Wound Care Services Research Articles

Standardized Wound Care: Patchwork Practices?

Standardized care is crucial in health care for ensuring consistent, safe, high-quality, efficient, and evidence-based practices. Care pathways that standardize procedures promote adherence to best practices, reduce variability in treatment, and encourage collaboration among health care teams. This approach ultimately improves patient outcomes, enhances safety, and boosts the overall effectiveness of health care services. However, despite these benefits being widespread across most of the U.S. health care system, wound care stands out as an area where standards can vary significantly. The inconsistency in wound care standards in the United States can be traced to several factors. These include limited structured clinical wound care education, the discretion of health care providers in different business environments, differences in wound care settings, varying access to advanced treatments and technology, patient demographics and socioeconomic status, as well as differences in state laws and regional or institutional practices. Addressing these disparities requires a comprehensive approach that considers the complex interplay of the abovementioned factors. Active measures are needed to improve access, equity, and the quality of wound care services for all patients, regardless of where they live, their socioeconomic status, their health care coverage, or the business interests of providers and their institutions as well as of vendors marketing wound care products inconsistent with evidence-based practice. By understanding and actively addressing these factors, we can work toward achieving more standardized, evidence-based, and patient-centered practices in wound care across the nation.

Advanced Practice Providers in Burn Care, 2013-2022.

This study evaluated the prevalence characteristics of advanced practice providers, including nurse practitioners and physician assistants, who provide care related to burns in the United States from 2013 to 2022 using national claims data. Our analysis was a retrospective, large cohort study evaluating debridement, wound care, and office-based services provided by advanced practice providers from 2013 to 2022 using the Medicare Provider Utilization and Payment Data Public Use Files from the CMS. The reported provider type and billing codes were used to identify healthcare professionals providing burn care. Trends over the study period and available data about care provided were analyzed. From 2013 to 2022, burn care providers included 6,918 (43.3%) surgeons, 4,264 (26.7%) other physicians, and 4,783 (30.0%) advanced practice providers. Overall, the number of advanced practice providers who billed for burn care increased by 250.4% from 714 in 2013 to 2,502 in 2022. Compared with physicians, advanced practice providers were more likely to be female and provide care in micropolitan areas with less than 50,000 people. Based on these trends, we project that the number of APPs providing services related to burns will increase by 56.7% from 2,502 in 2022 to 3,921 (95% CI, 3,541-4,303; R2=0.97) in 2030. With a growing need for burn care and predicted shortages in the surgeon workforce, the scope of practice and integration of advanced practice providers merits further discussion and evaluation.

An expanded focus in advanced wound care for geriatric emergency management nursing: a case study analysis.

Geriatric emergency management (GEM) nursing has emerged as a critical response to the increasing number of emergency department (ED) visits by older people, particularly in North America and specifically in Canada. This demographic often presents with complex medical conditions and atypical disease manifestations. The GEM programme, implemented in Ontario, Canada, aims to provide targeted assessment and establish community connections for frail older individuals, helping prevent their decline and loss of independence. There is a significant demand for specialised wound care services in EDs and frontline ED staff have a limited capacity to provide these. Advanced wound management was integrated into the GEM nursing scope of practice in an initiative. Patients who received wound care from GEM nurses and clinical nurse specialists had positive outcomes; those treated by GEM nurses had shorter wait times. Although the wound care role requires additional training and adds to the GEM nurse workload, the advantages appear substantial. Merging geriatric-focused care with specialist wound management may significantly benefit the care and satisfaction of older people attending the ED, as well as improve patient flow in the ED. This initiative requires further consideration by healthcare leaders and policymakers.

Wound Care Capacity of the Addiction Workforce in the Setting of Xylazine.

