Wound Care Guidelines Research Articles

Effect of Wound Care Guidelines on Women's Knowledge, Beliefs, and Practices Regarding Cesarean Section Wound Healing

Effect of Wound Care Guidelines on Women's Knowledge, Beliefs, and Practices Regarding Cesarean Section Wound Healing

Effect of Pre-Cesarean Section Wound Care Guidelines on Occurrence of Post-Operative Infection among Women /

Effect of Pre-Cesarean Section Wound Care Guidelines on Occurrence of Post-Operative Infection among Women /

304 A Novel Burn Education Program in a New Comprehensive Burn Center

Abstract Introduction In 2020 a large academic hospital with an existing pediatric burn program expanded its services to take adults. Prior to opening the comprehensive center, training and education for the nursing staff was designed and implemented, in amalgamation with the existing pediatric education program. This study describes and evaluates the implementation and efficacy of a novel burn nursing education program, established using the American Burn Association’s (ABA) nursing competencies and Kolb’s Experiential Learning Model. Methods For the purpose of this study Cohort 1 (C1) is defined as 83 nurses hired prior to 2021 and Cohort 2 (C2) is defined as 304 nurses hired after 2022. Didactic and simulated education sessions were created and presented in tandem for both initial and ongoing competency. Didactic sessions were evaluated in two cohorts because the program content was redesigned after 2021. C1 was evaluated using a pre-posttest, whereas, C2 was evaluated using only a post-test. Simulated content was evaluated using the verification in practice method with a check off sheet created using institutional wound care guidelines. Course efficacy was evaluated by attendees using a 1-5 Likert scale. Test scores from 2020-2022 were compared using a T-test with a p-value of < 0.05 considered significant. Results To date 387 nurses have completed a written exam, been validated in practice, and if in C1, completed an annual ongoing burn competency activity. In 2020, C1 showed a statistically significant increase in pre and posttest scores from 66.87%±9.36 to 88.26%±7.90, p=0.000015. When C1 was retested in 2021 using the same posttest, the scores were 80%±1.73 in 2020 to 84.33%±3.84 in 2022, p=0.36. The mean score for posttests for C2 in 2022 was 88%. Course evaluations returned by 155 nurses (77%) in 2020 indicated the course was too long, and some of the information was exorbitant for nursing practice. Therefore, in 2021 the course was redesigned. An additional 251 (65%) nurses have taken the course since, and have reported a mean of 4.5/5 for course efficacy and 4.9/5 for an increase in nursing confidence to care for the burn patient population. Conclusions The education program resulted in significantly higher posttest scores in C1 during the 2020-2021 period showcasing an increase in initial burn knowledge. Although the scores for C1 in 2022 were not statistically significant, the increase in mean scores shows the nurses not only retained the initial information, but built on it throughout the year with the addition of clinical practice. Nurses in C1 continue to practice at high levels and train nurses in C2 who reported the course was critical to their understanding of burn care. Nurses in both C1 and C2 will be required to complete an annual burn competency module to ensure ongoing competency in burn care. Applicability of Research to Practice Nursing Education

Management of acute surgical wounds in Saudi Arabia: nursing staff knowledge and practice.

Nursing staff play a crucial role in postoperative wound care and management; it is therefore imperative that their knowledge is kept up to date to avoid complications. The overarching objective of this study was to assess the knowledge and practice of nursing staff regarding various aspects of the management of acute surgical wounds. We conducted a cross-sectional study to assess nurses' clinical knowledge and practices in the management of acute wounds in four large hospitals in Saudi Arabia. The eligible participants included nurses who were working in the medical or surgical departments and those who were employed by the Ministry of Health. We administered a study questionnaire and conducted descriptive analysis to report frequencies and proportions of knowledge and practice aspects. A total of 360 nurses responded to the survey, giving a response rate of 70%. A total of 221 nurses completed all survey questions. Of the participants, 56.56% were ≥30 years old, 95.48% were female, and 50.02% had >6 years' working experience. With regards to nurses' knowledge: 71.9% of the participants had updated their knowledge about wound care in the past two years; 54.3% perceived their knowledge of the availability of wound products as good; 74.66% correctly reported the classic signs of inflammation; 66.97% correctly identified general signs of wound infection; 84.62% of the sample considered surgical site infection as one complication of surgical wound infection. Only 61.09% of the nurses reported following wound care guidelines, 48.42% considered wound appearance as a highly important factor that influences nurses' choice of surgical dressing products, and 41.63% considered hospital policies and practices as important in making evidence-based decisions in wound management. This study found that nurses' knowledge about the management of wounds was generally good; however, there were gaps in the practical component which need to be filled to avoid wound complications.

