Wound Care Protocol Research Articles

Postoperative wound care protocol prevents surgical site infection after craniotomy.

Postoperative wound care after craniotomy is not standardized. Evaluate the impact of a standardized post-craniotomy wound care protocol on surgical site infection (SSI). Prospective quasi-experimental single-center intervention cohort study involving adult patients undergoing craniotomy at a 461-bed academic medical center in Orange County, California from January 2019-March 2023 (intervention) compared to January 2017-December 2018 (baseline). A postoperative neurosurgical wound care protocol was developed involving chlorhexidine cloths to remove incisional clots and to clean the surgical incision and adjacent hair after craniotomy surgery. Protocol adherence was monitored by routine inpatient surveillance of wounds and photo-documentation for real-time feedback to surgeons and nursing staff. Impact of the intervention was assessed using multivariable regression models. There were 3560 craniotomy surgeries and 62 (1.7%) SSIs; 1251 surgeries and 30 (2.4%) SSIs during baseline, and 2309 surgeries and 32 (1.4%) SSIs during intervention. Process evaluation after implementation found significant decreases in incisional clots, erythema, drainage, and unclean hair. In multivariable analysis, the intervention was associated with fewer SSI (odds ratio (OR): 0.5 (0.3, 0.9), P = 0.02). A standardized post-craniotomy wound care protocol involving cleaning of the incision and adjacent hair, including removal of incisional clots with chlorhexidine cloths was effective in reducing the risk of SSI.

Efficacy of incisional negative pressure therapy in preventing post-sternotomy wound complications

BackgroundSternal wound infections represent a source of significant morbidity and mortality following median sternotomy. The use of incisional negative pressure wound therapy in prevention has yet to be elucidated. MethodsA retrospective study was conducted before and after a universal wound care protocol was implemented including the prophylactic use of negative pressure wound therapy (NPWT). The primary endpoint was sternal infections within 90 days of the index operation. ResultsIn the control period, there was a 3.0% rate of sternal infection within 90 days compared to 0.8% in the intervention period (p < 0.001). An odds ratio of 0.25 (95% confidence interval 0.11, 0.57; p < 0.001) in the intervention period as compared to the control period was demonstrated. ConclusionsThe use of a standardized wound care protocol including the universal application of NPWT for patients undergoing cardiac surgery with median sternotomy was an independent predictor of decreased rates of sternal infection.

A retrospective case series of the postoperative outcome for 30 dogs with inflammatory interdigital nodules, surgically treated with carbon dioxide laser and a nonantimicrobial wound-healing protocol.

Inflammatory interdigital nodules (IIN) affecting the paws of dogs is a multifactorial and painful condition. Surgery using carbon dioxide (CO 2 ) laser has been shown to be helpful in the management. To assess a postoperative treatment protocol without use of antibiotics following CO2 laser surgery for IIN treatment. Forty-seven paws, in 30 client-owned dogs, with IINs affecting the interdigital web between the 4th and 5th digits of the forepaws, surgically treated using CO2 laser, were included. Medical records were reviewed for demographic details, medication use and wound healing using a set wound care protocol. Time to resolution of the surgical wounds and the postoperative outcome were assessed. The mean healing time was 34 days. Resolution was seen in 42 of 47 paws with complications in five paws (11%), including development of new fistulae or nonhealing granulation tissue. Surgery was repeated in those five cases. Relapse occurred during the follow-up period of five-19 months in six paws (13%). This study shows that surgical treatment with CO2 laser for interdigital nodules is successful in most cases. The postoperative outcome using a wound-healing protocol avoiding use of antimicrobials can be used without compromising patient care whilst following antimicrobial stewardship guidelines.