As xylazine increasingly adulterates the unregulated opioid supply, people who use drugs (PWUD) are more likely to experience sequalae from xylazine. Given xylazine exposure is consistently associated with development of wounds which can heal with medically directed wound care, we sought to understand the level of preparedness and ability of front-line addiction professionals who interact with PWUD to provide wound care treatment. We administered a 26-item online survey assessing participant and organizational characteristics, level of wound care training, ability to test for xylazine and treat xylazine-associated wounds, and funding and billing characteristics to a national sample of addiction professionals using a listserv of over 11,000 individuals. We had a response rate of 12.8% in which 1,280 met eligibility criteria and completed the survey, with the majority (23.7%) being nurses. While nearly all participants had cared for patients who had experienced any xylazine-associated harms, less than half (43.6%) had cared for patients with xylazine wounds and 43.4% had any training or certification in wound care, including 26.9% of physicians. Although 75.9% of participants had access to wound care supplies, just 19.5% provided wound care services onsite. Most addiction professionals, especially physicians, lack wound care training and do not provide onsite treatment for drug-associated wounds at the organizational level. There is a critical need to bridge this gap in knowledge and build capacity to provide evidence-based wound care services to PWUD in areas impacted by xylazine adulteration.

Patients with venous leg ulcers can be managed safely in the community ----results of an observational comparison study in Singapore

AimTo examine the healing outcomes of patients with venous leg ulcers requiring compression bandaging in community care versus tertiary care. MethodThis was an analytical observational cohort study. Venous leg ulcer (VLU) patients who required compression bandaging were recruited from an outpatient vascular clinic between May 2021 and August 2022. Eligible patients received two—or four-layer compression bandaging and followed up with the community care or tertiary care centre nurses. The primary outcome was the difference in the total surface area of the VLU after 12 weeks, and the secondary outcome was the patient's quality of life, as measured by the Cardiff Wound Impact Schedule (CWIS). ResultsForty-seven VLU patients were recruited; 27 received compression bandaging in the community care and 20 by the tertiary care centre. Mean age 70 years old (SD 11.04). The two most prevalent comorbidities were hypertension (51.06 %) and diabetes mellitus (38.29 %). Among those who completed follow-up (12 weeks), the median difference of the total surface area of the VLU between community-based care (p = 0.02) versus tertiary-based care (0.003) was significant. However, there was no difference in the healing status between community and tertiary-based care (p = 0.68). There was no difference in the quality of life of patients between groups. ConclusionThis first tropical study comparing VLU healing outcomes between community and tertiary care found no significant difference in healing with compression bandaging by nurses in either setting. However, the small sample size and high dropout rate limit the generalizability of the findings, necessitating a larger-scale study with longer follow-up. Despite these limitations, the study is a crucial step toward improving wound care services in Singapore, and highlights the need for further research to guide future community wound care implementation.

Evaluating Patient Satisfaction With Nurse-Led Wound Care Services

Background: The increasing incidence of chronic wounds, combined with the high number of patients requiring hospital services, has led to the concept of nurse-led wound care clinics to support general practitioners in the treatment and management of wounds. Aim: This study aims to assess patients’ perception of, and satisfaction with, wound care services in a tertiary healthcare setting in Riyadh, Saudi Arabia. Methods: The study utilised a cross-sectional descriptive design and was conducted between September 2022 and October 2023, and data were collected via a client satisfaction questionnaire (CSQ-8). Results: Our findings revealed very positive responses overall. Considered together (response options 4 and 3), a majority of respondents (91.3%) rated the quality of service they received as “excellent” or “good”, and 85.6% reported receiving the kind of service they wanted. Regarding overall satisfaction, 92.5% of respondents reported being “very satisfied” or “mostly satisfied” with the overall service they received. Conclusion: This study reveals positive patient satisfaction with overall wound care services. However, there remains weakness in certain areas. This could be understood in more detail by conducting a qualitative study, so that action maybe taken to further improve the quality of healthcare services provided to patients.

Community Nurses In Canada: A Focus On Skin And The Prevention And Management Of Wounds

In Canada, community nurses play a key role in supporting preventative initiatives and the promoting and preserving of health of individuals, families, and communities. Specifically, home health nurses focus on the care of persons and their care partners living with long-term conditions. For First Nation nurses living and working in Alberta communities, serving the people means ensuring the people’s voices are heard. This article shares the journey of two community nurses, Holly Calliou and Susan McGillis, to illustrate the complexity of their roles and responsibilities in relation to skin and wound care services.

