General Concepts in Wound Management
W1. Acute and Impaired Wound Healing: Pathophysiology and Current Methods for Drug Delivery, Part 1: Normal and Chronic Wounds: Biology, Causes, and Approaches to Care
Demidova-Rice T, Hamblin M, Herman I. Advances in Skin and Wound Care. 2012;25(7):304-314.
Article Type: Integrative review
Description/Results:
* Reviews current understanding of the factors regulating wound repair, specifically growth factors and cytokines, endothelial progenitor cells, inflammatory substances, infection, and apoptotic factors; addresses impact of wound chronicity and comorbidities such as diabetes on regulation of wound repair.
* Addresses need for diagnostic tools that accurately identify the specific factors preventing healing in various wounds, and the potential for development of individualized corrective therapies based on these results.
What does this mean for me and my practice?
Helpful in-depth review of wound healing physiology and factors interfering with repair; enhances understanding of the many factors that can adversely affect healing.
W2. Acute and Impaired Wound Healing: Pathophysiology and Current Methods for Drug Delivery, Part 2: Role of Growth Factors in Normal and Pathological Wound Healing: Therapeutic Potential and Methods of Delivery
Demidova-Rice T, Hamblin M, Herman I. Advances in Skin and Wound Care. 2012;25(8):349-370.
Article Type: Integrative review
Description/Results:
* Provides in-depth review of major families of growth factors to include their role in normal and impaired wound healing, and factors interfering with their function, such as inadequate receptor sites or high levels of proteases.
* Authors describe novel delivery systems that could potentially overcome factors that interfere with the function of growth factors: protein-based systems such as collagen; fibrin gels or scaffolds; polysaccharide matrices such as carboxymethylcellulose or alginates; synthetic polymers such as polyethylene glycol; and gene delivery systems.
What does this mean for me and my practice?
Provides insight into methods currently being researched for management of nonhealing wounds; includes very helpful images.
W3. Role of a Point-of-Care Protease Activity Diagnostic Test in Canadian Clinical Practice: A Canadian Expert Consensus
Sibbald G, Snyder R, Botros M, Burrows C, Coutts P, D'Souza L, Kuhnke J, et al. Advances in Skin and Wound Care. 2012;25(6):267-275.
Article Type: Consensus panel report
Description/Results:
* Summarizes conclusions of an expert panel convened to address assessment and management of stalled wounds, and potential role of bedside diagnostics such as protease activity test.
* Provides guidelines for classifying, assessing, and managing stalled wounds, and provides insights into potential benefits and appropriate use of a point-of-care test for protease activity.
What does this mean for me and my practice?
Provides a concise summary of the "state of the science" in regard to stalled wounds and the role of MMPs (matrix metalloproteases).
W4. Scientific and Clinical Support for the Use of Dehydrated Amniotic Membrane in Wound Management
Fetteroff D, Snyder R. Wounds. 2012;24(10):299-307.
Article Type: Integrative review
Description/Results:
* Provides comprehensive review of the use of human amniotic membranes in the treatment of chronic wounds, to include mechanisms of action (provision of growth factors and cytokines) and indications for use (burns, diabetic ulcers, venous ulcers, surgical wounds, and traumatic wounds).
* Also provides a description of the process for application of amniotic membrane allograft.
What does this mean for me and my practice?
Provides clinicians with the scientific basis underlying the use of dehydrated human amniotic membrane for management of chronic wounds.
W5. Do Patient and Nurse Outcome Differences Exist Between 2 Negative Pressure Wound Therapy Systems?
Albert NM, Rock R, Sammon MA, Bena JF, Morrison SL, Whitman A, et al. Journal of Wound, Ostomy and Continence Nursing. 2012;39(3):259-266.
Article Type: Research study
Description/Results:
* Study involved 11 subjects (surgical wounds) randomly assigned to foam-based (6) or gauze-based (5) Negative Pressure Wound Therapy (NPWT) system; small sample size attributed to physician preference for foam-based NPWT. Outcomes measures included wound healing, pain, cost, length of stay, ease of use, and time for dressing change.
* No statistically significant differences in healing rates were observed. No differences in caregiver time or ease of use were noted.
What does this mean to me and my practice?
Provides limited evidence that foam- and gauze-based NPWT systems provide comparable outcomes.
W6. Curative Treatment Without Surgical Reconstruction After Perineal Debridement of Fournier's Gangrene
Jones EG, El-Zawahry AM. Journal of Wound, Ostomy and Continence Nursing. 2012;39(1):98-102.
Article Type: Case series
Description/Results:
* Provides review of 3 cases of patients with Fournier's gangrene (necrotizing fasciitis) in which the use of NPWT contributed to positive clinical outcomes. Excellent clinical illustrations.
What does this mean to me and my practice?
Although not a controlled trial, provides clinical data regarding the role of NPWT in management of complex wounds caused by necrotizing fasciitis. Graphic illustrations may be helpful to the clinician.
W7. The Influence of Metal Salts, Surfactants, and Wound Care Products on Enzymatic Activity of Collagenase, the Wound Debriding Enzyme
Jovanovic A, Ermis R, Mewaldt R, Shi L, Carson DJ. Wounds. 2012;24(9):242-253.
Article Type: Research study
Description/Results:
* Authors review data regarding the compatibility of wound care products and C. collagenase debriding ointment (ie, Santyl) and provide a table summarizing interactions between collagenase and 66 wound cleansers, antibacterial formulations, antimicrobial actives, and a variety of dressings including silver- and iodine-based dressings.
* Results showed incompatibilities with most silver and iodine-containing products, as well as wound cleansers (excluding formulas with hypochlorite).
* Products compatible with C. collagenase included commonly used wound dressings, wound cleansers containing sodium hypochlorite, and a variety of antimicrobial actives and formulations.
What does this mean for me and my practice?
Provides the clinician with current evidence regarding interactions between collagenase and commonly used antimicrobials; extremely beneficial to any clinician using collagenase for debridement of necrotic wounds.
W8. Effectiveness, Tolerability, and Safety of Electrical Stimulation of Wounds With an Electrical Stimulation Device: Results of a Retrospective Register Study
Herberger K, Debus E, Larena-Avellaneda A, Blome C, Augustin M. Wounds. 2012;24(4):76-84.
Article Type: Research study
Description/Results:
* The authors discuss potential mechanisms by which electrical stimulation may improve wound healing, including enhanced neutrophil and macrophage migration, fibroblast stimulation, and improved blood flow.
* Authors report on study involving 95 patients with refractory wounds (median wound duration of 13.7 months) who were treated with electrical simulation therapy (EST) for an average of 48.1 days using the wound EL system. Outcome measures included reduction in wound size, change in wound status, and the patient's perception of effectiveness and tolerability.
* Improvement was found in all clinical wound parameters, including reduced wound size, reduced fibrin and necrosis, and an increase in granulation and epithelialization.
What does this mean for me and my practice?
The study suggests EST may contribute to healing of chronic wounds. Controlled studies are needed to confirm these findings.
W9. Estimates of Evaporation Rates From Wounds for Various Dressing/Support Surface Combinations
Lachenbruch C, VanGilder C. Advances in Skin and Wound Care. 2012:25(1):29-36.
Article Type: Research study
Description/Results:
* Authors discuss the fact that exudate and moisture management involves both the absorptive capacity and evaporative properties of the dressing, and the air flow/moisture management properties of the support surface on which the patient is positioned; they point out that to date no studies have been done to compare the various combinations of dressings and support surfaces in terms of moisture management properties.
* Authors tested the ability of various support surfaces to manage moisture at the patient/surface interface using surface evaporative capacity testing, and measured moisture vapor permeability of a variety of dressings using artificial wound fluid.
* Authors provide a table that allows a clinician to compare the evaporative/moisture management effects of a particular dressing when used on a variety of support surfaces (air fluidized, high-level low air loss vs moderate-level low air loss, static air, self-adjusting foam and air, and foam).
What does this mean for me and my practice?
Reminds clinicians that exudate and moisture management is affected by the support surface as well as the dressing and provides very helpful table for estimating the combined effects. For example, the combination of a moist gauze dressing and an air-fluidized bed would be likely to cause dehydration at the wound surface, whereas the combination of a transparent adhesive dressing and a static air device could potentially cause maceration at the wound and skin surface.
