Recherche de publication

Aim:

This study set out to examine the impact of a biofilm pathway in chronic static wounds.

Method:

A survey of 500 nurses who had been using a Biofilm treatment pathway combining a monofilament fibre pad and a topical antimicrobial on static wounds for a period of two weeks was undertaken to gather information on wound healing in those patients who received the new treatment pathway.

Results / Discussion:

A total of 142 nurses, out of 171 respondents, completed all questions in the survey. 82 % of the patients (n=156) had a leg ulcer. The average duration of the wounds was 6 months prior to the change in treatment (range 2-52 weeks). 12 patients had wounds for longer than one year, with one patient having her wound for 11 years. These patients were not included in

the statistical analysis. All wounds were reported as ‘static’ prior to implementing the change in treatment. A total of 66 (46%) wounds had healed following the change in treatment. 39 (58%) patients healed in 1 month or less, with 16 healed in 2 months and 11 taking more than 2 months to heal. A further 32 patients were recorded as having 50-75% healing since using the pathway, with 26 patients showing 25% healing.

Conclusion:

Although this data was non-comparative, it can be concluded that there is a positive effect from using a monofilament debridement pad in combination with antimicrobial dressings to remove and prevent biofilm build up in static wounds. This could result in significant cost savings to the health service and improved outcomes for patients with static chronic wounds.

Aim:

Traumatic implantation of pigmented particles in the skin require removal as quickly as possible to prevent deeper penetration and persisting skin tattoo. We present the case of a patient with accidental contamination during his work as a channel digger. A cushions were inflated under pressure. the cushion burst when the patient was just 1-2 metres away. Water and mud exploded within the channel and covered the face and hands of the patient. Dirt particles penetrated the skin, eyes and cornea.

Method:

The particles in the eyes and cornea were removed surgically and a systemic antibiotic therapy was started. Laboratory examination revealed a C-reactive protein of 49.3 mg/l (normal: <5 mg/l). Cheeks and periocular region showed remarkable oedema. After a rehydration of the skin with aliphatic ointments (0.4 mg/ml Polihexanid in Unguentum leniens) under semi-occlusive dressing over 4 hours, a mechanical debridement with a monofilament fibre debridement pad* was performed.

Results:

Almost all particles could be eliminated leaving superficial skin lesions - pain-free. Antiseptic ointment (Clioquinol 5 mg/g) was recommended for the further skin treatment. The systemic antibiotic therapy was also continued. A follow-up two days after the debridement showed a decrease of oedema and inflammation and a skin totally cleared from dirt particles.

Conclusion:

The immediate comparison with the use of moistened compresses showed a clear predominance of the monofilament pad in the efficiency of particle removal. Usual treatments with scalpel blade or dermabrasion are time-consuming and painful for the patients. By the use of a monofilament fibre debridement pad in an early stage of traumatic tattoo, a very satisfying cosmetic result could be achieved.

Aim:

At present many care professionals are under pressure for time. Therefore there is a need to avoid delays in wound treatment due to mismanagement or incorrect treatment of the wound. Correct assessment and diagnosis should be the starting point for follow on management to implement good patient care and cost efficient wound treatment. Good debridement enables visualisation and assessment.

Method:

In this centre more than 200 patients have been treated according to the same protocol, all starting with wound debridement using a monofilament fibre debridement pad for acute and chronic wounds. Most of the patients had chronic wounds of varying duration, severity and causes. The case studies follow 4 patients with ulcer to show the wound status before and immediately after debridement. Photographs were taken.

Results / Discussion:

Photographic evidence was a very easy way of documenting outcomes when the debridement pad had removed devitalised tissue and the skin and wound were revealed. In all patients the average number of pads were 2 and the average time for debridement was 2 – 4 minutes per episode. Some patients required additional treatment episodes depending on the condition. Appropriate treatment regimens were implemented as a result of good assessment.

Conclusion:

Even wounds that appear non-complex often require debridement to aid diagnosis. The use of a very easy method which can be performed by all care professionals helps to simplify wound treatment and save time.