Post-operative Wound Care Protocol Prevents Surgical Site Infection After Craniotomy

<h3>Background</h3> Surgical Site Infections (SSIs) following craniotomy may be affected by extensive head vasculature. Attentive post-operative wound care to keep hair away, cleanse skin, and remove incisional clots that provide nutrients for organisms may help prevent SSIs. <h3>Methods</h3> In 2018, 72% of craniotomy SSIs at an academic medical center were related to post-operative wound disruption, drainage, and compromised wound healing. These SSIs involved Gram-positive organisms, consistent with skin flora. In January 2019, a post-operative wound care protocol developed by neurosurgical nurse and wound care specialists, and the infection prevention program was initiated, involving 1) soft bands to keep the incision clear of hair, and 2) 2% chlorhexidine gluconate (CHG) cloths to clean the incision and the proximal 6-inches of any drains, remove incisional clots, and clean adjacent skin and hair within 2 inches of the incision. Twice-weekly photos were taken of post-operative craniotomy wounds with protocol lapses and real-time feedback was provided to the bedside nurse, wound care nurse, and surgeon from February 2019-February 2020. Due to the Coronavirus Disease 2019 pandemic (COVID-19), the program progressively lapsed until January 2021, when it was reinstated. SSI rates were compared during the periods with and without the intervention using a chi-square test. <h3>Results</h3> Baseline Craniotomy SSI rate prior to January 2019 was 3.8% (5/133, SIR=2.6) and 1.7% (16/952, SIR=1.1) during the first intervention period. During COVID-19 surge, SSIs increased to 3.6% (5/140, SIR=2.3) without the intervention, and were restored to a lower rate, 1.6% (2/128, SIR=0.9) after the intervention was reinstituted. SSI rates were lower in intervention (1.7% (18/1080)) versus non-intervention periods (3.7% (10/273)), p=0.04. <h3>Conclusions</h3> A post-operative inpatient craniotomy wound care protocol involving hair care, incisional CHG cleansing and clot removal, plus photo documentation and feedback for protocol adherence was associated with SSI reduction.

Hyperbaric Oxygen Attenuates Aortic Vasoconstriction after Simulated Microgravity in Rats

Background The hindlimb suspended (HLS) rat model has been used in land-based research to evaluate effects of simulated microgravity. Previous research demonstrated that 2-4 weeks of HLS reduced vasoconstrictive responses of aortic, mesenteric, and femoral arterial rings to phenylephrine (PHE) while acute exposure to hyperoxia amplified constrictive responses to PHE. The purpose of this study was to determine if hyperbaric oxygen treatment (HBO) during HLS would reverse the attenuation of the vasoconstrictive response. Methods Five-month-old male Sprague Dawley rats were randomly divided into aging controls (AC), AC-HBO, HLS, and HLS-HBO. Groups receiving HBO (AC-HBO; HLS-HBO) were placed in a cage that was fitted for the animal hyperbaric chamber to maintain HLS. HBO groups received 24 treatments, once a day, 6 d/week using a wound care protocol. The chamber was flushed with 100% oxygen, compressed over 10 min to 2.5 atmospheres absolute (ATA) (22.5 psig), a 90-minute treatment, then a 10 min decompression. After 28 d of HLS, animals were sacrificed under isoflurane anesthesia and thoracic aorta segments isolated. Relaxation of aortic rings was measured in response to acetylcholine (ACh) and sodium nitroprusside (SNP) after pre-constriction with PHE (3×10-7). Constriction of aortic rings was also determined in response to increasing concentrations of PHE. All drugs were administered cumulatively in vessel baths at 10-10-10-4 M. Data were analyzed using four-parameter (i.e., minimum, maximum, EC50, slope) nonlinear regression, and groups compared using 2×2 ANOVA with HBO and HLS as main effects. Results Responses to ACh and SNP were not affected by HLS or HBO. However, in response to PHE, there was a decrease in maximum vasoconstriction in HLS compared to controls (44.7±7.3% vs 82.4±6.0%, respectively, p≤0.05) and in HBO compared to controls (48.5±6.5% vs 78.6±6.8%, p≤0.05). Conclusion These results indicate that PHE-induced constriction of thoracic aorta is decreased after HLS. HBO did not reverse HLS-induced reductions in contractile responses; instead, HBO independently reduced PHE-stimulated constriction of aortic segments. This suggests that HBO may be useful in conditions where constriction is enhanced, such as diabetes.