Deprescribing: What About Vitamins, Minerals, and Other Nutritional Supplements?

Deprescribing: What About Vitamins, Minerals, and Other Nutritional Supplements?

The challenges of wound management for hidradenitis suppurativa.

Hidradenitis suppurativa (HS) is an under-reported, poorly understood and often mismanaged inflammatory skin condition that manifests itself as painful, inflamed areas or boils. Although blind at first, it develops into exuding lesions often with tracking sinuses, leaving painfully stretched and scarred skin. While advances have been made in surgical and pharmaceutical interventions to interrupt the disease and prevent infection, effective wound management, evidence and guidelines remain limited. This article describes the experiences of an HS sufferer, in her quest for a satisfactory and acceptable wound management solution. It is hoped that the author's criteria for the ideal wound management system for HS will be the starting point for discussion and development of sound HS wound care guidelines.

Challenges and Dilemmas of Providing Healthcare to Patients in Home Care Settings With Hard-to-Heal Wounds

Hard-to-heal wounds (HHW) represent wound beds that are at high risk of stagnating during the inflammatory or proliferative phase because of various internal or external factors. A wound area reduction of less than 40% in 4 weeks is an indicator of HHW. With the acceleration of population aging, an increasing number of older adults are developing various chronic diseases with comorbidities. Although many older adults are affected by HHW, patients are regularly expected to recuperate at home or in long-term care institutions rather than in hospitals because of shortened hospitalization periods and changes in the medical insurance system. The provision of healthcare to patients with HHW in home settings is currently complicated by the lack of systematic nursing education on wound care, the lack of evidence-based guidelines for home wound care, and the inadequate wound care skills of nurses. HHW have major physical, psychological, and economic impacts on patients and their families and increase stress and frustration in nurses. Inappropriate wound care interventions increase medical expenditures and have multifaceted effects that are largely ignored by the medical care system. This phenomenon, which encompasses HHW, has been called a silent epidemic. In this paper, HHW are defined, the current status of home wound healing worldwide is analyzed, the relevant challenges and strategy implementations are discussed, and recommendations for the home care of HHW are provided.

Wound Care for Venous Ulceration.

Venous leg ulcers (VLUs) affect as many as 20% of patients with advanced chronic venous insufficiency and are associated with significant morbidity and health care costs. VLUs are the most common cause of leg ulcers; however, other etiologies of lower extremity ulcerations should be investigated, most notably arterial insufficiency, to ensure appropriate therapy. Careful clinical examination, standardized documentation, and ultrasound evaluation are needed for diagnosis and treatment success. Reduction of edema and venous hypertension through compression therapy, local wound care, and treatment of venous reflux or obstruction is the foundation of therapy. As key providers in venous disease, interventional radiologists should be aware of current standardized disease classification and scoring systems as well as treatment and wound care guidelines for venous ulcers.

Chronic pilonidal sinus wounds: regular cleaning and early laser depilation are key interventions to successful healing

Pilonidal sinus wounds are notoriously slow to heal and have a high risk of infection due to proximity to the anus, the moist environment of the natal cleft and friction of buttock cheeks. Since the first pilonidal sinus disease (PSD) protocol was issued to the US army in 1955, care for PSD has focused on the principles of wound care following surgical excision with secondary or modified closure, including cleaning of the wound, hair removal and daily dressings. These principles remain valid today, although advances in the choice of dressings and laser therapies for long-term hair management allow patients more independence and less frequent dressings. At present, there are no standard guidelines for wound care following pilonidal sinus (PS) surgery. This article recommends thorough wound cleaning, starting laser depilation early and individualised patient education to accelerate wound healing and reduce recurrence. Collaboration between specialists in a multidisciplinary team is essential.

807 Implementation of an Evidence-based Wound Care Process at a Regional Burn Center Reduces Hospital Acquired Infections

