Hydrocolloid Dressings Research Articles

Эластомерные композиции в составе раневых повязок

A review devoted to the analysis of compositions of hydrocolloid and lipocolloid wound dressings (chiefly containing elastomeric binder) mainly from the patent literature

Hydrogel or ointment? Comparison of five different galenics regarding tissue breathability and transepidermal water loss

PurposeFive different galenics were analyzed and compared concerning tissue breathability and gas exchange with the environment after an application period of 6 h on pig ear skin. Aim was to find the most suitable galenics for efficient moist treatment for everyday injuries (abrasions, lacerations and cuts) without influencing the transepidermal water loss. MethodsA quantity of 0.1 g of the different test preparations was applied once topically to an area of 2 cm2. The analysis of the breathability was performed by TEWL (transepidermal water loss) measurements in the first hour after product application. The moisture retention effect was assessed by corneometry in the first 5 h after product application. ResultsThe hydrogel preparations showed a higher breathability in contrast to a semi-occlusive ointment and petrolatum. The same applies to the moisture penetration of the skin. Here, all hydrogel formulations showed the highest tissue hydration. After 3 h an additional increase in moisture was observed for the areas treated with Tyrosur® CareExpert Wound Gel and the ointment. ConclusionIn contrast to petrolatum and the semi-occlusive ointment, treatment with the hydrogels led to a preservation of the breathability and good moistening of the tissue, which is due to the galenics of the gels consisting of water, carbomer and propylene glycol. The increase in moisture after 3 h in areas treated with Tyrosur® CareExpert Wound Gel and the semi-occlusive ointment indicates a sustained moisturizing effect mediated by dexpanthenol.

Comparison of the healing effect of occlusive hydrocolloid dressing and conventional gauze dressing concerning hernia operations in children

The purpose is using the occlusive hydrocolloid dressing (OHD) and gauze dressing (GD) to compare incidence of infection of wound and cost-effectiveness of dressing after hernia operation in children. Eighty children was undergo hernia surgery, wounds were dressing by OHD or GD. Hydrocolloid dressing was remain till suture was removed, and GD changed every day after operation. Calculations of cost dressing mean dressing alterations frequency and cost for each dressing in every treatment cluster. There are no variances amongst the two clusters concerning the incidence of wound infection. OHD was less costly and complex than GD, and GD necessary to be altered each day (p = 0.001). In conclusion, OHD is less costly to use, and less complex than GD because GD wanted to be altered more times during the period of healing.

Management of giant omphalocele with a simple and efficient nonsurgical silo

Introduction: Giant omphaloceles can be a challenge for pediatric surgeons and neonatologists worldwide. It is a rare and low-frequency congenital anomaly with no standardized management schemes or treatment protocols. Over the past few decades, we have developed a simple and efficient staged management for giant omphaloceles that allows definitive closure in the neonatal period, the results of which we outline in this report.Material and methods: With IRB approval, a retrospective and multicentric cohort study was carried out between 1994 and 2019 with patients with giant omphalocele defined as an abdominal wall defect greater than 5 cm in diameter and/or that contains more than 50% of the liver within the sac. We included all patients managed with the nonsurgical silo technique. Data on demographics, gestational age, associated malformations, amnion reduction and inversion time, anatomic closure, requirement of a mesh, intra- and post-silo complications, mortality and follow-up were collected. The technique consists of the construction of a silo with an adhesive hydrocolloid dressing (DuodermⓇ) to achieve an omphalocele staged-reduction until complete abdominal reintegration of the liver and bowel preservation of the amnion sac. This also enables the simulation of abdominal closure before definitive surgical closure, being managed in the neonatal intensive care unit (NICU).Results: Forty patients, 21 of whom were female, were managed with this technique. The average weight was 2900 gs (890–3900), and the median gestational age was 38 weeks (28–40). In total, 37.5% of cases had an associated comorbidity. The average silo reduction time was 7.3 days (0–35), the average time of amnion inversion was 5 days (2–9), and the average time to closure was 14.6 days (6–38). Anatomical closure was achieved in 95% of cases. In 4 patients, an absorbable mesh was used to reinforce the anatomical closure, and in 2 patients (5%), a mesh (DualmeshⓇ) was required to achieve an abdominal closure. There was no mortality associated with this nonsurgical silo technique. The average follow-up time was 60 (6 - 288) months.Conclusion: The staged silo management of giant omphalocele in this series is safe and effective and reduces the time to closure and potential morbidity and mortality compared with traditional surgical or medical management.

