Anti-embolism stocking care protocol to prevent associated skin problems: A quasi-experimental study.

AIM: The aim of this quasi-experimental study was to develop an anti-embolism stocking care protocol and assess its effectiveness in preventing associated skin problems on the legs. MATERIALS AND METHODS: The study was conducted between 02 March and July 20, 2016 in the surgical clinics of a private university hospital in Ankara, Turkey. The sample consisted of 27 nurses and 162 patients (three different patients were fitted of anti-embolism stockings by each of the 27 nurses; pre-protocol 81 patients and post-protocol 81 patients). Data were collected using data collection forms developed by the researchers. An anti-embolism stocking care protocol was developed and used. Nurses and patients were evaluated using an observational method. RESULTS: Following implementation of the protocol, nurses' mean knowledge (95.24 ± 5.60) and intervention skill (92.06 ± 10.42) scores were significantly higher than their pre-protocol knowledge (73.54 ± 14.26) and intervention skill (15.30 ± 6.84) scores. Nurses performed almost all steps of the care protocol correctly after the protocol was implemented. The rates of skin problems such as pressure ulcers, neurovascular problems and issues associated with wrinkles or creases in stockings were significantly reduced after implementation of the protocol. CONCLUSIONS: This study demonstrates that nurses' knowledge and intervention skills are increased when a care protocol is used, together with the prevention of errors and improved patient outcomes. The use of care protocols guides nurses in practice, raises awareness and helps to achieve nursing care objectives by standardizing information.

Cyanoacrylate glues for wilderness and remote travel medical care.

Cyanoacrylate (CA) glues are commonly used in medical and household repairs. Their chemical compositions have been refined over half a century, making some more suitable than others for creative applications. In remote settings where advanced medical care is not accessible, readily available CAs of differing chemical composition may possess an important therapeutic function. Within this paper we critically examine the published therapeutic risks and benefits of both pharmaceutical and hardware grade CAs when applied in acute care situations. Topics discussed include wound closure as well as the treatment of burns, abrasions, and blisters. Also considered are their chemical properties, toxicities, and potential off-label uses.

Barrier dressings in surgical site infection prevention strategies.

Healthcare-associated infections (HCAIs) are a matter of priority for the NHS. They are associated with significant morbidity, and frequently lead to increased length of hospital stay, pain and discomfort for the patient, and in some cases even permanent disability. It is estimated that surgical site infections (SSIs) constitute around 14% of all HCAIs. Any break in the skin affords a portal of entry for microbial pathogens, and hence places the patient at an increased risk of infection. To address the issue, a multi-factorial strategy for the prevention of SSIs is essential, with postoperative dressings playing a key part alongside universal precautions such as hand hygiene and aseptic technique. The available guidance specifies the need for a postoperative dressing which provides an effective physical barrier and a moist environment for optimal wound healing. Vapour-permeable barrier dressings appear to be effective in meeting both of these criteria and also offer additional advantages both to patients and practitioners, such as patient comfort and the ability to stay in place whilst the patient showers. However, regular wound assessment must be carried out to ensure the vapour-permeable postoperative dressing is the right choice for a specific patient at a given time.

Mepilex Ag: an antimicrobial, absorbent foam dressing with Safetac technology.

This article examines the role of a unique dressing-Mepilex Ag--that incorporates the rapid and sustained antimicrobial action of ionic silver with the benefits of Safetac soft silicone adhesive technology. The combined attributes of each component of this dressing allow both the control of pain and infection to be achieved simultaneously. This dual approach to the management of wounds is of significance since the evidence suggests that wound infection and the release of pro-inflammatory modulators result in both local pain and delayed healing. In this respect the control and treatment of pain is as important as the treatment of infection itself. A review of the clinical evidence relating to Safetac technology clearly demonstrates that it can be used to prevent dressing-related trauma, minimize pain at dressing change, and control exudate when used on a wide range of wound types and skin injuries. In combination with silver, this technology has been shown in in-vitro studies to have an almost instant and sustainable antimicrobial effect on a broad range of pathogens associated with delayed healing. Finally, in small clinical and case studies, Mepilex Ag has been shown to control wound bioburden and improve healing rates.

Using ActivHeal dressings in a London teaching hospital: a cost analysis.

Lower-cost 'generic' wound dressings are now available in the dressing categories of foams, films, alginates, gels and hydrocolloids. This offers the possibility of achieving significant financial savings while retaining good clinical standards of wound care. To test the potential for cost saving in a typical London teaching hospital, the ActivHeal range of dressings was substituted for normal 'branded' dressings over a 3-month period, during which dressing cost and clinical effectiveness were assessed. The result was an equivalent yearly cost saving of pound55 221 (54%), with retention of performance standards across the dressing range. Two years after the trial, wards in University College London Hospitals NHS Foundation Trust continue to benefit from significant annual cost savings on dressings by using the ActivHeal range of products, while maintaining a high standard of clinical care.

A focus on ActiFormCool in the reduction of pain in wounds.

Pain is as very common problem in wound management and is one that is often neglected. This has an impact on both healing rates and patient quality of life. Pain is an indication that something is wrong and acts as one of the body's most important protective mechanisms and as such, should never be ignored. A comprehensive assessment of pain is vital and a plan of care formed that considers the type of pain that is being experienced and what interventions should be used. ActiFormCool is an ionic hydrogel dressing that has the ability to reduce pain in painful wounds, and this natural type of intervention should be the first consideration in reducing pain.

