Wound Bed Preparation 2024: Delphi Consensus on Foot Ulcer Management in Resource-Limited Settings.

GENERAL PURPOSE: To review a practical and scientifically sound application of the wound bed preparation model for communities without ideal resources. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and registered nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant will:1. Summarize issues related to wound assessment.2. Identify a class of drugs for the treatment of type II diabetes mellitus that has been shown to improve glycemia, nephroprotection, and cardiovascular outcomes.3. Synthesize strategies for wound management, including treatment in resource-limited settings.4. Specify the target time for edge advancement in chronic, healable wounds.

Chronic wound management in low-resource settings deserves special attention. Rural or underresourced settings (ie, those with limited basic needs/healthcare supplies and inconsistent availability of interprofessional team members) may not have the capacity to apply or duplicate best practices from urban or abundantly-resourced settings. The authors linked world expertise to develop a practical and scientifically sound application of the wound bed preparation model for communities without ideal resources. A group of 41 wound experts from 15 countries reached a consensus on wound bed preparation in resource-limited settings. Each statement of 10 key concepts (32 substatements) reached more than 88% consensus. The consensus statements and rationales can guide clinical practice and research for practitioners in low-resource settings. These concepts should prompt ongoing innovation to improve patient outcomes and healthcare system efficiency for all persons with foot ulcers, especially persons with diabetes.

COVID-19 Pivoted Virtual Skills Teaching Model: Project ECHO Ontario Skin and Wound Care Boot Camp.

OBJECTIVE: To describe a virtual, competency-based skin and wound care (SWC) skills training model. The ECHO (Extension for Community Healthcare Outcomes) Ontario SWC pivoted from an in-person boot camp to a virtual format because of the COVID-19 pandemic. METHODS: An outcome-based program evaluation was conducted. Participants first watched guided commentary and videos of experts performing in nine SWC multiskills videos, then practiced and video-recorded themselves performing those skills; these recordings were assessed by facilitators. Data were collected using pre-post surveys and rubric-based assessments. Descriptive statistics and thematic analysis were applied to data analysis. RESULTS: Fifty-five healthcare professionals participated in the virtual boot camp, measured by the submission of at least one video. A total of 216 videos were submitted and 215 assessment rubrics were completed. Twenty-nine participants completed the pre-boot camp survey (53% response rate) and 26 responded to the post-boot camp survey (47% response rate). The strengths of the boot camp included the applicability of virtual learning to clinical settings, boot camp supplies, tool kits, and teaching strategies. The analysis of survey responses indicated that average proficiency scores were greater than 80% for three videos, 50% to 70% for three of the videos, and less than 50% for three of the videos. Participants received lower scores in local wound care and hand washing points of contact. The barriers of the boot camp included technical issues, time, level of knowledge required at times, and lack of equipment and access to interprofessional teams. CONCLUSIONS: This virtual ECHO SWC model expanded access to practical skills acquisition. The professional development model presented here is generalizable to other healthcare domains.

Wound Bed Preparation 2021.

GENERAL PURPOSE: To present the 2021 update of the Wound Bed Preparation paradigm. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant will: 1. Apply wound assessment strategies. 2. Identify patient concerns about wound care. 3. Select management options for healable, nonhealable, and maintenance wounds.

Wound Bed Preparation is a paradigm to optimize chronic wound treatment. This holistic approach examines the treatment of the cause and patient-centered concerns to determine if a wound is healable, a maintenance wound, or nonhealable (palliative). For healable wounds (with adequate blood supply and a cause that can be corrected), moisture balance is indicated along with active debridement and control of local infection or abnormal inflammation. In maintenance and nonhealable wounds, the emphasis changes to patient comfort, relieving pain, controlling odor, preventing infection by decreasing bacteria on the wound surface, conservative debridement of slough, and moisture management including exudate control. In this fourth revision, the authors have reformulated the model into 10 statements. This article will focus on the literature in the last 5 years or new interpretations of older literature. This process is designed to facilitate knowledge translation in the clinical setting and improve patient outcomes at a lower cost to the healthcare system.

