Wound Care Experts Research Articles

The Development and Preliminary Validity Testing of the Healing Progression Rate Tool.

Accurate assessment and clear documentation are important aspects of wound care; they provide a basis for appropriate patient care decisions and reimbursement. A descriptive, qualitative study was conducted to develop and provide preliminary evidence of the validity of a new tool to measure wound healing (the Healing Progression Rate [HPR]), a modified version of the Pressure Ulcer Scale for Healing (PUSH). Three (3) groups of current and future practitioners participated in the instrument development and evaluation process: 1) 3 wound care experts/authors (2 physical therapists, 1 nurse) with a minimum of 15 years of experience, 2) 6 additional wound care experts (4 nurses and 2 physical therapists) with a minimum of 10 years experience, and 3) 120 participants (77 [64.2%] RNs, 2 [1.7%] nursing students, 12 [10%] physical therapists [PTs], and 29 [24.2%] PT students). After the instrument was developed, the first group of 3 wound care experts used 2 photos of the same pressure injury at different points in time for 30 different wound cases to determine wound status (improved, worse, or the same) using the HPR and PUSH tools. The 6 experts from group 2 completed a similar exercise and, after completing a demographic questionnaire, the nonexpert participants scored 20 randomly selected cases (10 with the PUSH and 10 with the HPR) followed by a 4-question survey about the instruments. All data were collected on spreadsheets. Descriptive statistics were generated and mean HPR and PUSH scores for each image were compared to expert scores using a paired t-test. If the mean of participants' image scores was significantly higher or lower than that of the experts, it was placed in the "higher" or "lower" group. If the difference was not statistically significant, the image was placed in the "same" group. Chi-squared tests (χ2) were used to compare the frequency distribution within each of these 3 groups for the HPR and PUSH tools. Due to violations of normality, the nonparametric Friedman's analysis of variance and Wilcoxon signed rank test were used to compare the experts' votes on which tool they thought captured the difference between the pre- and post-wound pictures and to perform post hoc testing, respectively. Qualitative data from the exit survey were reviewed and grouped into common themes. In 8 cases, a statistically significant difference was found among the number of votes (from the 6 experts) for which tool best reflected the change in wound status (χ2 (2) = 11.20; P = .004). Post hoc comparison revealed experts believed the change in HPR score better reflected the change in wound status compared to the PUSH tool (P = .026). Almost 75% of nonexpert participants preferred the HPR, rating it as more objective (73%). The results of this preliminary validation study suggest that further validation and reliability testing is warranted.

Topical oxygenation therapy in wound care: are patients getting enough?

Wound management is a major burden on today's healthcare provider, both clinically with regard to available resources and financially. Most importantly, it has a significant impact on the patient's quality of life and experience. Within the field of wound care these pressures, alongside an ageing population, multiple comorbidities, disease processes and negative lifestyle choices, increase incidences of reduced skin integrity and challenging wounds. In an attempt to meet these challenges alternative, innovative therapies are being explored to support the wound healing process. Wound care experts are now exploring the scientific, biological aspects of wound healing at a cellular level. They are taking wound care back to basics with the identification of elements that, if introduced as an 'adjunct' or as a stand-alone device alongside gold-standard regimens, can positively impact the static or problematic wounds that pose the most challenges to clinicians on a daily basis. This article explores the phenomenon of oxygen, its place in tissue formation and the effect of depletion on the wound healing process and highlights ways in which patients may receive benefit from non-invasive intervention to improve wound care outcomes.

Wound Care: What the Medical Director Needs to Know

Wound Care: What the Medical Director Needs to Know

Inter-rater reliability of the Reaper Oral Mucosa Pressure Injury Scale (ROMPIS): A novel scale for the assessment of the severity of pressure injuries to the mouth and oral mucosa