Skin surface infrared thermography in pressure ulcer outcome prognosis

To assess the usefulness of skin surface infrared thermography (SSIT) as a prognostic tool in the treatment of stages III and IV pressure ulcers (PU), with hydrocolloid/hydrogel dressings plus 20 exposures to low-level laser therapy (LLLT), compared with hydrocolloid dressings alone, in a group of long-term bedbound care patients. In this comparative study, participants were randomly assigned to group I: PUs treated with specialist wound dressings and laser therapy, or to group II: PUs treated with specialist wound dressings without laser therapy. Thermal imaging sessions were carried out at the beginning of the study, and after two and four weeks of treatment. Thermal imaging processing was applied to compare percentage differences in the temperature distribution between the groups within selected regions of interest (ROIs). The correlation between the temperature distribution and PU healing was evaluated. A total of 43 patients took part. In the study, three variants of PU healing were observed: pure healing (H) with minimal granulation; healing with hypergranulation (H+G); and non-healing (NH). Analyses of SSIT-related thermographic patterns revealed their dependence on the course of healing. The percentage of successful PU healing reached 79.2% in group I compared with 73.7% in group II (p<0.05) The dominant variant of healing in Group I was H, while in group II the variants H and H+G were present with equal frequency. Thermal imaging processing allowed comparison of differences in the temperature distribution between the groups within ROIs. Application of LLLT significantly improved the healing process (p<0.05). The clinical significance of this finding should be confirmed with larger studies; however, SSIT may be useful as a prognostic tool during the treatment of PUs, with the ability to predict the course of healing initially, that is independent of LLLT treatment.

In vitro Evaluation of Medihoney Antibacterial Wound Gel as an Anti-biofilm Agent Against Ventricular Assist Device Driveline Infections.

Objectives: In adult ventricular assist device (VAD) programs in Australian hospitals, Medihoney Antibacterial Wound Gel (MAWG) is routinely used at the skin exit-site of VAD drivelines to prevent infections; however, its effectiveness remains unclear. Our aim was to assess antimicrobial activity of Medihoney wound gel, using in vitro models that mimic clinical biofilms grown at the driveline exit-site.Methods: Antimicrobial susceptibility testing of MAWG was performed for 24 clinical isolates grown under planktonic conditions, and four representative strains grown as biofilms. Different antimicrobial mechanisms of MAWG were assessed respectively for their relative contribution to its anti-biofilm activity. A colony biofilm assay and a drip-flow biofilm reactor assay mimicking the driveline exit-site environment were used to evaluate the activity of MAWG against biofilm growth at the driveline exit-site.Results: MAWG demonstrated species-specific activity against planktonic cultures [minimum inhibitory concentrations (MICs), 5–20% weight/volume (W/V) for Staphylococcus species, 20–>40% (W/V) for Pseudomonas aeruginosa and Candida species]. Higher concentrations [MICs, 30–>80% (W/V)] were able to inhibit biofilm growth, but failed to eradicate pre-established biofilms. The anti-biofilm properties of MAWG were multi-faceted, with the often-advertised “active” ingredient methylglyoxal (MGO) playing a less important role. The colony biofilm assay and the drip-flow biofilm reactor assay suggested that MAWG was unable to kill biofilms pre-established in a driveline exit-site environment, or effectively prevent planktonic cells from forming adherent monolayers and further developing mature biofilms.Conclusion: Our work suggests a suboptimal effectiveness of MAWG in preventing driveline infections due to biofilm development.

