Acute and chronic wound infections: microbiological, immunological, clinical and therapeutic distinctions.

Wound infection is a complex pathology that may manifest either as a rapid onset acute condition, or as a prolonged chronic condition. Although systemic antibiotic therapy is often appropriate and necessary for acute wound infections, it is often used inappropriately, excessively and unsuccessfully in chronic wound infections. Overuse of antibiotics in chronic (hard-to-heal) wound management contributes to antibiotic resistance. This literature review confirms that acute and chronic wound infections are significantly differentiated by their cause (microbial phenotype), the subsequent host immune response and by the resulting clinical manifestations. Consequently, recognition of the type of wound infection followed by appropriate and timely therapy is required to improve wound healing outcomes while encouraging more judicious and responsible use of antibiotics.

Implementation of Wound Hygiene in clinical practice: early use of an antibiofilm strategy promotes positive patient outcomes.

Non-healing wounds are devastating for patients, potentially causing long-term morbidity and an impaired quality of life. They also incur a huge health economic burden for health-care services. Understanding of the causes of non-healing wounds has increased significantly. While the need to address the underlying aetiology has always been acknowledged, the role of biofilm in delaying or preventing healing is now accepted. There is a consensus on the need to debride the wound to remove biofilm and then prevent its reformation, to kickstart healing. The potential benefits of incorporating an antibiofilm component within the wound bed preparation framework are clear. However, such a strategy needs to be flexible enough so that it can be implemented by all practitioners, regardless of their expertise or specialty. Wound Hygiene does this. This supplement describes the Wound Hygiene protocol, and includes a selection of case studies on different wound types, demonstrating its ease of use and effectiveness in clinical practice.

Encuesta sobre la higiene de las heridas: conocimiento, implementación, obstáculos y resultados.

OBJETIVO: Se ha desarrollado una encuesta para comprender el conocimiento y la implementación actual del concepto de higiene de las heridas un año después de su difusión. También se analizaron los obstáculos para su implementación y los resultados. MÉTODO: La revista Journal of Wound Care (JWC), con la colaboración de ConvaTec, desarrolló una encuesta de 26 preguntas, compuesta por respuestas de opción múltiple y texto libre, que distribuyó globalmente por correo electrónico y en línea; la encuesta estuvo abierta unas 12 semanas. Debido a la naturaleza exploratoria de la investigación, se utilizó una técnica de muestreo no probabilístico. Los autores analizaron los resultados de la encuesta para sacar conclusiones de los datos. RESULTADOS: Un total de 1478 participantes dio su consentimiento para el uso de sus datos combinados anonimizados. Casi el 90% era de Estados Unidos o el Reino Unido. La mayoría se desempeñaba como especialista en el cuidado de las heridas y estaba distribuido equitativamente entre centros de atención primaria y hospitales de agudos. El 66,6% había trabajado en el área de cuidado de las heridas durante más de 8 años. Los encuestados trabajaban con una amplia variedad de tipos de heridas. Más de la mitad (57,4%) había oído hablar del concepto de higiene de las heridas, y entre ellos, el 75,3% la había implementado; el 78,7% respondió que la aplicaba "siempre", mientras que el 20,8% lo hacía "a veces". Los tres principales obstáculos para su adopción fueron la confianza (39,0%), el deseo de que haya más estudios sobre la higiene de las heridas (25,7%) y la competencia (24,8%). En general, tras la implementación de la higiene de las heridas, el 80,3% informó que las tasas de cicatrización de sus pacientes habían mejorado. CONCLUSIÓN: Los encuestados estuvieron totalmente de acuerdo en que la implementación de la higiene de las heridas es un método exitoso para el tratamiento del biofilm y un componente fundamental para mejorar las tasas de cicatrización en heridas de difícil cicatrización. Sin embargo, los obstáculos para su adopción e implementación demuestran que se necesitan cursos integrales de educación y capacitación, apoyo institucional para los cambios de política, protocolos, y más estudios clínicos para promover la higiene de las heridas.

Guidelines for Point-of-Care Fluorescence Imaging for Detection of Wound Bacterial Burden Based on Delphi Consensus.