Wound dressings improve quality of life for hidradenitis suppurativa patients

To the Editor: An important challenge that patients with hidradenitis suppurativa (HS) face daily is wound care. Dressings are often designed for flat surfaces, making it difficult to fix dressings over dynamic contours of intertriginous areas. Frequent dressing changes for exudative, odorous wounds significantly detract from the quality of life (QOL) for HS patients.1 However, no standard wound care protocol exists for addressing HS lesion variety.2 Therefore, we designed a prospective cohort pilot study to determine the impact on QOL of wound dressing type and access in HS patients.

Clinical Relevance of Closed-Incision Negative Pressure Therapy (ciNPT) for SSI-Risk Reduction in Vascular Surgery Through a Groin Incision

Vascular surgery, especially lower limb revascularization surgery, has one of the highest rates of surgical complications, predominantly surgical site infections (SSI). Resulting in a significant burden of additional costs due to longer hospital stays, re-admissions and re-interventions, mainly attributable to deep incisional SSIs. Closed incisional negative pressure therapy (ciNPT) is a relatively new strategy in the postoperative management surgical wounds, aiming to reduce surgical wound complications. When discussing the clinical relevance of ciNPT, it is crucial to take into account the outcome of therapy as well as the additional costs related to ciNPT. Since, the additional costs must be justified by an associated decrease in the morbidity and costs associated with groin wound complications, which are particularly attributable to deep incisional SSIs. The current literature evaluating the beneficial effect of ciNPT in groin incisional vascular surgery, predominantly focusses on the decrease in superficial SSIs. Whereas this study aims to address and discuss the clinical relevance of ciNPT over conventional wound dressings, by separately evaluating and comparing the incidence of superficial and deep SSIs and their related re-admissions and re-interventions. In this single center prospective cohort study performed in a non-academic hospital in The Netherlands, 59 consecutive patients (67 incisions) were included between January and October 2019. All underwent elective vascular surgery with groin (access) incisions for either lower limb revascularization surgery or abdominal aortic aneurysm surgery. The study group was treated with six days ciNPT (PREVENA Incision Management System; KCI/3M, San Antonio, TX, USA) and matched for equal comparison to a historical retrospectively analysed cohort of 54 consecutive patients (60 incisions), all of whom have undergone elective vascular surgery for equal indications with groin (access) incisions in our center between January and October 2018. The standard-care group was treated following standard surgical wound care protocol with conventional surgical self-adhesive plaster (10×15cm, Mepore, Mölnlycke Health Care AB, Gothenburg, Sweden). Study groups were comparable at baseline, except for Body Mass Index (BMI), which was significantly higher in the ciNPT-group (P =.021). No significant differences for formation of seroma, hematoma, as well as wound dehiscence and SSIs were found between both groups. Groin SSIs were seen in 12.1% of the patients in the ciNPT-group and in 13.0% in the Standard-care group (OR 0.80, CI ((0.26, 2.48)), deep SSI contributed for 4 out of 7 patients of total SSIs in the ciNPT-group and for 2 out of 7 patients in the standard of care group (P-value >0.05). Analysis for incidence of hospital re-admission and re-intervention in both study groups showed no significant difference. Subset analysis in both study groups for SSIs differentiated in superficial and deep SSIs showed that only deep SSIs resulted in re-interventions. Based on the findings in the population of our single center study, we conclude that routine use of ciNPT was not effective in reducing groin wound complications, and therefore could not replicate the promising findings from some previous studies. Furthermore, we did not find a reduction in the incidence of deep SSIs, which comprise the highest morbidity and costs. Considering our findings as well as the associated additional expenses related to ciNPT, it might be superfluous at this stage to use ciNPT as the new standard of post-operative groin incision care for all lower limb revascularization and abdominal aortic aneurysm surgeries. In our opinion further research is warranted for establishing a risk-factor based model for determination of the indication of ciNPT. To be able to achieve a more substantiated decision for utilizing ciNPT compared to standard surgical wound care in groin incisional vascular surgical interventions.

