Patient-centered Outcomes for Individuals with a Venous Leg Ulcer: A Scoping Review.

GENERAL PURPOSE: To summarize randomized clinical trials addressing patient-centered outcomes of individuals with a venous leg ulcer. 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. Summarize the results of the review of randomized controlled trials addressing patient-centered outcomes of individuals with a venous leg ulcer.2. Identify the limitations of the research analyzed for the review.

To summarize randomized clinical trials addressing patient-centered outcomes of individuals with a venous leg ulcer with a scoping review. Authors searched PubMed using MESH terms for "venous ulcer" AND "randomized" for randomized clinical trials published from January 2002 to October 2021 that explored content-validated patient-centered outcomes for individuals with a clinically diagnosed venous leg ulcer. Authors also searched Cochrane Reviews from inception to April 15, 2022 for additional references using the same MESH terms. Studies in any setting were included if primary or secondary outcomes were venous ulcer-related mobility, pain or analgesic use, healing, infection, quality of life (including odor, social isolation, depression), amputation, or patient-level costs of treatment. Preclinical or nonrandomized clinical studies or those without venous leg ulcers were excluded. Authors tabulated interventions studied, numbers of patients treated per group, risk of delayed ulcer healing, and statistical significance of comparisons of 485 qualifying articles in Google Sheets. Authors graphically represented and tabulated frequencies of studies addressing patient-centered outcomes of individuals with venous ulcers. Studies mainly reported effects of compression, dressings, topical antimicrobials, or systemic therapy on patient healing or pain outcomes. Related ischemia, ultrasonography, or risk factors for delayed healing were not consistently reported, inflating variability of outcomes and decreasing consistency of differences reported. Research is needed on the mobility, amputation risk, infection risk, quality of life, and healthcare costs of patients with venous ulcers. Promising interventions include grafts, exercise, analgesics, electrical modalities, negative pressure, or vascular interventions. Consistently reporting each patient's baseline ischemia and vascular condition would improve relevance.

Diabetic foot ulcer: treatment challenges.

Wound care professionals face complex challenges in their attempts to achieve healing in patients with a diabetic foot ulcer (DFU).1 Peripheral neuropathy limits sensation, which necessitates consistent offloading of the DFU site. Peripheral arterial, venous, or lymphatic circulation disorders must be diagnosed and addressed. Early diagnosis and management of soft tissue or bone infection is required. Chronic kidney disease, glycemic control, and nutritional needs must be addressed along with counterproductive behavior patterns.2 The use of topical hydrocolloid-based hydrogel dressings3 or honey4 on DFUs facilitates moist wound healing and debridement. Randomized controlled trials (RCTs) indicate that carefully controlling all of these factors helps optimize outcomes for individuals with a DFU. Promising phase 2 clinical studies with stringent inclusion criteria and rigorously applied diagnostic and management procedures are rarely replicated in larger phase 3 RCTs with broader inclusion criteria and less rigorously applied DFU management procedures. Narrow RCT inclusion criteria can limit study applicability for the general DFU population. This installment of Evidence Corner reviews 2 RCTs that use different approaches to address these issues. The first RCT reports interim results of a new autologous skin construct applied to Wagner grade 1 DFUs.5 The second compares the effects of standard wound dressings (SWDs) vs negative pressure wound therapy (NPWT) applied to Wagner grade 2, 3, or 4 DFU according to standard protocols during real-world clinical practice in German patients.6.

Improving venous ulcer outcomes.

Venous leg ulcers (VLUs) are caused by compromised flow of venous and lymphatic fluids from the lower leg toward the central circulatory system. They are one of the most common types of chronic wounds, affecting 3% to 5% of those 65 years of age and older.¹ Most VLUs heal within 12 weeks with sustained lower leg compression sufficient to reduce the edema associated with venous insufficiency.² Diagnosing and improving a patient's venous insufficiency and addressing concomitant arterial disease are key elements of VLU management.³ Surgical correction has been effective for superficial venous insufficiency.4 Various topical,5 physical,6 or systemic7 interventions have been studied as adjuncts to compression in efforts to further improve VLU outcomes, with mixed results. This month's Evidence Corner summarizes recent randomized clinical trials (RCTs) documenting healing effects of topical gauze dressings impregnated with hyaluronic acid (HA) or placebo cream8 as an adjunct to patient-appropriate compression or low-level laser radiation as an adjunct to clinically prescribed elastic compression, diet, leg elevation, exercise, and moisture-retentive, absorbent, or microbicidal dressings.8.

