Management of cut wounds and lacerations in the Gaza Strip: a prospective clinical audit

Abstract

Background: Cut wounds and lacerations are common, but effective treatment is essential to achieve good cosmetic outcomes and maintain function. We assessed the use of local anaesthetic, infection control procedures, and antibiotics in the management of cut wounds and lacerations.

Methods: Eligible patients were those attending the emergency departments of Nasser and Dar Al Shifa Hospitals in the Gaza Strip with cut wounds or lacerations, from Aug 25 to Sept 2, 2018. The management of cut injuries and lacerations was observed directly in emergency departments. Approval for the study was obtained from the Human Development Department for both and hospital administrations of each. Due to the lack of local guidelines, we compared management with the international guidelines from The Royal Children's Hospital, Melbourne, NSW, Australia.

Findings: 84 patients attended Nasser Hospital and 100 Dar Al Shifa Hospital during the study period and all 184 were included. At Nasser hospital, the mean age was 12·0 years (SD 11·5; median 8 years) and 84 (76%) patients were boys. At Dar Al Shifa Hospital, the mean age was 16·0 years (SD 15·3; median 11 years) and 72 (72%) patients were boys. Hand washing was not done before wound management in 72 (86%) of 84 cases at Nasser Hospital and 82 (82%) of 100 at Dar Al Shifa Hospital. Environmental cleaning (cleaning of blood and other waste from the floor) was seen before the treatment of 60 (71%) patients at Nasser Hospital and 59 (59%) at Dar Al Shifa Hospital. Lidocaine was administered before suturing in 81 (96%) of cases in Nasser Hospital, and 65 (65%) of those in Dar Al Shifa Hospital. Antibiotics were given to 65 (77%) of 84 patients treated in Nasser Hospital and to 72 (72%) of 100 treated in Dar Al Shifa Hospital. Only one patient at Dar Al Shifa Hospital and three patients at Nasser Hospital actually required antibiotics but none of these received them.

Interpretation: Poor adherence to hand washing policies, environmental cleaning, and use of antibiotics was seen. Relevant reasons might be workload, lack of facilities, or lack of awareness of infection control polices, or a combination of these factors. Clear and consistent leadership with staff education and feedback needs to be implemented to achieve sustainable culture change and improve infection control management in Gaza hospitals.