Nano Calcium Oxide Incorporated Hydrocolloid Dressings for Wound Care

The study aimed to formulate hydrocolloid dressings incorporated with nano calcium oxide for effective wound healing. Hydrocolloid dressings create an insulated, moist environment in the wound bed for controlling the exudate and promoting autolytic debridement. Calcium ions play an important role in wound response and are considered to be an initial trigger in our immune response to healing, and research has shown that Ca2+ in the external medium is essential for wound repair. Seventy five parts per million of nano calcium oxide (NCO) obtained by thermal decomposition of calcium nitrate at 450 °C was used in the preparation of hydrocolloid dressings along with varying concentrations of micronized xanthan gum and HPMC. The dressings were evaluated for their surface characteristics, thickness, mechanical properties, folding endurance, pH, viscosity, swelling studies, water vapor transmission, and in vivo wound healing activity. The average particle size of NCO was found to be 307.8 nm. The SEM (scanning electron microscopy) analysis of the dressing revealed a porous surface and EDX (energy dispersive X-ray spectroscopy) characterization showed intense peaks of calcium and oxygen. The formulated dressings possessed uniform thickness, flexibility, and mechanical strength. The percentage of wound contraction was higher in wounds treated with formulated hydrocolloid dressings in comparison to standard commercial product (DuoDERM® hydrocolloid dressing) and control (untreated) group. The wound healing properties of hydrocolloid dressings were confirmed by histopathological analysis. Nano calcium incorporated hydrocolloid dressings with enhanced wound healing activity were developed successfully.

Conservative management of giant omphaloceles with hydrocolloid dressings

Abstract Omphalocele is a life-threatening abdominal wall defect without a treatment consensus due to its increased risk of complications. Discrepancies exist between a prompt or a delayed closure. In these cases, we present for the first time a conservative approach to close giant omphalocele lesions using hydrocolloid dressing.

Prophylactic Dressings for Maintaining Skin Integrity of Healthcare Workers When Using N95 Respirators While Preventing Contamination Due to the Novel Coronavirus: A Quality Improvement Project.

PURPOSE:Extended use of N95 respirator masks is far more prevalent during the coronavirus disease 2019 (COVID-19) pandemic. As WOC nurses, we were tasked with formulating procedures for protecting the facial skin integrity of healthcare workers (HCWs) using personal protective devices when caring for patients with suspected or active COVID-19, while avoiding contamination when the masks are donned or doffed. This quality improvement project describes how we approached this project within the limited time frame available as we cared for patients with established and suspected COVID-19.PARTICIPANTS AND SETTING:This project focused on HCW use of N95 respirator masks and dressings currently available in our facility. The 4 WOC nurses acted as quality improvement project directors and as participants. The setting for our project was our facility's simulation laboratory.APPROACH:We evaluated 6 topical products (an alcohol-free liquid acrylate, thin film dressing, thin hydrocolloid dressing, hydrocolloid blister care cushion, thin foam transfer dressing, and thick foam dressing) applied to skin in contact with 3 N95 respirators; all are available on our facility's formulary and all are in widespread clinical use. After the product was applied to the face and nose, the N95 respirator was donned and evaluated for fit. Participants then wore the devices for 10 hours and doffed the mask using established facility procedures. In order to evaluate for potential contamination including possible aerosolization, we applied a commercially available fluorescent lotion to simulate the presence of infectious particles. Contamination was assessed using an ultraviolet light for all dressings except for the alcohol-free liquid acrylate. We also evaluated cutaneous responses (skin integrity, irritation, comfort) during this period.OUTCOMES:We found that contamination of the simulated pathogen did not occur with removal of any of the protective products. No skin irritation was noted with any of the tested products after a 10-hour wear time underneath the N95 respirator masks, but mild discomfort was experienced with 3 of the dressings (thin film dressing and both hydrocolloid dressings).CONCLUSION:Based on these experiences, we recommend application of an alcohol-free liquid acrylate film to prevent facial skin injury associated with friction from the extended use of an N95 respirator mask. We further recommend performing a fit test and user-performed seal check with the use of any topical dressing and especially those that add cushion. For the duration of the COVID-19 pandemic, we recommend use of protective dressings to maintain skin integrity and protection from coronavirus infection as HCWs continue to provide care to all of patients under their care.

