Effect of quality nursing intervention on wound healing in patients with burns: A meta-analysis.

This meta-analysis aimed to explore the effects of quality nursing intervention on wound healing in patients with burns. A computerised search was conducted for randomised controlled trials (RCTs) on the effect of quality nursing intervention on wound healing in patients with burns in the PubMed, Embase, Google Scholar, Cochrane Library, China National Knowledge Infrastructure and Wanfang databases from the date of database inception to November 2023. Two researchers independently screened the literature, extracted data and performed quality assessment based on the inclusion and exclusion criteria. Stata 17.0 software was used for the data analysis. Twenty-nine RCTs involving 2637 patients with burns were included. The meta-analysis revealed that compared with conventional nursing, the implementation of quality nursing intervention in patients with burns significantly shortened the wound healing time (standardised mean difference [SMD] = -2.93, 95% confidence interval [CI]: -3.44 to -2.42, p < 0.001). The incidence of wound infections (odds ratio [OR] = 0.14, 95% CI: 0.07-0.27, p < 0.001) and complications (OR = 0.16, 95% CI: 0.11-0.23, p < 0.001) was also reduced significantly. This meta-analysis shows that applying quality nursing interventions in patients with burns can significantly shorten the wound healing time and reduce the incidence of wound infection and complications, thus promoting early patient recovery.

Wound infections: an overview.

In the ever-changing world of wound care and nursing, it remains apparent that chronic wounds are a growing challenge. Evidence shows that age increases the likelihood of developing a chronic wound, which supports the notion that the burden of these wounds on the NHS is likely to further intensify with the ageing population. There are many reasons why a wound may fail to progress, including wound aetiology, comorbidities and environmental and socio-economic factors. One of the most significant reasons why wounds may fail to progress and become chronic is untreated wound infection. In order for clinicians to be able to treat and manage wound infections, it is vital that they understand how infection develops, the many ways in which infections may present themselves and how and when to initiate appropriate topical and systemic therapies to treat wound bed infections. The present article provides an overview of wound bed infections and their management.

Use of internally validated in vitro biofilm models to assess antibiofilm performance of silver-containing gelling fibre dressings.

OBJECTIVE: To assess the efficacy of five silver-containing gelling fibre wound dressings against single-species and multispecies biofilms using internally validated, UKAS-accredited in vitro test models. METHOD: Staphylococcus aureus, Pseudomonas aeruginosa and Candida albicans single- and multispecies biofilms were cultured using Centres for Disease Control (CDC) biofilm reactors and colony drip flow reactors (CDFR). Following a 72 hour incubation period, the substrates on which biofilms were grown were rinsed to remove planktonic microorganisms and then challenged with fully hydrated silver-containing gelling fibre wound dressings. Following dressing application for 24 or 72 hours, remaining viable organisms from the treated biofilms were quantified. RESULTS: In single-species in vitro models, all five antimicrobial dressings were effective in eradicating Staphylococcus aureus and Pseudomonas aeruginosa biofilm bacteria. However, only one of the five dressings (Hydrofiber technology with combination antibiofilm/antimicrobial technology) was able to eradicate the more tolerant single-species Candida albicans biofilm. In a more complex and stringent CDFR biofilm model, the hydrofiber dressing with combined antibiofilm/antimicrobial technology was the only dressing that was able to eradicate multispecies biofilms such that no viable organisms were recovered. CONCLUSION: Given the detrimental effects of biofilm on wound healing, stringent in vitro biofilm models are increasingly required to investigate the efficacy of antimicrobial dressings. Using accredited in vitro biofilm models of increasing complexity, differentiation in the performance of dressings with combined antibiofilm/antimicrobial technology against those with antimicrobial properties alone, was demonstrated.

Use of a TLC-Ag dressing on 2270 patients with wounds at risk or with signs of local infection: an observational study.