BackgroundPatients who are intubated in the ICU are at risk of developing pressure injuries to the mouth and lips from endotracheal tubes. Clear documentation is important for pressure wound care; however, no validated instruments currently exist for the staging of pressure injuries to the oral mucosa. Instruments designed for the assessment of pressure injuries to other bodily regions are anatomically unsuited to the lips and mouth. ObjectivesThis study aimed to develop and then assess the reliability of a novel scale for the assessment of pressure injuries to the mouth and oral mucosa. MethodsThe Reaper Oral Mucosa Pressure Injury Scale (ROMPIS) was developed in consultation with ICU nurses, clinical nurse educators, Intensivists, and experts in pressure wound management. ICU nurses and portfolio-holders in pressure wound care from Peninsula Health (Victoria, Australia) were invited to use the ROMPIS to stage 19 de-identified clinical photographs of oral pressure injuries via secure online survey. Inter-rater reliability (IRR) was calculated using Krippendorff's alpha (α). ResultsAmong ICU nurses (n=52), IRR of the ROMPIS was α=0.307; improving to α=0.463 when considering only responses where injuries were deemed to be stageable using the ROMPIS (i.e. excluding responses where respondents considered an injury to be unstageable).Among a cohort of experts in pressure wound care (n=8), IRR was α=0.306; or α=0.443 excluding responses indicating that wounds were unstageable. ConclusionsAn instrument for the assessment and monitoring of pressure injuries to the mouth and lips has practical implications for patient care. This preliminary study indicates that the ROMPIS instrument has potential to be used clinically for this purpose; however, the performance of this scale may be somewhat reliant on the confidence or experience of the ICU nurse utilising it. Further validation is required.

Risk Factors for Abdominal Incision Infection after Colorectal Surgery in a Saudi Arabian Population: The Method of Surveillance Matters.

Reported surgical site infection rates range from 2.1% to 40% after colorectal surgery and are believed to be underestimated depending on the method of surveillance. The study aims were to identify an accurate incidence and associated risk factors for abdominal incision surgical site infection after elective open colorectal surgery in a Saudi population. This was a prospective observational longitudinal study of 300 consecutive adult patients, recruited upon admission to an 800-bed tertiary referral center. All consenting adults admitted for elective open colorectal surgery were included. Patients were followed for 36 d post-surgery by two certified and experienced wound care experts who diagnosed abdominal incision surgical site infections. The definition provided by the U.S. Centers for Disease Control and Prevention was used. Statistical analysis was performed using both univariate and multivariable logistic regression. Data were analyzed for 296 patients; the incidence of abdominal surgical site infection was 30%. Factors associated with surgical site infection by univariate analysis were pre-operative pre-albumin (p=0.04, odds ratio [OR] 0.81, 95% confidence interval [CI] 0.66-0.99); operative difficulty because of truncal obesity (p=0.006, OR 2.19, 95% CI 1.25-3.84) and obesity measured by body mass index (p=0.002, OR 4.00, 95% CI 1.95-8.20). Multivariable analysis identified only two significant risk factors: Pre-operative pre-albumin (p=0.02, OR 0.76, 95% CI 0.60-0.96), and obesity measured by body mass index (BMI; p=0.001, OR 4.71, 95% CI 2.20-10.10). Obesity and nutritional status correlated with post-operative abdominal surgical site infection. The method of surveillance and length of follow-up impact the rate reported.

What's new in critical illness and injury science? Nonaccidental burn injuries, child abuse awareness and prevention, and the critical need for dedicated pediatric emergency specialists: Answering the global call for social justice for our youngest citizens.

The most difficult clinical situations faced by physicians are child abuse/neglect and pediatric mortality. These phenomena are tragic, illogical, unnatural, emotional, and uncomfortable. They are also associated with significant distress and long-term consequences for communities, families, and healthcare providers. The World Health Organization reported approximately 6.6 million deaths in children Trauma, whether accidental or intentional, is a leading cause of mortality among children. Within the subset of pediatric trauma, burn injuries (both thermal and in some cases chemical) can be devastating because of their long-term psychological and functional sequelae, as well as the fact that up to 20% of pediatric burns may be nonaccidental in nature. When treated inappropriately or in an untimely fashion, burn injuries can have severe detrimental effects, especially when combined with preexisting factors such as child malnutrition. Most burn victims are initially brought to emergency departments, where they are evaluated and treated by emergency physicians prior to the involvement of surgical and wound care experts. Therefore, emergency medicine physicians need to be specifically trained in this clinical area of expertise, including appropriate resuscitation techniques, wound care, prevention of sepsis, and the ability to recognize child abuse.... Language: en

Reliability and validity of a Turkish language version of the Bates-Jensen Wound Assessment Tool.

The aim of this study was to evaluate content and construct validity of a Turkish language version of the Bates Wound Assessment Tool (BWAT) as well as its internal consistency and interrater reliability. The study was conducted in 13 intensive care units that included patients with pressure ulcers; the units were located in a university hospital in Central Anatolia, Turkey. The sample comprised 70 nurses and 20 patients who have stage II, III, and IV pressure ulcers. Data were collected between January and April 2011. Content validity was measured using the Davis Technique. The BWAT was scored by 2 groups, nurses with expertise in wound care and staff nurses. An expert nurse and a ward nurse conducted pressure ulcer evaluation on the same patient consecutively in order to determine interrater reliability. We also measured internal consistency via the Cronbach α. The content validity agreement rate was 0.82. The interrater reliability of the instrument was 0.82; its internal consistency calculated via the Cronbach α was 0.85. The findings of this study support the Turkish language version of the BWAT as possessing content validity, interrater reliability and internal consistency.

