Efficacy of a superabsorbent dressing with Hydration Response Technology.

Moderately and heavily exuding wounds are associated with delayed healing and an increased risk of infection. Elevated proteases found in chronic wound fluid keep a sustained state of inflammation. Superabsorbent dressings can absorb large quantities of exudate without losing their structure. Some are also able to bind and sequester proteases and bacteria within their structure. This article summarises the in-vitro and clinical evidence on the efficacy of Cutimed® Sorbion® Sachet S. The findings indicate that it helps facilitate autolytic debridement, absorbs exudate and reduces inflammation, and thus the risk of infection.

Remedial action in the management of wound-related pain.

Wound-related pain, particularly following wound care interventions, is a concern to all involved in wound management. However, little is understood about how remedial action to manage such pain can affect healthcare provision, particularly in terms of resources. This article describes a Delphi study - a process of gaining expert consensus in a particular area - identifying the main factors influenced by the presence of pain at wound dressing change. It was found that the presence of pain influences the choice and frequency of analgesia, use of anxiolytic medications, frequency of dressing change and the environment in which care is provided. These results can help clinicians to understand the close relationship that exists between pain and clinical intervention, and the implications for resource management.

Factors affecting cost-effectiveness in wound care decision making.

With increasing health service cutbacks, cost-effectiveness is a central issue in many wound care decisions. Clinicians are frequently required to justify clinical decision making in terms of health benefits obtained and the cost to health service providers. However, few clinicians have the skills to accurately interpret cost in more than local health economic terms, and the disjointed structures that exist in healthcare provision mean that even those who monitor health expenditure have little concept of the global cost of care provision. This article focuses on the pressures placed on healthcare providers to achieve cost-effectiveness in care, specifically in relation to wound care and the effect that pain at dressing change has on the cost of care.

Dressing-related trauma: clinical sequelae and resource utilization in a UK setting.

BACKGROUND: Dressings are the mainstay of wound care management; however, adherence of the dressing to the wound or periwound skin is common and can lead to dressing-related pain and trauma. Dressing-related trauma is recognized as a clinical and economic burden to patients and health care providers. This study was conducted to garner expert opinion on clinical sequelae and resource use associated with dressing-related trauma in a UK setting. METHODS: THIS WAS AN EXPLORATORY STUDY WITH TWO PHASES: qualitative pilot interviews with six wound care specialists to explore dressing-related trauma concepts, sequelae, and resource utilization; and online quantitative research with 30 wound care specialists to validate and quantify the concepts, sequelae, and resource utilization explored in the first phase of the study. Data were collected on mean health care professional time, material costs, pharmaceutical costs, and inpatient management per sequela occurrence until resolution. Data were analyzed to give total costs per sequela and concept occurrence. RESULTS: The results demonstrate that dressing-related trauma is a clinically relevant concept. The main types of dressing-related trauma concepts included skin reactions, adherence to the wound, skin stripping, maceration, drying, and plugging of the wound. These were the foundation for a number of clinical sequelae, including wound enlargement, increased exudate, bleeding, infection, pain, itching/excoriation, edema, dermatitis, inflammation, and anxiety. Mean total costs range from £56 to £175 for the complete onward management of each occurrence of the six main concepts. CONCLUSION: These results provide insight into the hidden costs of dressing-related trauma in a UK setting. This research successfully conceptualized dressing-related trauma, identified associated clinical sequelae, and quantified resource utilization associated with a typical occurrence of each trauma concept. Further research is warranted into dressing-related trauma and the associated costs.

Reviewing the evidence for advanced dressings.

The principles of moist wound healing have become widely accepted since the seminal work of George Winter in the 1960s. In the subsequent 50 years, many publications have extolled the clinical value of modern or advanced wound dressings. This article reviews the findings of two studies arguing that the benefits of advanced wound care products, which are based largely on th principles of moist wound healing, cannot be justified in terms of healing outcomes or cost effectiveness. These studies have the potential to affect clinical practice and decision making, and the article highlights the importance of analysing and interpreting the findings of such studies cautiously.

Reducing trauma associated with burns care using Safetac technology.

The nature of a burn may itself cause significant pain, which may be exacerbated by external factors such as dressing of the wound, wound debridement and surgical reconstruction. Selection of appropriate dressings is essential to minimise pain, particularly in cases where dressings need to be changed frequently, and to provide an optimum environment for wound healing. Although there are many products available for nurses to choose from, this article focuses only on the use of dressings with Safetac technology.

Principles of infection management in community-based burns care.

The development of infection in a burn can lead to poor healing outcomes and possibly sepsis. Although most patients with burns treated in the primary care setting are unlikely to develop life-threatening infections, clinicians would still benefit from an understanding of the factors that may increase the risk of infection, signs and symptoms of infection, and when to seek specialist advice.

Assessment and management of patients with burns.

Burns are a common injury in the UK. Most burns are limited in size and depth and are therefore suitable for management in the community. Primary care and non-specialist clinicians need to understand initial assessment of the burn and when referral to a specialist burns unit is indicated. Successful treatment of minor burns and ongoing care of severe burns in the community requires careful selection of dressings to support wound healing and achieve optimal outcomes for patients.

PHMB: an effective antimicrobial in wound bioburden management.

The effective management of bacterial bioburden is an essential element of wound care. Recent years have seen the increased use of topical antimicrobial dressings to control colonisation and infection, yet there is concern that some may inhibit wound healing and may have systemic sequelae (World Union of Wound Healing Societies (WUWHS), 2008). This article focuses on the safety and effectiveness of PHMB, an antimicrobial compound that is relatively underused in the UK, and argues that it is an effective option for the management of bacterial colonisation and infection.

Clarification about use of water in burns treatment.

In response to our article on burns management (art&science September 12), Mark Pittman writes that cold water and cling film are the best remedy for burns (letters September 26).

Meeting the clinical challenges of burns management: a review.

This article will look at some of the major clinical challenges faced by the clinician when managing the burn wound, identify how the Mölnlycke Health Care range of dressings with Safetac® is designed to meet these needs and provide evidence of the effectiveness of these products in this challenging field of wound care.

Films or fabrics: is it time to re-appraise postoperative dressings?

Post-operative wounds healing by primary intention are often seen as the simplest areas of modern wound care. However, have we overlooked the problems that can exist and are we really looking at postoperative dressing selection with the same vigour we attach to other areas of wound care? This article outlines the development of modern post operative dressings, both fabric and film-based and raises the question 'if postoperative wound infection is a problem should we consider more effective barrier dressings?'