W10. Wound Dressing Absorption: A Comparative Study
Fulton J, Blasiole K, Cottingham T, Tornero M, Graves M, et al. Advances in Skin and Wound Care. 2012;25(7):315-320.
Article Type: Research study
Description/Results:
* Provides comparative review of absorptive capacity of various categories of dressings (alginates, collagens, foams, gauzes, and hydrocolloids), and specific dressings within each category using phosphate-buffered saline at room temperature.
* In this in vitro study, collagens were the most absorptive and hydrocolloids were the least absorptive.
What does this mean for me and my practice?
Provides objective data regarding absorptive capacity of various dressings; would be beneficial to any clinician who must make dressing choices for wounds with variable volumes of exudate.
W11. Wound Care Outcomes and Associated Cost Among Patients Treated in US Outpatient Wound Centers: Data From the US Wound Registry
Fife C, Carter M, Walker D, Thomson B. Wounds. 2012;24(1):10-17.
Article Type: Research study
Description/Results:
* Provides analysis of data collected over 5 years from 59 hospital-based wound centers in 18 states (US Wound Registry data); sample included 5240 patients with 7099 wounds, including patients with comorbidities often excluded from RCTs. Data related to wound outcomes, patient and wound variables, time to heal, and cost to heal are presented for a variety of wounds, including surgical, pressure, diabetic foot, arterial, venous, traumatic, and amputation sites.
* 65.8% of wounds healed in an average of 15 weeks. 50.8% of wounds that healed did so with moist wound healing without advanced therapeutics (HBOT, NPWT, bioengineered skin). The average cost to heal was $3927 per wound. Diabetic foot ulcers averaged $5391 per patient and jeopardized flaps and grafts averaged $9358 to heal (does not include inpatient costs).
What does this mean for me and my practice?
Provides applicable outcome data reflecting actual practice for clinicians in outpatient wound centers.
W12. Exploring the Effects of Pain and Stress on Wound Healing
Woo K. Advances in Skin and Wound Care. 2012;25(1):38-44.
Article Type: Integrative review
Description/Results:
* Provides review of current evidence regarding prevalence of pain and stress among patients with chronic wounds, and the negative impact of stress and pain on wound healing (eg, increased production of inflammatory mediators and catecholamines, resulting in prolongation of the inflammatory phase and increased wound hypoxia).
* Author reviews strategies for reducing and managing wound-related pain and stress, and addresses implications for future research.
What does this mean for me and my practice?
Reminds clinicians of the significance and negative impact of wound-related pain and stress, and provides concise review of strategies to reduce pain and stress.
W13. Systemic Antibiotic Treatment of Skin, Skin Structure, and Soft Tissue Infections in the Outpatient Setting
Jones H. Advances in Skin and Wound Care. 2012;25(3):132-140.
Article Type: Integrative review
Description/Results:
* Provides review of current indications for systemic antibiotics in management of wound-related infections and comprehensive review of currently available oral and intravenous antibiotics, with emphasis on indications, contraindications, and bactericidal spectrum.
* Author addresses prevalence of methicillin-resistant Staphylococcus aureus and specifically addresses efficacy of various antibiotics in treatment of this organism.
What does this mean for me and my practice?
Would be very helpful to any advanced practice nurse with prescriptive privileges.
W14. A Retrospective Study Evaluating Silver-Impregnated Dressings on Cesarean Wound Healing
Connery S, Downes K, Young C. Advances in Skin and Wound Care. 2012:25(9):414-419.
Article Type: Research study
Description/Results:
* Retrospective study of 72 patients to compare effectiveness of silver dressings and standard gauze dressings on surgical site infections as indicated by additional postoperative visits for wound care (36 patients in each group).
* No significant difference in infection rates for 2 groups, though authors note that "silver group" had significantly more comorbidities when compared to the "standard dressing" group.
What does this mean for me and my practice?
Provides limited data that silver dressings as a stand-alone intervention may not be sufficient to provide significant reduction in incidence of surgical site infections.
W15. An In Vitro Comparison of 2 Silver-Containing Antimicrobial Wound Dressings
Hooper SJ, Williams DW, Thomas DW, Hill KE, Percival SL. Ostomy Wound Management. 2012;58(1):16-22.
Article Type: Research study (in vitro)
Description/Results:
* Two topical dressings (silver alginate, SA, and silver carboxymethylcellulose, SCM) were compared in vitro for antimicrobial activity against 9 common wound-colonizing species; Staphylococcus aureus bacterial kill was also investigated.
* Two-hour results: Statistically significant antimicrobial results were found with the SCM on gram- negative rod organisms, Escherichia coli and Pseudomonas aeruginosa; and with the SA on gram- positive organisms, Streptococcus pyogenes and Staphylococcus aureus. Antifungal activity against Candida albicans was similar for both dressings.
* Antimicrobial activity persisted from 4 to 13 days with the majority of antimicrobial activity against P. aeruginosa and S. aureus occurring between 5 and 8 days for both dressings. SA showed greater antimicrobial activity against anaerobes, C. albicans and E. coli; SCM was slightly more active against S. pyogenes.
What does this mean to me and my practice?
While further study is needed, the carrier dressing may impact the antimicrobial effects of silver. Human/clinical trials are needed to replicate and validate these findings.
W16. A Randomized Controlled Trial to Evaluate an Antimicrobial Dressing With Silver Alginate Powder for the Management of Chronic Wounds Exhibiting Signs of Critical Colonization
Woo K, Coutts P, Sibbald RG. Advances in Skin and Wound Care. 2012;25(11):503-508.
Article Type: Research study
Description/Results:
* 4-week prospective randomized controlled trial involving 34 subjects with chronic wounds that exhibited signs and symptoms of critical colonization; control group subjects were managed with an absorptive foam dressing and experimental group subjects were treated with a silver-alginate powder in addition to the foam dressing. Offloading for plantar surface ulcers and compression for venous ulcers was provided for all patients.
* Endpoints of the study included changes in signs of critical colonization using an established checklist, and changes in wound surface area. In the control group, the mean infection checklist score was 2.2 at baseline and 2.3 at week 4; in the silver powder group, the mean infection score was 3.3 at baseline and 1.3 at week 4 (statistically significant reduction, P <= .00). There was also a statistically significant reduction in wound surface area in the treatment group as compared to the control group (P < .001).
What does this mean for me and my practice?
Provides limited evidence that the addition of silver powder to wounds with evidence of critical colonization may reduce signs of critical colonization and promote healing.
W17. Developing Evidence-Based Algorithms for Negative Pressure Wound Therapy in Adults With Acute and Chronic Wounds: Literature and Expert-Based Face Validation Results
Beitz JM, van Rijswijk L. Ostomy Wound Management. 2012;58(4):50-69.
Article Type: Integrative review
Description/Results:
* Provides review of current literature and evidence related to negative pressure wound therapy (NPWT); and use of current best evidence to develop NPWT algorithms for use by nonexpert wound clinicians.
* Three algorithms were developed and evaluated by 12 experienced wound clinicians in terms of face validity for clinical practice: initial assessment, surgical or acute wound, and chronic wound.
* Additional work includes clear definition of terms and determination of algorithms' content validity using larger pool of wound experts.
What does this mean to me and my practice?
Provides condensed review of evidence base for NPWT and points out gaps in evidence. Summarizes work on development of algorithms to promote appropriate use of NPWT by nonspecialty wound clinicians.
W18. Diagnosing and Treating Moisture-Associated Skin Damage
Zulkowski K. Advances in Skin and Wound Care. 2012;25(5):231-236.
Article Type: Integrative review
Description/Results:
* Provides general review of moisture-associated skin damage, with primary focus on incontinence-associated dermatitis and measures for prevention and management. Includes a brief discussion of challenges related to accurate differentiation between MASD and pressure-related injuries.
What does this mean for me and my practice?
Reinforces previous publications regarding etiology, pathology, prevention, and management of MASD, and differential assessment of pressure ulcers and MASD.
W19. General Principles and Approaches to Wound Prevention and Care at End of Life: An Overview
Langemo D. Ostomy Wound Management. 2012;58(5):24-34.
Article Type: Integrative review
Description/Results:
* Provides overview of wound care principles in palliative treatment of end-of-life care patients.
* Addresses key elements of palliative wound care: wound assessment and prevention and treatment to enhance the patient's quality of life. Areas of specific focus include pain, infection, and odor management as well as appropriate dressing choices.
* Provides discussion on fungating and radiation wounds with possible topical dressing choices.
