Construction and Preliminary Validation of Bathing with Wounds at Home Scheme for Patients with Traumatic Wounds

Abstract

Background Trauma is a highly prevalent and costly global health problem. Prevention and control of infection is a major challenge in the management of traumatic wounds, while prolonged absence of skin washing after trauma will increase the incidence of wound infection, as well as the discomfort. Although many patients are willing to take a bath after trauma, the timing and method of bathing remains unclear. Therefore, it is necessary to build an appropriate scheme of bathing with wounds to keep the skin and wounds clean. Objective To construct a bathing with wounds at home scheme suitable for patients with traumatic wounds in China, and to provide a feasible care scheme for keeping the skin of trauma patients clean and improving the outcome of wound healing. Methods Database at home and abroad were searched to obtain original literature, the first draft of the items of bathing with wounds at home scheme for patients with traumatic wounds was formulated through evidence-based analysis, generalization, group discussion. Fifteen wound care experts with associate or higher titles were included, and Delphi consultation was used to modify and improve the bathing with wounds scheme, with an interval of one week for each round of correspondences, the reliability of the consultation results was evaluated by the expert positive and authority coefficients. The consistency of the consultation results was evaluated by the coefficient of variation, a revised draft was formulated with terminated consultation when the coefficient of variation less than 0.25, which means that the expert opinions tend to be consistent. Thirty patients with traumatic wounds were enrolled in the pre-test, Likert 5-point scale was used to verify the convenience, safety and patient compliance of the bathing with wounds scheme, and the final scheme was developed after discussion and modification. Results After the inclusion of 23 related papers, the first draft of bathing with wounds scheme was developed through evidence-based analysis and discussion, involving three first-level items (including preparation befor bathing, bathing operation and treatment after bathing), seven second-level items, nine third-level items and four fourth-level items. The opinions of the 15 experts converged after 2 rounds of correspondence, with recall rates of 93.75% and 100.00%, with authority coefficients of 0.947 and 0.957, respectively. The variation coefficients of importance and maneuverability of each item in the first round were 0-0.25 and 0-0.23, and those in the second round were 0.09-0.18 and 0.07-0.14, respectively, a total of 2 items were deleted, 5 items were modified and 2 items were added, resulting in a revised draft. The 30 enrolled patients with traumatic wounds took baths (2.70±0.47) times per week according to the bathing scheme, with the average bath time of 10-15min, convenience and compliance scores of (4.67±0.48) and (4.70±0.47), and no bathing-related adverse events and wound infection occurred.The pre-test proved that the bathing plan was safe、reliable、simple and have good patient compliance. The final draft of the bathing with wounds scheme for traumatic wound patients included three first-level items, eight second-level items, nine third-level items and three fourth-level items. Conclusion In the construction process of the bathing with wounds scheme for traumatic wound patients, the positive and authority coefficients of experts are high, which has been unanimously approved by corresponding experts. The compliance of 30 patients with traumatic wounds in the pre-test was high, suggesting that the bathing with wounds scheme is safe and convenient, which can be applied to bathing with wounds at home for patients with traumatic wounds in China.

Keywords

• trauma and wound|bath|wound care|skin care|evidence-based practice|expert correspondence method