scholarly journals Clinical impact of an anti-biofilm Hydrofiber dressing in hard-to-heal wounds previously managed with traditional antimicrobial products and systemic antibiotics

2020 ◽  
Vol 8 ◽  
Author(s):  
Daniel G Metcalf ◽  
Philip G Bowler
Keyword(s):  
Wound Closure ◽  
Wound Care ◽  
Clinical Impact ◽  
Wound Dressings ◽  
Wound Management ◽  
Therapeutic Success ◽  
Clinical Case Study ◽  
Management Technology ◽  
Systemic Antibiotics

Abstract Background Hard-to-heal wounds are often compromised by the presence of biofilm. This presents an infection risk, yet traditional antimicrobial wound care products and systemic antibiotics are often used despite the uncertainty of therapeutic success and wound progression. The aim of this study was to investigate the clinical impact of a next-generation anti-biofilm Hydrofiber wound dressing (AQUACEL Ag+ Extra[AQAg+ E]) in hard-to-heal wounds that had previously been treated unsuccessfully with traditional silver-, iodine- or polyhexamethylene biguanide (PHMB)-containing dressings and products and/or systemic antibiotics. Methods Clinical case study evaluations of the anti-biofilm dressing were conducted, where deteriorating or stagnant wounds were selected by clinicians and primary dressings were replaced by the anti-biofilm dressing for up to 4 weeks, or as deemed clinically appropriate, with monitoring via case report forms. The data was stratified for cases where traditional silver-, iodine- or PHMB-containing products, or systemic antibiotics, had been used prior to the introduction of the anti-biofilm dressing. Results Sixty-five cases were identified for inclusion, wounds ranging in duration from 1 week to 20 years (median: 12 months). In 47 (72%) cases the wounds were stagnant, while 15 (23%) were deteriorating; 3 wounds were not recorded. After an average of 4.2 weeks of management with the anti-biofilm dressing (range: 1–11 weeks), in 11 (17%) cases the wounds had healed (i.e. complete wound closure), 40 (62%) wounds improved, 9 (14%) wounds remained the same and 5 (8%) wounds deteriorated. Conclusions The introduction of this anti-biofilm dressing into protocols of care that had previously involved wound management with traditional antimicrobial products and/or antibiotics was shown to facilitate improvements in the healing status of most of these hard-to-heal wounds. Dressings containing proven anti-biofilm technology, in combination with antimicrobial silver and exudate management technology, appear to be an effective alternative to traditional antimicrobial products and antibiotics in the cases presented here. The use of antimicrobial wound dressings that contain anti-biofilm technology may have a key role to play in more effective wound management and antibiotic stewardship.

Skin problems in palliative care

2021 ◽  
pp. 613-621
Author(s):  
Sebastian Probst ◽  
Georgina Gethin
Keyword(s):  
Palliative Care ◽  
Wound Care ◽  
Skin Care ◽  
Wound Dressings ◽  
Wound Management ◽  
Care Needs ◽  
Skin Breakdown ◽  
Local Problems ◽  
Self Worth ◽  
Skin Conditions

Nursing aspects of palliative wound care are driven by patient and family goals integrated with three components of wound management: the management or palliation of the underlying cause of the wound, management of wound-related symptoms, and management of the wound and peri-wound skin. Wounds most commonly encountered include pressure ulcers, fungating malignant wounds, and fistulae. Patients with blistering skin conditions, inherited and acquired, have extensive long-standing wounds and palliative care needs. In addition, meticulous skin care for patients of all ages with debilitating long-term conditions is crucial to prevent unnecessary skin breakdown. The symptoms and local problems associated with broken skin and wounds include odour, exudate, excoriation, maceration, bleeding, pain, and pruritus. Key clinical interventions include the application of wound dressings and skin care products. Unless these are managed effectively and consistently, body image and feelings of self-worth are affected together with the ability to socialize and maintain function, including, for some people, employment.

