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.

Benefits of an NHS trust collaborating with the wound care industry

2021 ◽  
Vol 26 (Sup3) ◽  
pp. S34-S37
Author(s):  
Mark Collier
Keyword(s):  
Wound Care ◽  
World Health Organisation ◽  
World Health ◽  
Wound Management ◽  
Team Approach ◽  
Health Care Needs ◽  
Care Needs ◽  
Management Association ◽  
Health Related ◽  
Collaborative Working

The principle of collaborative working was widely promoted by the World Health Organisation (WHO) in 2010 when they wrote ‘that professionals who actively bring the skills of different individuals together, with the aim of clearly addressing the health-care needs of patients and the community, will strengthen the health system and lead to enhanced clinical and health related outcomes'. As a result of this, the development of a multidisciplinary team approach to the management of patients with wounds was actively promoted by various International organisations, such as the European Wound Management Association (EWMA) in 2014, however this article illustrates an example of how a collaborative working protocol has been incorporated within Tissue Viability and wound care environments within an NHS Trust for the past two decades.

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.

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.

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.

scholarly journals A review on wound management with special reference to nanotechnology

2020 ◽  
Vol 11 (3) ◽  
pp. 2815-2824
Author(s):  
Debosmita Datta ◽  
Raman Suresh kumar
Keyword(s):  
Wound Healing ◽  
Chronic Wounds ◽  
Wound Care ◽  
Skin Permeation ◽  
Healing Process ◽  
Water Soluble ◽  
Wound Dressings ◽  
Wound Management ◽  
Exciting Field ◽  
Molecular Events

Management of wound care mainly depends upon the advancement of innovative and effective wound care product to achieve speedy recovery and minimising scar formation. Wound healing management has been always an interesting field of research till date due to serious need for new wound treatment. Appropriate wound care is a significant challenge because of the complications associated with wounds as well as low permeability through the skin. The interconnected events of wound healing occur simultaneously to restore the tissue integrity and functions of the cells. Wound healing gets hampered by numerous factors. These physiological events occur easily in normal human being, but in some situations these molecular events are affected, resulting in hard to heal/ chronic wounds. In current years nanotechnology has emerged as an exciting field with several applications in skin regeneration. These nanoscale delivery systems have numerous benefits in the healing process such as decrease in drug’s cytotoxicity, administration of poorly water-soluble drugs, better skin permeation, controlled release behaviour, antimicrobial activity, as well as stimulation of fibroblast proliferation and reduced inflammation. Thus, emerged as an effective strategy and approach for the treatment of chronic wounds. This review briefly discusses about the wounds, characteristics of an ideal wound dressings along with a special mention regarding the several strategies of wound healing by nanotechnology with their functions and advantages.

Therapy-related issues: skin

2017 ◽  
Author(s):  
Philip Wiffen ◽  
Marc Mitchell ◽  
Melanie Snelling ◽  
Nicola Stoner
Keyword(s):  
Wound Care ◽  
Coal Tar ◽  
Calcineurin Inhibitors ◽  
Wound Dressings ◽  
Topical Calcineurin Inhibitors ◽  
Topical Antimicrobials ◽  
Skin Conditions ◽  
Selection Of

This chapter outlines information relevant to pharmacists and other healthcare professionals related to selected skin conditions. The review of wound care includes classification of wounds, selection of wound dressings, and a discussion of other wound care products and practices including topical antimicrobials, honey, larval therapy, and vacuum-assisted closure. Management of eczema covers the use of emollients, corticosteroids, and topical calcineurin inhibitors. The different treatments available to treat psoriasis are discussed, ranging from older agents such as coal tar to the role of biologics.

Managing Wounds

2012 ◽  
Author(s):  
Patricia Grocott
Keyword(s):  
Clinical Decision Making ◽  
Wound Care ◽  
Clinical Decision ◽  
The Body ◽  
Wound Management ◽  
Clinical Decisions ◽  
Excessive Pressure ◽  
Street Violence ◽  
Body Boundary ◽  
Skin Conditions

This chapter addresses the vital area of wound care, including the impact that wounds can have upon patients and their families, and the nursing management challenges that they present. As a registered nurse caring for patients with wounds, you will be responsible for making a clinical assessment of the patient with a wound, making clinical decisions based on the most appropriate evidence-based, nurse-led interventions, and, crucially, measuring patient outcomes. The latter involves continuous monitoring of how both the patient and his or her wound is responding, or not, to the treatment and care that you give. This chapter presents a generic approach to wound management, and this should help you to deliver high-quality, safe wound care for patients with wounds of differing aetiologies. This includes core components of interventions for acute, chronic, and palliative wound care. Importantly, the chapter has been designed to help you to make the links between assessment, clinical decision-making, nursing interventions, and patient care. Nurses play a key role in the multidisciplinary team in the delivery of wound care, and frequently act as the ‘point of contact’ for the manufacturers and suppliers of wound care products. The approach advocated in this chapter will equip you to make informed assessments and clinical decisions. Wounds are injuries to the body, the skin in particular, causing a breach of the layers of skin (see Chapter 12 Understanding Skin Conditions) and the body boundary. The term ‘wound’ also defines the act of injuring a person’s skin. This may be deliberate, e.g. during a surgical procedure, or deliberate to cause harm, e.g. during warfare, terrorist attacks, or domestic and street violence. Wounding can also occur with accidents (a cut from a kitchen knife), natural disasters (earthquake), and exposure to environmental stresses such as extreme heat (burns, skin cancers), extreme cold (frostbite), excessive pressure, and excessive exposure to water and moisture (trench foot). Wounds also develop because of diseases and conditions such as diabetes, which disrupt the structures of the skin and the normal metabolic processes that maintain skin health (see Chapter 9 Understanding Diabetes Mellitus).

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