Treating chronic wounds in an acute care setting: the forgotten diagnosis.

BACKGROUND: Chronic wounds include lower extremity ulcers, diabetic foot ulcers, and pressure injuries, and can take months or years to heal. Wounds place a high burden on outpatient and inpatient care settings. This burden is expected to increase markedly in the United States as the population ages and with increased rates of diabetes, obesity, and COVID-19. PURPOSE: To articulate the effect of chronic, hard-to-heal wounds on acute care facilities, and how a few days of inpatient care can have a significant effect on the healing trajectory. METHODS: An expert panel of 7 members, all with extensive knowledge and experience in the assessment and treatment of chronic wounds in an acute care setting, was convened in March 2022. The panel discussed the role of hospitals as part of the longer-term healing pathway of chronic wounds. RESULTS: Chronic wounds have a significant effect on hospitals that includes unseen costs, bed occupancy, demands on bedside nurses, and wound complications that lead to extended stays or readmissions. A successful inpatient wound program offers appropriate identification of previously undiagnosed wounds, elevation of bedside care through simplified protocols, quickly and easily understood education and easy dressing selection, and comprehensive discharge planning with a multidisciplinary team for continuity of care and reduced risk of readmission. CONCLUSION: Hospitals can play a key role in the management of chronic wounds, thus reducing the effect on each facility and the wider care network.

Implementing a Pressure Injury Prevention Bundle to Decrease Hospital-Acquired Pressure Injuries in an Adult Critical Care Unit: An Evidence-Based, Pilot Initiative.

Patients in critical care units (CCUs) are at risk of the development of hospital-acquired pressure injuries (HAPIs). Research supports the use of a pressure injury prevention (PIP) bundle to standardize PIP strategies and reduce the incidence of HAPIs. PURPOSE: This evidence-based practice initiative was undertaken to implement a PIP bundle to decrease HAPIs in an adult patient CCU. METHODS: A literature review was conducted during the first month of the implementation of the initiative to identify best PIP and bundle implementation practices. Wound, ostomy, and continence nurses conducted educational sessions and mentored registered nurses who became PIP bundle resource nurses. Adoption of the bundle was validated using an audit tool and PIP rounds. The pre- and post-implementation HAPI indices, pressure injuries / patient care days × 1000, were compared. RESULTS: Implementation of the PIP bundle resulted in a notable decrease in HAPIs on the unit. During the pre-intervention period, January 2017 to January 2018, there were 9 HAPIs (HAPI index 3.4). During the 10-month post-intervention period, 1 HAPI developed (HAPI index 0.48). CONCLUSION: An evidence-based PIP bundle initiative was implemented in an adult patient CCU to standardize the process for HAPI prevention and reduce the number of HAPIs. Staff involvement and leadership support were vital to the success of the initiative. Integration of the bundle into practice resulted in a notable decrease in HAPIs.

Desarrollo de dos fórmulas infantiles como alternativa económica y saludable para seguridad alimentaria y nutricional de la población lactante / Development of two infant formulas as an economic and healthy alternative for help to food security and nutritional security to the infant population

Introducción: Cuando la lactancia materna no es posible, se recurre a otros alimentos que brinden los nutrientes necesarios a los bebés, como las fórmulas infantiles, con características nutricionales que cumplan con la reglamentación actual y permitan un adecuado crecimiento al lactante. Objetivo: Diseñar dos fórmulas líquidas para lactantes que aporten los requerimientos diarios de macronutrientes y algunos micronutrientes (ácido fólico, zinc, calcio y hierro), con leche de vaca, higienizada por pasteurización, de bajo costo para que sea más asequible para la población lactante vulnerable a la vez que contribuye con su crecimiento. Materiales y métodos: Estudio exploratorio desarrollado en dos fases, formulación y elaboración de los productos y verificación de su eficacia en el crecimiento de lactantes. Resultados: Los productos cumplen con los requisitos de fabricación exigidos, de bajo costo y son capaces de sustentar un crecimiento normal, según clasificación de OMS. Conclusión: Las fórmulas desarrolladas tienen un adecuado aporte de macro y micronutrientes con características sensoriales y microbiológicas bajo los criterios exigidos por la reglamentación internacional y nacional, de bajo costos, permitiendo un adecuado crecimiento al lactante.

Introduction: When breastfeeding is not feasible, other sources to provide the required nutrients to babies are sought, such as infant formulas that comply with current regulation and with the baby's growth requirements. Objective: To design two liquid infant formulas that provide daily macronutrients and some micronutrients (folic acid, zinc, calcium, and iron) requirements, based on low-cost pasteurized cow milk in order to be more affordable for vulnerable babies and to contribute with their growth. Materials and Methods: Exploratory study developed in two phases: Formulation and preparation of the infant formula and verification of its efficacy in terms of babies' growth. Results: The infant formulas comply with all manufacturing requirements, are inexpensive, and appropriate to sustain normal growth, according to WHO. Conclusion: The two infant formulas developed have adequate macronutrient and micronutrient contribution with sensorial and microbiological characteristics that comply with local and foreign regulations, are inexpensive, and appropriate to sustain babies' normal growth.

Development and implementation of an advanced wound management class: preparing for OASIS-C.

This article explains the process of developing a 10-week course entitled Advanced Wound Management, in preparation for the implementation of Outcome and Assessment Information Set-C (OASIS-C). The impetus for choosing wound management was the result of a Needs Assessment completed by the nursing staff. The wound management learning needs identified by the clinicians in the Needs Assessment were aligned with the organization's goal to prepare for OASIS-C.

Equine infectious anemia virus-infected dendritic cells retain antigen presentation capability.

To determine if equine monocyte-derived dendritic cells (DC) were susceptible to equine infectious anemia virus (EIAV) infection, ex vivo-generated DC were infected with virus in vitro. EIAV antigen was detected by immunofluorescence 3 days post-infection with maximum antigen being detected on day 4, whereas there was no antigen detected in DC incubated with the same amount of heat-inactivated EIAV. No cytolytic activity was observed after EIAV(WSU5) infection of DC. These monocyte-derived DC were more effective than macrophages and B cells in stimulating allogenic T lymphocytes. Both infected macrophages and DC stimulated similar levels of memory CTL responses in mixtures of CD8+ and CD4+ cells as detected with (51)Cr-release assays indicating that EIAV infection of DC did not alter antigen presentation. However, EIAV-infected DC were more effective than infected macrophages when used to stimulate memory CTL in isolated CD8+ cells. The maintenance of antigen processing and presenting function by EIAV-infected DC in vitro suggests that this function is maintained during in vivo infection.