ICT asked members of industry to share some best practices related to proper wound care/pressure ulcer prevention and treatment modalities for infection control.
3M: Effective management of moisture in low to high exudating wounds is critical for optimized wound healing and quality of life. A high-exuding wound can result in excessive moisture and periwound skin maceration, which may delay wound healing and cause patient discomfort. Conversely, a low exudating wound can cause wound bed desiccation or dressing adherence, both of which also can lead to significant patient discomfort. Further, a dry environment may reduce the rate of re-epithelialization and slow the healing process. When selecting a dressing to cover either kind of wound, it is critical that the dressing provide a balanced moisture environment to promote healing and prevent additional skin damage.
Covidien: Proper wound care requires clinicians to make decisions about the wound, regardless of the underlying etiology. This decision must factor in the amount of drainage in order to maintain a moist wound environment. This concept should be followed regardless of the dressing material utilized. The Kendall AMD family of dressings (both gauze and foam) provides the clinician the ability to provide a moist wound environment and microbial barrier without changing protocols. The dressings kill common problematic bacteria like MRSA, VRE, and pseudomonas as well as yeast and fungi. The Kendall AMD dressings also can be used with most other wound care products this provides clinicians the ability to use their preferred products while receiving benefit of a microbial barrier from the PHMB impregnated products. Recent studies have shown reductions ranging from 24.1 percent to 81.3 percent in the overall infection rate by adding the Kendall AMD products to the existing infection control practices.(1-2)
1. Mueller SW and Krebsbach LE. Impact of an antimicrobial-impregnated gauze dressing on surgical site infections including methicillin-resistant Staphylococcus aureus infections. Am J Infect Control. 36(9):651-655. 2008.
2. Lovelace L. Just when you thought your statistics were good enough. APIC News. Winter 2007/2008: 25-30.
Medline Industries: Evidence based practice strategies or clinical practice guidelines for the care of individuals with Lower-Extremity Wounds as well as patients with pressure ulcers have been published by the Wound, Ostomy and Continence Nurses Society (WOCN) and are accepted and used as expert opinion for healthcare professionals who work with patients who are at risk for developing wounds or who have existing wounds. Currently there are not specific prevention interventions cited for Infection Control. However, overall management goals include the risk assessment and identification of risk factors that increase the chance of developing a pressure ulcer. Risk factors that may place individuals at higher risk or that may impede healing status include patients with diseases or health status that makes them susceptible to complications such as bacteremia, sepsis, osteomyelitis and pneumonia. Best practice strategies to minimize infection and to optimize wound healing do recognize that wounds as well as the periwound skin be cleansed at each dressing change. Removing pathogens and surface contaminants allows the wound to move more rapidly from the inflammatory phase to the proliferative phase of wound healing. Commercial wound cleansers utilize non-ionic surfactants that not only reduce surface tension but also minimize mechanical trauma that help to release and remove wound contaminants. The evidence-based guidelines also reference antimicrobial silver dressings as a topical treatment option for wounds suspected to be colonized or infected with multiple organisms as these dressings offer broad antimicrobial coverage.
Smith & Nephew: Prevention of pressure ulcers begins with the assessment of the causal factors that are related to skin damage: pressure, moisture, friction, and shear. A patient centered plan of care should address these factors. For example, patients who are immobile or have limited activity are at risk for pressure damage. Friction and shear often occur during movement and re-positioning of the patient and can be minimized with proper training. Moisture is a risk factor most often associated with incontinence, which can put skin at risk. Accurate assessment also plays an important role in wound care. Factors such as size, depth, tunneling, appearance of wound bed and condition of periwound skin will guide you in the decision of the appropriate wound management intervention, whether it is a topical dressing or NPWT. Other factors to consider include the need for debridement, exudate, bacterial load, and maintenance of a moist wound environment. Evaluate the wound daily and/or at each dressing change and anticipate progress in 10 to 14 days. If the patient is not progressing as anticipated, then re-assess the overall plan for factors contributing to delayed healing and re-assess the wound care intervention.
How has evolving wound care product technology helped clinicians provide more effective wound management/treatment/prevention?
3M: New technologies are addressing key wound treatment goals, such as fluid management properties, breathability, absorption and ultimately length of dressing wear. Longer wear times support not only patient comfort and an optimal wound-healing environment, but also the economic health of healthcare organizations. Fewer dressing changes may save clinicians time and reduce dressing waste.
