Ostomy Wound Management最新文献

Purpose: Because infection can thwart burn healing, microorganisms, their susceptibility patterns, and the effect of tangential excision timing on outcomes of burn patients were examined.

Methods: A prospective, observational study was conducted that involved 318 patients with deep second-degree burns from a gas explosion treated in Xinxiang, Henan, China between January 2009 and December 2016. Patient demographic data, culture and antimicrobial susceptibility test results, and outcome variables (resuscitation fluid volume, signs of shock, body temperature, heart rate, and time to wound healing) were analyzed. Outcomes were compared among patients who had early (<24 hours), middle (2 to 7 days), and late (> 7 days) post burn excision.

Results: Bacterial culture and drug sensitivity data were available for 314 of the 318 persons with burns >10% of total body surface area (TBSA). Of the 486 bacterial isolates, 330 (67.9%) were gram-negative and 156 (32.1%) were gram-positive. The number of isolates and resistance to third-generation cephalosporins increased over time. Patients having early tangential excision had significantly lower heart rate (P <.05) and reduced time to healing (P <.01) than patients in the middle or late excision group.

Conclusion: Early tangential excision was found to be safe and to facilitate healing.

Care of the patient with an ostomy is included in the curriculum of prelicensure nursing programs, but no studies examining student nurses' knowledge about stoma care have been published. The purpose of this project was to examine the ostomy knowledge, experiences, and confidence of nursing students in order to assess and improve the curriculum. At the end of the fall 2016 semester, students enrolled in 3 separate nursing courses in an undergraduate program were asked to participate in a project to examine students' ostomy knowledge, their experiences, and their confidence in providing care. This project was undertaken to explore the college's ostomy curriculum. Participation was voluntary, and no student who was willing to participate was excluded. Students completed a 50-question knowledge test, answered questions about the frequency of performing ostomy-related skills, and rated their confidence in providing ostomy care. Responses were examined with descriptive and inferential statistics. Of 189 possible participants, 138 completed the questionnaires and included mostly women (113, 81.9%); participant mean age was 27.26 ± 6.22 years. The mean number of correct knowledge responses was 35.66 (71.32%); 66 participants (47.8%) reported no experience caring for a patient with an ostomy. The most common skills performed in clinical rotations were emptying (49) and changing (24) the pouch. A scale of 1 to 5 was used to evaluate 6 confidence items, with students having a mean confidence score of 19.54 ± 5.20. They had the most confidence in their ability to empty a pouch and to size and fit the pouching and the least confidence in teaching and community resources. Confidence was related to the number of skills performed in the lab (r = .32; P <.001), the number of skills performed in clinical practice (r = .38; P <.001), and ostomy knowledge scores (r = .23; P <.007). Total correct knowledge scores did not differ significantly by year in the educational program. Based on the results of this survey, it was concluded that students had a beginning knowledge about ostomy care and very limited clinical experience, yet confidence in providing ostomy care was high. Curriculum adjustments were implemented, including strategies for increasing ostomy knowledge, opportunities to provide care, and confidence; these need further investigation in prelicensure undergraduate nursing programs. The effect of curriculum adjustments remains to be evaluated.

Many recent studies have focused on the potential role of topical agents in the wound healing process. To compare the time to healing of full-thickness wounds treated with topical estrogen, phenytoin, or silver sulfadiazine (SSD), an in vivo study was conducted using 32 male Wistar rats. Animals were housed individually in standard cages in similar environmental conditions, and a single, circular (4 mm in diameter), full-thickness skin wound was created on the dorsum of each rat. Animals were randomly divided into 4 groups of 8 rats each and treated with topical phenytoin, SSD, estrogen cream, or no treatment/control. Each wound was measured and examined daily until healing, defined as complete reepithelialization and closure of the wound. Group mean healing times were calculated, and Tukey's multiple comparison test was used to compare these data. Average times to healing were 11 days in estrogen group, 10 days in phenytoin group, 7.62 days in SSD group, and 11.87 days in control group. Wound healing was significantly faster in the SSD compared to control (P <.01) and the estrogen group (P <.01). No other differences were statistically significant. Further studies, especially randomized clinical trials on human beings with larger sample sizes, are recommended to elucidate if these topical agents affect wound outcomes.

The urgent need to eliminate unnecessary use of antibiotics in wound patients has been hampered by diagnostic uncertainty and the time required to obtain culture results. The authors evaluated bedside use of a handheld bacterial fluorescence imaging device for real-time visualization of bacteria within and around wounds, used in addition to monitoring of clinical signs and symptoms of infection, in a series of 7 patients (5 women, 2 men; age range 57-93 years) with varying comorbidities who were referred to the wound ostomy continence clinician for wound assessment. When excited by 405-nm violet light, tissues fluoresce green (collagens) and bacteria fluoresce red; specialized optical filters reveal these colored signals in real time on the device's display screen. Wounds exhibiting red fluorescence were presumed to have moderate/heavy bacterial contamination (≥104 CFU/g) and were subsequently swabbed. Swabs from the 5 wounds with regions of red fluorescence confirmed heavy growth of 1 or more pathogenic bacterial species. Images revealing pronounced bacterial fluorescence in 3 patients with pressure injuries about to be discharged led to prescription of systemic antibiotics and additional patient monitoring. In 2 patients (1 with a skin tear, 1 with a surgical wound), the absence of bacterial fluorescence prevented planned, unwarranted use of systemic antibiotics. Fluorescence images obtained bedside during routine wound assessments had a direct effect on antimicrobial stewardship practices. Follow-up images demonstrated antibiotic effectiveness and, in some instances, led to reduced antibiotic courses and duration. This case series demonstrates the potential use for real-time information on bacterial presence obtained via bacterial fluorescence imaging to guide evidence-based deployment of antibiotics and prevent unnecessary use. Additional studies to optimize the diagnostic potential and randomized controlled studies to examine the effect of this technique on antibiotic usage, antimicrobial stewardship practices, and wound outcomes are warranted.