The gap between currently available evidence and awareness of wound care in clinical practice: it is time to shower earlier




Poster session 2


Monday 17 September 2018 - 12:30 to 14:00

All authors in correct order:

Tam K1, Yu Y2, Chao S2, Chou Y3
1 Cochrane Taiwan; Department of Surgery, Shuang Ho Hospital, Taipei Medical University, Taiwan
2 School of Medicine, College of Medicine, Taipei Medical University, Taiwan
3 Shared Decision Making Resource Center, Shuang Ho Hospital, Taipei Medical University, Taiwan
Presenting author and contact person

Presenting author:

Ka-Wai Tam

Contact person:

Abstract text
Background: A postoperative 'water forbidden' strategy has been used for many decades. However, evidence has shown that early contact with water postoperatively does not increase infection rates.

Objectives: Our study evaluates the gap between the currently available evidence and awareness in postoperative wound care clinical practice.

Methods: We conducted a systematic review to compare outcomes between postoperative 'water contact' and 'water forbidden' groups. We searched the PubMed, EMBASE and Cochrane databases. We conducted a meta-analysis to calculate a pooled effect size using a random-effects model. On the basis of the pooled results, we conducted a questionnaire survey of clinical staff and patients to evaluate the gap between systematic review and clinical practice.

Results: We reviewed 12 trials including 4086 patients. The incidence of infection and wound complications did not significantly differ between 'water contact' and 'water forbidden' groups. Satisfaction was significantly higher in the 'water contact' group than in the 'water forbidden' group (risk ratio 17.33, 95% confidence interval 11.11 to 27.03). A survey of clinicians showed that awareness, acceptance of the evidence and current water contact strategy differed among departments. However, many clinicians showed no willingness to apply the water contact strategy for various reasons. A survey of patients showed low awareness of the issue and variation in their willingness to have contact with water.

Conclusions: A postoperative 'water forbidden' strategy causes inconvenience to patients. However, a majority of patients and clinicians are still hesitant in applying an early water contact strategy, even after seeing the results of the current review.

Patient or healthcare consumer involvement: Establishment of local clinical practice guidelines, advocacy from authorities and promotion by social media for an early water contact strategy are warranted.

Relevance to patients and consumers: 

We conducted a systematic review and meta-analysis revealed that contact with water as early as 24–48 hours postoperatively did not increase infection and wound complication rates, but increased patients’ satisfaction. Hence, we conclude that it is reasonable to allow patients early contact with water postoperatively. However, most patients and even clinical participants still follow the water-forbidden strategy. Authorities should take the responsibility to communicate the necessary knowledge by developing local clinical practice guidelines and propagandizing through media.