What does this mean to me and my practice?
An excellent primer and review of palliative wound care; would be helpful to any clinician caring for end-of-life patients.
W20. An Overview of Integrative Care Options for Patients With Chronic Wounds
Rosenbaum C. Ostomy Wound Management. 2012;58(5):44-51.
Article Type: Integrative review
Description/Results:
* Provides overview of common alternative care treatments available for patients with wounds, ostomies, and continence-related problems; these therapies may act as complements to traditional Western medicine in managing pain, enhancing relaxation, and improving coping skills.
* The therapies of acupuncture, yoga, biofeedback, guided imagery, massage, and aromatherapy are described with cited research studies to support their clinical benefit.
What does this mean to me and my practice?
Provides a helpful summary of current evidence related to complementary therapies and reminds clinicians to consider referral to a certified complementary clinician for management of refractory wound pain, stress, and anxiety that may inhibit healing.
W21. Wound Healing and Infection in Surgery: The Clinical Impact of Smoking and Smoking Cessation: A Systematic Review and Meta-analysis
Soreson LT. Archives of Surgery. 2012;147(4):373-383.
Article Type: Systematic review
Description/Results:
* Compared postoperative healing complications between smokers and nonsmokers as well as the impact of perioperative smoking cessation in over 479,000 patients across multiple countries and surgery specialties.
* Study found significantly higher incidence of complications in smokers: wound and tissue flap necrosis (P < .001), healing delay and incisional dehiscence including anastomotic leakage (P = .002), surgical site infection (P < .001), nonspecific wound complications (P < .001), and lack of fistula and bone healing (P < .001).
* Meta-analysis revealed that former smokers had significantly more combined healing complications (P < .001) compared to those who never smoked. Perioperative smoking cessation for 4 to 8 weeks significantly decreased surgical site infections (OR: 0.40; 95% CI: 0.20-0.83).
What does this mean to me and my practice?
Despite limitations inherent in a systematic review (including the limited number of controlled studies), this provides important data regarding the negative impact of smoking on wound healing and the marked benefits of smoking cessation for at least 2 months prior to planned surgery.
Pressure Ulcers
W22. The Braden Scale Cannot Be Used Alone for Assessing Pressure Ulcer Risk in Surgical Patients: A Meta-analysis
He W, Liu P, Chen HL. Ostomy Wound Management. 2012;58(2):34-40.
Article Type: Systematic review
Description/Results:
* The study purpose was to establish predictive validity of the Braden Scale in Pressure Ulcer (PrU) development in the surgical population.
* Three surgical patient international studies were identified (n = 609).
* The pooled sensitivity of the Braden Scale in predicting PrU formation was 0.42 (95% CI: 0.38-0.47); the pooled specificity in predicting PrU formation was 0.84 (95% CI: 0.83-0.85).
What does this mean to me and my practice?
Provides further data to indicate that the Braden Scale should not be used to assess risk for intraoperative pressure ulcers and to support the 2009 EPUAP and NPUAP Pressure Ulcer Prevention Guidelines, which identify risk factors for intraoperative pressure ulcer development not captured by the Braden Scale.
W23. Pressure Ulcer Prevention Program Study: A Randomized, Controlled Prospective Comparative Value Evaluation of 2 Pressure Ulcer Prevention Strategies in Nursing and Rehabilitation Centers
Shannon R, Brown L, Chakravarthy D. Advances in Skin and Wound Care. 2012;25(10):450-464.
Article Type: Research study
Description/Results:
* Authors compared clinical outcomes and used fiscal projection methodology to estimate cost savings for 2 different approaches to pressure ulcer prevention in skilled nursing/rehabilitation centers. Patients in both the control group and the treatment group received routine repositioning, nutritional support, skin assessment, and skin and wound care. The differences in care provided the 2 groups focused on products used for pressure redistribution and for incontinence care. The control group was managed with Span America pressure redistribution products, First Quality absorbent products, and a variety of skin care products; patients in the treatment group were managed with MEDLINE pressure redistribution products, absorbent products, and skin care products, with product selection guided by a decision tree.
* Pressure ulcer incidence among the treatment group was reduced by 67% as compared to the control group (P = .001). Although prevention costs per day were higher for the treatment group, the overall cost of care was less due to the reduced costs and reduced risks associated with the significant reduction in nosocomial ulcers.
What does this mean for me and my practice?
Provides objective data that pressure ulcer prevention is more cost-effective than treatment, and suggests that structured protocols using absorbent products with super absorbent polymers and skin care products with advanced skin nutrients may provide better clinical outcomes.
W24. Comprehensive Programs for Preventing Pressure Ulcers: A Review of the Literature
Niederhauser A, Lukas C, Parker V, Ayello E, Zulkowski K, Berlowitz D. Advances in Skin and Wound Care. 2012;25(4):167-188.
Article type: Systematic review
Description/Results:
* Authors reviewed current literature re: multifaceted pressure ulcer prevention programs to identify common components and evidence regarding effectiveness.
* Common components included a best practice skin bundle (risk assessment, pressure redistribution surfaces, nutritional assessment and management, turning and heel elevation, and moisture management); staff education; ongoing monitoring and reporting; root cause analysis and correction of any identified deficiencies; and creation of skin care champion teams.
* The majority of studies reported a reduction in pressure ulcer incidence; however, statistical significance was rarely reported.
What does this mean for me and my practice?
Provides a very helpful and concise summary of strategies that have been used to reduce agency-acquired pressure ulcers; would be beneficial to any clinician in an inpatient setting.
W25. Prophylactic Dressing Application to Reduce Pressure Ulcer Formation in Cardiac Surgery Patients
Brindle CT, Wegelin JA. Journal of Wound, Ostomy and Continence Nursing. 2012;39(2):133-142.
Article Type: Research study
Description/Results:
* Study involved 85 CSICU patients; all patients received standard preventive care and a self-adherent silicone foam dressing to the sacral area during surgery. Postoperatively patients were assigned to either the treatment group or the control group; the treatment group received standard prevention + the silicone adhesive foam dressing changed Q 3 days, and the control group received standard prevention but no silicone dressing.
* 11% of the control group developed PrUs (5 sDTI, 3 stage II), as compared to 2% of the intervention group (1 sDTI).
What does this mean to me and my practice?
Results suggest that a self-adherent silicone foam dressing may reduce the risk of intraoperative PrU incidence when added to a PrU prevention protocol.
W26. Reduction of Sacral Pressure Ulcers in the Intensive Care Unit Using a Silicone Border Foam Dressing.
Chaiken N. Journal of Wound, Ostomy and Continence Nursing. 2012;39(2):143-145.
Article Type: Research study
Description/Results:
* Author documented baseline prevalence of sacral ulcers of 13.6% over 35 months; during this period, all patients received standard pressure ulcer prevention care.
* During study period of 6 months, an enhanced pressure ulcer prevention program was implemented, which included staff education and the addition of a silicone adhesive foam dressing with twice-daily inspection. The incidence of sacral ulcers was reduced to 1.8% during this period, and all 5 patients who developed ulcers expired.
What does this mean to me and my practice?
Provides additional evidence that routine use of silicone foam dressing may reduce the incidence of sacral ulcers in the intensive care unit, when implemented as a component of a comprehensive prevention protocol that includes aggressive ongoing staff education.
W27. Use of a Sacral Silicone Border Foam Dressing as One Component of a Pressure Ulcer Program in an Intensive Care Setting
Walsh NS, Blanck AW, Alyson W, Smith L, Cross M, Andersson L, et al. Journal of Wound, Ostomy and Continence Nursing. 2012;39(2):146-149.
Article Type: Quality improvement initiative report
Description/Results:
* Authors report quality improvement initiative that reduced incidence of hospital-acquired pressure ulcers (HAPUs) from 12.8% to <1%; the initiative included hiring a WOC nurse, adopting the Braden Scale, and implementing a prevention skin bundle that included nutritional support, pressure redistribution surfaces, and staff education.
* An additional initiative was undertaken to reduce the incidence of HAPUs among ICU patients (HAPU incidence was 3.8% hospital wide but 21.3% in the ICU); it was theorized that the higher incidence was due in large part to positioning required for prevention of ventilator-associated pneumonia (VAP), and that the use of a silicone adhesive foam dressing might help to reduce the shear forces associated with increased head-of-bed elevation. The addition of the silicone foam dressing reduced incidence among intensive care unit patients to 4.8%; all patients who developed ulcers expired.