LINC-23. PRE-OPERATIVE AND POST-OPERATIVE INTERVENTIONS REDUCE RATES OF VENTRICULITIS IN PEDIATRIC BRAIN TUMOR PATIENTS: A PILOT STUDY

BACKGROUNDThe Philippine General Hospital, a public national referral center, sees 60–80 pediatric brain tumor cases per year. Historically, the rate of post-operative ventriculitis has been high, resulting in treatment delays and poor outcomes. Starting in July 2019, as a means to decrease infections, patients were provided standardized bathing and wound care kits and caregivers were trained to follow a bathing and wound care protocol.METHODSThis quality improvement study included patients younger than 18 years who underwent craniotomy at PGH were enrolled. The type of surgery, length of surgery, existence of post-operative CNS infection, length of stay and total cost of care was collected. The outcome of these interventions are analyzed 6 months after implementation.RESULTSThirty-two 32 patients were included, with mean age of 7 years (1–16). The surgeries performed were: tumor resection (n=20), ventriculo-peritoneal shunt insertion (VPS) (n=3), endoscopic third ventriculostomy (n=3), resection with tube ventriculostomy (n=3), Ommaya reservoir placement (n=2), and resection with shunt (n=1). Median surgery time was 4 hours (1–10). Three patients (9.4%) developed ventriculitis. No surgical site infections occurred. Compared to historical controls, a lower rate of infections was noted (9.4% vs. 15.5%, runchart analysis). Patients without post-operative infections had a shorter length of stay (median 14 vs 48 days, p<0.05) and a lower cost of care (median $1098 vs. $2425 USD, p<0.05).CONCLUSIONImplementation of simple hygiene interventions effectively lowered post-operative CNS infections and hospital costs in a public hospital setting. Incorporation of these into standard clinical practices is urgently needed.

Reduction of pin tract infections during external fixation using cadexomer iodine

PurposeKnee joint distraction (KJD) is a joint-preserving treatment for younger osteoarthritis patients. KJD has shown positive results in regular care, but the external fixation frame often caused pin tract skin infections. Therefore, the use of cadexomer iodine was included in the wound care protocol. The goal of this cross-sectional study was to evaluate whether use of this ointment reduced the number of patients with infections during KJD treatment.MethodsPatients treated with KJD in regular care were included if they gave consent for use of their data and completed treatment with the newest distraction device before 2020. All patients followed a wound care protocol, which since March 2019 included using cadexomer iodine ointment. The number of patients experiencing pin tract infections was compared between patients who did (March 2019–December 2019) and did not (November 2017–March 2019) use the ointment.ResultsSixty-seven patients were included; 34 patients used cadexomer iodine and 33 patients did not. Patient who did not use cadexomer iodine experienced twice as many infections (64% vs 32%;p = 0.010). There was a significant difference in the number of patients with serious infections, requiring more antibiotics than the standard 7-day oral antibiotics (30% without vs 6% with cadexomer iodine; p = 0.009).ConclusionsThe use of cadexomer iodine ointment during KJD results in a significant reduction of the number of patients experiencing pin tract infections during treatment. Use of this ointment should be considered standard protocol during KJD treatment and could be of value in general external fixator usage as well.

Effect Of Closed Wound Care Protocol On Nurses.Practices And Patients Wound Healing

Background: care of wounds is a dynamic, complex process and requires specific knowledge of the nursing team, comprising professionals who will develop this care both in prevention and in the specific treatment. This study aimed to assess nurses' practice regarding closed wound care in the surgical unit, and evaluate the effect of a wound care protocol on nurses' practice in, and assess patients' wound healing pre- and post-applying wound care protocol in at two hospital Mansoura University and emergency hospitals. The study sample includes two groups first group, consisted of 55 nurses from the two hospitals, and second group consist 207 patients with closed wound. The sample of nurses received a suggested protocol regarding wound care. Data collection was accomplished utilizing three tools; Astructured interview for the nurses, wound care observational checklist, andBraden scale, wound assessment tool. Data was collected from both nurses and patients three times; one time before implementing the wound care protocol, and a second time after its implementation and third one after 12 week's follow up. The result of this study revealed a statistically significant improvement in nurses' practice regarding wound care after implementing wound care protocol with (P-value = 0.014 and 0.000 respectively). Additionally, wound degeneration decreased in post-protocol implementation and during follow-up. The wound regeneration significantly improved with (P-value = 0.000) after implementing the wound care protocol. Conclusion: the study concluded presence of an improvement in nurses' practice after implementing the wound care protocol. Also, the wound healing improved significantly. Recommendations: nurses’ practice about surgical wound care and infection control in general needs to be updated, through in-service training protocol. The hospital should have policies regarding infection control measures, to be reviewed periodically.