Evaluation of Longitudinal and Tubular Compression Treatment for Lower Limb Edema.

BACKGROUND: Many patients with lower limb edema do not tolerate traditional higher-pressure compression devices and require alternative devices for edema control. METHODS: Two systems were evaluated for control of bilateral or unilateral lower limb edema: an elasticized longitudinal stockinette (ELS; EdemaWear; Compression Dynamics, Omaha, Nebraska) and an elasticized tubular bandage (ETB; Tubigrip; Mölnlycke Health Care, Norcross, Georgia). Twenty-five patients were recruited; patients with bilateral edema (n = 12) wore the ELS on one limb, and the ETB on the other. Patients with unilateral edema (n = 13) were randomized to wear either the ELS or ETB. Edema measurements, leg pain, and patient preference were recorded. RESULTS: There were 14 females (56%) and 11 males (44%); mean age was 66 years (range, 32-88 years); and mean body mass index was 40.4 kg/m (range, 26.1-66.9 kg/m). Patients with bilateral edema wearing ELS had a foot-to-leg circumference between 25.5 and 42.9 cm pre-ELS that remained essentially unchanged at 2 weeks. The five patients with unilateral edema using ELS had a 24.3- to 43.7-cm circumference pre-ELS and 24.2- to 42.6-cm range at 2 weeks. The patients with bilateral edema using ETBs had a foot-to-leg circumference of 25.5 to 43.7 cm before treatment, unchanged 2 weeks later. The eight patients with unilateral edema using ETB had a 25.4- to 45.3-cm circumference pre-ETB and 24.8- to 42.0-cm range post-ETB. Mean pain levels decreased from 1.0 at week 0 to 0.5 at week 2. More patients preferred ELS (17/23, 78.3%) over ETB (5/23, 21.7%). CONCLUSIONS: Both systems were easy to apply and provided low compression without increased pain. The ELS was preferred by more patients (78.3%) than ETB (21.7%).

Associations Among Skin Surface pH, Temperature, and Bacterial Burden in Wounds.

GENERAL PURPOSE: To present a cross-sectional cohort study conducted to assess the association between wound pH, local infection, and deep/surrounding infection. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant should be better able to:1. Synthesize the background information associated with the study assessing the association between wound pH, local infection, and deep/surrounding infection.2. Summarize the results of the study presented here. ABSTRACT: BACKGROUNDWounds with a higher pH often demonstrate lower rates of healing. Local and deep/surrounding infection can be diagnosed with the validated NERDS and STONEES clinical signs, respectively. This study assessed the association between wound pH, local infection, and deep/surrounding infection. METHODS: A 100-patient prospective cross-sectional cohort study was conducted with leg and foot wounds. Wound pH was measured using pH indicator strips. The wounds were assessed for clinical signs of local or deep/surrounding infection with the NERDS and STONEES criteria, respectively. Temperature measurements were documented with a handheld infrared skin thermometry device at the wound/periwound site, the equivalent site on the opposite side of the same leg/foot, and the wound mirror image site on the opposite leg/foot. RESULTS: There was no significant difference in the mean wound bed pH in patients with superficial critical colonization and those without (P = .837). The wound and periwound maximum temperature measurements were compared with an equivalent temperature on the mirror image on the opposite leg. There was a statistically significant difference in the mean temperature (ΔT) value between patients with deep/surrounding wound infection and three or more positive STONEES criteria (P = .002). CONCLUSIONS: Nontouch infrared thermometry comparing maximum mirror image wound temperatures versus the opposite extremities when combined with two or more other STONEES criteria is a significant indicator of deep and surrounding infection. Surface wound bed pH indicator strip measurements do not correlate with local wound infection using the NERDS criteria.