Skin problems in palliative care

2015 ◽  
Author(s):  
Patricia Grocott ◽  
Georgina Gethin ◽  
Sebastian Probst
Keyword(s):  
Palliative Care ◽  
Wound Care ◽  
Skin Care ◽  
Wound Dressings ◽  
Wound Management ◽  
Care Needs ◽  
Long Term Conditions ◽  
Local Problems ◽  
Self Worth ◽  
Skin Conditions

Nursing aspects of palliative wound care are driven by patient and family goals integrated with three components of wound management: the management or palliation of the underlying cause of the wound, management of wound-related symptoms, and management of the wound and peri-wound skin. Wounds most commonly found include pressure ulcers, fungating malignant wounds, and fistulae. Patients with blistering skin conditions, inherited and acquired, have extensive longstanding wounds and palliative care needs. In addition, meticulous skin care for patients of all ages with debilitating long-term conditions is crucial to prevent unnecessary skin breakdown. The symptoms and local problems associated with broken skin and wounds include odour, exudate, excoriation, maceration, bleeding, pain, and pruritus, and key clinical interventions include the application of wound dressings and skin care products. Unless these are managed effectively and consistently, body image and feelings of self-worth are affected together with the ability to socialize and maintain employment.

scholarly journals Study of hydrocellular functional material as microbicidal wound dressing for diabetic wound healing

2021 ◽  
Vol 19 ◽  
pp. 228080002110549
Author(s):  
Michael Rodrigues ◽  
Thilagavati Govindharajan
Keyword(s):  
Wound Healing ◽  
Wound Dressing ◽  
Wound Care ◽  
Cost Effective ◽  
Wound Dressings ◽  
Wound Management ◽  
Histopathological Analysis ◽  
Diabetic Wound ◽  
Functional Material ◽  
Diabetic Wound Healing

A hydrocellular functional material as a wound dressing is developed and it is found to be superior in its efficacy as compared to some of the comparator controls in diabetic wound healing studies. A study on wound contraction and Histopathological analysis is done in rats. The efficacy of the dressing is comparable to the established wound dressings like Carboxymethyl cellulose alginate dressings and autolytic enzyme based hydrogel. It is found to be superior to Polyhexamethylene biguanide dressing used as reference controls in this study. The reason for good wound healing performance of the dressing can be attributed to a combined property of effective exudates management and broad spectrum antimicrobial effect. The concept of functional hydro cellular material has shown good results due to the excellent balance of exudates pickup and drying it out. This ensures moist wound healing conditions on the wound. Because of its porous nature it allows good air flow and gaseous exchange in the structure. The cationic sites created on the surface of the dressing ensure a good antimicrobial action on the exudates in the dressing. It reduces the infection load on the wound. The nonleaching property of the dressing also helps in preventing the generation of more resistant and mutant strains of the microbes. The developed dressing can be used as a relatively durable long lasting dressing for wound management in diabetic wounds. The need of repetitive wound dressing changes can be brought down with this concept of dressing. It is not only cost effective in terms of its material cost but also is a cost effective solution when entire wound management cost is considered. Such novel wound dressing material can change the quality of life of diabetic wound patients especially in developing world, where access to functional advanced wound care dressings is limited.

The Personal Impact of Daily Wound Care for Hidradenitis Suppurativa

Dermatology ◽  
2021 ◽  
pp. 1-10
Author(s):  
Suzanne Moloney ◽  
Barry M. McGrath ◽  
Davood Roshan ◽  
Georgina Gethin
Keyword(s):  
Support Groups ◽  
Hidradenitis Suppurativa ◽  
Negative Impact ◽  
Wound Care ◽  
Statistical Significance ◽  
Unmet Need ◽  
Wound Dressings ◽  
Wound Management ◽  
Online Questionnaire ◽  
Personal Impact

<b><i>Background:</i></b> Recurring nodules, abscesses, and lesions characterise hidradenitis suppurativa (HS): a chronic, inflammatory skin disorder. Globally the prevalence of HS is estimated to be around 1% of the population. Leakage, pain, and odour from HS wounds require substantial management. Little is known of the personal burdens that routine wound management imposes on the patient. <b><i>Objectives:</i></b> To evaluate how routine HS wound management impacts patients in terms of the time spent changing dressings, the number of dressings required per day, pain experienced during dressing changes, and negative impact on various domains of their personal lives. <b><i>Methods:</i></b> An anonymous online questionnaire was posted on closed social media patient support groups between April and May 2019. Pearson χ<sup>2</sup> test was used to evaluate if Hurley stages influenced the personal impact of wound care routines on patients. Statistical significance was determined as <i>p</i> value &#x3c;0.05. <b><i>Results:</i></b> In total<i>,</i> 908 people from 28 countries responded. Of these, 81% (<i>n</i> = 734) reported that regular dressing changes negatively impacted on their quality of life. Most patients, 82% (<i>n</i> = 744), experience pain during dressing changes. 16% (<i>n</i> = 142) of patients required five or more dressings daily, and 12% (<i>n</i> = 108) spend over 30 min daily tending to wounds. Patients indicated high levels of dissatisfaction with currently available wound dressings. <b><i>Conclusion:</i></b> HS wound management imposes a substantial personal burden on patients. There is a clear unmet need for HS-specific wound dressings and wound care provisions, and a greater awareness of the condition and its impact is needed among clinicians.