Local tranexamic acid reduces surgical blood loss.

Tranexamic acid (TXA) is a synthetic lysine analog that reduces perioperative blood loss by blocking lysine-binding sites on plasminogen molecules. It has been reported to be effective in limiting blood loss and transfusion needs in various orthopedic surgeries and for pediatric patients at high risk of blood loss. Randomized controlled trials (RCTs) supporting the capacity of TXA to reduce blood loss and improve outcomes associated with various surgical procedures have increased fourfold in the 10 years since Evidence Corner addressed this topic, which highlighted the capacity of locally delivered TXA to reduce blood loss during orthopedic knee surgery and intravenously delivered TXA to reduce blood lost during elective cesarean sections. Research continues to explore whether the ideal method of TXA delivery is local or systemic. One systemic preoperative 10 mg/kg dose of TXA did not improve blood loss, wound healing, or pain-related outcomes associated with ambulatory foot and ankle surgery. However, repeated topical doses of TXA as well as combined systemic and topical doses improved blood loss, inflammation, and nutritional condition following hip arthroplasty. This installment of Evidence Corner reviews 2 recent studies exploring the effects of adding locally delivered TXA to intravenous (IV) systemic TXA during spinal surgery8 and confirming efficacy of a single dose of topical TXA on hip arthroplasty.

New options to manage epidermolysis bullosa.

RDEB is a genetic skin disorder involving COL7A1, the gene encoding C7, which is a component of the fibers anchoring the epidermis to the dermis. Affected patients (about 1.35 per million persons in the United States) experience lifelong painful itching, blistering, fibrosis, impaired healing, and scarring, with increased likelihood of infection and cancer. RCT involving those affected by RDEB are rare with limited sample sizes due to the low prevalence of this genetic disorder. Treatment with topical or systemic agents has not consistently improved patient outcomes. Therapies focused on replacing C7 using autologous bone marrow or keratinocyte grafts have been difficult, with high complication rates, and have been met with mixed success. Recent HSV-1 vector research4 led to development of HSV-1 vectors capable of transferring the COL7A1 coding sequence to keratinocytes and fibroblasts in vitro and to mice deficient in C7, as well as to RDEB human skin xenografts. This research offered new opportunities for gene therapy for patients with RDEB. In this final Evidence Corner, readers are invited to consider the implications of 2 small RCTs that suggest fruitful avenues for RDEB research and practice. The first study describes a pioneering phase 1 and 2 RCT of topical gene therapy for RDEB. The second study describes a small crossover RCT exploring the effect of topical calcipotriol (VD3) ointment on wound healing and pruritis in patients with RDEB.

Measured Wound Outcome Feedback Improves Surgical Site Infection Rates.

Feedback supports learning. No matter how effective medical professionals think they are, evidence of measured patient wound outcomes helps inform their wound care practice, empowering them to improve patient outcomes. Prospective randomized clinical trials (RCTs) proved this principle in relation to healing chronic wounds. Measuring wound healing outcomes and providing caregivers with feedback about the 4-week healing progress increased the percentage of diabetic foot ulcers healed within 20 weeks and venous leg ulcers healed within 24 weeks. Longitudinal research suggests this principle holds true in preventing surgical site infections (SSIs). When individual orthopedic surgeons were provided written feedback about their hand hygiene practices and corresponding SSI rates, surgeon hand hygiene improved and SSI rates in their patients were reduced. This Evidence Corner describes systematic review evidence indicating that feedback given to responsible wound care professionals reduced SSI incidence for patients undergoing orthopedic or trauma surgery3 and abdominal surgery.

Surgical Site Infection in Cancer Patients.