What does this mean to me and my practice?
Provides additional evidence that silicone adhesive dressings may help to reduce pressure ulcer incidence among ICU patients, when added to a comprehensive prevention protocol.
W28. Peer-to-Peer Nursing Rounds and Hospital-Acquired Pressure Ulcer Prevalence in a Surgical Intensive Care Unit: A Quality Improvement Project
Kelleher AD, Moorer A, Makik MF. Journal of Wound, Ostomy and Continence Nursing. 2012;39(2):152-157.
Article Type: Quality improvement initiative report
Description/Results:
* Retrospective review of quarterly prevalence studies showed a 27% prevalence rate in a 17-bed SICU at an Academic Teaching Hospital; hospital-wide in-services on PrU prevention did not result in desired practice changes in the SICU environment.
* Weekly peer-to-peer bedside rounding was implemented with focus on individualized preventive care based on Braden Score subscale scores. Following this intervention, HAPU rates dropped to 0% for 3 consecutive quarters. This is attributed to an increase in the frequency of preventive interventions.
What does this mean to me and my practice?
Provides objective data regarding impact of peer-to-peer rounds on pressure ulcer prevention measures and on patient outcomes; would be very helpful to any clinician charged with reduction of hospital-acquired pressure ulcers.
W29. Pressure Ulcer Knowledge in Medical Residents: An Opportunity for Improvement
Levine J, Ayello E, Zulkowski K, Fogel J. Advances in Skin and Wound Care. 2012;25(3):115-117.
Article Type: Research study
Description/Results:
* Authors assessed residents' knowledge of pressure ulcer staging, risk assessment, differential assessment of pressure ulcers and other wounds, prevention, and management using Pieper Tool (a general knowledge tool) and a photograph-based differential assessment/wound identification tool.
* Average score on the Pieper Pressure Ulcer Knowledge Test was 69%; there were significant gaps in knowledge related to positioning guidelines, heel elevation, and Braden Scale interpretation. Average scores for differential assessment were 57%, with only 26% correctly identifying sDTI.
What does this mean for me and my practice?
Provides objective data regarding need for physician education in the areas of pressure ulcer prevention, differential assessment of pressure and nonpressure wounds, and staging and management.
W30. Using High-Voltage Electrical Stimulation in the Treatment of Recalcitrant Pressure Ulcers: Results of a Randomized, Controlled Clinical Study
Franek A, Kostur R, Polak A, Taradaj J, Szlachta Z, Blaszczak E, et al. Ostomy Wound Management 2012;58(3):30-44.
Article Type: Research study
Description/Results:
* Randomized, controlled study investigating the effect of high-voltage electrical stimulation on chronic, lower-extremity stage II and III pressure ulcers.
* Experimental group (n = 26) received 50 minutes' continuous twin monophasic pulses 5 days/week for 6 weeks compared to control (n = 24). All participants received supportive care and individualized topical therapy.
* Wound healing occurred in both groups, but the treatment group demonstrated a statistically significant increase in healing rates, beginning at week 2 and continuing throughout the study.
What does this mean to me and my practice?
Provides helpful literature review regarding the impact of electrical stimulation on wound healing, and provides support for use of this therapy in management of lower extremity pressure ulcers.
W31. The Incidence of Pressure Ulcers in Surgical Patients of the Last 5 Years: A Systematic Review
Chen H, Chen X, Wu J. Wounds. 2012;24(9):234-241.
Article Type: Systematic review
Description/Results:
* Authors reviewed 17 studies conducted during the last 5 years on the incidence of perioperative pressure ulcers; studies involved a total of 5451 patients.
* The pooled incidence of surgery-related pressure ulcers was 15%, and the following were identified as risk factors: age > 60 years, complications with diabetes or renal insufficiency, low New York Heart Association Functional Classification scores, and greater length of surgery.
What does this mean for me and my practice?
Provides helpful data regarding the incidence of perioperative pressure ulcers and potential risk factors; beneficial to any clinician in the inpatient setting.
W32. Never Say Never: A Descriptive Study of Hospital-Acquired Pressure Ulcers in a Hospital Setting
Bye K, Buescher D, Sandrick M. Journal of Wound, Ostomy and Continence Nursing. 2012;39(3):274-281.
Article Type: Research study
Description/Results:
* Study designed to identify patient characteristics and risk factors associated with development of hospital-acquired pressure ulcers (HAPU), and to evaluate measures used to reduce risk for HAPU.
* Authors developed data collection tool based on risk factors identified in the literature.
* All patients with HAPU had multiple risk factors and comorbid conditions though almost 25% were classified as "low risk" according to current risk assessment tools.
What does this mean to me and my practice?
Study suggests that comorbid conditions may need to be added to risk assessment tools to improve their accuracy; further research is needed.
W33. All At-Risk Patients Are Not Created Equal: Analysis of Braden Pressure Ulcer Risk Scores to Identify Specific Risks
Tescher A, Branda ME, Byrne TJ, James M. Journal of Wound, Ostomy and Continence Nursing. 2012;39(3):282-291.
Article Type: Research study
Description/Results:
* Authors reviewed 12,566 charts to determine whether factors other than the Braden Scale could be used to improve accuracy in pressure ulcer risk assessment.
* Study demonstrated that Braden Scale is highly predictive of pressure ulcer development but does not assist the clinician in developing an individualized prevention plan. However, the subscale scores can enhance prevention by focusing on individual risk factors.
What does this mean to me and my practice?
Study supports the use of Braden Scale for identification of patients at risk for pressure ulcers and suggests that increased emphasis on the subscale scores can enhance development of individualized prevention plans.
W34. Pediatric Pressure Ulcer Prevalence: A Multicenter, Cross-sectional, Point Prevalence Study in Switzerland
Schluer A-B, Halfens R, Schols J. Ostomy Wound Management. 2012;58(7):18-31.
Article Type: Research study (prospective, cohort)
Description/Results:
* Describes a risk factor assessment and pressure ulcer (PrU) prevalence study in all hospitalized pediatric patients in 14 different Swiss pediatric hospitals using a standardized data collection tool with protocols to verify PrU identification and staging.
* A total of 412 patients participated (75% inclusion). Using the EPUAP PrU categories, overall prevalence was 35% with the following breakout; 121 (94%) category I; 16 (3%) category II or higher. Highest prevalence was among children in the intensive care unit and among children with an external medical device. The statistically significant risk factors included hospital unit, patient age, Braden Scale score, and institution.
What does this mean to me and my practice?
Provides data regarding prevalence of PrU and associated risk factors in the pediatric population.
W35. Diabetes Mellitus as a Risk Factor for Surgery-Related Pressure Ulcers: A Meta-Analysis
Liu R, He C, Chen HL. Journal of Wound, Ostomy and Continence Nursing. 2012;39(5):495-499.
Study Type: Research study
Description/Results:
* Purpose of the study was to determine if diabetes mellitus (DM) is associated with an increased likelihood of surgery-related pressure ulcers (PrU); authors evaluated 6 studies (2453 patients).
* Authors found that patients with DM were twice as likely to develop a perioperative PrU when compared to patients with normal glucose levels.
What does this mean to me and my practice?
Study suggests that DM is a risk factor for perioperative pressure ulcers and should be incorporated into any tool developed to predict risk of perioperative pressure ulcer development. (There is currently no tool to determine risk for perioperative PrUs.)
W36. Using Temperature of Pressure-Related Intact Discolored Areas of Skin to Detect Deep Tissue injury: An Observational, Retrospective Correlational Study
Farid KJ, Winkelman C, Rizkala A, Jones K. Ostomy Wound Management. 2012;58(8):20-31.
Article Type: Research study
Description/Results:
* Authors evaluated skin temperature and capillary refill in stage I pressure ulcers (PrUs) that progressed to deep tissue injuries (DTIs) and those that did not progress.
* A total of 85 acute care patients with stage I PrUs were assessed by a certified wound care nurse at baseline and reassessed 7 to 14 days later for skin necrosis.
* Among patients with cool skin, 52.7% progressed to DTIs, as compared to 3.3% among patients with warm skin (P < .0001); among patients with capillary refill > 3 seconds, 60% progressed to DTI, as compared to 21.8% among patients with capillary refill < 3 seconds (P < .0001).
* Skin necrosis occurred in 65.4% of patients with absent capillary refill and cool skin versus 0% of patients with warm skin with adequate skin perfusion.