Steer Clear: Inadvertent Use Of Antimicrobials Can Cause Unintentional Harm To Wound Healing

This article aims to raise awareness regarding the inadvertent misuse and/or overuse of antimicrobial agents in wound management and provide the correct indications, concentrations, and application techniques for commonly used antimicrobials to enhance wound care outcomes. A literature review revealed that misuse of topical antimicrobials can compromise wound healing and lead to adverse effects. Each antimicrobial presents unique benefits and challenges, necessitating careful consideration of indications, concentrations, and duration of use to optimize therapeutic outcomes. To mitigate the misuse of antimicrobials, wound care professionals must continually assess the wound and make changes to treatment based on the assessment finding. Moreover, by advocating for policy changes and access to specialized wound care services, health-care providers can further enhance patient care and reduce the risk of complications associated with improper

CSP2023: 409 - The role of physiotherapy within the community based Sheffield Lymphoedema and Ambulatory Wound Care Service: a service improvement project

CSP2023: 409 - The role of physiotherapy within the community based Sheffield Lymphoedema and Ambulatory Wound Care Service: a service improvement project

Application Of Modern Wound Care Using Moist Wound Healing Techniques In Diabetes Mellitus Patients

Diabetes Mellitus often becomes a serious health problem in various developing and developed countries in the world. Most people with diabetes mellitus are at risk of developing diabetic ulcers. If not treated quickly it can develop into an infection. The newest wound healing methods currently have an important role in treating diabetic ulcers, one of which is Modern Dressing with Moist Wound Healing. The aim of this research is to identify the effectiveness of modern wound care using moist wound healing dressing techniques in healing diabetic ulcers at the Sering Road. The research design used in this study used a quasi-experimental design with a cross- sectional method approach. The sampling used was accidental sampling, namely 30 respondents. Based on the results of the Paired T-Test and Independent T-Test, the p- value was obtained (0.000 < ? 0.05), in the control group, p value ? = 0.080 (p > 0.05). Thus, it can be said that there is no effectiveness of modern wound care using moist wound healing dressing techniques in healing diabetic ulcers at the Sering Road. It is hoped that Sering Road can improve the quality and quality of modern wound care services using moist wound healing dressing techniques for diabetic ulcer sufferers.

Key performance indicators to inform evaluation of wound care programmes for people with complex wounds: a protocol for systematic review.

The objective of the systematic review is to examine and summarise the available evidence in the literature of the use of key performance indicators (KPIs) to inform evaluation of wound care programmes and services for people with hard-to-heal (complex) wounds. The need for wound care is expected to grow with the continued ageing of the population and the resulting increased development of chronic conditions. This expected increase necessitates improvement of wound care programmes and services and their ability to deliver quality, evidence-based and cost-effective practice. The current literature lacks a systematic assessment of KPIs to inform evaluation of wound care services and programmes across various settings, and how the KPIs are used to improve the quality of wound care and achieve desired outcomes. This protocol sets out how the systemtic review will be undertaken. Primary studies will be screened from databases such as MEDLINE, CINAHL and Scopus, with unpublished studies and grey literature retrieved from Google Scholar and ProQuest Dissertations and Theses. The study titles and abstracts will be screened by two independent reviewers, using Covidence systematic review software to ensure they meet the inclusion criteria, who will then proceed with data extraction of the full-text using the standardised data extraction instrument. The reference lists of all studies selected for critical appraisal will be screened for additional publications. The two independent reviewers will critically appraise all studies undergoing full-text data extraction using the appropriate checklist from JBI SUMARI. At all stages, differences between reviewers will be resolved through discussion, with adjudication by a third, independent reviewer. Data points will be analysed with descriptive statistics and grouped, based on programme characteristics and publication status. Grey literature and peer-reviewed publications will form separate analyses. To answer review questions, the data will be summarised in a narrative format. A meta-analysis is not planned. At the time of writing, this protocol has been implemented up to the preliminary literature search. This review will address a current literature gap and systematically identify KPIs in wound care, allowing for programmes to evaluate their quality of care and improve their services in a methodical manner.