Development and psychometric testing of the Honaker suspected deep tissue injury severity scale.

This article describes the development of the Honaker Suspected Deep Tissue Injury Severity Scale (HSDTISS). The aims of the instrument are to (a) accurately evaluate the severity of the suspected deep tissue injury (SDTI), (b) determine progression of SDTI, and (c) demonstrate utility of the instrument in the clinical setting. The HSDTISS contains 3 items: total surface area size, skin integrity, and wound color/tissue assessment. The total surface area size item is scored on a scale of 1 to 8, the skin integrity item is scored on a scale from 1 to 3, and the wound color/tissue assessment item is scored on a scale of 1 to 7. A cumulative score is calculated for the HSDTISS; it ranges from 3 to 18. Content validity and interrater reliability testing were calculated. Content validity was evaluated by reviewing the items and scorings of the HSDTISS. Validation was derived from 10 content experts who participated in 2 rounds of evaluation and feedback. Intraclass correlation was used to evaluate the interrater reliability of the HSDTISS in a group of 21 clinicians (6 physical therapists and 15 RNs) by using the HSDTISS to evaluate photographs of 3 patients with SDTIs upon initial assessment and at discharge. The clinical utility of the instrument was determined by evaluation and subsequent comments received from 10 staff nurses within the hospital. Feedback from content experts supported content validity of the instrument. Calculation of an intraclass correlation coefficient showed strong interrater reliability (r = 0.997, P < .001). The time involved to complete assessment of 6 photographs was 8.2 ± 2.3 minutes, suggesting that the HSDTISS is straightforward and easy to use. Findings from this study suggest that the HSDTISS accurately diagnoses wound severity among patients with SDTI. Further testing is needed to confirm these results in a larger group of clinicians with variable expertise in wound care. Further testing is needed to confirm these results among a larger group of clinicians.

Trials, Tribulations, and Triumphs of a Pilot Initiative to Optimize the Management of Wounds Complicated by Diabetes Within the Home

To support home health care nurses in their efforts to optimize the management of patients with wounds complicated by diabetes, an initiative was introduced that incorporated a standardized assessment tool, electronic data entry, and the provision of written treatment recommendations with supporting rationale prepared by nurses with expertise in diabetes and wound care. A pilot study was conducted that provided preliminary evidence of the feasibility of this initiative as well as its potential effect on outcomes for patients, nurses, and the home care program.

Pressure ulcer multidisciplinary teams via telemedicine: a pragmatic cluster randomized stepped wedge trial in long term care

BackgroundThe study was conducted to determine the clinical and cost effectiveness of enhanced multi-disciplinary teams (EMDTs) vs. ‘usual care’ for the treatment of pressure ulcers in long term care (LTC) facilities in Ontario, CanadaMethodsWe conducted a multi-method study: a pragmatic cluster randomized stepped-wedge trial, ethnographic observation and in-depth interviews, and an economic evaluation. Long term care facilities (clusters) were randomly allocated to start dates of the intervention. An advance practice nurse (APN) with expertise in skin and wound care visited intervention facilities to educate staff on pressure ulcer prevention and treatment, supported by an off-site hospital based expert multi-disciplinary wound care team via email, telephone, or video link as needed. The primary outcome was rate of reduction in pressure ulcer surface area (cm2/day) measured on before and after standard photographs by an assessor blinded to facility allocation. Secondary outcomes were time to healing, probability of healing, pressure ulcer incidence, pressure ulcer prevalence, wound pain, hospitalization, emergency department visits, utility, and cost.Results12 of 15 eligible LTC facilities were randomly selected to participate and randomized to start date of the intervention following the stepped wedge design. 137 residents with a total of 259 pressure ulcers (stage 2 or greater) were recruited over the 17 month study period. No statistically significant differences were found between control and intervention periods on any of the primary or secondary outcomes. The economic evaluation demonstrated a mean reduction in direct care costs of $650 per resident compared to ‘usual care’. The qualitative study suggested that onsite support by APN wound specialists was welcomed, and is responsible for reduced costs through discontinuation of expensive non evidence based treatments. Insufficient allocation of nursing home staff time to wound care may explain the lack of impact on healing.ConclusionEnhanced multi-disciplinary wound care teams were cost effective, with most benefit through cost reduction initiated by APNs, but did not improve the treatment of pressure ulcers in nursing homes. Policy makers should consider the potential yield of strengthening evidence based primary care within LTC facilities, through outreach by APNs.Trial registrationClinicalTrials.gov identifier NCT01232764