EFFECT OF OPEN WOUND CARE PROTOCOL ON NURSES’ KNOWLEDGE AND PATIENTS WOUND HEALING

Background:Surgical wounds are of the most devastating injuries. They produce a dramatic change in the patient’s life. Nurses are the key persons in directing successful rehabilitation effort to assure patients attain functional capabilities, avoid further disabilities, and prevent complications. Aim:to assess nurses' knowledge regardingopen wound care in the surgical unit, evaluate the effect of a wound care protocol on nurses' knowledge in the surgical unit, and assess patients' wound healing pre- and post-applying wound care protocol in surgical units at Mansoura University and emergency hospitals. Subject and methods: A descriptive exploratory research study were carried out. Study sample:includes two groups first group, consisted of 55nurses from the two hospitals, second group consist 53 adult patients with openwounds, Data collection was accomplished utilizing three tools; Astructured interview for the nurses, wound care observational checklist,Bates-Jensen, Data was collected from both nurses and patients three times; one time before implementing the wound care protocol, and a second time after its implementationthiredthird time after 12 weeks follow up. The result of this study revealed a statistically significant improvement in nurses' knowledge after implementing wound care protocol (P-value = 0.014 and 0.000 respectively). Additionally, wound degeneration decreased in post-protocol implementation and during follow-up. The wound regeneration significantly improved (P-value = 0.000) after implementing the wound care protocol. Conclusion: the study concluded the presence of an improvement in nurses'knowledge after implementing the wound care protocol. Also, the wound healing improved significantly. Recommendations: nurses’ knowledge about surgical wound care and infection control in general needs to be updated, through in-service training programs. The hospital should have policies regarding infection control measures, to be reviewed periodically.

1241. Marked Improvement in Post-Operative Craniotomy Wound Care Using 2% Chlorhexidine (CHG) Cloths for Blood Clots Removal and Hair Cleaning in a Photo-Documentation Survey

BackgroundPost-operative wound care can be an important strategy to prevent surgical site infection (SSI) following craniotomy. Insufficient wound care, blood clots, and oily hair near the incision can increase SSI risk.MethodsWe conducted a pre-post prospective cohort evaluation of a quality improvement intervention to address inpatient post-operative craniotomy wounds at an academic hospital. A post-op wound care protocol was jointly developed by neurosurgical wound care nurses, clinicians, and infection preventionists. The protocol began on postoperative day 1, and included use of soft ties to keep adjacent hair away from the incision, use of 2% CHG cloths to clean skin and hair within 2 inches of the incision as well as the proximal 6 inches of any surgical drain, and use of 2% CHG cloths to remove blood clots. Selection of 2% CHG cloths for blood clot removal was made following comparison to several concentrations of peroxide. A twice-weekly photo-survey of all inpatients undergoing craniotomy was undertaken during the baseline period (October–December 2018) and intervention period (March–April 2019), with feedback to wound care nurses occurring during the intervention period only. The proportion of redness, extensive blood clots (>50% incision), and oily hair near the incision were compared between the baseline period and the intervention period using Fisher’s exact tests.ResultsA total of 156 photo assessments were performed in 71 patients (101 assessments in 45 patients in the baseline period, and 55 photo assessments in 26 patients in the intervention period). Demographics, body mass index, emergent status, and prior craniotomy were similar across the baseline and intervention periods. The intervention was associated with significant reductions in redness (27.7% vs. 11%, P = 0.015), blood clots (33.7% vs. 10.9%, P = 0.002), and oily hair near the incision (76.7% vs. 28.6%, P < 0.001) (Figure 1).ConclusionThe care of post-operative craniotomy wounds and adjacent hair was significantly improved through a standardized protocol to remove blood clots and ensure clean skin and hair adjacent to the incision during the post-operative inpatient stay. Photo documentation and feedback to wound care nurses helped ensure protocol adherence. Disclosures All authors: No reported disclosures.

