Wound Care Practices Research Articles

International collaboration in Guyana to reduce amputations in persons with diabetes

aim: This project created an interprofessional, patient-centered clinic in Guyana, South America to prevent and treat diabetic foot ulcers and reduce amputations. Methods: A multi-faceted, longitudinal, evidence-informed educational intervention, was linked to professional practice change and improved patient outcomes. The educational program was designed to: a apply effective primary and secondary educational strategies to translate knowledge into practice, b adapt the highly rated evidence-based guidelines from the Registered Nurses Association of Ontario and the Best Practice recommendations of the Canadian Association of Wound Care in a resource-poor setting, and c identify and empower key opinion leaders with a collaborative practice model. results: The interprofessional Diabetic Foot Centre was opened at the Georgetown Public Hospital Corporation in July 2008. Four teams of doctors, nurses and rehabilitation specialists were trained and mentored by an expert Canadian team modeling interprofessional collaboration. Thirty participants were taught in two training visits (20 trainees attended both). Trainees rotated through the clinic working with context-specific enablers that acted as quick reference guides to translate new knowledge into practice. The new knowledge was reinforced with practice reflection through daily seminars. To empower four key opinion leaders with a greater theoretical framework for education methodology, wound care practices and health care systems, they and the project coordinator were enrolled in the International Interprofessional Wound Care Course from the University of Toronto. This course consists of two 4 day residential weekends of interprofessional education separated by 8 months of self study modules and a selective that relates course material to day to day practice. Discussion/conclusions: Diabetic foot ulcers are a major and growing public health problem in Guyana and elsewhere. They represent the single largest (30%) reason for admission to the surgical wards. The development of sustainable local capacity in low-income countries requires more than one time training sessions. This international collaboration developed local capacity by modeling and adapting Best Practices using primary and secondary (enabling and reinforcing) educational strategies in a longitudinal format with key opinion leader training. This multiple intervention model has facilitated interprofessional collaboration along with knowledge, skills and attitude change to improve diabetic foot care patient outcomes.

Epidermolysis Bullosa

Epidermolysis bullosa (EB) is a lifelong genetic skin disorder. It is characterized by extreme skin fragility resulting in chronic erosions and blisters. There are many types of EB with different associated complications. However, all types of EB have one thing in common, and that is their skin fragility resulting in chronic wounds and erosions. Wound care plays a crucial role in the care of these individuals. It becomes a part of their daily routines. Wound care has two goals, wound protection and wound healing. It is important to understand how a wound heals, what an infected wound looks like, and what products are available. The purpose of this publication was to educate about the wound-healing process, infection, what products are available, and how to utilize those products correctly. Good wound care practices can improve an individual's quality of life. The ultimate goal is to allow these individuals the opportunity to live as normal a life as possible. Remember, we are children only once, and we need to give these children the opportunity to live the life of a child.

Book review

The second edition of Wound Care Practice edited by Paul J. Sheffield and Caroline E. Fife is a riveting, two-volume read which discusses the overarching principles of diagnosing and managing a diverse range of chronic wounds — from pressure ulcers to venomous spider bites.

Book review on wound care practice, 2nd edition

Book review on wound care practice, 2nd edition

Evidence-Based Management of Chronic Wounds

Identify the consistency of current chronic wound care practices with evidence-based recommendations for wound management. A retrospective study based on 400 subject records (venous ulcers, 183; diabetic ulcers, 103; and pressure ulcers, 114). Study records were located at hospitals, wound care centers and clinics, home health agencies, and nursing homes in 4 diverse geographic locations. Chronic wound assessment and evidence-based treatment practices were identified by extensive review of the literature, professional Web sites, and the Agency for Healthcare Research and Quality National Guideline Clearinghouse. Actual delivery of wound care practices was obtained from retrospective chart reviews and a structured data abstraction protocol. Collected data were then compared with recommended practices for consistency, adherence variations, and wound healing across data collection sites. Significant variations occurred in adherence to evidence-based recommendations across sites of care delivery, with selection and application of appropriate dressings showing the greatest need for improvement. Current chronic wound care practices are inconsistent with evidence-based recommendations for wound management. Further studies are needed to determine the best method for translating this information to multiple settings.