Excessive levels of bacteria impede wound healing and can lead to infectious complications. Unfortunately, clinical signs and symptoms of elevated bacterial burden are often unreliable. As a result, point--of--care fluorescence imaging, used to detect critical bacterial burden in wounds, is becoming widely recognized and adopted by clinicians across the globe as an accepted and added component of wound assessment protocol. A Delphi method was employed to establish consensus guidelines describing fluorescence imaging use. A multidisciplinary panel of 32 wound experts (56% MD, 22% podiatrist, 12.5% nurses/nurse practitioners) representing multiple sites of service (e.g., hospital outpatient, inpatient, private office, long-term care) completed two rounds of online questionnaires. The Delphi included key topics, including competencies required to perform imaging, clinical indications for imaging (e.g., signs/symptoms present, procedures warranting imaging), frequency of imaging, and a clinical workflow algorithm. Describing their clinical experiences of imaging impact, >80% reported changes in treatment plans, 96% reported that imaging-informed treatment plans led to improved wound healing, 78% reported reduced rates of amputations, and 83% reported reduced rates of microbiological sampling. The guidelines provided here will help to standardize use of fluorescence imaging among wound care providers and enhance the quality of patient care.

Wound hygiene survey: awareness, implementation, barriers and outcomes.

OBJECTIVE: In light of the COVID-19 pandemic, which has resulted in changes to caseload management, access to training and education, and other additional pressures, a survey was developed to understand current awareness and implementation of the wound hygiene concept into practice one year on from its dissemination. Barriers to implementation and outcomes were also surveyed. METHOD: The 26-question survey, a mixture of multiple choice and free-text, was developed by the Journal of Wound Care projects team, in consultation with ConvaTec, and distributed globally via email and online; the survey was open for just over 12 weeks. Due to the exploratory nature of the research, non-probability sampling was used. The authors reviewed the outputs of the survey to draw conclusions from the data, with the support of a medical writer. RESULTS: There were 1478 respondents who agreed to the use of their anonymised aggregated data. Nearly 90% were from the US or UK, and the majority worked in wound care specialist roles, equally distributed between community and acute care settings; 66.6% had been in wound care for more than 8 years. The respondents work across the spectrum of wound types. More than half (57.4%) had heard of the concept of wound hygiene, of whom 75.3% have implemented it; 78.7% answered that they 'always' apply wound hygiene and 20.8% 'sometimes' do so. The top three barriers to adoption were confidence (39.0%), the desire for more research (25.7%) and competence (24.8%). Overall, following implementation of wound hygiene, 80.3% reported that their patients' healing rates had improved. CONCLUSION: Respondents strongly agreed that implementing wound hygiene is a successful approach for biofilm management and a critical component for improving wound healing rates in hard-to-heal wounds. However, the barriers to its uptake and implementation demonstrate that comprehensive education and training, institutional support for policy and protocol changes, and more clinical research are needed to support wound hygiene.

AQUACEL® Ag Dressing with Hydrofiber® Technology.

PROBLEM: There are many silver-containing wound dressings available for managing and preventing wound infection. Each claims to provide effective antimicrobial activity due to the presence of silver in the dressing. However, assuming effectiveness on the basis of an antimicrobial alone ignores the importance of the carrier dressing and its overall role in wound healing. SOLUTION: Choice of a silver-containing wound dressing should include consideration of the impact that dressing technology has on the effectiveness of antimicrobial activity as well as its influence on other factors essential for wound healing. NEW TECHNOLOGY: AQUACEL® Ag dressing combines patented Hydrofiber® Technology with ionic silver, a proven broad-spectrum antimicrobial. Recent in vitro testing suggests that dressing technology may impact the antimicrobial effectiveness of silver-containing dressings as well as other factors relevant to wound healing. Specifically, a comparative in vitro study demonstrated how the ability of a dressing to micro-contour to the wound bed is critical to antimicrobial effectiveness. Compared with other silver dressings tested, AQUACEL Ag dressing minimized voids and spaces where bacteria can thrive, allowing the silver within the dressing to be in contact with the wound. AQUACEL Ag dressing was observed to kill more bacteria and control the spread of pathogens. INDICATIONS FOR USE: AQUACEL Ag dressing is indicated for the management of a variety of at risk/infected chronic and acute wounds. CAUTION: Not all silver dressings are created equal. Selection of an antimicrobial dressing should take into account in vitro data regarding antimicrobial efficacy of a dressing in addition to its ability to promote wound healing.