Role of Negative Pressure Wound Therapy in the Prevention of Surgical Site Infection in Colorectal Surgery

BackgroundSurgical site infection (SSI) is one of the most frequent complications in colorectal surgery. It is diagnosed in 10%–20% of colorectal procedures. Negative Pressure Wound Therapy (NPWT) has shown efficacy in the treatment of chronic and traumatic wounds, wound dehiscence, flaps and grafts. The main objective of this study is to assess NPWT in the prevention of SSI in colorectal surgery. Hospital stay reduction and SSI risk factors are secondary objectives. MethodsWe present a prospective case–control study including 80 patients after a colorectal diagnosis and surgical procedure (elective and non-elective) in 2017. Forty patients were treated with prevention NPWT for one week. Forty patients were treated according to the standard postoperative surgical wound care protocol. ResultsNo significant differences were found in demographic variables, comorbidities, surgical approach, elective or non-elective surgery, mechanical bowel preparation and surgical procedure. Three patients has SSI in the NPWT group (8%) (95%CI 0–17.5). Ten patients presented SSI in the control group (25%) (95%CI 12.5–37.5) (P=.034); OR 0.7 (95%CI 0.006–0.964). Hospital stay in the NPWT group was 8 days versus 12 days in the non-NPWT group (P=.22). In the multivariate analysis, mechanical bowel preparation was found to be the only risk factor for SSI (P=.047; OR: 0.8, CI 0.45–0.93). ConclusionsNPWT is a useful SSI prevention treatment in colorectal surgery.

Papel de la terapia presión negativa en la prevención de infección del sitio quirúrgico en cirugía colorrectal

BackgroundSurgical site infection (SSI) is one of the most frequent complications in colorectal surgery. It is diagnosed in 10 - 20% of colorectal procedures. Negative Pressure Wound Therapy (NPWT) has shown efficacy in the treatment of chronic and traumatic wounds, wound dehiscence, flaps and grafts. The main objective of this study is to assess NPWT in the prevention of SSI in colorectal surgery. Hospital stay reduction and SSI risk factors are secondary objectives. MethodsWe present a prospective case-control study including 80 patients after a colorectal diagnosis and surgical procedure (elective and non-elective) in 2017. Forty patients were treated with prevention NPWT for one week. Forty patients were treated according to the standard postoperative surgical wound care protocol. ResultsNo significant differences were found in demographic variables, comorbidities, surgical approach, elective or non-elective surgery, mechanical bowel preparation and surgical procedure. Three patients has SSI in the NPWT group (8%) (95%CI 0 – 17.5). Ten patients presented SSI in the control group (25%) (95%CI 12.5 – 37.5) (p=0.034); OR 0.7 (95%CI 0.006-0.964). Hospital stay in the NPWT group was 8 days versus 12 days in the non-NPWT group (p=0.22). In the multivariate analysis, mechanical bowel preparation was found to be the only risk factor for SSI (p=0.047; OR: 0.8, CI 0.45-0.93). ConclusionsNPWT is a useful SSI prevention treatment in colorectal surgery.