Modern dressings: must do better

Another month, another review that casts doubt on current wound-care practice. An article published in the October 2007 issue of Archives of Dermatology presents the outcomes of a systematic review by a group of French medics of efficacy studies on modern wound dressings. The review is worthy of particular note for the English-speaking wound world because it includes studies published in French and English, and so covers a wider range of journals than we might otherwise consider.

A point prevalence survey of wounds in north-east England

To review current wound-care practice and the standard of wound care in Hull and East Yorkshire; obtain information on prevalence, treatment and outcomes; provide a basis for estimating the extent of the problem, treatment modalities used, service provision and future needs; highlight areas of care in need of improvement; highlight areas with excellent wound practices and gain information for future research projects within the population of the region. Point prevalence interface audit of community and acute trusts. The cumulative wound prevalence for the region was 12%. Community nurses were involved in caring for 70.1% of patients with wounds, with 52.7% of wounds being treated in the patient's home. The largest proportion of wounds were surgical wounds (n=699, 41.5%), followed by leg and foot ulcers (n=629, 37.3%) and pressure ulcers (n=294, 17.4%). Diabetes and cancer were related to 15.1% and 9.7% of the wounds respectively. 41.9% of the wounds were on the lower leg. The primary and secondary dressings used the most were low/non-adherent dressings at 25.9% and 27.3% respectively.Almost half of the patients with a venous leg ulcer (46%) did not receive multilayer compression and 7% of patients with an arterial ulcer did; 23.6% of the leg and foot wounds were not assessed with a Doppler. Wounds represent a significant cause of morbidity in the general population.A systematic focus is necessary on effective and timely diagnosis, on ensuring treatment is appropriate to the cause and condition of the wound and on active measures to prevent complications.A number of initiatives have commenced in order to provide a effective and efficient wound care.

Wound Care Practices and Challenges in Nigeria

Wound Care Practices and Challenges in Nigeria

Survey comparing clinicians' wound healing knowledge and practice

A cross-sectional design in the form of a self-administered postal questionnaire was sent to 238 staff of a general hospital to compare wound healing knowledge and practice. Seventy-four questionnaires were returned (response rate = 31.09%). No significant statistical differences were identified between the groups. Wound care practices demonstrated a lack of evidence-based care along with the continued use of outdated and hazardous practices. Knowledge was primarily sourced from colleagues and personal experience, with journals and courses favoured by the specialized clinicians. The clinicians rated pre-graduate training as inadequate. Medical staff dominated decision-making in specialized groups, while the responsibility was shared between the nurse and the tissue viability nurse in non-specialized areas. The clinicians identified clinical effectiveness and availability as influencing their dressing choices.

What does it take to replace an old functioning information system with a new one?: A case study

Purpose To investigate the case of a municipal wound care practice and the process of designing a specific computer documentation record system. In carrying out our kind of action research, creation of the system that integrate digital photos, was supposed to remake the old wound care documentation system and transform it into a more advanced and unified tool. Methods Ethnographic studies were conducted before and parallel to the design work. Nurse practitioners were involved in design and actively determining essentials of the computer artefact. Developmental Work Research (DWR) is the framework against which data from the work practice and system development where analyzed and interpreted. Results First, an old-fashioned information system (IS) within health care work will not successfully be replaced by a new one, unless the new is better “as a whole”, that is, better supports work practices of a range of occupational and professional workers. Second, when designing information system for the public sector, system designers will almost always face dilemmas based on a contradiction between central, high level interest and a local level work-practice perspective. Discussion Our study reveals that the work practice of the municipal nurses is characterized by three distinctive features: High mobility, the need for face-to-face interaction in different locations, and a great variety of artefact usage. This implies that a new information system has to be “better as a whole” dealing with those characteristics.