OBJECTIVE: A description of wounds treated with a poly-absorbent silver dressing (with technology lipido-colloid with silver ions, TLC-Ag), and evaluation of the short-term clinical impact of the dressing on the wound healing process, under real-life conditions. METHOD: A large, prospective, multicentre, observational study of patients in 81 centres in Germany, presenting with an exuding wound at risk or with clinical signs of local infection for whom the evaluated TLC-Ag dressing (UrgoClean Ag, Laboratoires Urgo, France) has been prescribed. Main outcomes included: reduction in number of wound infections diagnosed and clinical signs of local infection, wound healing rate, clinical assessment of wound healing progression, relative wound area reduction (RWAR), local tolerability, handling and acceptance of the dressing. RESULTS: A total of 2270 patients with acute and chronic wounds of various aetiologies were treated with the evaluated dressing for a mean duration of 22±13 days. All clinical signs of local infection and the diagnosed wound infections were substantially reduced at two weeks after the treatment initiation. All wound infection parameters continued to reduce until the last visit. In the meantime, clinical improvement in wound healing was reported in 98.9% of acute wounds, with a wound closure rate of 68.5%. In chronic wounds, a median RWAR of 57.4% was achieved, with an improvement in healing process documented by clinicians in 90.6% of cases, stabilisation in 6.1% and worsening in 3.2%. Similar results were reported, regardless of exudate level and proportion of sloughy and granulation tissues in the wound bed at baseline. The dressing was well tolerated and well accepted by both patients and health professionals. CONCLUSION: These results, documented in a large cohort of patients treated in current practice, support and complete the clinical evidence on the healing properties and safety profile of the TLC-Ag dressing in the management of wounds at risk or with clinical signs of local infection, regardless of wound and patient characteristics. Declaration of interest: This study was supported by a grant from Laboratoires Urgo. UM, EB, LT and SB are employees of Laboratoires Urgo. JD, KCM and MD provided advisory and speaking services to pharmaceutical and other healthcare organisations including, but not limited to, Laboratoires Urgo. Data management and statistical analyses were conducted independently by INPADS GmbH, Germany.

Evaluar competencia clínica del profesional de enfermería, para identificación de infección en la herida de un paciente / Evaluate clinical competence of the nursing professional to identify infection to a patient's wound Abstract

Objetivo: determinar el nivel de competencia del profesional de enfermería para identificar infección en la herida de un paciente, en dos instituciones de la ciudad de Medellín. Método: es un abordaje cuantitativo, descriptivo de corte transversal. Muestra: 116 profesionales de enfermería que se desempeñan en áreas asistenciales. Instrumento: cuestionario ad hoc, que evalúa las competencias clínicas del profesional de enfermería para reconocer infección en la herida del paciente. El análisis de los datos se realizó mediante estadística descriptiva y los datos fueron procesados en Excel 2016, y SPSS Versión 25. Resultados: el nivel de competencia clínica del profesional de enfermería puntuó en nivel medio, para las categorías de actitud, habilidad y conocimiento no hubo mayores diferencias, aunque en actitud los profesionales alcanzaron nivel bueno, ninguno llegó a nivel alto. Se evidenció que un 92,2% guían su diagnóstico de infección de la herida a través de signos clásicos de infección aguda (rubor, calor, edema, empastamiento y dolor), y que un 50% de los participantes identificaban tecnologías en apósitos para el tratamiento local de la infección de la herida. No se encontró relación entre nivel de competencia clínica y experiencia asistencial, quienes realizaron diplomado en cuidado de heridas, mostraron mejor actitud en el cuidado de heridas, se hallaron diferencias significativas entre el nivel de competencia clínica y el número de pacientes que atendían los profesionales, alcanzando nivel bueno quienes atendían 20 pacientes o más. Conclusión: el nivel de competencia clínica de los profesionales de enfermería para identificar infección en la herida de un paciente es medio, lo que infiere la necesidad de fortalecer estas competencias en el pregrado, motivar participación en diplomados y certificaciones en el tema e instar a las instituciones para favorecer habilidades, conocimiento y actitud en el cuidado de pacientes que tienen heridas en riesgo de infección o infectadas. (AU)