Abstract Introduction Central line associated blood stream infection (CLABSI) rates in burn patients exceeds the national average. The purpose of this study was to determine if implementation of an evidence-based process for wound care and central line management reduce infections. Methods A protocol for central line and wound care was developed in conjunction with another burn center with lower CLABSI rates and a care bundle, based on colorectal surgical literature. The new protocol required hand to elbow washing prior to wound care, separating the dirty and clean steps of the wound care process, changing protective gear when going from dirty to clean and performing the Hospital Acquired Infection (HAI) bundle elements separate from wound care. CLABSI and Ventilator Associated Pneumonia (VAP) rates were then compared with the previous year. Results Following implementation of the new wound care guidelines, the number of CLABSIs declined from 10 in 2017 to 2 in 2018 and 1 so far in 2019 (through August 2019). The median number of CLABSIs per 1000 days was 0 (range of 0 to 11) before the bundle and 0 (range of 0 to 4.2) after implementation of the bundle. Using the Wilcox rank sum test, there was no significant difference (p=0.09) between the CLABSI rate per 1000 device days between the time period before the bundle implementation and after the bundle implementation, however this may be due to the small sample size. Although the CLABSI rate did not show a statistically significant decrease, the proportion of positive blood cultures decreased by 50% after implementation of the bundle. The number of VAPs declined from 8 in 2017 to 6 in 2018 and so far in 2019 no VAPs have been reported (through August 2019). There was no difference in device days between groups. Conclusions Creating a wound care process that clearly defines and separates clean and dirty steps, similar to colorectal surgical bundles in the reduction of Surgical Site Infection, reduced CLABSI and HAI rates in a clinically significant, if not statistically significant way in the Burn Intensive Care Unit. Further study is needed to increase the power of this study to possibly detect statistically significant differences. Applicability of Research to Practice Implementation of an evidence-based, standardized practice for wound care improved infection rates at one regional burn center. It would be beneficial for this process to be replicated at other centers to further test correlation with infection reduction.

Nursing Experience of a Patient With Breast Cancer Who Suffered From a Fungating Wound

This report discusses an experience of taking care of a breast cancer patient with rapidly deteriorating, fungating wounds and herpes simplex virus wounds and describes the physical and psychological effects on the patient and the related decreases in the quality of life of both the patient and her caregivers. Nursing care was implemented from December 14th, 2017 to January 23rd, 2018. Data collection was performed through direct caregiving, observation, interviews, and chart review. Three major problems were identified: difficulties with wound care, psychological distress of the patient, and the coping problems of the caregivers. Based on these problems, nursing interventions were implemented. During the period, fungating wound care guidelines were used to teach the patient and her caregivers the core principles of fungating wound management. Meanwhile, the COPE framework (creativity, optimism, planning, and expert information) was applied to train the patient and her caregivers how to develop problem-solving skills and build self-confidence. Finally, the patient and her family successfully overcame these challenges. The patient was relieved of stress and anxiety, became better able to self-manage her symptoms, sustain hope for the future, and improve her perception of body self-image. We suggested that the patient and her family be considered a single, supportive unit and then helped them cope with the disease and build self-care confidence in order to improve their life quality and to coexist with the disease. We hope that our clinical experience will be taken as a reference by patient caregivers.

DENTAL CARE LEVEL ASSESSMENT AT SDS/TEN: SYSTEMATIC ANALYSIS OF CLINICAL CASES

Background. Dental care is essential for all hospitalized patients with Stevens-Johnson syndrome and/or toxic epidermal necrolysis (SJS/TEN), the clinical cases of which are reported annually in scientific journals.
 Purpose of publication was analysis of dental care from clinical reports about SJS/TEN and ours own clinical case of SJS, for dental help optimization.
 Materials and methods. The clinical cases reports in Russian and Ukrainian languages of databases Google and Google Academy from 2016 to May 2019 (and some earlier publications) were selected by the keywords "Stevens-Johnson syndrome", "Lyell's syndrome", "toxic epidermal necrolysis" and analyzed together with our own clinical case of SJS.
 Clinical case. The list of dental prescriptions, according to the case history, included: local anesthesia with 10% lidocaine spray, rinsing the mouth with a decoction of herbs; later lidocaine was replaced by the metacyl-anesthesin suspension applications.
 Discussion. Currently there are no clinical guidelines for wound care and skin care of Stevens-Johnson syndrome and toxic epidermal necrolysis. Analysis of the literature and ours own clinical case showed the simultaneous using of the same drugs in different forms. As a rule, this concerned systemic and local corticosteroids, and a combination of at least two antiseptics. Insufficient attention was paid to assessing the periodontal state of patients and to professional and/or individual measures to control dental biofilm (mentioned in only one case). Meanwhile, it can be very important in patients with chronic periodontitis, given the role of periodontal pathogens in dental biofilm as a reservoir in particular for respiratory infections that can lead to nosocomial pneumonia. Using of outdated empirical antiseptics (furatsilin, potassium permanganate, sodium tetraborate, colloid silver) were reported, which toxicity exceeds the useful effect. When the benzocaine anesthetic (the para-aminobenzoic acid ester derivatives group) was selected, cross-reactivity with other sulfonamides, which are known to cause severe hypersensitivity reactions, was not taken into account. There were no reports about non-adhesive modern dressings for affected skin. There was a case of using empirical drugs without evidence base (solcoseryl, trypsin).
 At present, accumulated evidence suggests the role of endogenous hepatogenic hypervitaminosis A, which leads to the spillage of toxic retinoid compounds into the circulation, and the development of cytotoxicity with the widespread of granulosin-mediated apoptosis. So the use of keratoplasty drugs, rich in carotenoids, in particular sea buckthorn oils, can be harmful.
 Thus, lately, the methods and means of dental care have not hardly changed, despite the 4th year of the order No. 916 dated 12.30.2015 “Drug allergies, including anaphylaxis” of the Ministry of Health of Ukraine.
 Conclusions.
 1. When treating patients with SJS/ТEN, withdrawal of any agent suspected of causing the condition is critically important.
 2. It is necessary to more widely introduce modern non-adhesive dressings on the affected skin, as they require fewer changes and caused less discomfort to the patients.
 3. Oral lesions are managed with mouthwashes; topical anesthetics are useful in reducing pain and allowing the patient to take in fluids. This determines the optimal minimum in order to avoid new adverse effects from unjustified empirical and outdated polypharmacy.
 Perspectives. The clinical guidelines from the order No. 916 dated June 30, 2015, "Drug allergy, including anaphylaxis" of the Ministry of Health of Ukraine should be more widely studied and used in practice, including dentistry.

