Comparing Outcomes for Prontosan Versus Normal Saline for Negative Pressure Wound Therapy With Instillation
Primary Purpose
Wound Infection
Status
Completed
Phase
Phase 4
Locations
United States
Study Type
Interventional
Intervention
Normal saline
Prontosan
Sponsored by
About this trial
This is an interventional treatment trial for Wound Infection focused on measuring hospital admission
Eligibility Criteria
Inclusion Criteria:
- Male or female greater than 18 years of age
- Admission to the hospital for an infected wound
- Diabetic, ischemic, neuropathic, venous, surgical wounds, any anatomical location
- Subjects requiring serial (more than 1) operative debridement
Exclusion Criteria:
- Pregnancy
- Patients with exposed bowel, brain matter, spinal cord
- Patients with exposed peripheral bypass grafts
- Known allergy or sensitivity to Prontosan or components of NPWT
- Known allergy or sensitivity to adhesives
- Uncontrolled bleeding disorders/coagulopathy
- Wounds that tunnel to unexposed areas
- Malignancy
Sites / Locations
- Medstar Georgetown University Hospital Center for Wound Healing
Arms of the Study
Arm 1
Arm 2
Arm Type
Active Comparator
Active Comparator
Arm Label
Normal Saline
Prontosan
Arm Description
The use of Normal Saline as the solution for Negative Pressure Wound Therapy with instillation.
The use of Prontosan as the solution in Negative Pressure Wound Therapy with Instillation.
Outcomes
Primary Outcome Measures
Number of Operating Room Visits
Compare the number of operative room visits between Prontosan NPWTi and normal saline NPWTi.
Secondary Outcome Measures
Hospital Admission Length of Stay
Compare the hospital admission length of stay between Prontosan NPWTi and normal saline NPWTi.
Full Information
NCT ID
NCT01939145
First Posted
September 3, 2013
Last Updated
November 8, 2016
Sponsor
Georgetown University
1. Study Identification
Unique Protocol Identification Number
NCT01939145
Brief Title
Comparing Outcomes for Prontosan Versus Normal Saline for Negative Pressure Wound Therapy With Instillation
Official Title
A Prospective Randomized Trial Comparing Outcomes for Prontosan Versus Normal Saline for Negative Pressure Wound Therapy With Instillation
Study Type
Interventional
2. Study Status
Record Verification Date
November 2016
Overall Recruitment Status
Completed
Study Start Date
September 2013 (undefined)
Primary Completion Date
July 2014 (Actual)
Study Completion Date
July 2016 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Georgetown University
4. Oversight
Data Monitoring Committee
No
5. Study Description
Brief Summary
This is a prospective, randomized trial comparing the outcomes for Prontosan versus normal saline as the solution for negative pressure wound therapy with instillation (NWPTi). Negative pressure wound therapy (NPWT) is a well established method of treatment for acute and chronic wounds. The combination of negative pressure with instillation of a solution is a relatively novel concept that has gained popularity and is currently used nationally and internationally. NPWTi is the standard of care for our division. Despite the growing use, there is limited information regarding the selection of the ideal instillation solution. This is a single site, investigator initiated, NPWTi study comparing the use of Prontosan with normal saline for the adjunctive treatment of the acutely infected wound that requires hospital admission. A total of 100 subjects will be included with 50 subjects in each treatment arm. The outcomes that will be measured are 1) number of operations, 2) length of hospital stay, 3) % of wounds closed prior to discharge, 4) time to closure prior to discharge, 5)% remained closed at 30 day follow-up, and 6) reduction of qualitative bacterial cultures. The results from this study will better characterize the most appropriate use of NPWTi.
Detailed Description
Overview This is a prospective, randomized, comparative trial examining 2 different instillation solutions for NPWTi. All wound types that meet the eligibility criteria will be enrolled into the study. After enrollment, subjects will be randomized into either the Prontosan NPWTi group (n=50) or the normal saline NPWTi group (n=50). Data will be collected from inpatient hospital records.
