Journal of tissue viability最新文献

Background: Surgical wound dehiscence (SWD) has various definitions, which complicates accurate and uniform diagnosis. To address this, the World Union Wound Healing Societies (WUWHS) presented a consensus based definition and classification for SWD (2018).

Aim: This quasi-experimental pretest-posttest study investigates the inter-rater reliability among healthcare professionals (HCP) and wound care professionals (WCP) when assessing wound photos on the presence or absence of SWD before and after training on the WUWHS-definition.

Methods: Wound expert teams compiled a set of twenty photos (SWD⁺: nineteen, SWD^-: one), and a video training. Subsequently, 262 healthcare professionals received the pretest link to assess wound photos. After completion, participants received the posttest link, including a (video) training on the WUWHS-definition, and reassessment of fourteen photos (SWD⁺: thirteen, SWD^-: one).

Primary outcomes: 1) pretest-posttest inter-rater-reliability among participants in assessing photos in congruence with the WUWHS-definition 2) the impact of training on assessment scores.

Secondary outcome: familiarity with the WUWHS-definition.

Results: One hundred thirty-one participants (65 HCPs, 66 WCPs) completed both tests. The posttest inter-rater reliability among participants for correctly identifying SWD was increased from 67.6 % to 76.2 %, reaching statistical significance (p-value: 0.001; 95 % Confidence Interval [1.8-2.2]). Sub-analyses per photo showed improved SWD posttest scores in thirteen photos, while statistical significance was reached in seven photos. Thirty-three percent of participants knew the WUWHS-definition.

Conclusion: The inter-rater reliability among participants increases after training on the WUWHS-definition. The definition provides diagnostic criteria for accurate SWD diagnosis. Widespread use of the definition may improve uniformity in care for patients with SWD.

Debridement is an important component of wound management and can improve outcomes for patients. Debridement needs to be done by an appropriately trained health professional, but the scope of practice, credentials, training, competencies, and regulatory requirements regarding wound debridement can differ. Best Practice Recommendations were created to positively influence patient safety related to all methods of debridement, across the continuum of care, and to be implemented widely by nurses at all professional levels in Canada.

Aim: To further develop the Best Practice Recommendations for wound debridement, with an international perspective, by creating a consensus document to support the global adoption of evidence-based debridement practice for health professionals.

Methods: A consensus meeting utilising Delphi methods was conducted between the authors to review the consensus statements. Once 80 % agreement was achieved, a wide range of wound care experts were identified by the authors and invited to participate in an external review of the statements.

Results: Fifteen consensus statements about wound debridement were agreed upon and are presented in this paper.

Conclusions: These best practice recommendations have been reviewed by a wide range of practitioners from across the UK and Canada and aim to provide guidance on the standardisation of debridement practices for healthcare professionals.

Aim: Pressure-ulcer occurrence in the seated patient is understudied. Preventative devices have been developed and are prescribed commonly, but there is little quantitative evidence of their effectiveness. This study explores the concept of a lateral pressure device, a prevention device that applies pressure to the sides of the seated buttocks, to reduce the amount of tissue distortion and blood-vessel occlusion. It is hypothesized that this device will reduce deep tissue injury by reducing the pressure at the bone-muscle interface, as demonstrated computationally in previous research. This study aimed to use oximetry to investigate the efficacy of the device in maintaining transcutaneous gas tensions of the tissue as close to baseline as possible.

Methods: Oximetry electrodes were attached to participants' ischial tuberosity and greater trochanter for different amounts of lateral pressure. The amount of lateral pressure is a given percentage of the pressure due to the participants' underbody pressure.

Results: The results show that 50 % lateral pressure is sufficient to produce an improvement in participants' gas tensions at their ischial tuberosity, without negatively impacting the tissue at their greater trochanter, relative to the control of sitting with no application of lateral pressure.

Conclusion: Despite a rudimentary prototype device design, and that participants each placed their own oximetry sensors, results support the application of lateral pressure as a method to maintain transcutaneous gas tensions. Further work should be carried out on a larger sample to consolidate these findings.