Wound bed preparation: The impact of debridement and wound cleansing

Wound healing is a complex series of events that are interlinked and dependent on one another. Acute wounds usually follow a well-defined process. In the past this model of healing has been applied also to chronic wounds, but it is well known that chronic wound healing is different from acute wound healing. Wound bed preparation as a concept allows the clinician to focus systematically on all of the critical components of a non-healing wound to identify the cause of the problem, and implement a care programme in order to achieve wound healing. To assist with implementing the concept of wound bed preparation, the TIME acronym was developed in 2002 by a group of wound care experts. It is important to understand wound bed preparation and TIME within the context of total patient care. Debridement is an integrated part of wound management, achieving certain goals and, thus, creating a healthy wound bed, margins and peri-wound skin with the objective to promote and accelerate healing. Debridement is defined as the removal of foreign material and necrotic tissue from a wound and it can also help to stimulate wound healing. However, not all methods of debridement are the same. Each method has advantages and disadvantages that must be clearly understood. Wound cleansing loosens and washes away cellular debris such as bacteria, exudate, purulent material and residual topical agents from previous dressings. Failure to use the correct method for a given wound may lead to further delays in wound healing, increase patient suffering, and unnecessarily increase the cost of care. Aim of this review is to give an overview of current standards and definitions concerning wound bed preparation and debridement.

Challenges in Classification of Gluteal Cleft and Buttocks Wounds

The damaging effects of moisture, pressure, friction, and shear on human tissue are well-known among wound care experts. Nevertheless, accurate classification of these lesions is frequently challenging, even for experienced wound clinicians. The authors gathered clinical illustrations of gluteal cleft wounds and conducted a literature search as a basis for presentation to conference attendees, with the goal of gaining consensus regarding guidelines for accurate classification of these wounds. The aim of this article was to summarize results of the consensus sessions that occurred at the Wound Ostomy Continence Nurses' Society National conferences in 2011 and 2012, and to highlight areas where consensus has been achieved as well as areas in which consensus has not yet been reached.

The effectiveness of cleansing solutions for wound treatment: a systematic review protocol

The effectiveness of cleansing solutions for wound treatment: a systematic review protocol

Competencies of specialised wound care nurses: a European Delphi study

Health care professionals responsible for patients with complex wounds need a particular level of expertise and education to ensure optimum wound care. However, uniform education for those working as wound care nurses is lacking. We aimed to reach consensus among experts from six European countries as to the competencies for specialised wound care nurses that meet international professional expectations and educational systems. Wound care experts including doctors, wound care nurses, lecturers, managers and head nurses were invited to contribute to an e-Delphi study. They completed online questionnaires based on the Canadian Medical Education Directives for Specialists framework. Suggested competencies were rated on a 9-point Likert scale. Consensus was defined as an agreement of at least 75% for each competence. Response rates ranged from 62% (round 1) to 86% (rounds 2 and 3). The experts reached consensus on 77 (80%) competences. Most competencies chosen belonged to the domain 'scholar' (n = 19), whereas few addressed those associated with being a 'health advocate' (n = 7). Competencies related to professional knowledge and expertise, ethical integrity and patient commitment were considered most important. This consensus on core competencies for specialised wound care nurses may help achieve a more uniform definition and education for specialised wound care nurses.

Developing the Standardized Wound Care Documentation Model

The aim of this study was to validate a set of previously developed criteria for wound care documentation and to use the validated criteria as a framework for developing a wound care documentation model. The Skin Integrity component of the Finnish Care Classification, the Finnish Classification of Nursing Diagnosis, and the Finnish Classification of Nursing Interventions serve as the basis for the wound care documentation model. Finnish wound care specialists, mainly nurses, from different Finnish hospitals, and from the Finnish Wound Care Society having on average 18 years of experience in wound management. Data were collected using electronic survey technology. A Delphi technique was used to develop and validate the documentation system. The final model consists of 7 main categories and 25 subcategories of the Skin Integrity component of the Finnish Classification of Nursing Diagnosis and 5 main categories and 25 subcategories of the Skin Integrity component of the Finnish Classification of Nursing Intervention. Based on the results of the Delphi survey, consensus was reached on all elements of the wound care documentation model. The Delphi process was used to develop a wound care documentation model for use in an electronic record to promote systematic documentation of both wound assessment and wound care. Future research should address the utility of this documentation model for nurses with expertise in wound care and generalist nurses.