Wounds with a higher pH often demonstrate lower rates of healing. Local and deep/surrounding infection can be diagnosed with the validated NERDS and STONEES clinical signs, respectively. This study assessed the association between wound pH, local infection, and deep/surrounding infection. A 100-patient prospective cross-sectional cohort study was conducted with leg and foot wounds. Wound pH was measured using pH indicator strips. The wounds were assessed for clinical signs of local or deep/surrounding infection with the NERDS and STONEES criteria, respectively. Temperature measurements were documented with a handheld infrared skin thermometry device at the wound/periwound site, the equivalent site on the opposite side of the same leg/foot, and the wound mirror image site on the opposite leg/foot. There was no significant difference in the mean wound bed pH in patients with superficial critical colonization and those without (P = .837). The wound and periwound maximum temperature measurements were compared with an equivalent temperature on the mirror image on the opposite leg. There was a statistically significant difference in the mean temperature (ΔT) value between patients with deep/surrounding wound infection and three or more positive STONEES criteria (P = .002). Nontouch infrared thermometry comparing maximum mirror image wound temperatures versus the opposite extremities when combined with two or more other STONEES criteria is a significant indicator of deep and surrounding infection. Surface wound bed pH indicator strip measurements do not correlate with local wound infection using the NERDS criteria.

Validated 60-Second General Foot Screen: A Pilot Trial and Guide to Diagnoses and Treatment.

GENERAL PURPOSE: To provide information on a 60-second General Foot Screen to assist in the prevention and/or identification and management of common foot problems. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant should be better able to:1. Use the 60-second General Foot Screen to assist healthcare professionals in the recognition of common foot problems.2. Identify risk factors, causes, and treatment of selected foot problems. ABSTRACT: Foot health is important to overall patient health. Early diagnosis and treatment of diabetes, neuropathy, fungal foot infections, foot deformity, and vascular disease/lower leg edema can improve patient quality of life. One way to achieve this is effective screening. To this end, researchers piloted a validated 10-item screening tool to assess foot health on 120 patients; 74.17% had at least one positive abnormality, demonstrating the critical importance of these early findings. Only 25.83% of individuals had completely low-risk feet. This easy-to-use tool can assist healthcare professionals in the recognition and treatment of common foot problems. The article also outlines the early signs of disease by screening item and provides a guide to treatment to enable effective prevention and quality care.

Evaluating a Surfactant-Containing Polymeric Membrane Foam Wound Dressing with Glycerin in Patients with Chronic Pilonidal Sinus Disease.

GENERAL PURPOSE: To present an evaluation of a surfactant-containing polymeric membrane foam wound dressing for use on patients with chronic pilonidal sinus disease. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After completing this continuing education activity, you should be able to:1. Recall risk factors for and pathophysiology of pilonidal sinus wounds.2. Summarize the evidence-based elements of wound assessment and treatment.3. Identify the study methodology and results. ABSTRACT: To evaluate the clinical use of a surfactant-containing polymeric wound dressing with glycerin in patients with chronic pilonidal sinus wounds.This case series was conducted in an outpatient dermatology and wound clinic. Sixteen patients aged between 18 and 49 years with chronic nonhealing pilonidal sinus wounds over 4 weeks in duration were recruited.Dressing changes were performed daily because of frequent contamination from bowel evacuation, sweating, or frictional forces in the perianal and intergluteal skin. Patients were seen at follow-up visits to the clinic at weeks 4, 8, and 12 from study initiation.Subjects were predominantly males (81% [n = 13]) with a mean age of 23 years. At study initiation, the mean wound duration was 3.2 months, and mean surface area was 3.3 cm (0.18-19.6 cm). The majority of wounds showed signs of superficial infection (63% [n = 10]) and deep infection (88% [n = 14]). At week 12, 10 wounds (63%) had closed, 1 (6%) had decreased in surface area, 2 (13%) had increased in size, and 3 (19%) of the patients were lost to follow-up. Mean pain score was 3.4 at first visit; most patients reported reduction in pain scores by weeks 4 and 12. Participants reported improved mobility and ability to self-apply dressing. No adverse reactions were observed.Use of a surfactant-containing polymeric membrane foam wound dressing with glycerin may have facilitated wound closure in 10 of 13 patients who completed the 12-week study.