Introduction: Pressure injuries (PIs) are a significant issue in healthcare system: nursing students are recommended to be prepared to assess the risk, prevent and manage them. However, despite the coronavirus disease-2019 (COVID-19) pandemic significantly affected nursing students' learning opportunities no data regarding their impact of PIs knowledge, attitudes and learning occasions have been documented to date.

Aims: To describe the post-pandemic knowledge and attitudes regarding PI prevention and management and to compare clinical learning opportunities in the field of PIs before and after the COVID-19 pandemic.

Method: A descriptive multi-method study involving students at the time of their graduation in the before (n = 114) and after the pandemic (n = 113). The Italian versions of the Pressure Ulcer Knowledge Assessment Tool (PUKAT-IT) and Attitude Toward Pressure Ulcer Prevention (APuP-IT) scales were used. Data regarding pre- and post-pandemic learning opportunities were retrospectively collected from the Student Portfolio of Skills.

Results: The average PUKAT-IT score was 57.92 % (cut-off 60 %), which indicates insufficient knowledge; the average APuP-IT score was 78.19 % (cut-off 75 %), which shows positive attitudes towards PI. Comparing the pre- and the post-pandemic groups, learning opportunities in PI risk assessment and prevention significantly decreased (overall 38.90 vs 32.27 and 35.26 vs 25.97, respectively) while those regarding the PI management remained stable.

Conclusion: In the post-pandemic times, nursing students' knowledge about PIs remains insufficient while their attitudes are adequate; the pandemic significantly reduced students' exposure to prevention and assessment learning opportunities during their internship, which suggests a need to update educational strategies to ensure appropriate knowledge and learning experiences in this field.

Purpose: Patients in the intensive care unit (ICU) are at a high risk of developing incontinence-associated dermatitis (IAD), the incidence and severity of which are positively related to pressure injuries, thus affecting nursing quality indicators. This quality improvement project aimed to decrease the severity and incidence of IAD, with a focus on enhancing awareness among nursing staff.

Design: This 36-month project was implemented via the Plan-Do-Study-Act (PDSA) model.

Subjects: and setting: Included staff members worked in the ICUs (central and emergency ICUs) at a Grade A tertiary hospital in Suzhou (South of Jiangsu), China.

Methods: The quality improvement project included three main procedures: (1) formulating and implementing a modified prevention and treatment nursing protocol for early structured skin care with perineum ventilation, formulating a guidance sheet for incontinence nursing care; (2) organizing training and assessments of theories and skills, including three special sections on incontinence care training (theoretical knowledge, project process, video watching), skills training for nursing staff, and an incontinence nursing workshop to engage and evaluate all staff; (3) annual analysis and discussion of nursing quality control.

Results: Following project completion, there was a decrease in the overall incidence of IAD. Moreover, ICU nurses may attach more importance/awareness to IAD.

Conclusions: This project successfully reduced the incidence of IAD among ICU patients.

Aim of the study: To map the available evidence on nursing care provided to prevent the development of pressure ulcers/injuries in emergency services.

Material and methods: Scoping review that follows the Preferred Reporting Items for Systematic reviews and the Meta-Analyses extensions for Scoping Reviews and the Joanna Briggs Institute guidelines. The inclusion criteria were based on the PCC mnemonic. The main variables of interest were the nursing care provided to prevent the development of pressure ulcers/injuries (Condition) reported in studies developed in hospital emergency services (Context) with adult participants (Population). The scoping review protocol was registered on the OSF platform.

Results: During the selection process, 175 articles were identified in different databases. Applying the inclusion and exclusion criteria, 20 studies were included in this scoping review. The preventive measures for the development of pressure ulcers/injuries were grouped into 9 categories: "risk factors and risk assessment", "support surfaces", "dressings for pressure ulcer/injury prevention", "skin and tissue assessment", "repositioning and early mobilization", "preventive skin care", "nutrition in pressure ulcer/injury prevention", "health education" and "vital signs management". The instruments for assessing the risk of developing pressure ulcers/injuries mentioned in the studies are the Braden, Waterlow and Norton scales. The most documented tool for assessing the risk of developing pressure ulcers/injuries in hospital emergency services was the Braden Scale.