Early intervention and care for Diabetic Foot Ulcers in Low and Middle Income Countries: Addressing challenges and exploring future strategies: A narrative review.

Diabetic Foot Ulcers (DFUs) are a significant health concern, particularly in Low- and Middle-Income Countries (LMICs). This review explores key strategies for managing DFUs in LMICs, including integrating podiatry, endocrinology, and wound care services, educating patients, promoting self-care, and preventive measures to reduce amputation rates. A comprehensive literature review was conducted, focusing on studies conducted in Low and Middle Income Countries to facilitate a qualitative analysis. The review examined the aetiology and risk factors to developing DFUs, clinical presentation, multidisciplinary management and evidence based interventions, challenges to the provision of care and future directions, all pertaining to DFUs in low and middle income countries. The aetiology and risk factors contributing to the development of DFUs are complex and multifaceted. Factors such as limited access to health care, inadequate diabetes management, and socioeconomic disparities significantly influence the incidence of DFUs. Clinical presentation varies, with patients often presenting at advanced stages of the disease due to delayed or missed diagnoses. Multidisciplinary management, incorporating podiatry, endocrinology, and wound care services, has exhibited substantial promise in enhancing patient outcomes. Evidence-based interventions, including offloading techniques, wound debridement, and the use of advanced wound dressings, have proven effective in promoting ulcer healing. The burden of DFUs in LMICs requires comprehensive strategies. Integrating podiatry, endocrinology, and wound care services, along with patient education and self-care practices, is essential for reducing amputations and improving patients' quality of life. Regular follow-up and early detection are vital for effective DFU management, emphasizing the need for ongoing research and investment in LMIC health care infrastructure. Embracing these multidisciplinary, patient-centered approaches can effectively address the challenge of DFUs in LMICs, leading to better patient outcomes and improved quality of life.

EFFECTIVENESS OF MODERN WOUND TREATMENT USING WANDING TECHNIQUES MOIST WOUND HEALING IN HEALING DIABETIC ULCERS IN CLINIC RUMAT JAKARTA

Diabetes Mellitus often becomes a serious health problem in various developing and developed countries in the world. Most people with diabetes mellitus are at risk of developing diabetic ulcers. If not treated quickly it can develop into an infection. The newest wound healing methods currently have an important role in treating diabetic ulcers, one of which is Modern Dressing with Moist Wound Healing. The aim of this research is to identify the effectiveness of modern wound care using moist wound healing dressing techniques in healing diabetic ulcers at the Rumat clinic in Jakarta. The research design used in this study used a quasi-experimental design with a cross-sectional method approach. The population in this study were all patients who underwent wound care at the Rumat Jakarta clinic. The sampling used was accidental sampling, which took cases or respondents who happened to be present or available in a place according to the research context, namely 30 respondents. Based on the results of the Paired T-Test and Independent T-Test, the p-value was obtained (0.000 < α 0.05), this proves that there is the effectiveness of modern wound care using the Moist Wound Healing dressing technique in healing diabetic ulcers in home clinics in Jakarta. Meanwhile, in the control group, after carrying out bivariate analysis using statistical tests, a significance value of p value α = 0.080 (p > 0.05) was obtained. Thus, it can be said that there is no effectiveness of modern wound care using moist wound healing dressing techniques in healing diabetic ulcers at the Rumat Clinic in Jakarta. It is hoped that the Jakarta Rumat Clinic can improve the quality and quality of modern wound care services using moist wound healing dressing techniques for diabetic ulcer sufferers.