What does this mean to me and my practice?
Provides initial evidence that skin temperature and capillary refill may help to identify stage I PrUs that are likely to progress to DTIs.
W37. Prospective, Nonrandomized Controlled Trials to Compare the Effect of a Silk-Like Fabric to Standard Hospital Linens on the Rate of Hospital-Acquired Pressure Ulcer
Coladonato J, Smith A, Watson N, Brown A, McNichol LL, Clegg A, et al. Ostomy Wound Management. 2012;58(10):14-31.
Article Type: Research study
Description/Results:
* Authors compared the use of a synthetic antimicrobial fabric (nylon/polyester) designed to minimize friction/shear and to wick moisture to standard hospital textiles (100% cotton or 50/50 cotton/polyester blend) for hospital bed linens, underpads, and gowns; the outcome endpoint was pressure ulcer (PrU) development.
* A total of 582 patients on 2 units (medical renal and surgical intensive care) were studied; supportive care protocols for each group remained the same.
* PrU development in the standard textile group was higher than the intervention arm, 12.3% and 4.6%, respectively (P = .01).
What does this mean to me and my practice?
Provides initial evidence that a different type of textile weave that wicks moisture, manages bioburden, and reduces friction and shear may help to prevent PrU formation. Further investigative study is needed.
W38. An In Vitro Quantification of Pressures Exerted by Earlobe Pulse Oximeter Probes Following Reports of Device-Related Pressure Ulcers in ICU Patients
Goodell TT. Ostomy Wound Management. 2012;58(11):30-34.
Article Type: Research study
Description/Results:
* The purpose of this study was to assess the pressure of a pulse oximetry earlobe probe applied to earlobes and the possible contribution to earlobe device-related pressure ulcers (PrU).
* Mean pressure exerted upon the load cell was 20.7 mm Hg (95% CI: 18.1-24.1); this is high for fragile tissue and may exceed capillary closing pressures, which range from 6 to 48 mm Hg.
What does this mean to me and my practice?
Provides objective data that pulse oximetry probes applied to a vulnerable anatomic site (the earlobe) can lead to development of a PrU.
W39. Eradication of Methicillin-Resistant Staphylococcus aureus in Pressure Ulcers Comparing a Polyhexanide-Containing Cellulose Dressing With Polyhexanide Swabs in a Prospective Randomized Study
Wild T, Bruckner M, Payrich M, Schwarz C, Eberlein T, Andriessen A. Advances in Skin and Wound Care. 2012;25(1):17-22.
Article Type: Research study
Description/Results:
* A total of 30 patients with persistent methicillin-resistant Staphylococcus aureus unresponsive to use of topical agents including silver and iodine were randomized to 1 of 2 groups: patients in group 1 underwent wound cleansing with PHMB (polyhexamethylene biguanide)-impregnated swabs for 20 minutes followed by application of a foam dressing and repeated Q 2 days; and patients in group 2 underwent wound cleansing with saline followed by application of a hydrobalance dressing impregnated with PHMB, changed every 2 days on average. Patients in both groups had semiquantitative swab cultures taken on days 0, 7, and 14. Additional outcomes measures included patient-reported pain using a 10-point visual analog scale, and digital wound photographs analyzed with a digital tool.
* At day 14, methicillin-resistant Staphylococcus aureus was eradicated in 66.67% of the patients in the cleansing protocol, and in 100% of patients in the dressing protocol. Digital analysis of the wound photographs revealed enhanced granulation tissue formation in the dressing group; patients also reported reduced pain (from VAS score of 7.4 at baseline to 1.3 on day 14, as compared to a change from 6.8 at baseline to 3.22 at day 14 in the cleansing group).
What does this mean for me and my practice?
Results suggest that sustained release antimicrobial dressings may be more effective in eradicating surface bacteria than cleansing with an antimicrobial agent. However, more study is needed since this was a very small sample size and involved only pressure ulcers colonized with methicillin-resistant Staphylococcus aureus.
W40. A Comparison Between the Use of Intravenous Bags and the Heelift Suspension Boot to Prevent Pressure Ulcers in Orthopedic Patients
Bales I. Advances in Skin and Wound Care. 2012;25(3):125-131.
Article Type: Research study
Description/Results:
* Study involved a convenience sample of orthopedic patients who were alternately assigned to heel protection with an intravenous bag or heel protection with a commercial heel suspension boot.
* The commercial heel suspension boot provided significantly better outcomes (0/15 patients with commercial boot developed S/S of pressure, as compared to 6/15 of patients with intravenous bags).
What does this mean for me and my practice? Provides objective data that commercially available heel suspension boots provide better outcomes than the use of products such as intravenous bags that were not designed for heel and Achilles tendon protection.
W41. Use of High-Frequency Ultrasound to Detect Heel Pressure Injury in Elders
Helvig E, Nichols LW. Journal of Wound, Ostomy and Continence Nursing. 2012;39(5):500-508.
Study Type: Research study
Description/Results:
* Goals were to examine the usefulness of high-frequency ultrasound (HFU) to detect heel pressure ulcers (PrU) in geriatric medical patients, and to expand nursing knowledge about PrU development.
* Sample consisted of 100 individuals > 65 years, with at least 1 heel that showed no evidence of pressure injury, and admission in the past 28 days. Visual assessment and ultrasound scans were done on the PrU free heel, and patients were followed with visual assessment and scans at routine intervals. Heels were protected by elevation per hospital protocol and compliance was charted.
* Results suggest that HFU may be helpful in early identification of heel pressure ulcers.
What does this mean to me and my practice?
Valuable information for clinicians interested in implementation of HFU as a diagnostic tool.
W42. Autonomic Dysreflexia: Be Aware and Be Prepared
Parikh R, Franzen M, Gould L. Wounds. 2012;24(6):160-167.
Article Type: Case study
Description/Results:
* Authors report the case of a 57-year-old male with C5 quadriplegia who developed autonomic dysreflexia (AD) during sharp debridement and excision of a stage IV pressure ulcer. The patient's symptoms included hypertension, headache, diaphoresis, and anxiety.
* The authors propose an increased risk of AD in spinal cord injured-patients undergoing wound debridement due to the effect of noxious cutaneous stimuli on the sympathetic nervous system, and recommend spinal or general anesthesia rather than local anesthesia for wound debridement in patients with a prior history of AD.
* Authors also provide a clinical summary of AD and flowchart/treatment protocol.
What does this mean for me and my practice?
Provides valuable information and alerts for any clinician providing wound care and debridement for spinal cord injured patients.
W43. Anesthesia Protocol for Heel Pressure Ulcer Debridement
O'Neill D, Tsui S, Ayello E, Cuff G, Brem H. Advances in Skin and Wound Care. 2012;25(5):209-219.
Article Type: Integrative review
Description/Results:
* Reviews reasons for debridement of heel ulcers when goal is healing, to include the importance of wide debridement of wound edges to remove nonfunctional fibroblasts at wound edge.
* Provides in-depth discussion of rationale and guidelines for use of regional anesthesia for heel ulcer debridement, to include preoperative workup, intraoperative management, and postoperative care.
What does this mean for me and my practice?
Provides helpful review of the science underlying both wide excisional debridement of heel ulcers when goal is healing, and regional anesthesia for ulcer debridement. Note standard of care for uninfected ulcers covered with dry eschar remains "leave it alone" when goal is maintenance.
Nutrition
W44. Nutrition Implications for Postsurgical Wound Healing
Kondrack NL. Ostomy Wound Management. 2012;58(2):10-13.
Article Type: Integrative review
Description/Results:
* Provides a summary of current evidence regarding impact of nutrition on postsurgical wound healing, prevention of surgical site infection, and postoperative complications. Includes discussion of ERAS (enhanced recovery after surgery) protocols, which include the use of probiotics, carbohydrate loading.
* Authors discuss nutritional guidelines for patients with BMI > 30 (2.0-2.5 g protein/kg ideal body weight) and benefits of immunomodulating nutrients such as omega-3 fatty acids and arginine. (Authors also identify situations in which arginine is contraindicated.)
What does this mean to me and my practice?
Provides essential nutrition information for any wound care clinician who works in the perioperative setting. Reemphasizes the importance of consulting with a dietician in wound healing, especially in the critical care setting.
W45. Tips for Utilizing MyPlate With Patients With Wounds
Collins N, Koontz E. Ostomy Wound Management. 2012;58(5):12-14.