Simplifying wound dressing selection for residential aged care

To demonstrate the effectiveness of a simplified wound dressing regimen and develop a decision tree tool for wound management, for use by nurses in a residential aged care setting. A three-phase process was used. Firstly, practice was audited, including a cost analysis of existing wound treatment. Secondly, staff were educated on wounds, wound care products and a simplified wound management protocol. In the final phase, the new wound care products and protocol used for skin tears and other wounds (as assessed by a nurse practitioner) were evaluated and ongoing education provided as required. A total of 93 residents from two residential aged care facilities participated in the study. Overall, 178 wounds were identified, of which 121 were considered eligible for treatment under the new protocol. The majority of residents were aged >85 years and the major wound type was skin tears 72.7% (n=88). The mean healing time for skin tears was significantly shorter than for other wounds (19.7±14.2 days versus 30.9±25.2 days, p=0.0359). Most wounds were suitable for the simplified dressing selection regimen. Data collected from a survey of nursing staff demonstrated that the simplified protocol products were easy to apply, conformed well, were easy to remove and stayed in place. In addition, patient satisfaction was positive and removal of dressings was generally pain free. In summary, data collected from this project showed that the dressings were effective, performed well and simplified wound dressing selection for nursing staff.

Evaluation of a new wound care protocol, Haiti, and recommendations for field implementation

Evaluation of a new wound care protocol, Haiti, and recommendations for field implementation

Improving mortality outcomes of Stevens Johnson syndrome/toxic epidermal necrolysis: A regional burns centre experience

IntroductionStevens Johnson Syndrome/toxic epidermal necrolysis (SJS/TEN) are rare, potentially fatal desquamative disorders characterised by large areas of partial thickness skin and mucosal loss. The degree of epidermal detachment that occurs has led to SJS/TEN being described as a burn-like condition. These patients benefit from judicious critical care, early debridement and meticulous wound care. This is best undertaken within a multidisciplinary setting led by clinicians experienced in the management of massive skin loss and its sequelae. In this study, we examined the clinical outcomes of SJS/TEN overlap & TEN patients managed by our regional burns service over a 12-year period. We present our treatment model for other burn centres treating SJS/TEN patients. MethodsA retrospective case review was performed for all patients with a clinical diagnosis of TEN or SJS/TEN overlap admitted to our paediatric and adult burns centre between June 2004 and December 2016. Patient demographics, percentage total body surface area (%TBSA), mucosal involvement, causation, severity of illness score (SCORTEN), length of stay and survival were appraised with appropriate statistical analysis performed using Graph Pad Prism 7.02 Software. ResultsDuring the study period, 42 patients (M26; F: 16) with TEN (n=32) and SJS/TEN overlap (n=10) were managed within our burns service. Mean %TBSA of cutaneous involvement was 57% (range 10–100%) and mean length of stay (LOS) was 27 days (range 1–144 days). We observed 4 deaths in our series compared to 16 predicted by SCORTEN giving a standardised mortality ratio (SMR) of 24%. ConclusionManagement in our burns service with an aggressive wound care protocol involving debridement of blistered epidermis and wound closure with synthetic and biological dressings seems to have produced benefits in mortality when compared to predicted outcomes.

Prevention of post-operative pediatric tracheotomy wounds: A multidisciplinary team approach

ObjectiveTracheotomy-related pressure wounds have been reported as high as 29%. All advanced stage (stage 3 or 4) wounds are reported by hospitals, and CMS will no longer reimburse healthcare costs to manage them. We present the results of an intensive, multidisciplinary wound prevention strategy starting in the operating room at the time of tracheotomy placement. MethodsProspective analysis of a tracheostomy wound care protocol at an academic, tertiary-care pediatric hospital from September 2012 to February 2016. Participants include all patients having undergone tracheostomy placement followed by protocoled daily dressing changes until the first tracheostomy tube change by team consisting a senior level otolaryngology resident or pediatric otolaryngology fellow, certified wound care specialist, respiratory therapist, and bedside nurse. ResultsPost-operative tracheostomy-related wound data from 3 years prior to clinical intervention was obtained and compared to the intervention cohort. From March 2010–August 2012, 161 tracheotomy procedures were performed with 36 (22.4%) subsequent pressure wounds; 31% of these were stage 3 or 4 wounds. After multidisciplinary protocol implementation, there have been 121 additional tracheotomy procedures with reduction to 12 (9.9%) total tracheotomy-related wounds (p = 0.0064) and none (0%) were stage 3 or 4 (p = 0.0014). All stage 1 and 2 wounds were identified early, underwent appropriate intervention, and avoided further progression. ConclusionsThis protocol was successful in the elimination of all tracheostomy-related advanced stage, hospital-acquired pressure injuries and led to prompt identification of early stage wounds post-operatively.