Surgical site infection (SSI) incidence is affected by 3 types of interacting factors: the infecting organisms (eg, number, type, virulence), the local wound environment (eg, foreign matter, aseptic technique, wound dressings), and systemic host defenses (eg, smoking, obesity, diabetes). Cancer or related chemotherapy and other aspects of cancer care may affect host defenses, as evidenced by increased SSI risk following "clean" surgery to remove breast cancer tissue compared with similar "clean" surgeries in patients who do not have cancer. If patient risk factors for development of an SSI are strictly controlled in individuals undergoing breast cancer surgery, the likelihood of the development of an SSI drops sharply, creating the illusion that preoperative antibiotics are not needed. This Evidence Corner, which includes 2 studies, clarifies evidence supporting the use of recognized preoperative antibiotic administration to support host defenses in patients undergoing breast cancer surgery. In the first study, the controversy about wound dressings following cancer surgery is also explored. Some surgeons question whether routine use of gauze dressings promotes the ideal local wound environment after surgical excision of cancerous tissue. Disintegrating gauze strands can act as foreign bodies in wounds, and gauze dressings have been reported to increase SSI incidence in clean surgical wounds. The second study compared healing and SSI incidence of Mohs surgical excisions dressed with either an antibiotic-free, film-forming silicone wound dressing or a triple antibiotic primary dressing following Mohs micrographic or non-Mohs dermatologic surgery. The surprising results reinforce the importance of the local wound environment as a key factor in minimizing SSI in oncologic surgery.

Alternative Wound Management: Translating Science into Practice.

GENERAL PURPOSE: To present a scoping review of preclinical and clinical trial evidence supporting the efficacy and/or safety of major alternative wound care agents to summarize their effects on validated elements of wound bed preparation and wound management paradigms. 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. Differentiate the effectiveness of the topical wound care agents included in this review.2. Compare the preventive efficacy of intravenous agents administered to trauma and surgical patients.3. Select the effectiveness of products in this review that are left in place after surgical procedures.4. Identify an oral agent that can be helpful in mitigating the effects of COVID-19.

Effective wound healing is achieved by well-timed host, cell, and environment interactions involving hemostasis, inflammation, formation of repaired dermal structures, and epithelialization, followed by months to years of scar remodeling. Globally, various natural or synthetic agents or dressings are used to optimize wound environments, prolong drug release, aid in fluid absorption, provide favorable healing environments, and act as a mechanical barrier against wound trauma. In this scoping review of evidence from the PubMed and clinicaltrials.gov databases, authors examined clinical study evidence supporting the efficacy and safety of selected phytochemicals, vehicles, polymers, and animal products considered "naturally derived" or "alternative" wound interventions to provide a summary of preclinical evidence. Agents with the most clinical evidence were honey, alginates, polyurethane, gelatin, and dextran. Practice implications are described in the context of the TIMERS clinical paradigm.

Managing Oral Mucositis in Patients With Cancer.

Patients with oral mucositis (OM) have inflamed epithelial lesions of the mouth that progress to form painful ulcerations with submucosal hemorrhaging and infection. Oral mucositis makes it painful to eat, drink, and speak, resulting in distress, weight loss, and declining health.1 These symptoms occur in up to 40% of patients within 5 to 10 days after beginning chemotherapy (CT), and in nearly all patients within 1 to 2 weeks of starting radiotherapy (RT) for head and neck cancer. Oral mucositis can be severe enough to interrupt treatment and reduce survival rates. In 2014, the Mucositis Guidelines Leadership Group of the Multinational Association of Supportive Care in Cancer and International Society of Oral Oncology released OM treatment guidelines aiming to provide nutritional support, while reducing pain, inflammation, hemorrhaging, and oral microbial contamination. This installment of Evidence Corner explores 2 recent systematic reviews of randomized controlled trial (RCT) evidence informing clinical decisions in ways that may change thoughts about effective topical OM treatment.

Feed Abdominal Surgery Patients to Improve Outcomes.

Malnourishment of surgical patients has long been recognized as contributing to postoperative morbidity and mortality.1,2 Early protocols calling for lengthy perioperative patient fasting have been replaced by interventions aimed at diagnosing and addressing each patient's nutritional and metabolic needs; maintaining fluid and electrolyte balance, energy, and protein stores; and preserving muscle strength and gut microbiome by restoring oral feeding as soon as possible postoperatively.3 Interventions to achieve this physiologic balance have been the subject of considerable research, yet neither comprehensive preoperative programs4 nor early postoperative oral feeding5 have been reported to result in consistently improved clinical outcomes following abdominal surgery. This installment of Evidence Corner explores 2 systematic reviews, one of which presents clinical outcomes of early resumption of enteral food intake within 24 hours after gastrointestinal (GI) surgery,6 and the other presents clinical outcomes of perioperatively enhanced nutrition for those undergoing radical cystectomy (RC) for bladder cancer.7.