Surgical Site Infection (SSI) Rates Among Patients Who Underwent Mastectomy After the Introduction of SSI Prevention Policies

To describe the results of an intervention program to reduce the rate of surgical site infection (SSI) in the breast tumor department of a referral teaching hospital for patients with cancer. Preventive measures introduced in the Breast Tumor Department of the study hospital included the following: starting in July 2000, use of sterile technique for wound care; starting in 2001, use of closed antireflux silicone evacuation systems, use of perioperative antimicrobial prophylaxis, provision of feedback to surgeons, and remodeling of the ambulatory wound care clinic. We conducted surveillance of all patients who underwent mastectomy between February 1 and December 31, 2001, and the SSI rate was calculated. A case-control analysis was performed for risk factors known to be associated with SSI. Results were compared with the data from 2000. The study included data on 385 surgeries. SSIs were registered in 52 (13.7%) of these 385, which was a rate 58.6% less than the 2000 infection rate (33.1%). Risk factors associated with SSI included concomitant chemotherapy and radiation therapy (OR, 3.6 [95% confidence interval {CI}, 1.9-7.1]), surgery performed during an evening shift (OR, 1.9 [95% CI, 1.1-3.6]), and insertion of a second drainage tube during the late postoperative period (OR, 2.8 [95% CI, 1.4-5.7]). The mean number (+/- SD) of postoperative visits to the outpatient wound care clinic was reduced from 11.6+/-7.1 in 2000 to 9.2+/-4.4 in 2001 (P<.001, Student's t test). The mean number of days that the evacuation systems were used was reduced from 19.0 to 16.0 days (P=.001, Student's t test). Continuous wound surveillance, along with feedback to surgeons, use of closed antireflux evacuation systems, and standardized practices in wound and drainage-tube care, decreased by 58.6% the rate of SSI in a breast surgical department with high rates of infection.

Surgical Site Infection (SSI) Rates Among Patients Who Underwent Mastectomy After the Introduction of SSI Prevention Policies

Objective.To describe the results of an intervention program to reduce the rate of surgical site infection (SSI) in the breast tumor department of a referral teaching hospital for patients with cancer.Methods.Preventive measures introduced in the Breast Tumor Department of the study hospital included the following: starting in July 2000, use of sterile technique for wound care; starting in 2001, use of closed antireflux silicone evacuation systems, use of perioperative antimicrobial prophylaxis, provision of feedback to surgeons, and remodeling of the ambulatory wound care clinic. We conducted surveillance of all patients who underwent mastectomy between February 1 and December 31, 2001, and the SSI rate was calculated. A case-control analysis was performed for risk factors known to be associated with SSI. Results were compared with the data from 2000.Results.The study included data on 385 surgeries. SSIs were registered in 52 (13.7%) of these 385, which was a rate 58.6% less than the 2000 infection rate (33.1%). Risk factors associated with SSI included concomitant chemotherapy and radiation therapy (OR, 3.6 [95% confidence interval {CI}, 1.9-7.1]), surgery performed during an evening shift (OR, 1.9 [95% CI, 1.1-3.6]), and insertion of a second drainage tube during the late postoperative period (OR, 2.8 [95% CI, 1.4-5.7]). The mean number (± SD) of postoperative visits to the outpatient wound care clinic was reduced from 11.6 ± 7.1 in 2000 to 9.2 ± 4.4 in 2001 (P&lt; .001, Student'sttest). The mean number of days that the evacuation systems were used was reduced from 19.0 to 16.0 days (P =.001, Student'sttest).Conclusions.Continuous wound surveillance, along with feedback to surgeons, use of closed antireflux evacuation systems, and standardized practices in wound and drainage-tube care, decreased by 58.6% the rate of SSI in a breast surgical department with high rates of infection.

Skin and Wound Assessment and Care in Oncology

To present an in-depth overview of skin and wound assessment and care that will provide a solid foundation to better understand the effects of treatment and cancer on skin and wound care in oncology patients. Current research and published literature. Adequate skin and wound assessment and care are essential to maintaining adequate quality of life and decreasing morbidity and mortality in oncology patients. Any systematic changes in skin and wound care practices for patients with cancer will be led by oncology nurses. Thus, a broad understanding of skin and wounds is essential.