Wound healing potential of silver nanoparticles embedded in optimized bio-inspired hybridized chitosan soft and dry hydrogel

Interactive wound dressings combining healing and antimicrobial potentials, besides ensuring patient compliance with a recognized wound care service gained considerable interest recently. Both hydrogel spray dried microparticles (HMP) and soft hydrogel (G) were prepared. The bio-inspired combinatory platform included natural bio-macromolecules namely: chitosan (CS) and collagen (COL) with wound healing enhancement and connective tissue building capabilities cross linked with the natural genipin (GN) to build a three dimensional structured matrix. The optimized plain hydrogel obtained by a box behnken design (BBD) program (G) scored maximum swelling and porosity. The network was hosted with green synthesized cefotaxime sodium (cef.Na) AgNPs reduced by the anabolic folic acid (FA). Both hydrogels exhibited good antimicrobial activity against gram +ve and –ve bacteria. The wound healing activity, evaluated in injured rats, showed >98 % and complete wound closure after two and three weeks respectively. Oxidative stress minimization was proved by the estimation of biochemical markers malondialdehyde (MDA) and superoxide dismutase (SOD) levels at the wound site.

Community-Based Wound Care Programs for Unhoused Individuals.

Wound care management for unhoused individuals is challenging due to the lack of healthcare infrastructure to handle the unique needs of this population. Therefore, we aimed to obtain insights for best practices and to establish a care clinic that is low threshold, community-based and meets the needs of unhoused people. We employed two approaches: (1) conduct a targeted narrative review of the literature of existing or proposed community-based program models that can address the wound care needs of unhoused individuals, and (2) assess cost-effectiveness and describe the results of a survey administered to unhoused clients and their health care providers at a community-based wound care program in Honolulu, Hawai'i. The literature search and screening yielded 11 articles relevant to the topic. Per the literature, existing community-based healthcare programs were successful when: (1) wound care services were incorporated into a broader social/health program, (2) cost-effective, and (3) comprehensive services were provided. Survey results in Honolulu found that the wound care program matched the needs of the targeted population and was cost-effective. Difficulty in following clients until wound closure and the sustainability of the program, particularly the lack of insurance reimbursement for street-based services, were perceived challenges. Additionally, the lack of insurance reimbursement for street-based wound care services continues to impact sustainability. Community-based programs can be successful in addressing the wound care needs of unhoused individuals if they address complex fundamental issues. This paper highlights existing gaps in logistics and policies that must be addressed to meet the specific medical needs of these vulnerable individuals.

The Influence of Marketing 5.0 and Creating Share Value on Wound Care Quality and Purchased Intention among Wound Care Professional

This literature review examines the Influence of Marketing 5.0 and Creating Share Value on Wound Care Quality and Purchase Intention among Wound Care Professionals. As contemporary marketing practices evolve, the emergence of Marketing 5.0 signifies a shift towards holistic and customer-centric strategies, emphasising the significance of meaningful interactions and value co-creation. Simultaneously, Creating Share Value underscores the role of businesses in addressing societal challenges alongside profit generation. This literature review reveals that Marketing 5.0 strategies promise to enhance the quality of wound care services through personalised communication, enhanced patient engagement, and technology-enabled solutions. Creating Share Value initiatives establishes a sense of purpose and collaboration among wound care professionals, ultimately contributing to improved patient care and organisational success. The literature review of these marketing strategies contributes to understanding contemporary marketing concepts in the healthcare context, particularly wound care.

Lessons from Making Wound Care Work: how to build a better future for people living with a chronic wound