Can a smartphone app help manage wounds in primary care?

Although wound care guidelines are available for primary care providers, barriers to assessment and treatment remain. This article examines current evidence supporting wound management, wound guidelines, and provider comfort with wound management in primary care and discusses the need for improved training, education, and the development of a simplified approach to wound management in primary care. This review of evidence examines knowledge of wound care, wound curriculum, and the current availability of guidelines for health care providers at the frontlines. Few primary care curriculums and institutions require wound care education. Access to guidelines, pathways, and educational resources is limited, which negatively effects primary care provider's knowledge and comfort level in treating wounds in current clinical practice. Educating the general practitioner on evidence-based wound management and providing adequate resources remain a priority. Increasing awareness of available electronic wound care applications (apps) can improve a timely wound care assessment, diagnosis, and initiation of treatment.

Wound healing elective: an opportunity to improve medical education curriculum to better manage the increasing burden of chronic wounds

Chronic wounds are highly prevalent and have become a public health crisis. Successful treatment of chronic wounds requires that healthcare providers study both the pathophysiology of wound healing and maintain knowledge of the most current wound care guidelines set forth by the Agency for Healthcare Research and Quality. Unfortunately, medical students currently receive limited wound care training. A focused and well-organized course integrating a diverse group of medical and surgical faculty, residents, and medical students in the clinical years has been created to address this growing medical issue. The goal of such curricular innovations is to help future physicians gain exposure to chronic wounds and develop crucial clinical skills so they enter residency prepared to offer basic treatments and prevent rapid deterioration of the many wounds they will encounter.

Effect of Designed Wound Care Guidelines for Pediatric Nurses on Occurrence of Surgical Site Complications

Surgical site complications are the commonest nosocomial infections and responsible for considerable morbidity and mortality as well as increased hospitalizations and treatment cost related to surgical operations, wound care guidelines proved to avoid occurrence of wound complications. The aim of the current study: was to evaluate the effect of designed wound care guidelines for pediatric nurses on occurrence of surgical site complications. Design: pre-posttest quasi-experimental research design was utilized to fit the aim of the current study. Setting: the study was conducted in the Intermediate Surgical Intensive Care Unit (ISICU) at Cairo University Specialized Pediatric Hospital (CUSPH). Sample: A convenient sample of 30 nurses and 60 children in the postoperative period after abdominal surgeries were participated in the current study; children were divided into two equal groups: 30 as a control group and 30 as a study group and nurses were the same for the study and control group of children. Data collection tools: data were collected using the following tools: structured interview sheet, pre/posttest sheet and observation checklists to evaluate nurse's knowledge and practice as well as postoperative recording sheet. Results: the results revealed that, there was statistically significant difference between the total mean score of nurses’ knowledge and practice before and after implementation of wound care guidelines. Children in the study group exposed to less wound complications than children in the control group. Conclusion: the study concluded that children who cared by nurses receiving wound care guidelines sessions were exposed to less surgical site complications than those in the control group.