Platelet-Rich Plasma: Optimal Use in Surgical Wounds.

Activated platelets release a rich broth of growth factors involved in wound healing. One way to deliver activated platelets to wounds is in the form of platelet-rich plasma (PRP) harvested by centrifuging the patient's venous blood after activating the platelets with collagen or calcium chloride and/or autologous thrombin, then delicately removing the supernatant, called platelet-poor plasma (PPP). Platelet-rich plasma is usually injected into the lesion and/or applied topically, then sealed in or over the wound using a moisture-retentive dressing. Platelet-rich plasma (often with PPP) has been applied at different times, depths, and frequencies to chronic and acute wounds using various PRP doses and vehicles to achieve widely differing results. Meta-analyses have reported that PRP improved healing rates of open diabetic foot ulcers and venous ulcers and may reduce pain and surgical site infection (SSI) incidence in open and closed acute surgical wounds. However, inconsistency in study methods and outcome measures limited consistency of pain and SSI results. No consistent effect on healing or deep SSI rates was reported as a result of adding 1 intraoperative dose of PRP in the surgical site before closing elective foot and ankle surgery incisions of 250 patients as compared with 250 similar patients receiving the same procedure without PRP. After decades of research, ideal parameters of PRP delivery and use on each type of wound remain unclear for improving SSI, acute wound pain, and healing outcomes. This installment of the Evidence Corner reviews 2 surgical studies that may provide clues about optimal PRP use. One triple-blind randomized clinical trial (RCT) focused on irrigation of freshly closed carpal ligament surgical incisions with PRP as compared with PPP. Another non-blind RCT explored the effect of injecting PRP into open pilonidal sinus excisions 4 days and 12 days after surgery.

Digital delivery of non-pharmacological intervention programmes for people living with dementia during the COVID-19 pandemic.

The COVID-19 pandemic significantly impeded face-to-face health and social care delivery for people living with dementia and their carers. Interruption of meaningful activity engagement along with increased social isolation is known to be associated with loss of skills, increased loneliness, physical deterioration and decline in cognition and mood in people with dementia. To ensure continuity of care for people living with dementia, for whom multimodal, non-pharmacological intervention programmes were being provided, there was an urgent need to adopt a remote delivery model. Guidance on digitally delivered assessment and care specific to non-pharmacological interventions for dementia is lacking. Adoption of technology-enabled care for people with dementia requires overcoming barriers to technology use, adaptation of therapeutic guidelines, adaptation of communication methods and carer support. Despite these challenges, therapists successfully transitioned from in-person to digital delivery of therapeutic interventions with associated benefits of continued meaningful activity engagement discussed.

Herpes Zoster (Shingles) Patient-Centered Wound Outcomes: A Literature Review.

GENERAL PURPOSE: To present a comprehensive review of patient-centered outcomes of topical or systemic interventions applied to those with shingles or postherpetic neuralgia to inform clinical practice and identify related research needs. 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 be able to:1. Explain the importance of early diagnosis and treatment of herpes zoster (HZ).2. Identify interventions that have resulted in documented improvement of validated patient-centered outcomes in patients with HZ or postherpetic neuralgia.3. Recognize the average per patient medical costs of HZ in the US.

One in three people endure herpes zoster (HZ; also known as shingles) during their lifetime, experiencing pain, secondary infections, postherpetic neuralgia, reduced quality of life, and considerable patient costs. These patient burdens remain to be reviewed. To perform a comprehensive review of patient-centered outcomes of topical or systemic interventions applied to those with shingles or postherpetic neuralgia to inform clinical practice and identify related research needs. The PubMed database was searched with supplementary Google Scholar searches for Medical Subject Headings "shingles" or "post-herpetic neuralgia" to find clinical studies documenting validated patient-centered outcomes: pain, secondary infection, healing, function, depression, social isolation, treatment costs, or quality of life. Six representative case studies were examined. Pertinent original and derivative clinical study references were included. Preclinical studies, reviews, or studies of non-HZ conditions were excluded. Two authors tabulated clinical efficacy evidence for interventions affecting patient-centered outcomes. Evidence supported efficacy for systemic antiviral or topical anesthetic interventions improving pain, healing, sleep, vision, or quality of life for those with HZ or postherpetic neuralgia. Patient cases reported improved pain and/or sleep using occlusive dressings. Treatment costs and secondary infections were reported only in cases or cohort studies. Randomized clinical research focused on medications improving patient pain, healing, sleep, or vision outcomes. Research is needed measuring outcomes of adding occlusive dressings to optimal care and effects on secondary infections and treatment costs.