Effectiveness of Hydrocolloid Dressings for Treating Pressure Ulcers in Adult Patients: A Systematic Review and Meta-Analysis

The aim of this study was to assess the effectiveness of hydrocolloid dressings in the treatment of grade I, II, III, and IV pressure ulcers in adult patients. We compared the therapeutic effects of hydrocolloids and alternative dressings in pressure ulcer treatment. We conducted a systematic review, using a literature search only in English, from database inception until 20 April 2020, to identify randomized trials comparing various types of dressings applied in the healing of pressure ulcers. The databases were PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). The study selection was performed independently by two reviewers. Data were extracted based on the guidelines included in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. The risk of bias in the included studies was assessed using a standardized critical appraisal instrument developed by the Cochrane Collaboration. Random-effect meta-analysis of data from three or more studies was performed using meta-analysis software (Comprehensive Meta-Analysis V3, Biostat, New Jersey, USA). A total of 1145 records were identified, of which 223 were qualified after further verification, of which eight were finally included in further analysis. Hydrocolloid dressings were not superior to control therapeutics (p = 0.839; Z = 0.203; CI 95%: 0.791–1.334). They were not associated with higher healing rates (p = 0.718; Z = 0.361; OR: 0.067; CI 95%: 0.297–0.431), nor did they decrease the incidence of adverse events compared with control therapeutics (p = 0.300; Z = −1.036; OR: 0.067; CI 95%: 0.394–1.333). In the above cases, Egger’s test also did not indicate publication bias (t value = 0.779, p = 0.465; t value = 1.198, p = 0.442; t value = 0.834, p = 0.465, respectively). The present meta-analysis shows that hydrocolloid dressings are not significantly better than alternative ones in the healing of pressure ulcers in adult patients.

Hydrocolloid dressings can be used to treat hypertrophic scars: An outpatient dermatology service devoted to treat keloids and challenging scars.

Since we first described the rationale for the use of hydrocolloid dressings to treat keloids and hypertrophic scars, this technique has been used as an occlusive therapy alternative to the use of silicone sheets in our outpatient clinic. In this paper, we describe the use of these dressings on two patients with challenging scars: a large postburn hypertrophic scar on a young patient's hand and arm, with a growing keloid on the wrist, and a progressive scar on the lower eyelid, developing after a complication of a cosmetic blepharoplasty procedure, leading to ectropium. The methods on the proper use of these dressings are reviewed here in detail. Larger clinical trials are needed to further evaluate this technique in the treatment of hypertrophic scars and keloids.

Successful management of the open abdomen with hydrocolloid dressing in a resource-constrained setting.

To evaluate and detail the management of a difficult, long-term, open abdomen in a resource constraint setting with the use of Hydrocolloid dressing. An observational retrospective study was conducted at a single level-1 trauma center. Over a 5-year period, all the open abdomen patients were evaluated and the cohorts who were treated with Hydrocolloid dressings were described in detail from their admission to their discharge. During this period, there were 147 open abdomens. 7.5% (11) patients required long-term open abdomen management, in which Hydrocolloid dressing was utilized. Of this group, there were no entero/colonic-atmospheric fistulas, and there was either de-novo complete skin coverage, successful skin graft placement, or definitive abdominal wall repair in all the patients. De-novo complete skin coverage took an average of 7.4months. All the patients were discharged home after an average of 107days hospitalized. Despite not being an optimal management of an open abdomen, there are always a small group of these patients who lose abdominal domain, are critically ill or injured, and have prolonged hospitalization with an open abdomen. In this cohort, and especially in resource constraint settings, Hydrocolloid dressing is a cost-efficient, simple, and effective method to treat the 'long-term' open abdomens.