Optimal wound care management in hidradenitis suppurativa

Introduction: Hidradenitis suppurativa (HS) presents the problem of a chronic, relapsing, painful, draining wound. There is a myriad of HS wound care management strategies implemented by clinicians and patients centered around which dressings to use. Many factors affect which HS wound care dressing is the most appropriate to use such as the type of HS wound, cost, ease of application, patient comfort, absorbency and odor management among many others.Aim: In this work, the authors aim to prepare a set of guidelines for optimal HS wound care dressing use based on a tier system, ideal characteristics of HS dressings and the type of HS lesion. The dressing recommendations focus on cost-effectiveness for patients, ease of accessibility and ultimately, improvement in the quality of life of patients suffering from HS.Methods: PubMed was utilized to search the terms ‘wound care + HS’; ‘non-surgical wound care + HS’; ‘optimal wound care + HS’; ‘HS wounds’; and ‘optimal wound dressings’.Results: Silver-impregnated foam is considered the most optimal HS wound care dressing because it contains nearly all characteristics of an ideal wound care dressing.Conclusion: However, silver-impreganted foam is expensive and difficult to access for patients, so lower-tier HS wound care dressings must be considered prior to utilizing this tier 4 dressing.

Plan to Reduce Improper Care of Peripherally-inserted Central Venous Catheters in Outpatient Chemotherapy Patients

This project aims at improving peripherally-inserted central venous catheter (PICC) care in chemotherapy outpatients. From February to March 2011, 16.8% of PICCs were not cared for properly. The main problems encountered were dermatitis, catheter obstruction and catheter slippage. These problems were caused by lack of wound care guidelines for the PICC, the nursing staff's lack of knowledge and skills for PICC nursing care, and patients and their families’ lack of knowledge regarding PICC home care. Improvement plans included: 1. To establish norms for care of normal and abnormal PICC wounds and produce instructional videos; 2. To design correct flushing and butterfly fixation methods of the PICC. 3. To develop the transparent waterproof protective jacket and to produce a home nursing care manual and instructional video. After implementation of this project, the rate of improper PICC care decreased to 6.1% in September to November 2011, thus achieving the goals of this project. This PICC care project not only enhanced the professional knowledge and skills of nurses, but also the knowledge of patients regarding self-care.

Smoking, chronic wound healing, and implications for evidence-based practice.

Chronic wounds are rising in prevalence and creating significant socioeconomic burdens for patients and healthcare systems worldwide. Therefore, it is now more important than ever that clinicians follow evidence-based guidelines for wound care when developing personalized treatment plans for their patients with chronic wounds. Evidence-based guidelines for treating venous leg ulcers, diabetic foot ulcers, and pressure ulcers, the 3 main categories of chronic wounds, focus primarily on biologic therapies. However, there are also evidence-based guidelines for treating behavioral risks to poor healing, such as smoking, which should be incorporated into treatment plans when appropriate. The purpose of this article was to review the mechanisms through which smoking adversely impacts the wound healing process, and propose strategies for incorporating evidence-based guidelines for treating tobacco dependence into treatment plans for patients with chronic wounds who smoke.

P108 Publications Improve Wound Care Guideline Quality And Impact

BackgroundHigh quality evidence based (EB) wound care guidelines reduce costs of care and improve outcomes. They may help stem the growing burden of chronic wound care only if disseminated and...

Cascade® Autologous System Platelet-Rich Fibrin Matrix in the Treatment of Chronic Leg Ulcers

Lower extremity ulcers (venous, diabetic) are often unresponsive to standard treatment. Various systemic and local cellular, vascular, and anatomical factors can result in nonhealing wounds that are refractory to normal healing processes and standard care. Several published wound care guidelines strongly suggest that if an ulcer does not respond to standard good wound care within 4 weeks, then advanced wound therapies should be considered. These advanced therapies include wound bed preparation agents (negative wound pressure therapy, hyperbaric oxygen), recombinant growth factors, or bioengineered cell therapies. The Cascade® system produces platelet-rich fibrin matrix (PRFM), a novel autologous sterile biologic, produced at the bedside from a small volume (18 mL) of the patient's own blood by using Vacutainer® separation technology optimized for fibrin and platelet isolation. Prepared as an easy to apply, suturable membrane, without the use of exogenous thrombin, PRFM consists of a dense cross-linked fibrin lattice containing intact, viable platelets with their full complement of platelet-derived growth factors. From the FDA 510(k) clearance: The Cascade system "is designed to be used for the safe and rapid preparation of autologous platelet-rich plasma from a small sample of blood at the patient point of care." PRFM has been used to successfully treat severe venous leg ulcer (VLU), neuropathic diabetic foot ulcer (DFU), mixed arterial and Charcot-deformity associated foot ulcers. When treating venous or DFUs, the Cascade system should be used together with standard wound care practice (therapeutic compression for VLU and weight off-loading, debridement, and infection control for DFU) in patients with an adequate blood supply to the lower limb.