Received Wound Care Research Articles

Predictive value of emergency department patients’ self-efficacy beliefs on follow-up care of lacerations

Summary Background Patients receiving wound care in the emergency department (ED) often do not follow instructions or return for follow-up appointments sometimes resulting in complications. This research examined self-efficacy and outcome beliefs regarding wound care and their relationship to patients' returning to the ED to have sutures removed. Methods This study included a convenience sample of 100 patients requiring sutures for lacerations who presented to the EDs of a suburban and a community hospital in the United States each with an annual ED census of greater than 50,000. Participants completed the wound care questionnaire (WCQ), a self-efficacy and outcome beliefs instrument. Results Self-efficacy beliefs for following laceration care instructions including returning to the ED were identified as significant predictors of patients who returned and those who did not return to the ED for suture removal. Additionally, older age was a significant predictor of return to the ED for suture removal, but outcome beliefs were not. Conclusions The WCQ, completed by ED patients requiring sutures for lacerations, can be used by nurses to predict which patients will return to the ED for suture removal. This is one of the first studies to identify self-efficacy as a predictor of follow-up behavior in the ED.

Emergency department management of mild traumatic brain injury in the USA

Objective: To describe the emergency department (ED) management of isolated mild traumatic brain injury (TBI) in the USA and to examine variation in care across age and insurance types. Methods:...

The Wound Care Team: A New Source of Group A Streptococcal Nosocomial Transmission

In August 2001, the Centers for Disease Control and Prevention (CDC) notified the Texas Department of Health (TDH) of an unusually high number of wounds infected with group A streptococci (GAS) in an acute care facility. The TDH initiated an investigation, ultimately identifying 28 cases of non-pharyngeal, non-community-acquired GAS that had occurred between December 2000 and August 2001 and resulted in 3 deaths and 4 nonfatal cases of invasive disease. Ten specimens were sent to the CDC for emm typing; all isolates were emm type 114. However, the source of the outbreak could not be confirmed through laboratory testing at that time. A case-control study was conducted comparing the 10 case-patients with 52 control-patients with wounds that were not infected with GAS. Age, gender, type of wound, underlying medical conditions, and treatment by the wound care team were examined for association with GAS infection. The odds of having wound care team treatment versus not having it were 424.2 (95% confidence interval, 19.0 to 9,495.2) among case-patients when compared with control-patients. No other risk factor showed this magnitude of association. This study provided overwhelming epidemiologic evidence that the wound care team was the means of transmission. One year later, when two patients receiving wound care were concurrently diagnosed as having GAS, a member of the wound care team was found to be GAS positive for the matching emm type. This is the first report of a GAS hospital outbreak linked to a wound care team.

UPDATING PRESSURE ULCER CARE

Do not clean ulcer wounds with skin cleansers or antiseptic agents-e.g., povidone iodine, iodophor, sodium hypochlorite solution (Dakins solution), hydrogen peroxide, or acetic acid. Antiseptic agents are reactive chemicals that are cytotoxic to normal tissue. (Treatment of Pressure Ulcers, Clinical Practice Guideline #15, U.S. Department of Health and Human Services Agency for Health Care Policy and Research, pg. 50.) In the home care setting Medicare will not reimburse for dressing supplies if patients are receiving wound care treatment with products containing harmful substances, such as povidone iodine or hydrogen peroxide. When using a static support surface the guidelines recommend considering the characteristics of stiffness (indentation load deflection of 25% of 30 pounds), density (1.3 pounds/cubic foot) and thickness (3 to 4 inches). If the patient is unable to assume a variety of positions or compresses the static support surface, or if the pressure ulcer does not heal, the guidelines recommend use of a dynamic support surface and a low-air-loss bed or air-fluidized bed if the patient has a large Stage III or Stage IV ulcer. Care of pressure ulcers requires that: 1) pressure be relieved with frequent repositioning and pressure intensity be reduced with adequate support surfaces; 2) nutrition be addressed and malnutrition corrected; and 3) topical or local wound care be based on the use of physiologic products to cleanse the wound, the removal of necrotic tissue via debridement, and the use of dressings that support moist wound healing. JoAnn Maklebust, MSN, RN, CS, NP Mary Sieggreen, MSN, RN, CS, NP, CNS Detroit, MI