Orthotic management of the neuropathic foot: An interdisciplinary care perspective

2015 ◽  
Vol 39 (1) ◽  
pp. 73-81 ◽  
Author(s):  
Christopher Robinson ◽  
Matthew J Major ◽  
Charles Kuffel ◽  
Kevin Hines ◽  
Pamela Cole
Keyword(s):  
Clinical Case ◽  
Wound Care ◽  
Relevant Literature ◽  
Treatment Modalities ◽  
Patient Specific ◽  
Interdisciplinary Care ◽  
Clinical Case Study ◽  
Charcot Joint ◽  
Neuropathic Foot

Background: Clinical management of the patient with neuropathic foot is becoming commonplace in orthotic clinics worldwide. The presentations that can result from neuropathic foot are diverse, requiring clinicians to understand the pathomechanics of ulceration, infection, and Charcot joint arthropathy to provide effective interventions. Objectives: The purpose of this clinical perspective is to provide a review of the literature regarding clinical conceptsassociated with orthotic management of neuropathic foot. Study design: Literature review and clinical case study. Methods: Relevant literature were reviewed and summarized, and a clinical case study synthesizing reviewed concepts was presented. Results: Given the multifactorial nature of the neuropathic foot, treatments must be multifaceted and patient-specific to effectively address the underlying disease processes. While systemic issues such as peripheral arterial disease are treated by physicians, local issues such as foot deformity are managed by orthotists. Orthotic interventions commonly include custom footwear to reduce the risk of ulceration through creation of a protective environment or targeted plantar offloading. Patient and caregiver education to encourage management compliance is equally as important to ensure successful treatment. Conclusion: Patients with neuropathic foot benefit from an interdisciplinary care approach which engages physicians, wound care practitioners, and orthotists to treat and manage systemic and local problems. Addressing this pathology through interdisciplinary care may positively affect the patient’s health status while lowering associated healthcare costs through improved treatment efficacy. Clinical relevance The commonality of neuropathic foot and associated complications including ulceration, infection, and Charcot joint arthropathy requires that the patient care team have a fundamental understanding of these pathologies and common treatment modalities. We review orthotic treatment modalities to assist clinicians with the management of patients with neuropathic foot.

The clinical impact of hydroresponsive dressings in dynamic wound healing: Part I

2021 ◽  
Vol 30 (1) ◽  
pp. 15-24
Author(s):  
Francois Sterpione ◽  
Karine Mas ◽  
Mark Rippon ◽  
Alan Rogers ◽  
Georges Mayeux ◽  
...  
Keyword(s):  
Wound Healing ◽  
Comparative Study ◽  
Wound Dressing ◽  
Wound Closure ◽  
Clinical Effectiveness ◽  
Clinical Impact ◽  
Wound Dressings ◽  
Primary Measurement ◽  
Clinical Healing ◽  
Wound Bed Preparation

Objective: Management of any wound, either acute or hard-to-heal, might involve the use of multiple and different wound dressings in its treatment. This approach is necessary to overcome the myriad of clinical challenges the wound presents, as well as any underlying comorbidities that might affect the clinical outcomes. This article describes the clinical effectiveness of a coordinated wound dressing treatment regimen. Method: This was an open-labelled non-comparative study involving patients with a variety of hard-to-heal and acute wounds of differing levels of severity, but all of which required removal of devitalised tissue to enable wound healing to progress. The first phase used the hydroresponsive wound dressing HydroClean (PAUL HARTMANN AG, Germany). The PUSH score was used as the primary measurement parameter. Results: A total of 86 patients (38 male/48 female), with a mean age of 67.7±21.7 years, took part in the study. The results showed that the hydroresponsive dressing was effective in managing wound exudate production and promoting wound cleansing and debridement, supporting good wound bed preparation. Wound closure was observed in 16/86 (18.6%) wounds at the end of the study (20 weeks). This enabled clinicians to switch to alternative wound dressings to promote subsequent clinical healing outcomes. Conclusion: In this study, the hydroresponsive wound dressing was highly effective in preparing a clean wound bed such that the next stage of wound healing could be supported.

