Nursing and Midwifery Studies

Nursing and Midwifery Studies

The healing effects of an egg white formulation on pressure ulcers: A triple-blind clinical trial

Document Type : Original Article

Authors
1 School of Nursing and Midwifery, Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
2 Department of Pharmacognosy, School of Pharmacy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
3 Nursing Care Research Center in Chronic Diseases, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
4 Department of Biostatistics and Epidemiology, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
Abstract
Background: Pressure ulcers represent a significant health challenge for individuals with mobility impairments. The development of effective and cost-efficient treatments that can expedite the healing process is essential. Egg white is rich in the nutrients necessary for wound healing.
Objectives: This study aimed to assess the healing effects of an egg white formulation on pressure ulcers.
Methods: This triple-blind clinical trial was carried out over a span of nine months, from March 2022 to November 2023, at Golestan and Imam Khomeini hospitals in Ahvaz, Iran. A total of 78 patients with Grade II and III pressure ulcers were enrolled based on specific inclusion criteria. Participants were randomly assigned to either the intervention group, which received the egg white formulation, or the control group, which received standard treatment. The healing of ulcers was monitored using the Pressure Ulcer Scale for Healing (PUSH) tool at baseline and at the end of each week from the first to the fourth week. The healing progress between the two groups was analyzed using repeated measures analysis of variance, with all statistical tests performed using SPSS-25.
Results: The findings indicated no significant differences between the intervention and control groups regarding the mean scores for ulcer area (P=0.46), exudate amount (P=0.95), and overall ulcer healing (P=0.11). However, there was a statistically significant difference in the mean scores for ulcer tissue type (P<0.001).
Conclusion: While the overall difference in ulcer healing rates was not statistically significant, the intervention group demonstrated a greater mean improvement. Therefore, we recommend considering egg white formulation as a complementary treatment for pressure ulcers alongside standard therapies. Further research with larger sample sizes over extended periods is warranted to validate these findings.
Keywords

