Clinical use of 0.1% polyhexanide and propylbetaine on acute and hard-to-heal wounds: a literature review.

OBJECTIVE: To summarise the findings on the effect of the clinical use of 0.1% polyhexanide-propylbetaine (PHMB/betaine) solution/gel on acute and hard-to-heal (chronic) wound healing. METHOD: A literature search was conducted in MEDLINE, CINAHL, Embase, Scopus and the CENTRAL Trials Registry of the Cochrane Collaboration. Paired reviewers conducted title and abstract screening and full-text screening to identify experimental, quasi-experimental and observational studies. Study quality and risk of bias were not formally evaluated. RESULTS: A total of 17 studies met the eligibility criteria. The findings from 12 studies indicated that the use of 0.1% PHMB/betaine solution/gel had: a low risk of contact sensitivity; could help debridement during wound cleansing; aided effective wound bed preparation; reduced wound size, odour and exudate; improved pain control; reduced microbial load; and enhanced wound healing. The results of three studies indicated that both 0.1% PHMB and saline solution were effective in reducing bacterial load, while another showed that adding 0.1% PHMB to tie-over dressings had no effect on reducing bacterial loads in wounds. Another study concluded that disinfection and granulation of pressure ulcers with hydrobalance dressing with 0.3% PHMB was faster and more effective than using 0.1% PHMB/betaine. CONCLUSION: The findings of this literature review showed that 0.1% PHMB/betaine solution/gel appeared to be useful and safe for wound cleansing, was effective in removing soft debris and slough from the wound bed, and created a wound environment optimal for healing. Although these actions cannot be attributed solely to this treatment modality, these results do highlight the unique action of this combined product. However, more robust studies are needed to confirm these results.

[Eficiency, equity or eficacy? Is it nurses or health systems dilemma?]. / Efficienza, equità o efficacia? Un dilemma per i sistemi sanitari e per gli infermieri.

Besides the increasing costs of health technologies and the epidemic and demographic transactions, the causes of the current inadequacy of resources in the health field are also to be ascribed to people changed expectations toward nursing and medicine. Such aspects have put in a critical position the working of the health services, which are incapable of facing the escalating and relentless health expenses. The evidence-based approach to the clinical practice and the following output of guidelines as a solution to the rationing of health services, may, in someone opinion, make headway towards the control of expenditure because it allows a synergy between optimal and basic principles. The reasoned use of the resources does not only presuppose that nurses can decide, as far as the patient is concerned, what is strictly necessary and at the same time most effective to the fulfillment of the nursing needs which have been pinpointed; nurses should also commit themselves to organise for the best, according to their level of responsibility, the scenario where clinic decisions are taken and to affect the guidance processes of the strategic choices of the institution they are part of. Nurses, as other professional do, have to honour also a commission which implies, on different levels, to take on an executive function, a teamwork function, an active and responsible cooperation in the working of health service. A superficial and cursory use of the guidelines as an allocation of resources might, on the other hand, raise objections in the name of ethics: health cannot be treated as a commodity, nor can health be subjected to market laws of supply and demand. The degree of legitimation of a health policy must therefore derive from the degree of harmonization and coherence between an evidence element and a social and cultural context where both have to be put a test.