Hydrocolloid dressing as a prophylactic use for hand–foot skin reaction induced by multitargeted kinase inhibitors: protocol of a phase 3 randomised self-controlled study

IntroductionAlthough topical use of moisturisers is slightly effective for the prevention and avoiding the aggravation of hand–foot syndrome induced by multikinase inhibitors, there is still room for improvement. Hydrocolloid dressing...

Managing Welfare and Antimicrobial-Resistance Issues in Treating Foot-and-Mouth Disease Lesions: A New Therapeutic Approach.

IntroductionFoot-and-mouth disease (FMD) causes negative impacts on global food security, the livestock trade, national economies, and farming-family livelihoods, particularly in resource-poor developing countries with inadequate biosecurity and low levels of vaccination from inadequate veterinary services. As smallholder farmers have limited understanding of disease-risk management, their focus in FMD outbreaks is on accessing clinically effective therapies. However, most are provided inappropriate traditional treatments and/or topical or parenteral antibiotics, often delivered by paraveterinarians inadequately trained in antimicrobial custodianship. This results in negative financial impacts on livelihoods plus risks of food safety and development of antimicrobial resistance. We report the use of a novel pain-relief therapy for FMD.MethodsClinical examinations in an outbreak of suspected FMD in April 2019 in Muang Khay village in Luang Prabang province, Laos confirmed signs and lesions of severe, subacute, ulcerative glossitis and interdigital dermatitis, typical of FMD. All affected buffalo (n=99) and cattle (n=37) presented for treatment in a population of 238 large ruminants, from 15 of 136 households, were administered a topical anesthetic pain-relief product (PRP) wound gel by spray-on (10–30 mL per animal) formulation developed for aversive husbandry procedures (Tri-Solfen, Animal Ethics, Australia).ResultsTreatment with PRP resulted in immediate improvement in demeanor and locomotion, and no adverse events were observed. On follow-up interview, all owners confirmed that their animals were eating within 2 days and lesions had healed within 5 days. Having experienced the positive clinical impacts of PRP on affected animals, these and surrounding farmers were keen to purchase the PRP for future use. The veterinary authorities rapidly registered the PRP for FMD therapy in Laos due to the observed efficacy.DiscussionThese findings suggest a potential paradigm shift from treating FMD with expensive antimicrobials, which risks antimicrobial resistance, to a new, less expensive therapeutic approach that reduces animal suffering and may motivate farmers to report disease to access treatment. Use of the PRP is suggested as an innovation that may improve future FMD management, particularly in developing countries.

Combined Transplantation of Mesenchymal Stem Cells and Endothelial Colony-Forming Cells Accelerates Refractory Diabetic Foot Ulcer Healing.

Background This study is aimed at investigating the effect of combined transplantation of umbilical cord mesenchymal stem cells (UCMSCs) and umbilical cord blood-derived endothelial colony-forming cells (ECFCs) on diabetic foot ulcer healing and at providing a novel therapy for chronic diabetic foot ulcer. Methods We reported the treatment of refractory diabetic foot ulcers in twelve patients. Among them, five patients had two or more wounds; thus, one wound in the same patient was treated with cell injection, and other wounds were regarded as self-controls. The remaining seven patients had only one wound; therefore, the difference between the area of wound before and after treatment was estimated. The UCMSCs and ECFCs were injected into the wound along with topically applied hyaluronic acid (HA). Results In this report, we compared the healing rate of multiple separate wounds in the same foot of the same patient: one treated with cell injection combined with topically applied HA-based hydrogel and was later covered by the hydrocolloid dressings, while the self-control wounds were only treated with conventional therapy and covered by the hydrocolloid dressings. The wound underwent cell injection showed accelerated healing in comparison to control wound within the first week after treatment. In other diabetic patients with only one refractory wound, the healing rate after cell transplantation was significantly faster than that before injection. Two large wounds healed without needing skin grafts after combination therapy of cell injection and HA. After four weeks of combination treatment, wound closure was reached in six patients, and the wounds of the other six patients were significantly reduced in size. Conclusions Our study suggests that the combination of UCMSCs, ECFCs, and HA can safely synergize the accelerated healing of refractory diabetic foot ulcers.