Subjects


  1. Zaidi SRH, Sharma S. Pressure Ulcer. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. PMID: 31971747
  2. Levine JM. Historical perspective on pressure ulcers: the decubitus ominosus of Jean-Martin Charcot. J Am Geriatr Soc. 2005;53(7):1248-51. doi: 10.1111/j.1532-5415.2005.53358.x. PMID: 16108947.
  3. Bansal C, Scott R, Stewart D, Cockerell CJ. Decubitus ulcers: A review of the literature. Int J Dermatol. 2005;44(10):805-10. doi: 10.1111/j.1365-4632.2005.02636.x. PMID: 16207179.
  4. Vanderwee K, Clark M, Dealey C, Gunningberg L, Defloor T. Pressure ulcer prevalence in Europe: a pilot study. J Eval Clin Pract. 2007;13(2):227-35. doi: 10.1111/j.1365-2753.2006.00684.x. PMID: 17378869.
  5. Jenkins ML, O'Neal E. Pressure ulcer prevalence and incidence in acute care. Adv Skin Wound Care. 2010;23(12):556-9. doi: 10.1097/01.ASW.0000391184.43845.c1. PMID: 21084878.
  6. Santamaria N, McCann J, O'Keefe S, Rakis S, Sage S, Tudor H, et al. Clinical innovation: results from a 5-year pressure ulcer prevention project in an Australian university. Wounds Int. 2015;6(3):12-6.
  7. Karimian M, Sarokhani D, Sarokhani M, Sayehmiri K, Mortazavi Tabatabai SA. Prevalence of bedsore in Iran: a systematic review and meta-analysis. J Mazandaran Univ Med Sci. 2016;26(136): 202-10.
  8. Norman G, Westby MJ, Rithalia AD, Stubbs N, Soares MO, Dumville JC. Dressings and topical agents for treating venous leg ulcers. Cochrane Database Syst Rev. 2018;6(6):CD012583. doi: 10.1002/14651858.CD012583.pub2. PMID: 29906322; PMCID: PMC6513558.
  9. Karimi F, Yaghoubinia F, Keykhah A, Askari H. Investigating the effect of home-based training for family caregivers on the incidence of bedsore in patients with stroke in Ali Ebne Abitaleb Hospital, Zahedan, Iran: a clinical trial study. Med Surg Nurs J. 2018;7(3):e87325. doi: 10.5812/msnj.87325.
  10. Hao XY, Li HL, Su H, Cai H, Guo TK, Liu R, et al. Topical phenytoin for treating pressure ulcers. Cochrane Database Syst Rev. 2017;2(2):CD008251. doi: 10.1002/14651858.CD008251.pub2. PMID: 28225152; PMCID: PMC6464402.
  11. Kranke P, Bennett MH, Martyn-St James M, Schnabel A, Debus SE, Weibel S. Hyperbaric oxygen therapy for chronic wounds. Cochrane Database Syst Rev. 2015;2015(6):CD004123. doi: 10.1002/14651858.CD004123.pub4. PMID: 26106870; PMCID: PMC7055586.
  12. Shahriari M, Zare F, Nimrouzi M. The curative role of moomiaii in traditional Persian medicine. Acta Med Historic Adriat. 2018;16(2):283-92. doi: 10.31952/amha.16.2.6
  13. Mehrabani M, Hosseini MA, Nourozi Tabrizi K, Karimloo M. Comparison of Honey dressing with Hydrocolloid dressing effects on pressure ulcer healing of ICU hospitalized patients. J Health Promot Manage. 2012;1(3):37-45.
  14. Lazarzareh E, Davami B, Valizadeh H, Shahsavarinia K, Nazemiyeh H, Khodaie L, et al. Formulation and clinical evaluation of a topical dosage form of Alkanna orientalis root extract for management of pressure lesions: A pilot cross-sectional clinical trial. Pharm Sci. 2022;29(4):504-10. doi:10.34172/ps.2022.41
  15. Yücel A, Kan Y, Yesilada E, Akın O. Effect of St.John's wort (Hypericum perforatum) oily extract for the care and treatment of pressure sores; a case report. J Ethnopharmacol. 2017;196:236-41. doi: 10.1016/j.jep.2016.12.030. PMID: 28011162.
  16. Moghadari M, Rezvanipour M, Mehrabani M, Ahmadinejad M, Tajadini H, Hashempur MH. Efficacy of mummy on healing of pressure ulcers: A randomized controlled clinical trial on hospitalized patients in intensive care unit. Electron Physician. 2018; 10(1):6140-7. doi: 10.19082/6140. PMID: 29588812; PMCID: PMC5853986.
  17. Fernandez M, Andersen C. The good egg, the forgotten benefits: protein, carotenoids, choline and glycemic index. Handbook of eggs in human function: Wageningen Academic Publishers; 2015. p. 615-23.
  18. Jalili-Firoozinezhad S, Filippi M, Mohabatpour F, Letourneur D, Scherberich A. Chicken egg white: Hatching of a new old biomaterial. Mat Today. 2020;40:193-214. doi:1016/j.mattod.2020.05.022.
  19. Kui GE, Shu-liang L, Chun Q, Ting X, Yi-wen N, Liu R, et al. A study on the promoting effect of L-arginine on the burn wound healing of the rats with diabetes. Chin j Burns. 2003;19(Z1):11-4. doi:10.3760/cma.j.issn.1009-2587.2003.z1.105 .
  20. Hasanzadeh Ghr, Nouri A, Hajiabadi M, Soltan K, Javadi A. The effect of egg yolk on burn wound healing in Rats. J Gorgan Univ Med Sci. 2005;7(2):6-10.
  21. Yenilmez E, Başaran E, Arslan R, Berkman MS, Güven UM, Bayçu C, et al. Chitosan gel formulations containing egg yolk oil and epidermal growth factor for dermal burn treatment. Pharmazie. 2015;70(2):67-73. PMID: 25997244.
  22. Jahani S, Ashrafizadeh H, Babai K, Siahpoosh A, Cheraghian B. Effect of ointment-based egg white on healing of second- degree wound in burn patients: a triple-blind randomized clinical trial study. Avicenna J Phytomed. 2019;9(3):260-270. PMID: 31143693; PMCID: PMC6526036.
  23. Kottner J, Cuddigan J, Carville K, Balzer K, Berlowitz D, Law S, et al. Prevention and treatment of pressure ulcers/injuries: The protocol for the second update of the international Clinical Practice Guideline 2019. J Tissue Viability. 2019;28(2):51-8. doi: 10.1016/j.jtv.2019.01.001. PMID: 30658878.
  24. Edsberg LE, Black JM, Goldberg M, McNichol L, Moore L, Sieggreen M. Revised national pressure ulcer advisory panel pressure injury staging system: Revised pressure injury staging system. J Wound Ostomy Continence Nurs. 2016;43(6):585-97. doi: 10.1097/WON.0000000000000281. PMID: 27749790; PMCID: PMC5098472.
  25. Bolourchifard F, Abdolrahimi M, Yaghmaei F, Baghban AA. Incidence of pressure ulcer and its risk factors in patients at orthopedic wards. Adv Nurs Midwifery. 2008;19(67):1-5.
  26. Günes UY. A prospective study evaluating the Pressure Ulcer Scale for Healing (PUSH Tool) to assess stage II, stage III, and stage IV pressure ulcers. Ostomy Wound Manage. 2009;55(5): 48-52. PMID: 19471048.
  27. Hollisaz MT, Khedmat H, Yari F. A randomized clinical trial comparing hydrocolloid, phenytoin and simple dressings for the treatment of pressure ulcers [ISRCTN33429693]. BMC Dermatol. 2004;4(1):18. doi: 10.1186/1471-5945-4-18. PMID: 15601464; PMCID: PMC545970.
  28. Stotts NA, Rodeheaver GT, Thomas DR, Frantz RA, Bartolucci AA, Sussman C, et al. An instrument to measure healing in pressure ulcers: development and validation of the pressure ulcer scale for healing (PUSH). J Gerontol A Biol Sci Med Sci. 2001; 56 (12):M795-9. doi: 10.1093/gerona/56.12.m795. PMID: 11723157.
  29. Pirbalouti AG, Yousefi M, Nazari H, Karimi I, Koohpayeh A. Evaluation of burn healing properties of Arnebia euchroma and Malva sylvestris. Electronic J Biol. 2009;5(3):62-6.
  30. Kaith BS, Kaith NS, Chauhan NS. Anti-inflammatory effect of Arnebia euchroma root extracts in rats. J Ethnopharmacol. 1996; 55(1):77-80. doi: 10.1016/s0378-8741(96)01477-8. PMID: 9121171.
  31. Esmaili R, Khalilian A, Nasiri E, Jafari H, Dehghani O, Alipour S. Study regarding the effect of calendula officinalis cream in healing of pressure sores. J Mazandaran Univ Med Sci. 2008;18(66):19-25.
Volume 13, Issue 4
Autumn 2024
Pages 232-240

  • Receive Date 17 February 2024
  • Revise Date 15 May 2024
  • Accept Date 24 June 2024