Article Type: Integrative review
Description/Results:
* Provides review of downloadable handouts (available at http://www.ChooseMyPlate.gov) that the clinician can use to educate patients about role of nutrition in wound healing.
* Provides a practical guide for health care practitioners to individualize nutritional recommendations and meal planning based on lifestyle, eating preferences, and avoidance of empty calories.
What does this mean to me and my practice?
Very helpful tools that could be used by any wound care clinician who is responsible for providing nutritional education and recommendations.
W46. Diabetes and Wounds: Weight Loss as a Preventative Strategy
Collins N, Sloan C. Ostomy Wound Management. 2012;58(8):8-12.
Article Type: Integrative review
Description/Results:
* Reviews the importance of weight loss for diabetic patients with wounds and presents specific therapeutic strategies based on the Transtheoretical Model of Change that can be used to discuss with patients the importance of weight loss and adherence to dietary guidelines.
* Authors introduce the use of Web site (http://www.ChooseMyPlate.gov) to identify ADA-recommended snacks and meal choices that are available for patients with diabetes mellitus at all stages in the change model (Preparation, Action, or Maintenance).
What does this mean to me and my practice?
Provides clinicians with effective strategies to empower patients to implement lifestyle changes, prevent diabetic wounds, and facilitate their healing.
W47. Vitamin Supplementation: The Lingering Question in Wound Healing
Collins N, Eilender E. Ostomy Wound Management. 2012;58(6):8-11.
Article Type: Integrative review
Description/Results:
* Authors review the limited data related to vitamin supplementation as an adjunct in wound healing, and the fact that to date the only type of wounds for which nutritional guidelines have been established is pressure ulcers.
* Authors provide an in-depth explanation of the role of Vitamins A & C and of zinc and copper in wound healing, to include recommended dosages and signs of toxicity.
What does this mean to me and my practice?
Presents a good review of the role and interactions of vitamins and minerals in tissue regeneration and the need to monitor patients for side effects/toxicity.
Lower Extremity Ulcers
W48. More Frequent Visits to Wound Care Clinics Result in Faster Times to Close Diabetic Foot and Venous Leg Ulcers
Warriner R, Wilcox J, Carter M, Stewart D. Advances in Skin and Wound Care. 2012;25(11):494-501.
Article Type: Research study
Description/Results:
* Retrospective cohort study involving 206 patients with Wagner Grade I or II diabetic foot ulcers and 215 patients with venous leg ulcers from 9 wound care centers in 5 states, all of whom had achieved complete wound healing. For each type of ulcer, patients were grouped into those seen weekly and those seen every other week.
* For patients with diabetic foot ulcers, 63.8% closed within 4 weeks in the weekly visit group, compared to 2% in the every other week group; median time to closure in weekly group was 21 days versus 79 days for every other week group. For venous ulcers, 52% healed in weekly visit group at 4 weeks as compared to 0% in every other week group; median time to closure was 21 days for weekly group versus 80 days for every other week group.
What does this mean for me and my practice?
Provides limited evidence that closer follow-up may provide faster healing for patients with venous ulcers and diabetic foot ulcers, possibly due to prompt identification and management of wound-related complications.
W49. Guidelines for the Management of Wounds in Patients With Lower-Extremity Venous Disease
Kelechi T, Johnson J. Journal of Wound, Ostomy and Continence Nursing. 2012;39(6):598-606.
Article Type: Research report/evidence-based guideline summary
Description/Results:
* Provides an executive summary of the 2011 update of Lower Extremity Venous Disease (LEVD) evidence-based guideline produced by WOCN; provides level of evidence for each recommendation.
* Provides both prevention and intervention strategies, to include recommendations for edema management, nutritional support, topical therapy, pain management, medications, and adjunctive therapies.
* Provides a comprehensive reference list, glossary of terms, and appendices on cellulitis, eczema, edema, and compression therapy.
What does this mean to me and my practice?
Essential reference for any clinician providing care for patients with lower extremity venous disease.
W50. WOC Nurse Consult: Misconceptions About the Ankle Brachial Index
Bonham P. Journal of Wound, Ostomy and Continence Nursing. 2012;39(1):47-48
Article Type: Integrative review
Description/Results:
* Provides clear evidence-based guidelines for correct performance, calculation, and interpretation of Ankle Brachial Index measurements; also provides resources for clinicians to update skills.
* Key points include having patient remain supine for 10 minutes prior to testing; using correctly sized blood pressure cuff; using highest brachial pressure for both right and left ABI calculation; obtaining both DP and PT pressures for each extremity and using the highest of the 2 values for calculation; the use of Doppler for all pressures.
What does this mean to me and my practice?
Extremely valuable reference for any clinician providing assessment or management of patients with lower extremity ulcers.
W51. Sickle Cell Disease and Leg Ulcers (CE Article)
Ladizinski B, Bazakas An, Mistry N, Alvai A, Sibbald G, Salcido R. Advances in Skin and Wound Care. 2012;25(9):420-430.
Article Type: Integrative review
Description/Results:
* Authors review pathology of sickle cell disease and sickle cell ulcers and provide concise guidelines for wound management (to include indications for compression therapy, importance of pain management, and importance of prompt identification and treatment of soft tissue infection and osteomyelitis).
* Authors also review currently available and emerging therapies for systemic therapy, including blood transfusions and drug therapy to increase levels of HbF (fetal hemoglobin) as opposed to HbS (sickle cell hemoglobin): hydroxyurea; arginine butyrate (not currently approved for sickle cell ulcers); and inhaled nitric oxide gas or L-arginine administered as a dietary supplement.
What does this mean for me and my practice?
Very helpful and concise review of therapy guidelines and options for clinicians caring for patients with sickle cell ulcers.
W52. Martorell Hypertensive Ischemic Leg Ulcer: An Underdiagnosed Entity
Alavi A, Mayer D, Hafner J, Sibbald RG. Advances in Skin and Wound Care. 2012;25(12):563-574.
Article Type: Integrative review
Description/Results:
* Reviews pathology, clinical presentation, diagnosis, and management of Martorell hypertensive ischemic leg ulcers and provides clear guidelines for differentiating between these lesions and arterial ulcers (location, pain pattern, and biopsy results).
* Authors provide data suggesting that these lesions are becoming more common and are frequently misdiagnosed and mismanaged (surgical debridement and skin graft are usually the most effective management).
What does this mean for me and my practice?
Very helpful for any clinician caring for patients with lower extremity wounds.
W53. Malignant Melanoma Misdiagnosed as a Diabetic Foot Ulcer
Ata A, Polat A, Tanr[latin dotless i]verdi F, Ar[latin dotless i]can A. Wounds. 2012;24(2):43-46.
Article Type: Case study
Description/Results:
* Authors report the case of a 55-year-old male with a 5-month history of a foot ulcer diagnosed as a diabetic foot ulcer. The patient underwent debridement, silver-based topical agents, and antibiotic therapy without success. At 5 months, an incisional biopsy confirmed malignant melanoma; the patient was also diagnosed with liver and brain metastasis and expired within a few weeks of the diagnosis.
* The authors point out that while malignant melanomas account for only 4% of all skin cancers, 80% of skin-cancer related deaths are attributed to this disease. Fourteen malignant melanoma cases misdiagnosed as diabetic foot ulcers are summarized.
What does this mean for me and my practice?
The case study highlights the impact of delayed diagnosis of malignant melanomas of the foot and emphasizes the importance of early biopsy if neuropathy or ischemia is not present.
W54. A Retrospective, Longitudinal Study to Evaluate Healing Lower Extremity Wounds in Patients With Diabetes Mellitus and Ischemia Using Standard Protocols of Care and Platelet-Rich Plasma Gel in a Japanese Wound Care Program
Sakata J, Sasaki S, Handa K, Uchino T, Sasaki T, Higashita R, et al. Ostomy Wound Management. 2012;58(4):36-49.
Article Type: Research study
Description/Results:
* Authors utilized Japanese wound center database to identify 39 patients with 40 chronic, nonhealing lower extremity wounds (diabetic, ischemic, and one pressure ulcer); all had failed standard treatment (average of 75 days of therapy).
* Wounds were treated with topical platelet-rich plasma (PRP) gel treatment; the number of treatments ranged from 1 to 17 (mean = 5). A total of 83% of these wounds healed within 145.2 days (P = .00002).