Covidien: As technology advances, clinicians gain the ability to select dressings that simplify the selection process by providing multiple features and benefits. Many new dressing technologies extend wear times by adding antimicrobial technology or by incorporating other factors such as low friction topsheets with high moisture vapor transmission rates (MVTR). By combining these components many complications such as maceration, friction and shear injuries may be avoided. An example of this technology can be found in the Kendall AMD antimicrobial bordered foam dressings. The Kendall AMD bordered foam dressings incorporate all of these factors to simplify the dressing selection process and to help prevent complications such as maceration, friction and shear injuries. When dressings become smarter, both the clinicians and patients benefit as the dressings help manage factors that often delay healing. These dressings also provide cost benefits as they may grant longer wear times while helping to manage or prevent additional complications.
Medline Industries: Todays wound care clinicians most definitely have hundreds of wound care products available, backed by evolving new evidence and scientific rationales. The advent of antimicrobials combined with moisture retentive technology as well as the bio-signaling technologies such as collagen, growth factors and biomaterials has allowed for significant advances in wound healing that may not have been possible before. It is our professional responsibility to reexamine our practice patterns to ensure that we are current, meeting the standard of care for wound care in the 21st century.
Smith & Nephew: Technology has advanced in a number of areas, providing more effective options in wound management. Products like ALLEVYN are highly absorbent, and provide dynamic moisture control for all levels of exudate, provide wear time up to seven days, and enhance patient comfort. Antimicrobial dressings like ACTICOAT, with its unique and patented nanocrystalline technology, are effective against a broad spectrum of over 360+ pathogens, including 188+ strains of MRSA. ACTICOAT can reduce the bacterial load in the wound by providing an effective antimicrobial barrier between the wound and the environment. Another technology example is IODOSORB, which has a unique Cadexomer Iodine formulation. It releases iodine for sustained antimicrobial activity, absorbs twice its weight in exudate, and it alerts caregiver by changing color when its time to change the dressing. Technology advances in negative pressure wound therapy are evident as pumps become smaller and easier to use. Advances and research in NPWT have provided clinicians with more choice to meet the needs of the wound and the patient and recent clinical research has validated both foam and gauze interfaces to be equally effective wound fillers.
Wound Care Product Showcase
To meet the challenges of low- to high- exudating wounds, 3M Tegaderm High Performance Foam Adhesive Dressing is scientifically formulated to adapt to changing wound environments and facilitate the bodys dynamic wound-healing process. It combines four unique layers to deliver exceptional fluid handling, which helps create the optimal moist healing environment. In clinical and laboratory tests, the dressing outperformed other leading foam adhesive dressings in managing the full range of low- to high-moisture conditions present in chronic and acute wounds. The dressing is thin, fits comfortably under clothes and is less likely to catch on material, including bedding. It is also waterproof, so patients can wear it in the shower.
AQUACEL® and AQUACEL® Ag Ribbon Dressings with Strengthening Fibers is now available for the management of moderate- to highly-exuding chronic and acute wounds. AQUACEL® Ag Dressings are indicated for wounds at risk for infection. The new dressing, half the width of the currently available dressing, is designed for use in excised abscesses and smaller wounds that tunnel below the wound surface. AQUACEL® and AQUACEL® Ag Ribbon Dressing with Strengthening Fiber is available in the standard 0.75 inches by 18 inches (2 cm by 45 cm), and new, narrower size of 0.39 inches by 18 inches (1 cm by 45 cm).
The newest addition to the Covidien Kendall AMD antimicrobial foam family of dressings is the Kendall AMD bordered foam dressings. These dressings incorporate the Polyhexamethylene Biguanide (PHMB) 0.5 percent impregnated foam that extend wear times up to seven days while killing MRSA, VRE, pseudomonas, yeast and fungi. The bordered dressings are designed to have a smooth, low friction topsheet allowing movement without transferring undue forces to the periwound tissue helping to minimize friction and shearing injuries The unique design of the Kendall AMD antimicrobial foam bordered dressing prevents microbes from growing within or penetrating through the dressing while providing directional swelling to help minimize dead space. The patented design encourages exudate absorption while promoting a moist wound healing environment.