Conclusion: International literature identified several preventive interventions that could be implemented in emergency services to avoid pressure ulcers/injuries development. However, is crucial that those preventive interventions were systematic implemented (in combination) since hospital admission.

Aim: Nursing care activities conducted at night tend to disturb their sleep, but to our knowledge, no nocturnal care protocols for pressure injury prevention have been established. This scoping review aimed to map the nocturnal care for pressure injury prevention and propose nocturnal care recommendations that have a reduced impact on the patient's care environment.

Methods: Literature databases were searched and two independent researchers screened the articles according to the inclusion criteria and extracted the data. The inclusion criteria were original articles/case studies, studies involving human subjects, and studies on nocturnal care for the prevention of pressure injuries.

Results: Eight met the inclusion criteria, three studies focused on bedding and five on care activities. Parasympathetic activity was more likely to be maintained or enhanced when an automatic repositioning function was used. Additionally, the time to sleep resumption was significantly shorter when repositioning was performed during deep sleep than during shallow sleep. Significantly fewer awakenings in response to light or sound occurred when incontinence care was provided to awake patients than when it was performed regularly. Moreover, some studies have highlighted the usefulness of the small change method and the 30° side-lying position for repositioning.

Conclusion: Using a mattress with an automated turning function, providing care during wakefulness or deep sleep, and using repositioning methods with small positional changes may be effective in reducing the impact on patient's care environment. Further research is needed to determine nocturnal care for pressure injury prevention with less impact on the patient's care environment.

Background: Surgical wound dehiscence (SWD) is interpreted differently amongst healthcare professionals due to a lack of uniformity in definitions in literature. Inconsistent defining impedes accurate diagnosis, appropriate care, intercollegiate consultation, and benchmarking. Despite the introduction of a consensus-driven definition by the World Union of Wound Healing Societies (WUWHS) in 2018, its application in literature and clinical practice remains unclear.

A objectives: This scoping review aims to systematically explore the literature to identify existing SWD definitions, provide an overview, identify knowledge gaps, and extract articles that reference the WUWHS definition.

Methods: This review was performed in accordance with the PRISMA-ScR guidelines and Joanna Briggs Institute Methodology for Scoping Reviews. A systematic literature search was performed through MEDLINE, EMBASE, Cochrane Library and Google Scholar. Eligibility screening and data extraction were independently performed by two researchers.

Results: This study included 34 articles: 28 systematic reviews, two randomized clinical trials, three retrospective studies, and one book chapter. SWD was defined in different ways, such as "breakdown/disruption of the surgical wound" (n = 17), "separation/splitting apart of the wound edges" (n = 13), "gaping/re-opened wound" (n = 7), mechanical failure (n = 2), or infection (n = 1). Other studies defined SWD in relation to its depth (skin layers involved) or length over the incision, both complete and partial (n = 9). One study referenced the WUWHS definition.

Conclusion: Existing literature demonstrates a substantial variety in defining SWD, and little adoption of the WUWHS definition following its introduction in 2018. Uniform use of the definition should be considered as this will improve the quality of care.

Background: Pressure Injuries are a prevalent and concerning issue in critical care settings, impacting patient well-being and healthcare systems.

Purpose: Measure the point prevalence of acquired pressure injuries in Omani critical care units and assess the adequacy of preventive measures.

Methods: A multicenter cross-sectional survey was conducted in four major Omani hospitals, encompassing various geographical regions and health sectors. A convenient sample of 156 adult patients in critical care units was examined using the European Pressure Ulcer Advisory Panel methodology. Data on prevalence, risk assessment, and prevention measures were collected and analyzed.

Results: The study revealed a prevalence rate of 21.8 % for hospital-acquired pressure injuries (including stage I) and 19.2 % (excluding stage I) in Omani critical care units. The sacrum was the most affected area, with stage II being predominant. Alarmingly, some at-risk patients did not receive appropriate preventive equipment, while low-risk patients received unnecessary measures. Approximately 73.3 % of at-risk patients received adequate prevention.

Conclusion: This pioneering study in Oman addresses the prevalence of Pressure Injuries, revealing rates that are higher than international norms. Additionally, the research underscores deficiencies in preventive measures, such as inadequate prevention for at-risk patients and unnecessary measures for low-risk individuals.