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The effectiveness of cleansing solutions for wound treatment: a systematic review protocol

Queirós, Paulo RN, PhD; Santos, Eduardo RN; Apóstolo, João RN, PhD; Cardoso, Daniela RN; Cunha, Madalena RN, PhD; Rodrigues, Manuel RN, PhD, Agregation

Author Information
JBI Database of Systematic Reviews and Implementation Reports: May 2013 - Volume 11 - Issue 5 - p 169-181
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Inclusion criteria

Types of participants

This review will consider studies that include patients with chronic and acute wounds (of any etiology) with the exception of obstetric wounds. It will be include patients of 18 or more years, in any setting (hospital, community and general practice) with the exception of patients with very poor nutrition.

Types of intervention(s)/phenomena of interest

This review will consider studies that use any cleansing solution or chemicals as cleansing solutions other than antiseptic solutions in wound treatment.

For this purpose we will be compare the effects on rates of healing and infection in acute and chronic wounds with the following cleansing solutions (may include, but not be limited to):

  • Tap water compared with normal saline;
  • Water (distilled and/or cooled boiled water) compared with sterile normal saline;
  • Tap water compared with cooled boiled tap water;
  • Tap water compared with polyhexanide/betaine solution;
  • Tap water compared with any other solution;
  • Sterile normal saline compared with polihexanide/betaine solution;
  • 0.5% or 2% Chlorhexidine Gluconate(CG);
  • 70% Alcohol;
  • Povidone-iodine; and
  • Any other comparable solution that appears in scientific papers.

Types of outcomes

This review will consider studies that include the outcome “infection rate” and “healing rate”.

In this regard, this review will focus in two types of outcomes:

1) Primary outcome (infection rate);

2) Secondary outcome (healing rate).

Both analyses will be divided in three groups:

1) Acute wounds;

2) Chronic wounds; and

3) Wounds with specific aetiology.

Types of study

This review will only consider experimental study designs including randomised controlled trials, non-randomised controlled trials, or other quasi-experimental studies, including before and after studies for inclusion.

Search strategy

The search strategy incorporates published and unpublished studies. A three-step search strategy will be used in this review. An initial limited search of MEDLINE and CINAHL will be undertaken, followed by an analysis of text words in the titles and abstracts, and of the index terms used to describe the article. A second search using all identified keywords and index terms will then be undertaken across all databases included. Thirdly, the reference list of all identified reports and articles will be searched for additional studies. Studies published in English, Spanish and Portuguese will be considered for inclusion in this review. In this regard, all studies in other languages will be excluded. The search strategy per database will encompass the period January 2000 to January 2013.

The databases to be searched will include:

CINAHL Plus with Full Text, MedicLatina, Academic Search Complete, MEDLINE with Full Text, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Nursing & Allied Health Collection: Comprehensive (via EBSCO);


Elsevier - Science Direct (via b-on - Online Knowledge Library);



JBI Library;

ACP online;

BioMed Central;

Health Technology Assessment database;

Scielo - Scientific Electronic Library Online.

The search for unpublished studies will include:

Agency for Healthcare Research and Quality (AHRQ);

‘Grey Literature Report’ from New York Academy of Medicine;

Mednar; website;

National Library of Australia's Trove service;

ProQuest - Nursing and Allied Health Source Dissertations;

Banco de teses da CAPES (;

RCAAP - Repositório Científico de Acesso Aberto de Portugal.

Initial English language keywords to be used will be:

Water, sodium chloride, polihexanide, clean*, wound*, heal*, infect*, detergents, povidone-iodine, chlorhexidine, hydrotherapy, shower, bath, irrigate

Assessment of methodological quality

Papers selected for retrieval will be assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information package (SUMARI). Any disagreements that arise between the reviewers will be resolved through discussion with a third reviewer (Appendix I). Any disagreements that arise between the reviewers will be resolved through discussion, or with a third reviewer.

Data collection

Data will be extracted from papers included in the review independently by two reviewers, using standardized data extraction tools from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument JBI-MAStARI (Appendix II). The data extracted will include specific details about the interventions, populations, study methods and outcomes of significance to the review question and specific objectives. For missing information or data that needs clarification, the authors of primary studies will be contacted. Any disagreements that arise between the reviewers will be resolved through discussion, or with a third reviewer.

Data synthesis

Quantitative data will, where possible, be pooled in statistical meta-analysis using JBI-MAStARI. All results will be subject to double data entry. Effect sizes expressed as odds ratio (for categorical data) and weighted mean differences (for continuous data) and their 95% confidence intervals will be calculated. Heterogeneity will be assessed statistically using the standard Chi-square. Plausible explanations for variations in treatment effects will be explored using subgroup analyses, where possible, to specify population and intervention differences and quality of studies. Where statistical pooling is not possible, the findings will be presented in narrative form including tables and figures to aid in data presentation where appropriate.

Conflicts of interest

There are no conflicts of interest.


The authors thank the support provided by Health Sciences Research Unit - Nursing (UICISA-E), hosted by the Nursing School of Coimbra (ESEnfC).


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                    Appendix I: Appraisal instruments

                    SUMARI Appraisal instrument

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                    Appendix II: Data extraction instruments

                    MAStARI data extraction instrument

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                    Water; sodium chloride; polihexanide; clean*; wound*; heal*; infect*; detergents; povidone-iodine; chlorhexidine; hydrotherapy; shower; bath; irrigate

                    © 2013 by Lippincott williams & Wilkins, Inc.