0.05).Wound-related data,including wound type,wound location,wound area,wound volume and wound duration,showed no statistical significance(P>0.05),indicating that baseline data of patients in the two groups were comparable.Comparison of main outcome measures:(1)Wound infection rate:The wound infection rate of the chronic wound patients included in this study was 75%(159/212).Before enrollment,the wound infection rate of the observation group was 70.8%(75/106),and that of the control group was 79.2%(84/106),the difference was not statistically significant(χ~2=2.038,P=0.153).The wound infection rates in the observation group and the control group were 51.9%and 61.3%in one week,the difference was not statistically significant(χ~2=1.920,P=0.166).The wound infection rates in the observation group and the control group were 30.2%and 39.6%in three weeks,the difference was not statistically significant(χ~2=2.076,P=0.150).(2)Healing time and wound healing rate:The healing time of the observation group was 47(34,65)d,while that of the control group was 43(30,58)d.The Wilcoxon rank sum test using non-parametric test showed no statistically significant difference in the healing time between the two groups(T=-0.597,P=0.550).During the follow-up,all the patients had healed their wounds,and the healing time was 15d-170d.The healing rate of the observation group was 72.6%(77/106),and that of the control group was 78.3%(83/106),and there was no significant difference between the two groups(χ~2=0.917,P=0.338)The healing rates in one month of observation group and control group were 21.7%、24.5%,there was no significant difference between the two groups(χ~2=0.239,P=0.625).And the healing rates in three months of observation group and control group were 86.8%、89.6%,there was no significant difference between the two groups(χ~2=0.408,P=0.523).Comparison of secondary outcome indicators:(1)The positive rate of bacterial culture:before enrollment,the positive rate of bacterial culture in the observation group was 66%(70/106),and that in the control group was 68.9%(73/106),and there was no significant difference between the two groups(χ~2=0.193,P=0.660).The positive rate of bacterial culture on 4 weeks was 39.6%(42/106)in the observation group and 45.3%(48/106)in the control group,and there was no significant difference between the two groups(χ~2=695,P=0.404).(2)PUSH score:Before enrollment,the PUSH scores of the observation group and the control group were 12(10,15)and 13(10,15),respectively,and there was no statistical significance between the two groups(z=-0.814,P=0.416).During the observation week,the PUSH scores of the observation group and the control group were 11(7,14)and 12(8,14),respectively.The rank sum test showed that there was no significant difference in the weekly PUSH scores between the two groups(z=0.341,P=0.733).The PUSH scores of the observation group and the control group were 10(6,13)and 10(6,13),respectively,and there was no statistical significance in the PUSH scores of the two groups at two weeks(z=-0.373,P=0.709).Conclusions:1.The skin cleansing rate of patients with chronic wounds is low and needs to be improved urgently.When formulating an individualized skin cleansing plan in the future,it is necessary to consider the impacts of the patient’s ability to take care of themselves,whether the wound is painful,and the wound duration on the patient’s skin cleansing after the injury.2.Washing the skin of patients with chronic wounds will not affect wound healing or cause wound infections.When the patient’s body can tolerate and conditions permit,it is recommended that the patient can clean the skin outside the wound at home. |
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