Exploring a New Frontier: Adapting and Applying NHSN SSI Definitions for Surveillance of LVAD Infections

Device infection is a common and severe post-surgical complication associated with left ventricular assist device (LVAD) implantation. The objective of this project was to adapt the National Healthcare Safety Network’s (NHSN) surgical site infection (SSI) definitions to allow tracking of LVAD infections including those related to the chest and drivelines. In 2012, the NHSN’s SSI definitions were adapted through collaborative efforts between infection prevention and the LVAD team. The definition of SSI at the chest site (superficial and deep) followed NHSN criteria. Additional criteria specific to driveline infections were incorporated into the NHSN SSI definitions. Superficial driveline infection was defined as presence of at least 2 symptoms (erythema, purulent drainage, pain/tenderness) OR physician diagnosis. Deep driveline infection was defined as radiographic evidence of fat stranding AND at least one symptom (purulent drainage, pain/tenderness) OR physician diagnosis. LVAD patients were surveilled for infection for one year after implantation. Chi-square for trend analysis was used to evaluate trends in infection rates over the study period. Between 2012 and September 2014 a total of 46 infections were identified out of 303 procedures (rate=15.2/100 procedures). Of the 46, 10 (22%) were chest infections and 36 (78%) were driveline infections. All chest infections were deep or organ space. Deep infections were more common than superficial at the driveline site accounting for 31 (86%) of the total infections. There was no temporal trend in infection rates (p=0.41). Infection trends are useful in identifying areas for improvement in postsurgical wound care protocol and patient education. Adapting and applying NHSN SSI definitions for surveillance of LVAD infections can be helpful in tracking and trending postsurgical infections in this population.

Organization of wound healing services: The impact on lowering the diabetes foot amputation rate in a ten-year review and the importance of early debridement

Diabetes foot ulceration (DFU) has a negative impact on the quality of life and leads to disabling morbidity, such as lower extremity amputation (LEA). This study aimed to evaluate the LEA trend before and after the establishment of the diabetes foot team, an on-time debridement, on-site screening, and multidisciplinary integration with standardizing care, in Chang Gung Memorial Hospital, Chia Yi, Taiwan, starting in 2010.The study retrospectively investigated the non-traumatic LEA rate in diabetes foot (identified by using ICD-9-Clinical Modification (CM) codes, 250.70–250.83) and whole patients with diabetes (ICD-9 250.XX) yearly from 2004 to 2013. Patients were enrolled from hospitalization, emergency room (ER), or outpatient departments, respectively.Despite the overall incidence of diabetes foot in patients with diabetes remaining constant, from 3.47% in 2004 to 3.58% in 2013, the incidence of hospitalized diabetes foot from diabetes reduced, from 2.83% in 2004 to 1.51% in 2013. Introduction of integrated wound care also led to a reduction of the average LEA rate in hospitalized patients, from 15.27% (2004–2009) to 6.08% (2010–2013) (P<0.001). A similar decline of the LEA rate was observed for patients from hospitalization, ER and outpatient departments together with an average LEA rate from 7.99% (2004–2009) down to 3.02% (2010–2013) (P<0.001). In trend analysis, the curve estimation revealed a quadratic trend in the relationship between LEA rate and time (R-square=0.869, P=0.001) for hospitalized patients as well as a linear (R-square=0.819, P<0.001) and quadratic (R-square=0.845, P=0.001) trend in the relationship between LEA rate and time for hospitalization, ER, and outpatient departments together. The LEA rate for DM patients declined from 372.72/100,000 in 2004 to 61.74/100,000 in 2013.With establishment of an organizing, standardized wound care protocol and integrated multidisciplinary team, we demonstrated a significant decline in the LEA rate both in diabetes foot patients and all patients with diabetes. These improvements can be attributed to introducing an efficient pathway with on-time debridement and early intervention of diabetes foot ulcers.