Improving wound infection management: education and evaluation of an infection management pathway.

OBJECTIVE: To assess the clinical impact and acceptance of an infection management (IM) pathway, designed to improve the consistency of care of wound infection when introduced, and supported by an educational programme. METHOD: An education and evaluation programme (T3 programme) was-conducted in Portugal, Spain and Italy. This consisted of a two-hour educational, virtual seminar, followed by a four-week evaluation of an IM pathway during which survey data were collected on the impact of this pathway on clinician-selected patients. Finally, all participants reconvened for a virtual meeting during which the combined results were disseminated. The pathway provided guidance to clinicians regarding the targeted use of antimicrobial wound dressings according to the presence and absence of signs and symptoms of wound infection. RESULTS: Responses relating to 259 patients treated according to the IM pathway, 139 (53.7%) of whom had received previous antimicrobial treatment, were captured. Signs and symptoms of infection resolved within four weeks of treatment in >90% of patients. All 25 patients who had received prior antimicrobial treatment for ≥3 months experienced a resolution in the signs and symptoms of infection within four weeks. The majority of participating clinicians agreed that the IM pathway improved decision-making (94.9%) and confidence (97.3%), and helped to determine the correct antimicrobial treatment (91.4%) in the context of wound infection. CONCLUSION: The T3 programme was an efficient way to deliver a structured educational programme. The use of the IM pathway resulted in >90% of patients achieving resolution of their signs and symptoms of wound infection.

Ibuprofen slow-release foam dressing reduces wound pain in painful exuding wounds: preliminary findings from an international real-life study.

BACKGROUND: Wound pain is a serious problem for people with chronic wounds. The aim of this real-life study was to compare the effect of a foam dressing that releases ibuprofen (Biatain Ibu) with local best practice on the treatment of painful exuding wounds. METHODS: A total of 185 patients with painful exuding wounds were randomized to either ibuprofen foam treatment (n = 98) or local best practice (n = 87). The primary endpoint was pain relief over 7 days of treatment, assessed daily using a 5-point verbal rating scale (no relief, slight relief, moderate relief, lots of relief, and complete relief). Secondary endpoints included a total reduction in pain intensity for the whole study period (using an 11-point Numeric Box Scale: 0 = no pain to 10 = worst possible pain) and incidence of adverse events (AEs). RESULTS: More patients in the ibuprofen foam treatment group reported wound pain relief and lower wound pain intensity values after 7 days (p < 0.0001 for both variables). Within the four most common ulcer aetiolgies, patients reported significantly more effective pain relief with ibuprofen foam treatment (venous: p = 0.009, mixed arterial venous: p < 0.0001, arterial: p = 0.0009, and vasculitis: p = 0.009). In all groups, patients from the ibuprofen foam group reported lower pain intensities. The results were significant for patients with venous (p < 0.002) and arterial (p < 0.0001) leg ulcers. Two AEs were reported. CONCLUSIONS: The ibuprofen foam represents an effective and safe alternative to local best practice in the management of painful exuding wounds.

Development and implementation of a clinical pathway to improve venous leg ulcer treatment.

  A clinical pathway (CP) was developed and implemented to improve treatment outcomes for patients with venous leg ulcers. The CP and products (Rosidal® sys, Suprasorb® A, Suprasorb® P, and Suprasorb® C, Lohmann & Rauscher GmbH, Rengsdorf, Germany) were tested by case evaluation. Patients from the center were examined to determine his or her general condition, associated factors, wound type and stage, wound evolution, quality of life (QOL), treatment efficacy, and costs. Patients with venous leg ulceration (N = 20) were recruited to the clinical evaluation. Examination was performed upon presentation, and then at 2-week intervals for 12 weeks. The patients were then followed until ulcer closure. The outcome of the study group (SG) was compared to the results of a randomly selected patient control group (CG) at the center before implementing the clinical pathway. Statistic evaluation was performed using StatXact 5.0, double sided (α = 0.05) for paired and Wilcoxon test, and unpaired with Mann-Whitney (N = 20, [10/10]). After implementation, a statistically significant (P < 0.005) shorter period for ulcer closure was demonstrated for the SG when compared to previous treatment given to the CG. In the SG, 5/10 ulcers closed within 12 weeks versus 3/10 in the CG. An improvement in QOL was noted for the SG (P < 0.05 for the combined parameters, and P < 0.005 for pain), as well as cost savings (P < 0.05). The CP applied throughout the complete care chain improved quality of treatment outcomes and made effective use of resources and materials.