Aim:

Time constraints and reimbursement for managing patients with chronic lymphedema present challenges for healthcare professionals. The case series demonstrates how a debridement device and a Velcro compression wrap were used to implement self-care as a solution.

Method:

20 patients with primary and secondary lymphedema were enrolled into the study. Following assessment of the patient’s condition and ability to understand and apply the treatment, each patient was educated and trained how to:

1. Use the monofilament fibre debridement pad for skin and wound preparation.

2. Apply the Velcro compression wrap system for treatment and maintenance.

3. Perform correct application and to record clinical improvements.

Time for each treatment episode, frequency of visits and overall treatment time were measured

Results / Discussion:

The number of treatment episodes reduced from 3 to 2 per week. The time for each episode reduced on average from 1 hour to 30 minutes. Improvements in the condition of each patient showed improvement in mobility, less independency, and leads to more time left for the patients. Additionally patients were able to participate in their care, giving them control.

Conclusion:

The use of simple solutions for self-care such as those used in this study could provide solutions to benefit the patient and healthcare professionals. Reductions in treatment times and the use of patients instead of a more costly therapist could equate to cost savings for the organisation.

Aim:

To investigate the synergistic use of monofilament debridement (MFD) in conjunction with three different types of common debridement methods -enzymatic (ED) conservative sharp debridement (CSD), and autolytic debridement (AD) in order to determine the reduction of devitalized tissue and improve overall effectiveness of wound management.

Method:

Three patients with recalcitrant wounds of similar condition were managed with the above mentioned debridement methods in outpatient clinics and skilled care settings. In this small study a monofilament debridement pad was introduced to improve overall effectiveness. The study period was four weeks with dressing changes three times per week. Following debridement, the wounds were covered with prescribed dressing and managed according to standard local practice. Percentage of necrotic tissue removal and wound size were measured prior to implementing the monofilament debridement with dressing changes and afterward to determine effectiveness of a synergistic approach to appropriate wound bed preparation. Photographs were taken.

Conclusion:

Use of the monofilament debridement device was found to work synergistically with all three types of debridement modalities to efficiently and effectively remove devitalized tissue safely and painlessly. There was noted reduction of devitalized tissue, which allowed for appropriate wound bed preparation and healing environment.

Aim:

Clinical nurses specialist - Tissue Viability Nurses (TVNs) are no exceptions to significant change and challlenges in terms of their role and scope of practice. The use of advanced treatment modalities such as Conservative sharp debridement (CSD) and Negative pressure wound therapy (NPWT) are amongst the skill they posses for the healing of complex wounds. Debridement in wound bed preparation is a well recognised concept to aid wound bed prepation in order to facilitate wound healing. This can be an intergral part in the management of complex infected surgical wounds where devitalised tissue is present prior to application NPWT. Sharp debridment over a vital organ is high risk, costly and can be life-threatening if done under aneasthetic. And CSD over bowel can equally be a high risk procedure and this will demand a surgeons skill for precision and safety. However, if left untreated this can impead wound healing and lead to other serious complications. Many TVNs are competent to perform CSD but the associated risk and complications of CSD over bowel cannot be ignored. This case study will look at the efficacy of the use of a Monofilament Fibre Lolly (MFL) by a TVN to debride devitalised tissue over bowel in a high risk patient.

Method:

Patient BH is a 46 year old lady who was admitted with a wound infection two weeks after a midline incisional hernia repair with application of mesh. She has asthma and was also diagnosed with alcoholic liver disease . On admission, she was septic and was treated with intravenous antibitiotic and she was taken to theatre for wound debridement. She went to theatre twice for repeat debridement of necrotic tissue causing significant bowel exposure at wound bed with some loose mesh. NPWT was used post-operatively by the surgical team to manage the wound. TVN input was sought to complete a wound assessment and for the re-application of NPWT due to patients compromised medical condition. And she was deemed unfit for anaesthetic. The use of the MFL was chosen as part of a product evaluation by the TVN. MLF was deemed to be atraumatic and has the ability to reach deep undermined areas to an open abdominal wound. It was moistened with 10mls of normal saline and was used to gently lift the devitalised tissue over the bowel using a circular motion with light pressure. Two MFL were used to cover all areas of the wound bed to effectively remove all devitalised tissue and reduce bacterial bioburden. NPWT was applied with careful consideration and protection applied over all exposed bowel.