scholarly journals Recent advances in topical wound care

2012 ◽  
Vol 45 (02) ◽  
pp. 379-387 ◽  
Author(s):  
Sujata Sarabahi
Keyword(s):  
Wound Healing ◽  
Chronic Wound ◽  
Wound Care ◽  
Skin Grafting ◽  
Primary Objective ◽  
Wound Management ◽  
Accelerate Wound Healing ◽  
Constant Change ◽  
Healing Wounds ◽  
Systemic Antibiotics

ABSTRACTThere are a wide variety of dressing techniques and materials available for management of both acute wounds and chronic non-healing wounds. The primary objective in both the cases is to achieve a healed closed wound. However, in a chronic wound the dressing may be required for preparing the wound bed for further operative procedures such as skin grafting. An ideal dressing material should not only accelerate wound healing but also reduce loss of protein, electrolytes and fluid from the wound, and help to minimize pain and infection. The present dictum is to promote the concept of moist wound healing. This is in sharp contrast to the earlier practice of exposure method of wound management wherein the wound was allowed to dry. It can be quite a challenge for any physician to choose an appropriate dressing material when faced with a wound. Since wound care is undergoing a constant change and new products are being introduced into the market frequently, one needs to keep abreast of their effect on wound healing. This article emphasizes on the importance of assessment of the wound bed, the amount of drainage, depth of damage, presence of infection and location of wound. These characteristics will help any clinician decide on which product to use and where,in order to get optimal wound healing. However, there are no ′magical dressings′. Dressings are one important aspect that promotes wound healing apart from treating the underlying cause and other supportive measures like nutrition and systemic antibiotics need to be given equal attention.

Community nursing care for chronic wounds: a case study of optimal home treatment of a venous leg ulcer

2019 ◽  
Vol 17 (Sup5) ◽  
pp. S32-S39 ◽  
Author(s):  
Renata Batas
Keyword(s):  
Nursing Care ◽  
Chronic Wounds ◽  
Wound Care ◽  
Multidisciplinary Treatment ◽  
Aging Population ◽  
Lower Limbs ◽  
Wound Dressings ◽  
Community Nursing ◽  
Venous Leg Ulcer

Europe's aging population presents an increasing number of chronic diseases, including vascular diseases that can lead to chronic wounds. These chronic wounds carry a significant health burden for individuals and economic burden for healthcare systems. Of chronic ulcers in the lower limbs, 80–85% are venous leg ulcers (VLUs). VLUs can be treated using a combination of compression therapy, modern wound dressings and wound-bed preparation based on tissue management, inflammation and infection control, moisture balance and epithelial advancement. This approach should improve the patient's quality of life in a way that is fast, cost-effective and minimises pain. Optimal treatment should involve holistic, comprehensive care for the individual patient, supported by multidisciplinary teamwork and patient education for self-care. An aging population also increases the need for community nursing care in patients' homes. Access to home wound care differs between European countries, particularly whether it is provided by registered nurses, as part of the healthcare system, or by homecare assistants, as part of the social care system. In countries like Slovenia, community nurses play an important role in the multidisciplinary treatment of VLUs, as they care for patients in the home environment and can best assess their condition. The GP first makes the initial wound assessment and diagnosis before authorising the community nurse to provide wound care in the patient's home. A case study is presented of a 91-year-old male patient with a VLU, alongside reduced mobility and multiple comorbidities. The treatment method provided optimal healing and is described and illustrated in detail.

scholarly journals Antimicrobial stewardship strategies in wound care: evidence to support the use of dialkylcarbamoyl chloride (DACC)- coated wound dressings

2021 ◽  
Vol 30 (4) ◽  
pp. 284-296
Author(s):  
Mark G Rippon ◽  
Alan A Rogers ◽  
Karen Ousey
Keyword(s):  
Wound Infection ◽  
Antimicrobial Stewardship ◽  
Antimicrobial Agents ◽  
Wound Care ◽  
The Body ◽  
Wound Dressings ◽  
Wound Management ◽  
Resistant Bacteria ◽  
Treatment Regimens ◽  
Bacterial Binding