The impact of evolving V.A.C ® Therapy technology on outcomes in wound care. Prologue.

In May 2011, an international panel of wound care experts from multiple disciplines convened to develop this document to summarise the evolution of negative pressure wound therapy (NPWT) technology devices over the past 15 years, specifically concentrating on the V.A.C.(®) Therapy (KCI USA, Inc., San Antonio, TX) family of products. The aim of this document, which will be comprised of six articles, is to describe appropriate use of current technology options across a variety of wound types. The articles will include literature reviews, initiation criteria, treatment outcomes, technical pearls and clinical cases that will show the enhanced outcomes and potential economic value of the various NPWT technologies in use today.

The Response of Academic Medical Centers to the 2010 Haiti Earthquake: The Mount Sinai School of Medicine Experience

On January 12, 2010, Haiti was struck by a 7.0 earthquake which left the country in a state of devastation. In the aftermath, there was an enormous relief effort in which academic medical centers (AMC) played an important role. We offer a retrospective on the AMC response through the Mount Sinai School of Medicine (MSSM) experience. Over the course of the year that followed the Earthquake, MSSM conducted five service trips in conjunction with two well-established groups which have provided service to the Haitian people for over 15 years. MSSM volunteer personnel included nurses, resident and attending physicians, and specialty fellows who provided expertise in critical care, emergency medicine, wound care, infectious diseases and chronic disease management of adults and children. Challenges faced included stressful and potentially hazardous working conditions, provision of care with limited resources and cultural and language barriers. The success of the MSSM response was due largely to the strength of its human resources and the relationship forged with effective relief organizations. These service missions fulfilled the institution's commitment to social responsibility and provided a valuable training opportunity in advocacy. For other AMCs seeking to respond in future emergencies, we suggest early identification of a partner with field experience, recruitment of administrative and faculty support across the institution, significant pre-departure orientation and utilization of volunteers to fundraise and advocate. Through this process, AMCs can play an important role in disaster response.

Wound Literature Review 2010

Wound Literature Review 2010

Say Goodbye to Wet-to-Dry Wound Care Dressings

Say Goodbye to Wet-to-Dry Wound Care Dressings

Bates-Jensen Wound Assessment Tool

A group of 3 WOC nurses and a nurse researcher, in partnership with the author of the Bates Wound Assessment Tool (BWAT), sought to validate wound photographs depicting each characteristic of the instrument. The BWAT contains 13 items that assess wound size, depth, edges, undermining, necrotic tissue type, amount of necrotic, granulation and epithelialization tissue, exudate type and amount, surrounding skin color, edema, and induration. These are rated using a modified Likert scale; a score of 1 indicates the healthiest and 5 indicates the most unhealthy attribute for each characteristic. In 2001, the PSST was revised and renamed the Bates-Jensen Wound Assessment Tool to reflect the global use of the tool with wound types beyond pressure ulcers. Phase 1 involved the selection of digitalized wound photographs for 11 of the BWAT wound characteristics by the researchers. The photographs needed to be of high resolution and good quality for eventual publication and validated by the original BWAT author as being representative of the intended characteristic. In phase 2, a face-to-face validation exercise was completed to include, edit, or exclude these photographs. Corrections were made; additional photographs were obtained for the remaining characteristics and to replace those not validated. Phase 3 involved an electronic survey that achieved validation online. Phase 2 participants consisted of 15 WOC nurses with a mean of 11.5 years of experience with wounds. Phase 3 had 8 WOC nurses and 1 master's prepared wound care specialist, with approximately 10 years of experience. One third of participants in each phase were familiar with the BWAT. In a separate exercise to rate photographs that would be used for testing the implementation of the pictorial guide, 7 WOC nurses and 2 RNs who used the BWAT regularly and 2 researchers participated in a face-to-face discussion. A total of 214 photographs were reviewed in this study. Seventy-three percent (n = 55) of the photographs for the pictorial guide were endorsed in phase 2, and 100% (n = 53) in phase 3 to demonstrate the 65 BWAT characteristics. In addition, photographs that could be used for a competency exercise and for pre- and posttests were also rated by the panels. The photographic content of the BWAT pictorial guide has been validated by a small group of wound care experts. The purpose of the exercise was to create a visual learning aid to enhance the education around wound assessment and as a resource for nurses in practice. Now published in a pocket guide format, it is a standardized way to teach BWAT wound assessment skills in a consistent format.