British Journal of Community NursingVol. 28, No. Sup6 Clinical CommentLessons from Making Wound Care Work: how to build a better future for people living with a chronic woundSarah Gardner, Elisabeth Neal, Ali Hedley, Izzy Duddy, Keith SmallSarah GardnerE-mail Address: [email protected]Independent Tissue Viability consultant and Chair, Legs MatterSearch for more papers by this author, Elisabeth NealHead of Communications UK, MölnlyckeSearch for more papers by this author, Ali HedleyMedical and Professional Affairs Manager UK, MölnlyckeSearch for more papers by this author, Izzy DuddyConsultant, LexingtonSearch for more papers by this author, Keith SmallAssociate Director, LexingtonSearch for more papers by this authorSarah Gardner; Elisabeth Neal; Ali Hedley; Izzy Duddy; Keith SmallPublished Online:1 Jun 2023https://doi.org/10.12968/bjcn.2023.28.Sup6.S22AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Adderley U. The National Wound Care Strategy Programme. Wound Care Today. 2023. https://www.woundcare-today.com/journals/issue/wound-care-today/article/national-wound-care-strategy-programme (accessed 23 May 2023) Google ScholarBlackburn J, Ousey K, Stephenson J. Nurses' Education, Confidence, and Competence in Appropriate Dressing Choice. Adv Skin Wound Care. 2019;32(10):470-476. https://doi.org/10.1097/01.asw.0000577132.81124.88 Crossref, Medline, Google ScholarCensuwide. Survey on behalf of Molnlycke Wound Care. Q13. On file. 2021 Google ScholarGuest JF, Fuller GW, Vowden P. Cohort study evaluating the burden of wounds to the UK's National Health Service in 2017/2018: update from 2012/2013. BMJ Open. 2020;10(12):e045253. https://doi.org/10.1136/bmjopen-2020-045253 Crossref, Medline, Google ScholarMölnlycke. Making wound care work. 2022. https://www.molnlycke.co.uk/campaigns/making-wound-care-work/ (accessed 20 May 2023) Google ScholarNational Wound Care Strategy Programme. Case study: improving wound care knowledge and skills in the workforce: mandating online wound care education. 2023. https://www.nationalwoundcarestrategy.net/wp-content/uploads/2023/04/MSE-mandating-education-case-study-summary-Final.pdf (accessed 23 May 2023) Google ScholarNursing Times. Wound care services and the coronavirus pandemic: strategies for nursing directors. Nursing Times (supplement). 2021; 117:3 Google ScholarOpinion Matters Survey. Survey on behalf of Mölnlycke Health Care Limited. Data on file. 2020a Google ScholarOpinion Matters. Molnlycke Health Care Limited—Wound Care Patient Research. On file. 2020b Google ScholarPA Consulting. Interim evaluation of the NWCSP first tranche implementation sites and the NWCSP for lower limb wounds: evaluation report—highlights. 2022. https://www.nationalwoundcarestrategy.net/improving-wound-care/ (accessed 23 May 2023) Google ScholarSchofield A. What have tissue viability services learnt from the coronavirus pandemic? Nursing Times [online]; 2021; 117(3): 23–25 Google ScholarThe Patients Association. Chronic wound care survey—report on findings. On file. 2021a Google ScholarThe Patients Association. Findings-patient advisory panel event 2. On file. 2021b Google Scholar FiguresReferencesRelatedDetails 1 June 2023Volume 28Issue Sup6ISSN (print): 1462-4753ISSN (online): 2052-2215 Metrics History Accepted 1 May 2023 Published online 1 June 2023 Published in print 1 June 2023 Information© MA Healthcare LimitedPDF download