Results / Discussion:

With the TVNs knowledge and competence in CSD the use of a new debridement tool such as MFL over bowel at the bedside was performed safely and in a timely fashion. MFL for debridement showed significant reduction of bacterial bioburden through removal of devitalised tissue and infected loose mesh with no complications such as bleeding and trauma that

are associated with other forms of debridement. 40% of slough/infected loose mesh were removed using the MFL and 60% were loosened and softened).

Conclusion:

This case study is an example of the increasing complexity of cases and ithe wound management faced by TVNs. With the availability of a new debridement tool such as the MFL, high risk patients not fit for anaesthetic are able to receive timely and safe wound bed preparation. The MFL was found to be less invasive compared to CSD and can be safely used over bowel.

Aim:

This abstract reports on a multi-centre, UK wide case series of a new monofilament fibre debridement (MFD) lolly in an acute and community setting for the management of cavity wounds and hard to reach areas.

Method:

Twelve UK Healthcare centres have produced 25 patient case studies. All of the clinicians involved utilised the same data collection form which included patient consent and images.

Results / Discussion:

Of the 25 patients 14 were male and 11 female with an average age of 70. Wound type was 11 surgical, 8 leg ulcers, 5 pressure ulcers and 1 hyperkeratosis. The MFD lolly was used once in 9 patients, twice for 6 patients and three times for 10

patients. In all 3 groups there was 100% reduction in devitilised tissue apart from 2 patients who had no devitilised tissue only signs of a biofilm. Pain was assessed using the VAS scale and 12 patients had a consistent score of 0. Average pain scores of 1-3 were obtained for 7 patients and a score of 4-6 for 4 patients. One patient was unable to communicate and one patients has an extensive painful ulcer score 9 and 10 but after MFD lolly this was 8. Free text comments reinforced this along with it being easy to use and handle.

Conclusion:

The new MFD lolly was shown to be very effective at removing devitilised tissue and biofilm, easy to use and handle and was either pain free or associated with low levels of pain.

Aim:

The efficacy of a wound dressing including effective exudate management and pain reduction, tolerability and user/patient satisfaction are the most important factors beside the treatment of the underlying disease. Therefore a clinical study with a new developed hydroactive wound dressing* was performed to evaluate the key factors of successful wound treatment in patients with chronic wounds.

Methods:

During an international, multicentre study data were collected regarding dressing performance (application, adaptability, shrinking, convenience, removability, improvement wound condition, wound edge protection, skin condition, exudate management) and rating of pain (VAS 0-10). Conclusion and general notes took place after an additional final visit.

Results:

64 patients (68 wounds: burns, leg ulcer, DFS, pressure ulcer, donor sites, other) existing since 0,5 – 31 months are included into the statistical evaluation. The wounds were superficial (77,4 %) and deep (22,6%) at the first visit. Infection was assessed in 18 % (n=12). Dressing performance (easiness of application, shrinkage of dressing, improvement of wound, wound edge, skin condition, uncomplicated use, reduction of maceration, would you use it again) was assessed in median with 1,51 (1=excellent, 2=very good). Regarding patient convenience (softness, non-adherence, removability in one piece), the hydroactive dressing was assessed in median with 1,74. Improvement of wound condition was confirmed in 95,2 %. Significant pain reduction was demonstrated (3,37 visit 1, 1,80 visit 4). Decrease of amount of exudate was also found (4,26 at visit 1, 2,85 at visit 4). The electronic evaluation (W.H.A.T.) showed a decrease of sloughy /necrotic tissue and an increase of granulation tissue. No safety-related reports have been served.

Conclusion:

The hydroactive dressing* showed clinical effectiveness and safety in a wide range of indications offering a noticeable facilitation in daily routine. Pain reduction and patient convenience leads to better quality of life and treatment satisfaction of the patient.