Outline of Study Procedures
Patients meeting the eligibility criteria requiring hospital admission for an infected wound will be identified. Demographic information will be obtained.
Informed consent will be obtained.
Subjects will be taken to the operating room for wound debridement within 72 hours of admission per standard of care (SOC). Further, antibiotic therapy and medical management will be performed per SOC.
Randomization into the Prontosan or normal saline instillation group will be conducted after the informed consent has been signed, but before the first operation.
For the first operating room visit the following will be conducted:
Pre- and post debridement qualitative cultures
Debridement performed in SOC fashion
Post debridement measurements
Application of NPWTi
For subsequent operating room visits the following will be conducted:
a. Pre- and post debridement qualitative cultures b. Debridement performed in SOC fashion c. Post debridement measurements d. Application of NPWTi or closure i. The decision to close the wound will be determined by the clinician per SOC.
ii. The technique utilized for closure will be determined by the clinician per SOC.
Subjects will discharged from the hospital
a. Criteria for discharge will be per the judgment of the investigator per SOC
After hospital discharge, the subject will be followed in the outpatient wound clinic per SOC. Information from the one month follow-up period will be collected. Subjects will be exited from the study at that point.
Subject Recruitment No active recruitment strategy will be employed. Patients who meet the eligibility criteria will be approached to participate into the study.
Participation Completion and Discontinuation:
Subjects may elect to discontinue participation at any time for any reason. Investigators may elect to remove the subject from participating at any time for any reason.
Surgical Technique:
Surgical debridement will be performed in SOC manner and is at the discretion of the investigator.
Postoperative Care:
Will be conducted in customary SOC fashion and is at the discretion of the investigator. The 30 day follow-up visit is part of SOC
Application of Devices/Dressing:
The device that will be utilized is the V.A.C. Ulta with Veraflo Technology (Kinetic Concepts Inc., San Antonio, TX). This is an FDA approved device that is indicated for wound care. The investigators currently use this device as the SOC for the inpatient management of the acutely infected wound. The device consists of a foam sponge applied to the wound surface with an adhesive drape that keeps it in place. This device applies subatmospheric pressure at -125mmHg to the wound surface. The instillation component includes the delivery of a topical solution at prescribed fashion to the wound surface. This solution is dwelled (no negative pressure during this interval) in the sponge for a specific duration and then is evacuated.
Negative Pressure Wound Therapy:
The setting for negative pressure will be -125mmHg, continuous setting, and moderate intensity. The application of the foam and drape will be conducted in the customary fashion. The negative pressure duration will be 2 hours.
Prontosan:
Prontosan (B Braun, Bethlehem, PA) is 0.1% polyhexanide, 0.1% betaine, sodium hydroxide, and purified water. The polyhexanide is an antiseptic and betaine is a surfactant. This solution is an FDA approved device indicated for topical irrigation. This solution has high tolerability with robust antimicrobial activity. Polyhexanide has been utilized as the instillation solution for NPWTi with positive clinical results. Prontosan is currently being used as the instillation solution for NPWTi in this facility as the SOC. The dwell setting for this solution is 20 minutes. The volume of solution to be used is dependent on the size of the wound hence varies.
Normal Saline:
Normal saline (0.9% NaCl) is an isotonic solution that is widely used for intravenous application but is also used as our SOC for wound irrigation. This solution has high tolerability. Normal saline has been used as the instillation solution for NPWTi. The dwell setting for this solution is 20 minutes. The volume of solution to be used is dependent on the size of the wound hence varies.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Wound Infection
Keywords
hospital admission
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
100 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Normal Saline
Arm Type
Active Comparator
Arm Description
The use of Normal Saline as the solution for Negative Pressure Wound Therapy with instillation.
Arm Title
Prontosan
Arm Type
Active Comparator
Arm Description
The use of Prontosan as the solution in Negative Pressure Wound Therapy with Instillation.