Background: Traditionally, infections are treated with antimicrobials (for example, antibiotics, antiseptics, etc), but antimicrobial resistance (AMR) has become one of the most serious health threats of the 21st century (before the emergence of COVID-19). Wounds can be a source of infection by allowing unconstrained entry of microorganisms into the body, including antimicrobial-resistant bacteria. The development of new antimicrobials (particularly antibiotics) is not keeping pace with the evolution of resistant microorganisms and novel ways of addressing this problem are urgently required. One such initiative has been the development of antimicrobial stewardship (AMS) programmes, which educate healthcare workers, and control the prescribing and targeting of antimicrobials to reduce the likelihood of AMR. Of great importance has been the European Wound Management Association (EWMA) in supporting AMS by providing practical recommendations for optimising antimicrobial therapy for the treatment of wound infection. The use of wound dressings that use a physical sequestration and retention approach rather than antimicrobial agents to reduce bacterial burden offers a novel approach that supports AMS. Bacterial-binding by dressings and their physical removal, rather than active killing, minimises their damage and hence prevents the release of damaging endotoxins. Aim: Our objective is to highlight AMS for the promotion of the judicious use of antimicrobials and to investigate how dialkylcarbamoyl chloride (DACC)-coated dressings can support AMS goals. Method: MEDLINE, Cochrane Database of Systematic Reviews, and Google Scholar were searched to identify published articles describing data relating to AMS, and the use of a variety of wound dressings in the prevention and/or treatment of wound infections. The evidence supporting alternative wound dressings that can reduce bioburden and prevent and/or treat wound infection in a manner that does not kill or damage the microorganisms (for example, by actively binding and removing intact microorganisms from wounds) were then narratively reviewed. Results: The evidence reviewed here demonstrates that using bacterial-binding wound dressings that act in a physical manner (for example, DACC-coated dressings) as an alternative approach to preventing and/or treating infection in both acute and hard-to-heal wounds does not exacerbate AMR and supports AMS. Conclusion: Some wound dressings work via a mechanism that promotes the binding and physical uptake, sequestration and removal of intact microorganisms from the wound bed (for example, a wound dressing that uses DACC technology to successfully prevent/reduce infection). They provide a valuable tool that aligns with the requirements of AMS (for example, reducing the use of antimicrobials in wound treatment regimens) by effectively reducing wound bioburden without inducing/selecting for resistant bacteria.

scholarly journals Unprecedented Silver Resistance in Clinically Isolated Enterobacteriaceae: Major Implications for Burn and Wound Management

2015 ◽  
Vol 59 (8) ◽  
pp. 4734-4741 ◽  
Author(s):  
Phillip J. Finley ◽  
Rhy Norton ◽  
Cindy Austin ◽  
Amber Mitchell ◽  
Sara Zank ◽  
...  
Keyword(s):  
Wound Care ◽  
Phenotypic Expression ◽  
Heavy Metal Resistance ◽  
Metal Resistance ◽  
Wound Dressings ◽  
Wound Management ◽  
Klebsiella Pneumonia ◽  
Content Type ◽  
Ionic Silver ◽  
High Silver

ABSTRACTIncreased utilization of inorganic silver as an adjunctive to many medical devices has raised concerns of emergent silver resistance in clinical bacteria. Although the molecular basis for silver resistance has been previously characterized, to date, significant phenotypic expression of these genes in clinical settings is yet to be observed. Here, we identified the first strains of clinical bacteria expressing silver resistance at a level that could significantly impact wound care and the use of silver-based dressings. Screening of 859 clinical isolates confirmed 31 harbored at least 1 silver resistance gene. Despite the presence of these genes, MIC testing revealed most of the bacteria displayed little or no increase in resistance to ionic silver (200 to 300 μM Ag+). However, 2 isolates (Klebsiella pneumoniaandEnterobacter cloacae) were capable of robust growth at exceedingly high silver concentrations, with MIC values reaching 5,500 μM Ag+. DNA sequencing of these two strains revealed the presence of genes homologous to known genetic determinants of heavy metal resistance. Darkening of the bacteria's pigment was observed after exposure to high silver concentrations. Scanning electron microscopy images showed the presence of silver nanoparticles embedded in the extracellular polymeric substance of both isolates. This finding suggested that the isolates may neutralize ionic silver via reduction to elemental silver. Antimicrobial testing revealed both organisms to be completely resistant to many commercially available silver-impregnated burn and wound dressings. Taken together, these findings provide the first evidence of clinical bacteria capable of expressing silver resistance at levels that could significantly impact wound management.

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