Assessment of Materials to Prevent Sutures Cutting Through Atrophic Skin.

Sutures can tear through thin skin, especially in the elderly. To reinforce thin skin, several materials have been suggested through which sutures may be placed. To evaluate the relative tear-through resistance to suture provided by various materials applied to a skin substitute. We measured the force needed for 3-0 polypropylene suture to tear through an artificial skin substitute, both alone and after various materials were applied. These materials included wound closure tapes, nonwoven polyester tape, hydrocolloid dressing, polyethylene film, and cyanoacrylate glue. The Student t-test and one-way analysis of variance were used to determine differences in the mean forces. Reinforced wound closure tape and nonwoven polyester tape were superior to the other materials, and provided a 3.1-fold and 3.6-fold increase in tear-through resistance, respectively, compared with skin substitute alone (p < .001). Orientation of wound closure tape and nonwoven polyester tape with their reinforcing fibers placed parallel to the skin substitute edge provided increased tear-through resistance compared with perpendicular placement. Affixing these latter materials with liquid adhesive also improved holding strength. Reinforced wound closure tape and nonwoven polyester tape, when applied to a skin substitute, provide significantly increased tear-through resistance to suture compared with skin substitute alone.

Effectiveness of anti-pressure protective mask for medical personnel fighting against coronavirus disease 2019

Objective To evaluate the effectiveness of anti-pressure protective mask for medical personnel fighting against the coronavirus disease 2019 (COVID-19) Methods Convenience sampling method was used to select 120 military frontline anti-epidemic medical personnel supporting Wuhan medical team from Jan 26 to Feb 24, 2020, and they were evenly divided into blank group, control group and observation group The blank group did not use anti-pressure dressings, the control group wore face protection equipments after using hydrocolloid dressings, and the observation group wore face protection equipments after using anti-pressure protective mask At the end of the intervention, the facial comfort, facial pressure injuries, and adverse effects were compared between the three groups Results At the end of the intervention, the facial comfort score was 6 00 (6 00, 7 00) in the blank group, 5 00 (4 00, 5 00) in the control group, and 1 00 (0 50, 2 00) in the observation group, with significant differences found among the three groups (H=97 392, P<0 001) According to the further inference of the rank mean, the blank group had the largest facial comfort rank mean (96 68), while the observation group had the smallest facial comfort rank mean (20 88) At the end of the intervention, three cases (7 5%, 3/40) in the blank group had no facial injury, 28 cases (70 0%, 28/40) had facial pressure injury at stage 1, and nine cases (22 5%, 9/40) at stage 2;27 cases (67 5%, 27/40) in the control group had no facial injury and 13 cases (32 5%, 13/40) had facial pressure injury at stage 1;37 cases (92 5%, 37/40) in the observation group had no facial injury and three cases (7 5%, 3/40) had facial pressure injury at stage 1 There was significant difference in the incidence of facial pressure injuries among the three groups (χ2=71 863, P<0 001) The observation group had the lowest facial pressure injury rate among the three groups There was no skin allergic reaction in the three groups and none of them was infected with COVID-19 Conclusion Anti-pressure protective mask can effectively reduce the incidence of facial pressure injuries and improve the facial comfort when wearing facial protective equipment, and it can be used for protecting frontline anti-epidemic medical personnel

In search of ideal donor site wound dressings

Background: Split skin grafting (SSG) is a commonly used reconstructive technique for wound cover. Donor site wounds (DSW) after split-skin graft harvesting are rather clean wounds. Depending on the thickness of the SSG, the DSW should re-epithelialize completely in 7 to 21 days. This study was initiated with a background to look for an ideal dressing for the management of DSW. Aim of the study was to compare efficacy of Cellulose acetate mesh, Collagen sheet, Hydrocolloid dressings and chlorhexidine tulle for donor site wound management after harvesting split thickness skin graft.Methods: 100 patients with 100 donor site wounds were included in the study. Patients were randomized into four different groups of 25 each, depending upon the type of dressings used to cover the wound. Data regarding time to complete wound healing and pain at the donor site were recorded on visual analogue scale (VAS). Requirement of pain killers during post-operative period were recorded. Complications like infection or hyper-granulation were also recorded.Results: The study included 72 males and 28 females. The primary objective was to observe the effectiveness of wound dressings in the treatment of DSWs and time to complete wound healing. In this context, collagen dressing was found to be the most effective in current study (p&lt;0.07) and also the least pain was experienced by the patients where collagen dressings were used.Conclusions: The study concluded that collagen dressings was best amongst the various dressings studied with average healing time of 9 days with least pain score over DSW.

