Journal of wound care最新文献

Objective: The presence of microorganisms in a wound may lead to the development of pathologically extensive inflammation, and either delay or prevent the healing of hard-to-heal (chronic) wounds. The aim of this case series is to explore the use of topical gentamicin ointment, an aminoglycoside with activity against aerobic Gram-negative bacteria, as an option to address hard-to-heal wounds.

Method: We present a retrospective case series of patients with hard-to-heal wounds of varying pathophysiologies treated with topical gentamicin.

Results: Regardless of the inciting aetiology, all 10 of the presented patients responded to topical gentamicin as evidenced by resolution of much of the inflammation and reduction in wound size or complete wound closure.

Conclusion: By helping to clear the bacteria-induced biofilm that may be present on a hard-to-heal wound, gentamicin may allow the wound healing process to continue past the inflammatory phase, and onto proliferation, remodelling and eventual closure.

Objective: The Veterans Health Administration (VHA) recently piloted the implementation of the TeleWound Practice Program (TWP), which provides interprofessional wound care to Veterans remotely. We assessed the perceptions of Veterans and healthcare team members (HCTMs), and their experiences with the TWP.

Method: We surveyed Veterans from four VHA medical centres who had received at least one TWP visit between 1 May 2020 and 31 May 2021, and HCTMs associated with any TWP encounter between 1 September 2019 and 31 March 2021. Survey data were summarised using descriptive statistics and open-ended question responses were analysed using thematic coding.

Results: Out of 534 Veterans approached, 194 completed the survey (a 36% response rate). Most were interested in continuing to use TeleWound care (66%), felt more motivated to participate in their wound care due to the TWP (70%), and reported reductions in travel distance (81%) and cost (81%) related to wound care. Of the 32 HCTMs approached, 19 completed the TWP survey (a 59% response rate). Respondents indicated that the TWP improved their own professional decision-making skills (82%) and supported Veterans to take a more active role in their health (100%). Challenges included insufficient training for HTCMs, lack of stakeholder buy-in, and logistical and technical issues. Suggestions for improvement related to equipment, additional training and dedicated TWP staff.

Conclusion: In this study, the Veterans were satisfied with the TWP and were more motivated to engage in wound self-management after receiving care through the TWP. HCTMs also perceived the TWP as beneficial to Veterans. However, additional efforts are needed to address barriers to TWP implementation across the VHA system of care.

Exudate management is essential for creating a moist wound environment that promotes optimal healing, especially in highly exuding wounds, where choosing an appropriate wound dressing to handle high volumes of exudate is a key part of the wound management strategy. Superabsorbent wound dressings (SWDs) have been designed to absorb and retain large amounts of exudate. Thus, they are advocated for management of wounds with moderate-to-high levels of exudate to reduce the risk of leakage and damage to the periwound skin. The SWD category contains numerous brands with different structural and compositional designs. Those differences affect absorption capacity of the products, but also affect structural integrity, risk of leakage, adherence to the wound bed upon dressing removal etc. Herein, we aim to provide a brief overview of the clinical evidence and technical performance characteristics of the SWD category, and identify technical improvement areas. Clinical evidence within the SWD category was primarily limited to product evaluations, case series and case studies. With limited comparative clinical evidence available within this product category, we provide an overview of in vitro comparisons of technical performance characteristics related to absorption capacity, fluid retention, structural integrity, waterproofness, and ability to sequester host-derived enzymes and microorganisms. Substantial differences in in vitro performance characteristics in this product category were identified, which may have implications for their clinical performance. With the currently available in vitro evidence, there is no SWD showing superior performance across all functionalities, indicating a continued need for product development within this product category.

Objective: Wound management can be costly and challenging to the health services' scarce resources. Information regarding the number of wounds in a community care setting and their associated aetiology will provide nurses and nurse managers with an insight into the specific needs of these clients with wounds and highlight areas where care or services can be improved or further developed. This research aimed to establish the prevalence and aetiology of wounds, the current delivery of wound care, wound documentation and referral pathways in an Irish community care setting.

Method: A retrospective chart review was carried out on all clients in the community care area who received wound care from the Public Health Nursing Service over a specified one-year period.

Results: A total of 331 individuals were identified as having wounds, and nearly half presented with more than one wound, equating to 632 wounds in total (point prevalence (PP)=0.46%). A total of 56% (n=186; PP=0.14%) had leg ulcers (LUs), 18% (n=58; PP=0.04%) had pressure ulcers (PUs), 15% (n=49; PP=0.04%) had developed a diabetic foot ulcer (DFUs) and a further 11% (n=38; PP=0.03%) had wounds of other aetiologies. The mean duration of wounds was 11.37 months. Comorbidities were present in 99% (n=327) of clients with wounds, with cardiovascular disease observed in 87% (n=288) of clients and diabetes in 45% (n=148). Nursing wound-related concerns resulted in 52% (n=171) of clients receiving antibiotics, with 71% (n=121) being prescribed more than one dose. As many as 61% (n=104) of clients prescribed antibiotics did not have completed documentation to demonstrate a suspected wound infection. It was established that 16% of the Public Health Nursing Service's active caseload was made up of clients with wounds and the management of these wounds accounted for 65% of nursing time, equating to 28 full-time community nurses.

Conclusion: This study has identified that people with chronic (hard-to-heal) wounds often present with more than one chronic disease, which may negatively influence the wound's healing trajectory, lengthening its duration. The criteria for onward referral for suspected wound infections have been examined and resulted in large numbers of poorly documented wound assessments, leading to a high reliance on the use of oral antibiotics as commonplace for the management of hard-to-heal wounds. Hard-to-heal wounds, such as lower LUs, PUs and DFUs, are either caused or significantly affected by the presence of underlying comorbidities. Therefore, aligning the prevention and management of these burdensome wounds with National Clinical Programmes will deliver efficient, cost-effective, holistic quality care to clients in Irish community healthcare settings.