* Statistical analysis showed that increased wound area, wound age, hypertension, and >8 PRP gel treatments were associated with poorer outcomes whereas prior revascularization and a moderate (vs severe) wound infection were associated with greater potential for healing.
What does this mean to me and my practice?
Provides evidence that PRP gel treatment may be beneficial for recalcitrant wounds that fail standard wound care; PRP gel is believed to act through molecular and cellular stimulation of the normal wound healing process.
W55. Composite Fat and Skin Grafting for the Management of Chronic Sickle Cell Ulcers
Bartsich S, Morrison N. Wounds. 2012;24(3):51-54.
Article Type: Case study
Description/Results:
* The authors highlight the challenging and often-relapsing course of chronic sickle cell ulcers. Fat grafting has been performed to restore bulk in facial anomalies, burn scars, irradiated skin, and chronic open wounds. Grafted adipose tissue is suggested to produce lasting changes in local tissues including increased tissue bulk and improved vascularity.
* Authors report on case where skin graft with autologous fat grafting was used to treat a chronic sickle cell ulcer of 1-year duration that had previously failed local wound care and skin grafts. The wound remained closed at 2 months postoperatively.
What does this mean for me and my practice?
Although further study is needed, the case suggests that fat grafting may promote healing in otherwise refractory chronic sickle cell ulcers.
W56. The Effect of Pentoxifylline on Chronic Venous Ulcers
Parsa H, Zangivand A, Hajimaghsoudi L. Wounds. 2012;24(7):190-194.
Article Type: Research study
Description/Results:
* Authors report results of randomized controlled trial on efficacy of pentoxifylline in treating chronic venous ulcers; 40 patients were randomized to a control or interventional group. Both groups received standard compression therapy, and the intervention group also received pentoxifylline 400 mg 3 times a day. Outcomes measures included time to healing and reduction in edema, pain, and ulcer size.
* Results showed that at 3 months, the treatment group showed improvement in mean time to complete healing (P = .007) and mean ulcer size (P = .02).
What does this mean for me and my practice?
The results of the study provide limited evidence that pentoxifylline plus compression therapy is beneficial in increasing the healing rate of chronic venous ulcers.
W57. A Prospective, Single-Center, Nonblinded, Comparative, Postmarket Clinical Evaluation of a Bovine-Derived Collagen With Ionic Silver Dressing Versus a Carboxymethylcellulose and Ionic Silver Dressing for the Reduction of Bioburden in Variable-Etiology, Bilateral Lower-Extremity Wounds
Manizate F, Fuller A, Gendics C, Lantis J. Advances in Skin and Wound Care. 2012;25(5):220-225.
Article Type: Research study
Description/Results:
* Authors review negative impact of high bioburden on wound healing, to include impact of high MMP levels; also discuss potential benefits of collagen-based dressing in management of chronic wounds.
* Study involved 10 patients with bilateral leg ulcers; one ulcer was treated with the collagen-silver dressing and one was treated with carboxymethylcellulose-silver dressing; wounds were cultured at weeks 1 and 4, and wound surface area was measured weekly.
* There was an increase in bacterial loads in all wounds, with no statistical difference between the 2 groups and no correlation between bioburden and wound size. The collagen dressing was associated with a higher rate of wound closure, but the difference was not statistically significant.
What does this mean for me and my practice?
Provides helpful review of impact of chronic inflammation on wound healing, along with potential benefit of collagen-based dressings. Findings raise questions regarding the effectiveness of silver-based dressings in reducing bacterial loads, but sample size is too small to permit any conclusions or to derive implications for clinical practice.
W58. Hyperbaric Oxygen Therapy for Chronic Wounds
Kranke P, Bennett MH, Martyn-St James M, Schnabel A, Debus SE. Cochrane Collaboration. 2012;4:1-62 Art. No.: CD004123. DOI: 10.1002/14651858.CD004123.pub3.
Article Type: Systematic literature review
Description/Results:
* Review of current literature was conducted to assess the clinical benefits and safety of adjunctive hyperbaric oxygen therapy (HBOT), used in conjunction with a standard wound care regimen for treatment of chronic lower extremity wounds (diabetic foot ulcers, DFU, and venous insufficiency wounds). Insufficient data existed to include arterial and pressure ulcer wounds in this review.
* At 6 weeks, a statistically significant improvement in healing was demonstrated with HBOT; however, this benefit did not persist at 18 weeks, 6 months, or 1 year of follow-up. HBOT treatment did not reduce minor amputation rates, and there is inconclusive evidence as to the effect of HBOT on major amputation rates.
* Statistically significant improvements were demonstrated in transcutaneous oxygen levels (P = .0001) for the affected diabetic foot, but this did not translate into improved long-term wound healing.
* No major adverse events were observed; minor events included barotrauma and claustrophobia.
What does this mean to me and my practice?
Provides a concise summary of the evidence related to the use of HBOT for management of neuropathic and venous ulcers; no long-term benefits were found with these wounds. HBOT may be beneficial for arterial ulcers; the impact of HBOT on healing of these wounds was not investigated due to an insufficient number of studies.
Atypical Wounds, Burns
W59. Twelve Common Mistakes in Pilonidal Sinus Care
Harris C, Laforet K, Sibbald RG, Bishop R. Advances in Skin and Wound Care. 2012;25(7):324-334.
Article Type: Integrative review
Description/Results:
* Provides clinically relevant guidelines for effective management of pilonidal sinus wounds, based on both literature review and clinical experience.
* Key points include prompt recognition and management wound infection, consistent hair removal, wound cleansing following bowel movements, and dressings that manage exudate and also maintain separation of the 2 opposing wound surfaces.
What does this mean for me and my practice?
Provides very helpful guidelines for any clinician who manages patients with pilonidal sinus wounds.
W60. Atypical Ulcers: Wound Biopsy Results From a University Pathology Service
Tang J, Vivas A, Rey A, Kirsner R, Romanelli P. Ostomy Wound Management. 2012;58(6):20-39.
Article Type: Research study
Description/Results:
* A study of 350 tissue biopsies was performed over a 2-year period in 1 wound pathology center.
* The tissue specimens were received from wound healing centers across the United States and categorized by diagnosis.
* Of the 350 biopsies, 104 (29.7%) were diagnosed as atypical. Histopathologic diagnostic frequency was as follows: malignancy (24), vasculitis (18), external-radiation, arthropod, factitial, or self-imposed (15), pyoderma gangrenosum (14), calcific uremic arteriolopathy/calciphylaxis (9), infectious (3), sickle cell disease (1), hypertensive ulcer (10), and lupus (6).
What does this mean to me and my practice?
Reemphasizes the need to obtain a wound biopsy when wounds fail to respond to optimal care or the chronic wound appears unusual. The article provides review of various atypical wounds with the histopathologic and special stain features described.
W61. The Management of Intravenous Infiltration Injuries in Infants and Children
Treadwell T. Ostomy Wound Management. 2012;58(7):40-44.
Article Type: Integrative review
Description/Results:
* Authors discuss risk factors for extravasation injuries (age, catheter gauge, type of catheter, skin color, and types of infused fluids or medications) and provide guidelines for treatment to include indications for the use of hyaluronidase, phentolamine, or nitroglycerin ointment.
What does this mean to me and my practice?
Provides a structured protocol for management of extravasation injuries in the pediatric population; would be helpful to any clinician working with these patients.
W62. Evidence for Interventional Procedures as an Adjunct Therapy in the Treatment of Shingles Pain
Shannon H, Anderson J, Damle J. Advances in Skin and Wound Care. 2012;25(6):276-284.
Article Type: Integrative review
Description/Results:
* Summarizes importance of effective management of pain associated with herpes zoster to prevent post herpetic neuralgia and provides guidelines for appropriate use of various medications, including lidocaine, capsaicin, tricyclic antidepressants, anticonvulsants, and opioids.
* Describes specific interventional procedures (various nerve blocks) that can be used for management of HZ pain refractory to medications; includes contraindications and adverse effects for each procedure.
What does this mean for me and my practice?
Concise summary of HZ pain management options and guidelines for any clinicians caring for these patients.
W63. Quality of Pediatric Second-Degree Burn Wound Scars Following the Application of Basic Fibroblast Growth Factor: Results of a Randomized, Controlled Pilot Study
Hayashida K, Akita S. Ostomy Wound Management. 2012;58(8):32-36.