Psychological Methods of Managing Surgical Pain.

In patients who experience chronic or acute wound pain, analgesic requirements as well as patient-centered and clinical outcomes can be affected by psychological interventions as explored by considerable research. Psychological interventions are classified as procedural: informing patients of wound or surgery procedures; sensory: describing how the wound or procedure will feel; behavioral: telling patients what to do to facilitate procedures or recovery; cognitive: coaching patients how to think more positively about the wound or procedure; relaxation: systematic muscle relaxing and/or breathing techniques; hypnosis: suggesting changes in patient perceptions; mindfulness: techniques based on meditation or contemplation; emotional: methods of coping with stress related to the wound or procedure; or patient-generated narratives focusing on the procedure or wound. These interventions are often used alongside analgesics or anesthetics. Evidence suggests that various psychological interventions may be effective in managing chronic pain lasting 3 or more months. In June 2020, a planned systematic review exploring their interactions with pharmacologic agents in managing chronic nonspecific lower back pain was announced. Pilot research has initiated a randomized controlled trial (RCT) testing the value of mindfulness training for military veterans dealing with chronic pain. In this installment of Evidence Corner, 2 recent systematic reviews that explored whether such interventions improve patients' experiences or clinical outcomes for those undergoing abdominal and general1 surgery are reviewed.

Does Hyperbaric Oxygen Improve Lower Extremity Ulcer Outcomes?

A person with a diabetic foot ulcer (DFU) requires multidisciplinary care, including moist wound healing, consistent offloading of insensate areas, glycemic control, and adequate circulation. This is especially important during the COVID-19 pandemic, as patients with diabetes are at a higher risk of mortality.1 Reviewed in a 2018 installment of Evidence Corner,2 a double-blind, randomized clinical trial (RCT) reported that topical oxygen continuously diffused to DFU tissue resulted in nonhealing DFUs healing more than 20 days faster than those that were similarly treated with standard therapy and a sham device.3 More than twice the DFUs closed in patients receiving continuously diffused topical oxygen in comparison with the sham arm completely healed in 12 weeks (P = .02). It has been hypothesized that intervals of hyperbaric oxygen (HBO)-breathing 100% oxygen at atmosphere absolute (ATA) greater than the 1.0 normal at sea level-may similarly improve lower extremity ulcer healing outcomes. This month's Evidence Corner summarizes 2 studies regarding patients receiving HBO. The first study focused on patients with a DFU on a non-ischemic limb.4 The second studied the effects of HBO on lower extremity ulcers on ischemic limbs in patients with or without diabetes mellitus (DM).5 Read on to discover how informative and beneficial each of these studies can be in furthering best practice as well as which patients may experience improved lower limb ulcer healing in response to interventions that increase tissue oxygenation.

Wound Phototherapy.

Researchers have tested the effects of low-level light therapy (LLLT) using low-power lasers or non-coherent, non-collimated light therapy from light-emitting diodes (LEDs) on wounds for decades, exploring the efficacy of phototherapy treatments for chronic1 and acute2 wounds. Low-level light therapy has received device clearance in the United States for cosmetic improvement of aging or sun-damaged skin, acne, actinic keratoses, non-melanoma skin cancer, improving circulation, and decreasing pain as well as stiffness and muscle spasm. 3 It has been used for dental, dermatologic, neurologic, and chiropractic conditions in Canada, Europe, and Asia for several years.4 There are few adequately powered, double-blind randomized clinical trials (RCTs) carefully evaluating energy dose-response of each color or wavelength of LLLT. Typical ranges of LLLT include infrared light waves (800-1200 nm, penetrating 5-10 mm of tissue), red (630-700 nm, penetrating 2-3 mm), yellow (570-590 nm, penetrating 0.5-2 mm), and blue to ultraviolet (400-170 nm, penetrating ⟨ 1 mm).3 Low-level light therapy is delivered at various power densities (W/cm2), time durations, and duty cycles, accumulating as energy absorbed over time, called fluence (J/cm2). The variety of wound outcomes in response to differing LLLT parameters used to stimulate various aspects, depths, and types of tissue injury can be confusing. In this installment of Evidence Corner, a systematic review5 of LED effects on dermatologic conditions and wounds and a second on LLLT effects on diabetic foot ulcers (DFUs)1 add clarity to LLLT effects on some aspects of wound management.