Herpetic Infection in Epidermolysis Bullosa

Patients with various forms of epidermolysis bullosa have fragile skin which can act as a breeding ground for multiple microbial agents. Standard wound care practices advocate the use of special dressings on open erosions as well as antibiotic topical medications to treat and prevent cutaneous infections. We report a child with recessive dystrophic epidermolysis bullosa admitted to our institution because of fevers at home. She was treated with multiple antibiotics for a cutaneous infection of the right hand. During her hospital stay, she sustained persistent fevers, and oral erosions developed, with progressive hemorrhagic crusting. Viral culture of the lip grew herpes simplex virus type 1, consistent with a diagnosis of herpetic gingivostomatitis. We present this patient to illustrate the importance of investigating wounds of epidermolysis bullosa patients for viral agents when faced with managing a child with an unclear source of fever. To the best of our knowledge, although this is the first report of herpetic gingivostomatitis in association with epidermolysis bullosa, it is likely to be more prevalent than the literature could suggest.

Prediction and monitoring the therapeutic response of chronic dermal wounds

A significant proportion of chronic wounds fail to heal in response to treatment of underlying pathologies combined with good wound care practice. Current prognostic tests to identify these wounds rely on the use of algorithms based on clinically measurable parameters such as wound dimensions and wound duration. Venous leg ulcers may be stratified into healing/non healing at 24 weeks of compression therapy and diabetic foot ulcer treatment outcome assessed using a 3-parameter algorithm. Accurate and reproducible measurement of wound area is required for these algorithms to have clinical utility. Whilst a number of attempts have been made to develop computerised wound-assessment techniques, wound tracing by clinicians combined with planimetry remains the standard methodology. Once treatment has been initiated, it is important to continuously monitor the wound to assess efficacy of treatment. This can be achieved by measuring wound area change over the first weeks of treatment to identify whether re-assessment of treatment strategy is required. A number of algorithms for assessing rate of wound area change have been evaluated to determine a surrogate endpoint for healing. Retrospective analysis of large patient groups indicates that approximately 75% correct prediction of healing outcome can be achieved.

Using case reports to aid reflective practice in wound care

Reflection is a widely-used tool in education and practice for giving individuals insight into events and incidents. Case reports, though lacking in rigour as a source of evidence, also provide an opportunity to reflect on and examine practice. They therefore provide a useful opportunity of examining practice in wound care, which is lacking in many nursing curricula. A case report is given here to illustrate some of the lessons that can be learned by reflection--even by an experienced nurse.

Infection Control Practices in U.S. Burn Units

The purpose of this study was to determine infection control procedures most commonly used in burn units in the United States. We used two data collection formats: a brief quantitative survey and a brief qualitative interview. Our response rate was 75% (104/139). We found wide variability in general infection control practices as well as in wound care practices in intensive care units. The majority of units reported having written infection control guidelines specific to the burn unit. Respondents noted challenges that burn injury presents to infection control. A broad range of techniques for preventing device- and procedure-related infection also were provided by respondents. Compliance with hand washing on the part of physicians and ancillary staff remains a major challenge. To improve the quality of infection control and reduce variation in practice, we must continue to monitor the types of practices that are delivered, provide feedback to providers on how they care for their patients, where evidence exists disseminate best practices, and build the evidence base through efficacy trials.

The physiological basics of wound healing

Nurses regularly take the lead in wound management. They should have a good general knowledge of the normal structure and function of skin. This article outlines the process of wound healing to enhance wound care practice. Normal anatomy of the skin is described followed by a review of the four phases of wound healing.

The physiological basics of wound healing

Nurses regularly take the lead in wound management. They should have a good general knowledge of the normal structure and function of skin. This article outlines the process of wound healing to enhance wound care practice. Normal anatomy of the skin is described followed by a review of the four phases of wound healing.

A Survey of Nursesʼ Wound Care Knowledge

To provide information about nurses' knowledge and practices in the prevention and care of wounds, based on responses to a 2004 survey in Advances in Skin & Wound Care and its sister publication, Nursing2004. This continuing education activity is intended for physicians and nurses with an interest in understanding best practices for preventing and treating wounds. After reading the preceding article and taking this test, the participant should be able to: 1. Discuss the Advances in Skin & Wound Care and Nursing2004 wound care survey results. 2. Relate the survey responses to best practice standards for for preventing and treating wounds. 3. Identify implications for improvements in wound care education and practice based on survey results.