Article Type: Research study
Description/Results:
* Pilot study comparing daily application of basic fibroblast growth factor (bFGF)+ conventional treatment to conventional treatment alone in 20 pediatric patients with deep second-degree burns.
* The study endpoints were burn closure time, hyperpigmentation, and hypertrophic scarring.
* Burn wounds healed faster in the bFGF group than in the control group, 13.8 (+/- 2.4) days compared to 17.5 (+/- 3.1) days, respectively. Outcomes related to skin color and hypertrophic scar development were also better in the bFGF group (both P < .01).
What does this mean to me and my practice?
Provides preliminary evidence that the use of bFGF may enhance healing of deep second-degree burns in pediatric patients. Further study is needed.
W64. Systematic Review and Meta-analysis on the Use of Honey to Protect From the Effects of Radiation-Induced Oral Mucositis
Song J, Twumasi-Ankrah P, Salcido R. Advances in Skin and Wound Care. 2012;25(1):23-28.
Article Type: Systematic review
Description/Results:
* Provides review of current theory regarding pathology of mucositis in patients receiving radiation, and potential mechanisms by which honey may reduce the risk of mucositis.
* Included results of 3 studies involving 120 patients receiving radiation therapy for head and neck cancer who were treated prophylactically with honey. In this meta-analysis, there was an 80% reduction in mucositis among patients treated with honey.
What does this mean for me and my practice?
Suggests that honey may be effective in reducing the incidence of mucositis, but the limited number of studies and methodologic weaknesses in the studies involved limits the ability to generalize results; more studies are needed.
Professional Practice
W65. More Than Skin Deep: Developing a Hospital-wide Wound Ostomy Continence Unit Champion Program
Taggart E, McKenna L, Stoelting J, Kirkbride G, Mottar M. Journal of Wound, Ostomy and Continence Nursing. 2012;39(4):385-390.
Article Type: Quality improvement project
Description/Results:
* The authors describe the development of a unit-based skin champion program to improve patient outcomes; they based their program on Donabedian's approach (structure, process, outcomes); they address both the positive aspects and the challenges associated with program development.
* Outcomes included reduction in HAPU (from 7% to 4% in first year) and increased staff satisfaction.
What does this mean to me and my practice?
Would be very helpful to any WOC nurse contemplating development of a WOC resource team as part of an overall program to improve patient outcomes.
W66. Developing the Standardized Wound Care Documentation Model: A Delphi Study to Improve the Quality of Patient Care Documentation
Kinnunen UM, Saranto K, Ensio A, Iivanainen A, Dykes P. Journal of Wound, Ostomy and Continence Nursing. 2012;39(4):397-407.
Study Type: Research study
Description/Results:
* Authors used Delphi approach to develop a documentation model for use in an electronic medical record (EMR); intent is to promote systematic documentation of wound assessment and wound care.
* Authors note that previous studies have demonstrated improved quality of documentation, reduced documentation errors, and positive RN attitudes associated with the use of EMR.
What does this mean to me and my practice?
Relevant to wound care clinicians in any setting moving toward the use of EMR.
W67. Construction and Use of Wound Care Guidelines: An Overview
Al-Benna. Ostomy Wound Management. 2012;58(8):37-47.
Article Type: Integrative review
Description/Results:
* Author reviews the process for multidisciplinary development of evidence-based clinical guidelines and their potential value to the wound care clinician.
* Strategies for effective implementation of evidence-based guidelines are also presented, as well as examples of wound care guidelines and algorithms.
What does this mean to me and my practice?
Beneficial to any clinician who is committed to maintaining an evidence-based practice.
W68. Using Science to Advance Wound Care Practice: Lessons From the Literature
Bolton LL, Baine WB. Ostomy Wound Management. 2012;58(9):16-31.
Article Type: Integrative review
Description/Results:
* Presents a historical and practical discussion of how evidence-based (EB) medicine can be applied to wound care using strategies, tools, and tactics to improve clinical and fiscal outcomes.
* Authors provide a list of EB resources and clinical tools
What does this mean to me and my practice?
Provides insight into the relevance and status of EB practice in relation to wound care; reminds clinicians that clinical decision-making must be based on evidence rather than opinion.
W69. Pressure Ulcer Care and Public Policy: Exploring the Past to Inform the Future
Lyder C, Ayello E. Advances in Skin and Wound Care. 2012:25(2):72-76.
Article Type: Regulatory review
Description/Results:
* Provides review of regulations currently affecting skin and wound care in all settings, and their impact: includes review of OBRA, F-Tag 314, and minimum data set, and potential citations and penalties for failure to provide appropriate care in the long-term care setting; discussion of changes in reimbursement for hospital-acquired pressure ulcers and implications for accurate documentation of ulcers present on admission, and for prevention of hospital-acquired ulcers; changes in reimbursement (OASIS C) in home care; and new Inpatient Rehabilitation Facility Reporting requirements on new or worsening pressure ulcers.
* Provides a summary of impact of regulatory changes: increased focus on pressure ulcer prevention and on accurate assessment and documentation of pressure ulcer status, and documented reduction in incidence of agency-acquired pressure ulcers.
What does this mean for me and my practice?
Provides very helpful review of current regulatory guidelines related to pressure ulcer prevention in all care settings; would be of particular benefit to nurses who serve as expert reviewers in pressure ulcer cases.
W70. MDs, DPMs, and NPPs: Do You Know What Was Submitted on Your Medicare Claims?
Schaum K. Advances in Skin and Wound Care. 2012;25(7):301-303.
Article Type: Regulatory update
Description/Results:
* Reviews common errors in coding and billing for outpatient wound care services, and addresses responsibilities of wound care providers in assuring accuracy in billing.
What does this mean for me and my practice?
Provides essential information for any wound care provider working in an outpatient setting.
W71. 2012 Financial Outlook: Hospital-Based Outpatient Wound Care Departments
Schaum K. Advances in Skin and Wound Care. 2012;25(3):108-112.
Article Type: Regulatory review
Description/Results:
* Provides concise review of changes in payment for wound care services provided in Hospital Outpatient Departments, including surgical and nonsurgical debridement, compression wraps, negative pressure wound therapy, hyperbaric oxygen therapy, ultrasound, and skin and dermal substitutes.
What does this mean for me and my practice?
Provides critical information for any clinician who has primary or shared responsibility for accurate billing in an HOPD.
W72. Is It a Suction Pump for Use on Wounds or Is It a Negative Pressure Wound Therapy Pump?
Schaum K. Advances in Skin and Wound Care. 2012;25(9):394-398.
Article Type: Regulatory update
Description/Results:
* Provides update on CMS definitions and coverage guidelines for negative pressure wound therapy systems and wound suction pumps (devices that provide dressings and pumps but no separate canister for wound drainage).
* Addresses importance of obtaining signed order for NPWT prior to delivery of the supplies in order to avoid a noncoverage decision and also discusses guidelines for continued use of NPWT in the home/outpatient setting.
What does this mean for me and my practice?
Provides essential information for clinicians ordering or managing NPWT and suction devices in the home and outpatient setting.
W73. 3-Day Payment Window Policy Q & A
Schaum K. Advances in Skin and Wound Care. 2012;25(8):345-348.
Article Type: Regulatory update
Description/Results:
* Provides explanation and clarification of CMS rule that services provided to a patient in a hospital owned outpatient department (HOPD) within 3 days preceding admission to the inpatient facility are considered part of the inpatient stay, if the services provided in the outpatient clinic are related to the reason for admission.
* Provides guidelines for billing for such services that meet established criteria.
What does this mean for me and my practice?
Critical information for any wound clinician working in a hospital-owned outpatient department.
W74. A Global Perspective of Wound Care
Sibbald G, Ayello E, Smart H, Goodman L, Ostrow B. Advances in Skin and Wound Care. 2012;25(2):77-86.
Article Type: Editorial
Description/Results:
* Provides review of health care systems and implications for advancement of evidence-based wound care across the globe; includes advantages and disadvantages of various health systems and the different challenges faced by "resource-rich" versus "resource-poor" countries. Also provides a summary of resources available to advance evidence-based practice, including evidence-based guidelines, accredited educational programs, and certification programs.
* Includes discussion of ways in which resource-rich and resource-poor countries can collaborate to advance care in both settings.
What does this mean for me and my practice?
Provides insight into wound care and health care around the world and ways in which "wound care as we know it" must be modified based on economic, cultural, and religious customs in other countries.