Application And Cost-benefit Analysis Of Different Sliver Dressings In The Treatment Of Chronic Wound Bacterial Biofilm Infection

Objective1.To grasp the occurrence of bacterial biofilm and the application of silver dressings for chronic wounds in a hospital.2.To systematically review the efficacy of different silver dressings in nursing chronic wound bacterial biofilm infection.3.To explore the application and cost-effectiveness of different silver dressings in chronic wound bacterial biofilm infection,so as to provide reference for medical personnel and patients to choose this dressing in the future.Methods1.Current situation investigation:118 chronic wound patients in the wound clinic of a third-class A hospital were investigated by convenience sampling method.The survey included the incidence of clinical identification index of wound bacterial biofilm,the application of silver dressings and the evaluation of nurses and patients on the use of silver dressings.2.Systematic review:The wound bacterial biofilm related studies of silver dressings in Chinese and English databases were systematically searched.According to the inclusion and exclusion criteria,two researchers independently conducted literature screening,data extraction,literature quality assessment,and descriptive analysis of the included literatures.3.Application evaluation:70 patients with chronic wound bacterial biofilm infe--ction in outpatient department of a hospital were divided into control group(the algi--nate silver dressing)and experimental group(the new carboxymethyl cellulose sodi--um silver dressing,hereinafter referred to as the new silver dressing))by randomized control method,35 cases in each group,all of which were treated for 28 days.Wound area reduction rate,pressure ulcer healing score,p H value of exudate,incidence of cl--inical identification index of wound bacterial biofilm,safety evaluation,cost-effecti--veness ration and incremental cost-effectiveness ratio were observed in the two gro--ups.Epidata3.1 software was used to input data,and SPSS25.0 software was used for statistical analysis.Results1.The incidence rate of bacterial biofilm in chronic wound in a hospital was70.7%.The use of silver dressings accounted for 90.68%in nursing chronic wound bacterial biofilm,and the top 3 silver dressings in frequency of use were the alginate silver dressing(39.71%),the hydrophilic silver-containing dressing(36.76%),and new silver dressing(19.11%).Wound nurses and patients had the highest positive rate for the new silver dressing(84.62%and 79.92%,respectively).Wound nurses had a good evaluation on the performance of the new silver dressing,but had a low evaluation on the"ease of applying the dressing"due to its higher unit price.2.A total of 10 literatures were included.Four foreign literatures all reported that the new silver dressing had good curative effect.Three domestic literatures reported that the nano-silver dressing had some effect,but did not have enough advantages compared with the combined measures.Three domestic literatures reported silver ion dressings,but the efficacy was not consistent.3.There was no statistical significance in the comparison of baseline data between the two groups(P>0.05).Repeated measurement analysis showed that there were significant differences in wound area reduction rate(P=0.032)and pressure healing score(P<0.01)between the two groups except for p H of exudate(P=0.402).And there were no adverse events in either group.On the 28th day after intervention,the incidence of clinical identification index of wound bacterial biofilm in the experimental group was lower than that in the control group(P<0.05).The cost-effectiveness ratios of the experimental group and the control group were87.79yuan/cm~2and 89.29 yuan/cm~2.Compared with the experimental group,each additional 1cm~2wound healing in the control group would more cost 105.2 yuan.Conclusions1.The incidence of bacterial biofilm in chronic wound is high in outpatient clinic.Silver dressing is the main nursing measure to treat wound bacterial biofilm.Among them,traditional silver dressings are widely used,while the new silver dressing are not widely used in clinical application mainly due to higher unit price.2.Based on the existing evidence,although it is not possible to make a unified and comprehensive evaluation on the efficacy of various silver dressings in the treatment of wound bacterial biofilm,foreign studies have shown that the new silver dressing has better efficacy.There are no literatures about the new silver dressing in China,which need to be studied urgently.3.The new silver dressing has good efficacy in promoting wound healing,improving the effect of wound bacterial biofilm,and has achieved high cost and economic benefits,which provides guidance for subsequent clinical practice.