Intervention Type
Drug
Intervention Name(s)
Normal saline
Other Intervention Name(s)
0.9% Saline
Intervention Description
Normal saline (0.9% NaCl) is an isotonic solution that is widely used for intravenous application but is also used as our SOC for wound irrigation. This solution has high tolerability. Normal saline has been used as the instillation solution for NPWTi. The dwell setting for this solution is 20 minutes. The volume of solution to be used is dependent on the size of the wound hence varies
Intervention Type
Device
Intervention Name(s)
Prontosan
Other Intervention Name(s)
Prontosan Wound Irrigation Solution
Intervention Description
Prontosan (B Braun, Bethlehem, PA) is 0.1% polyhexanide, 0.1% betaine, sodium hydroxide, and purified water. The polyhexanide is an antiseptic and betaine is a surfactant. This solution is an FDA approved device indicated for topical irrigation. This solution has high tolerability with robust antimicrobial activity. Polyhexanide has been utilized as the instillation solution for NPWTi with positive clinical results. Prontosan is currently being used as the instillation solution for NPWTi in this facility as the SOC. The dwell setting for this solution is 20 minutes. The volume of solution to be used is dependent on the size of the wound hence varies.
Primary Outcome Measure Information:
Title
Number of Operating Room Visits
Description
Compare the number of operative room visits between Prontosan NPWTi and normal saline NPWTi.
Time Frame
Patients will be followed during their hospital stay which is an average of approximately 2 weeks.
Secondary Outcome Measure Information:
Title
Hospital Admission Length of Stay
Description
Compare the hospital admission length of stay between Prontosan NPWTi and normal saline NPWTi.
Time Frame
Patients will be followed during their hospital stay which is an average of approximately 2 weeks.
Other Pre-specified Outcome Measures:
Title
Time to Closure
Description
Compare the percent of wounds closed and the time to closure during the hospital admission and up to one year after discharge between Prontosan NPWTi and normal saline NPWTi.
Time Frame
Patients will be followed during their hospital stay which is an average of approximately 2 weeks.
Title
Wound Recidivism
Description
Compare the percent of wounds that remained closed 30 days and up to one year after discharge between Prontosan NPWTi and normal saline NPWTi.
Time Frame
30 days post discharge from hospital
Title
Bacterial Culture Results
Description
Compare the qualitative bacterial culture results between Prontosan NPWTi and normal saline NPWTi.
Time Frame
Patients will be followed during their hospital stay which is an average of approximately 2 weeks.
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Male or female greater than 18 years of age
Admission to the hospital for an infected wound
Diabetic, ischemic, neuropathic, venous, surgical wounds, any anatomical location
Subjects requiring serial (more than 1) operative debridement
Exclusion Criteria:
Pregnancy
Patients with exposed bowel, brain matter, spinal cord
Patients with exposed peripheral bypass grafts
Known allergy or sensitivity to Prontosan or components of NPWT
Known allergy or sensitivity to adhesives
Uncontrolled bleeding disorders/coagulopathy
Wounds that tunnel to unexposed areas
Malignancy
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Paul Kim, DPM
Organizational Affiliation
MedStar Georgetown University Hospital
Official's Role
Study Director
First Name & Middle Initial & Last Name & Degree
Christopher Attinger, MD
Organizational Affiliation
MedStar Georgetown University Hospital
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
John Steinberg, DPM
Organizational Affiliation
MedStar Georgetown University Hospital
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Karen Evans, MD
Organizational Affiliation
MedStar Georgetown University Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Medstar Georgetown University Hospital Center for Wound Healing
City
Washington
State/Province
District of Columbia
ZIP/Postal Code
20007
Country
United States
12. IPD Sharing Statement
Plan to Share IPD
No
IPD Sharing Plan Description
Data collected has not been approved for use beyond the scope of this trial and will not be made available.
Learn more about this trial
Comparing Outcomes for Prontosan Versus Normal Saline for Negative Pressure Wound Therapy With Instillation
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