Exposure to a Manuka Honey Wound Gel Is Associated With Changes in Bacterial Virulence and Antimicrobial Susceptibility.

The use of manuka honey for the topical treatment of wounds has increased worldwide owing to its broad spectrum of activity towards bacteria in both planktonic and biofilm growth modes. Despite this, the potential consequences of bacterial exposure to manuka honey, as may occur during the treatment of chronic wounds, are not fully understood. Here, we describe changes in antimicrobial susceptibility and virulence in a panel of bacteria, including wound isolates, following repeated exposure (ten passages) to sub-inhibitory concentrations of a manuka honey based wound gel. Changes in antibiotic sensitivity above 4-fold were predominantly related to increased vancomycin sensitivity in the staphylococci. Interestingly, Staphylococcus epidermidis displayed phenotypic resistance to erythromycin following passaging, with susceptibility profiles returning to baseline in the absence of further honey exposure. Changes in susceptibility to the tested wound gel were moderate (≤ 1-fold) when compared to the respective parent strain. In sessile communities, increased biofilm eradication concentrations over 4-fold occurred in a wound isolate of Pseudomonas aeruginosa (WIBG 2.2) as evidenced by a 7-fold reduction in gentamicin sensitivity following passaging. With regards to pathogenesis, 4/8 bacteria exhibited enhanced virulence following honey wound gel exposure. In the pseudomonads and S. epidermidis, this occurred in conjunction with increased haemolysis and biofilm formation, whilst P. aeruginosa also exhibited increased pyocyanin production. Where virulence attenuation was noted in a passaged wound isolate of S. aureus (WIBG 1.6), this was concomitant to delayed coagulation and reduced haemolytic potential. Overall, passaging in the presence of a manuka honey wound gel led to changes in antimicrobial sensitivity and virulence that varied between test bacteria.

Investigating the Efficacy of Hydrocolloid Dressing for Preventing Nasotracheal Tube-Related Pressure Injury in the PICU.

To investigate the efficacy of hydrocolloid dressing in reducing the occurrence rate and severity of nasotracheal tube-related pressure injury. Randomized controlled trial. A PICU in a tertiary medical center in southern China. Pediatric patients received invasive mechanical ventilation via nasotracheal tubes. The hydrocolloid dressing was cut into an optimal square size, which should cover the area from the nasal columella to the ala. Eligible participants were randomly allocated to the control group and the experimental group. The participants in the experimental group received hydrocolloid dressing to protect nasal skin from the beginning of nasotracheal intubation, while the participants in the control group received the current care procedure (without hydrocolloid dressing) unless pressure injuries occurred. The hydrocolloid dressing was changed daily to assess the nasal skin. The pressure injury staging system that was redefined and updated by the National Pressure Ulcer Advisory Panel in 2016 was used. The mean duration of nasotracheal intubation was 150.10 ± 117.09 hours in the experimental group and 161.75 ± 120.72 hours in the control group. Forty-five participants had nasotracheal tube-related pressure injuries in control group, whereas 26 patients had in experimental group (72.6% vs 43.3%; absolute difference, 29.3%, 95% CI, 12.5-46%; p = 0.001). The median survival times of the nasal skin integrity were 95.5 hours in the control group and 219.5 hours in the experimental group (p < 0.001). Hydrocolloid dressing can not only reduce the occurrence rate of nasotracheal tube-related pressure injury in the child with long-term nasotracheal intubation but also improve the endurance of the nasal skin significantly.