Peristomal skin care: an overview of available products.

Intact skin provides a protective barrier between the body and its environment. The frequent application and removal of stoma appliances can damage skin by stripping away the epidermal layer. Hydrocolloid flanges in either a one- or two-piece appliance hold moisture in the mass and are therefore more skin friendly than older appliances with acrylic adhesives, making hydrocolloid the choice for ostomy appliance manufacturers. Peristomal skin problems are a significant problem for the stoma patient. As many as one third of colostomy patients and more than two thirds of ileostomy and urostomy patients will be affected (Lyons and Smith, 2003). The correct and judicial use of barrier creams, gels, lotions, sprays and wipes in peristomal skin care can play an important role in giving the stoma patient a good quality of life.

Promoting skin health.

This article outlines the nurse's role in promoting the best methods of maintaining healthy skin. It discusses the key structures of the skin and its functions, the role of emollient therapy in children and adults, and external environmental factors.

A guide to the properties and uses of silver dressings in wound care.

Silver-release dressings are extensively used for wound management, particularly in the treatment of burns, chronic leg ulcers and wounds requiring an antibacterial. A variety of products is now available. The properties and uses of these dressings are discussed, followed by a review of advances over recent years

Using an adhesive retention tape on split skin graft donor areas.

Donor split skin graft areas are often painful, a problem that can be exacerbated when dressings that have been applied slip, particularly when they are on the patient's thigh. Helen McPhee carried out a small trial to assess whether Mefix, an adhesive retention tape, could help to reduce these problems

Use of Allevyn heel in the management of heel ulcers.

OBJECTIVE: This small uncontrolled study examined the effectiveness of Allevyn Heel. METHOD: Twenty-two patients were recruited: 13 with heel pressure ulcers, four with diabetic heel ulcers, four with arterial heel ulcers and one 'other'. Ulcers were assessed before treatment and after the start of the dressing regimen at weeks two and four and at the end of the study. RESULTS: Patients were treated with Allevyn Heel for a mean of 47.2 days, and dressings were left in place for an average of 2.2 days before being changed. By the end of treatment, 32% of the ulcers had completely or almost healed, and a further 27% were showing evidence of granulation. Application was considered easy in 98% of instances, and 91% of the patients reported that Allevyn Heel was comfortable to wear. CONCLUSION: Allevyn Heel was found to be effective and easy to use. This extends the range of wounds that are suitable for management with Allevyn, although a larger-scale study is needed to confirm the utility of Allevyn Heel for these type of heel wounds. DECLARATION OF INTEREST: This study was supported by Smith and Nephew, Germany.

Evaluation of two calcium alginate dressings in the management of venous ulcers.

Calcium alginate dressings facilitate the management of highly exudating wounds such as venous ulcers. To evaluate and compare the performance of two calcium alginate dressings in the management of venous ulcers, a prospective, randomized, controlled clinical study was conducted among 19 outpatients at two wound clinics in California. Ten patients (53%) were treated with Alginate A and nine patients (47%) with Alginate B. Dressings were changed weekly and patients were followed for a maximum of 6 weeks or until the venous ulcer no longer required the use of an alginate dressing. At each dressing change, the wound was assessed and dressing performance evaluated. Absorbency of exudate, patient comfort during wear, ease of removal, adherence to wound bed, dressing residue following initial irrigation, patient comfort during removal, ease of application, and conformability were assessed. Patients using Alginate A experienced significantly less foul odor (P = 0.02) and less denuded skin (P = 0.04) than Alginate B at follow-up wound assessments. With the exception of conformability, Alginate A was rated significantly better than Alginate B (P less than or equal to 0.05) in all dressing performance assessments. No significant healing differences were observed. As the different performance characteristics of various calcium alginate dressings become more obvious in clinical practice, further study is warranted to determine their optimal effectiveness.

Using a new foam dressing in the care of fungating wounds.

Fungating wounds may present with a number of unpleasant symptoms such as malodour, high levels of exudate and pain. The cosmetic appearance of the wound, along with these associated symptoms, can be a significant cause of distress to patients. As a result of the fact that fungating wounds rarely heal, their management is based on symptom control, promoting comfort and maintaining or improving the patient's quality of life. The treatment of these wounds is generally palliative in nature and often involves the use of dressings or other topical products to control symptoms. This case study details the use of a new hydropolymer foam dressing (Tielle Plus) in the management of a large fungating breast wound. The dressing was clinically and cost effective, nursing staff found it easy to use, and the patient found it very comfortable and less noticeable under her clothing.

[Having trouble with pressure ulcers care?].

Since 1997, we, the community pharmacists, have established this society, Aichi Prefecture Society for the Study of Pressure Ulcers Care, in order to furnish drug information about pressure ulcers care. Moist atmosphere is required for the healing of pressure ulcers. The moist environment that could be regulated depends on the physicochemical property of ointment bases. Therefore, ointment should reasonably be chosen to adjust the moisture. Since 2000, we have been committed to providing pharmacists, who work on home care, with a booklet to instruct how to choose ointments for pressure ulcers treatment. In 2002, when the Aichi pharmaceutical association held a training conference held at various hospitals using the booklet as a teaching material, hospital pharmacists cooperated by making a field study trip to observe pressure ulcers treatments. Nowadays researchers at pharmaceutical colleges have also cooperated in studying the efficacy and economical effect of the method of blending different ointments to improve the healing process of pressure ulcers.