558 Wound Care Program Development to Advance Physical Therapy Practice in a Specialized Burn Unit

Abstract Introduction There is a nation-wide shortage of nurses which is true at our institution as well. As a result, there is a lack of consistent, qualified staff to perform wound care in our burn center. Wound care is within a physical therapist’s (PT) scope of practice and we felt this was an area for opportunity and expansion for PT practice at our institution as we had not previously been involved in wound care services for any patient population. Methods We posted on the ABA PT/OT SIG page asking other burn centers about PT involvement in daily wound care. Respondents then participated in an online question/answer session. Based on this information, additional education resources, and our own institution’s practice model for nursing, we developed a PT checklist for demonstrating competency with theory and practice for burn wound care. The 2 primary burn PTs completed a 4 week training under the direction of the nurse clinical coordinators and advanced practice providers (APPs) and were deemed competent. The attending MDs have signed off on our process. We have now developed a training program to ensure more PTs are competent with wound care for the burn patient. Results Of 186 members of the OT/PT SIG who had access to the original post, we received only 8 responses. Five of eight had PTs partially involved in wound care in the inpatient setting with burn patients. PTs are the primary wound care providers in 2 of 8 responding burn centers. In the remainder, PTs were primarily involved in wound care only in the outpatient setting. Four centers participated in the online video question and answer sessions. Despite all of them following ABA guidelines, there was no standardization of developing a wound care program. Our program includes 1:1 orientation to the burn unit for 3-4 weeks, direct supervision of wound care and dressing changes by the primary burn PTs, completion of knowledge-based quiz, and demonstration of skills checklist. Conclusions It was feasible to create a new wound care program including PTs in a burn center. We found variation in practice due to regional preferences, physician preferences, availability of different dressings, and staff training. We feel confident in our competency process as it includes both a written knowledge assessment as well as requiring demonstration of techniques. Developing this program has increased the trust between the PTs, physicians, and APPs thereby allowing us to advance our PT practice. We can now perform high quality wound care and complete more aggressive functional mobility without fear of disrupting dressings. Based on actual visualization of the wounds, we can provide more thorough patient education and perform more specific range of motion stretching. Applicability of Research to Practice Utilizing PTs knowledge of all soft tissue healing may be of benefit. We encourage other PT departments to advocate to participate in wound care of the burn patient.

Rapid Analysis of Drugs: A Pilot Surveillance System To Detect Changes in the Illicit Drug Supply To Guide Timely Harm Reduction Responses - Eight Syringe Services Programs, Maryland, November 2021-August 2022.

A record number of 2,912 drug overdose deaths occurred in Maryland during the 12-month period July 1, 2020-June 30, 2021. Illicitly manufactured fentanyl, fentanyl analogs, or both* were involved in 84% of these deaths.† Timely identification of illicit drug market changes (e.g., fentanyl rapidly replacing heroin) could improve the public health response, specifically communications about risks for novel psychoactive substances. During November 19, 2021-August 31, 2022, the National Institute of Standards and Technology (NIST)§ tested 496 deidentified drug paraphernalia samples that staff members collected at eight Maryland syringe services programs (SSPs), also known as needle exchange programs,¶ in partnership with the Maryland Department of Health Center for Harm Reduction Services (CHRS).** All test results were available within 48 hours. Among the 496 paraphernalia samples collected, 367 (74.0%) tested positive for an opioid, and 364 (99.2%) of these samples contained fentanyl or fentanyl analogs. Approximately four fifths of fentanyl-positive samples also tested positive for the veterinary medicine xylazine, a sedative that when combined with opioids might increase the potential for fatal respiratory depression and soft tissue infections when injected (1). For 248 of the 496 samples, SSP participants also completed a questionnaire about the drugs they had intended to purchase. Among the 212 participants who had intended to buy an opioid, 87.7% were exposed to fentanyl, fentanyl analogs, or both, and 85.8% were unknowingly exposed to xylazine. Results improved awareness of fentanyl and xylazine among SSP staff members and galvanized efforts to enhance SSPs' wound care services for participants experiencing soft tissue injuries possibly associated with injecting xylazine. Rapid analysis of drug paraphernalia can provide timely data on changing illicit drug markets that can be used to mitigate the harms of drug use more effectively.

Using wound cartoon visual education to enhance nurses’ knowledge of wound care

Cartoon education methods have been used effectively as a teaching tool and were considered potentially useful to improve nurses’ knowledge and professional skills to ensure quality patient care. Therefore, this study aimed to enhance nurses’ knowledge of wound care using the cartoon visual education program. After the 4 weeks, nurses were given questionnaires about knowledge of wound care, self-efficacy, situation anxiety, and trait anxiety to understand the nurse’s situation before and after the teaching program analysis. Significant differences were observed in their education level, rank, marital status, and whether or not they had children, and received wound education. Linear regression results show significant differences in wound care knowledge and situational anxiety. The study indicates that cartoon visual education is enhancing nursing staff’s knowledge of wound care and mitigating situational anxiety and thus can improve the quality of wound care by nursing staff and is used to standardise wound care education, resulting in better wound care services.