Effects of Stents or Prostanoids on Critical Limb Ischemia.

Peripheral arterial disease (PAD) affects up to 10% of the global population and is often underdiagnosed and inadequately treated until it progresses to critical limb ischemia (CLI) with rest pain, gangrene, and/or ulceration. At this late stage in PAD management, outcomes are typically measured in terms of amputation or mortality. The 5-year mortality rate has been reported to exceed the likelihood of that due to prostate and breast cancer combined. Structured exercise and/or calf muscle stimulation increased collateral circulation, improving pain, quality of life, and mobility outcomes for patients with all levels of PAD severity. Controversy persists about interventions to optimize related amputation or mortality outcomes in individuals with CLI. Summarized herein, 2 Cochrane reviews clarify the quality and quantity of evidence of the effects on CLI-related outcomes comparing percutaneous transluminal angioplasty (PTA), a procedure for opening infrapopliteal arteries by inflating an endovascular balloon, with or without intravascular stenting, and the use of a systemic prostanoid as compared with a placebo.

Can Skin Cells Improve Outcomes for Patients With Deep Burns?

Early excision and split-thickness skin autografts (STSGs) have become standard care for full-thickness burns, but healing the donor site challenges these patients who are already at metabolic and microbial risks, increasing with the total body surface area (TBSA) burned. Engineered skin substitutes containing 1 or more cellular or acellular components of the epidermis, dermis, or hypodermal components have been designed to function as potential STSG replacements, supplementing the barrier or scaffold functions of lost skin. They have reduced the area of STSG tissue needed, helping to improve mortality and healing of patients with large-area, full-thickness burns. Randomized clinical trials (RCTs) continue to explore new ways to optimize scarring, healing, tissue viability, timing, costs, and infection for patients with full-thickness burns2 or chronic wounds. Results for chronic wounds were often inconclusive, based on small studies using varied standards of care with non-blinded outcome evaluation, but evidence on burns is becoming more compelling. This Evidence Corner reviews recent studies that support further improvement of clinical or patient-centered outcomes for hospitalized patients with deep burn wounds managed with STSGs and autologous cultured epidermal cells5 or non-cultured autologous skin cell suspensions.

Reliability and feasibility of registered nurses conducting web-based surgical site infection surveillance in the community: A prospective cohort study.

Surgical site infections increase health care costs, morbidity, and mortality in 2% to 5% of surgical patients. Standardised post-surgical surveillance is rare in community settings, causing under-reporting and under-serving of the documented 60% of surgical site infections occurring following hospital discharge. This study evaluated feasibility and concordance (inter-rater reliability) of paired registered nurses using a web-based surveillance tool (how2trakSSI, based on validated guidelines) to detect surgical site infections for up to 30 days after surgery in a cohort of 101 patients referred to Calea Home Care Clinics in Toronto, Canada, March 2015 to July 2016. After paired registered nurse assessors used the tool-less than 10 minutes apart to measure concordance 5 to 7 days postoperatively, they provided feedback on its usefulness at two teleconference discussion groups September 6 to 7, 2016. Overall concordance between assessors was 0.822, remaining consistently above 0.65 across assessor education level and experience, patient age and weight, and wound area. Assessors documented 39.6% surgical site infection prevalence 5 to 7 days after surgery, confirming clinical need, relevance, reliability, and feasibility of using this web-based tool to standardise community surgical site infection surveillance, noting that it was user-friendly, more efficient to use than traditional paper-based tools and useful as a registry for tracking progress.