Objective: to determine the level of competence of the nursing professional to identify infection in a patient's wound, in two institutions in the city of Medellín. Method: it is a quantitative, descriptive, cross-sectional. Sample: 116 nursing professionals, involved in healthcare areas. Resource used: ad hoc questionnaire, which assesses the clinical skills of the nursing professional to identify infection in the patient's wound. Data analysis was performed using descriptive statistics and the data were processed in Excel (2016), and SPSS Version 25. Results: the level of clinical competence of the nursing professional scored at a medium level, for the categories of attitude, ability and knowledge there were no major differences, although in attitude the professionals reached a good level, none reached a high level. It is evidenced that 92.2% guide their diagnosis of wound infection through classic signs of acute infection (redness, heat, edema, filling and pain), and that 50% of the participants identified technologies in dressings for treatment local wound infection. No relationship was found between level of clinical competence and care experience, those who completed a diploma in wound care, improved attitude in wound care, significant differences were found between the level of clinical competence and the number of patients attended by professionals, reaching good level who attended 20 patients or more. Conclusion: the level of clinical competence of nursing professionals to identify infection in the wound of a patient is medium, which implies the need to strengthen, undergraduate, motivate participation in diplomas and certifications on the subject and urge institutions to favor skills, knowledge and attitude in the care of patients who have wounds at risk of infection or infected. (AU)

Defying hard-to-heal wounds with an early antibiofilm intervention strategy: 'wound hygiene'.

Biofilm has been implicated as a barrier to wound healing and it is widely accepted that the majority of wounds not following a normal healing trajectory contain biofilm. Therefore, strategies that inform and engage clinicians to reduce biofilm and optimise the wound tissue environment to enable wound progression are of interest to wound care providers. In March 2019, an advisory board was convened where experts considered the barriers and opportunities to drive a broader adoption of a biofilm-based approach to wound care. Poor clarity and articulation of wound terminology were identified as likely barriers to clinical adoption of rigorous and proactive microbial decontamination that is supportive of wound healing advancement. A transition to an intuitive term such as 'wound hygiene' was proposed to communicate a comprehensive wound decontamination plan with an associated message of expected habitual routine. 'Wound hygiene', is a relatable concept that supports meticulous wound practice that addresses barriers to wound healing, such as biofilm, while aligning with antimicrobial stewardship programmes.

Cost-effectiveness of adjunct haemoglobin spray in the treatment of hard-to-heal wounds in a UK NHS primary care setting.

OBJECTIVE: To evaluate the cost-effectiveness of topical haemoglobin spray as adjunct therapy in the treatment of hard-to-heal wounds within a UK National Health Service (NHS) community setting. METHOD: In a previously published comparative clinical evaluation, 50 consecutive patients treated with topical haemoglobin spray, as adjunct to standard care and followed up over 26 weeks, were compared with 50 consecutive retrospective controls from the same clinic treated with the same standard care protocol in the year prior to the introduction of adjunct topical haemoglobin spray. A de novo cost-effectiveness and break-even analysis were performed, using data from the previously published clinical evaluation, for all patients (intent-to-treat) and for patients with complete follow-up using a micro-costing approach and considering only wound care dressing costs. RESULTS: At 26 weeks, the total cost of dressings for all patients in the intervention group was £6953 with 874 cumulative weeks healed, compared with £9547 with 278 cumulative weeks healed for all patients in the control group. The incremental cost-effectiveness ratio (ICER), the incremental cost per additional week healed with adjunct topical haemoglobin spray, is therefore negative (dominant). Total treatment costs per week were lower from week six onwards, with break-even estimated to be at week 10.2. When considering only patients with complete follow-up, the results were similarly dominant, with a mean 10.9 more weeks healed, a mean dressing cost saving per patient of £81.83 by week 26 (-37%). Cost savings were realised from week five, and a break-even was estimated to occur at week 8.0. CONCLUSION: Topical haemoglobin spray has the potential to restore the healing process, reduce healing times and reduce dressing costs in a NHS community setting, within a few weeks of adoption.

Chronic wounds: the challenges of appropriate management.

The immense burden imposed by chronic wounds-those persisting over 6 weeks despite active intervention-on patients and health services is well recognised. There are various reasons for why a wound fails to progress towards closure, and clinicians must investigate the underlying cause of wound chronicity, as this information guides the management of such wounds. The TIME framework (T=tissue; I=infection/inflammation; M=moisture balance; E=wound edges) is a useful tool for practitioners to systematically undertake wound assessment and product selection. This article discusses chronic wound management based on the TIME framework, examining the aspects to be considered when managing chronic wounds. It also describes the process of dressing selection for overcoming the various barriers to wound healing, specifically discussing the AQUACEL family of dressings.

Evolución de heridas crónicas infectadas en un paciente con elefantiasis / Evolution of Infected Chronic Wounds in a Patient with Elephantiasis

Se presenta un caso clínico de un paciente con elefantiasis y úlceras sobreinfectadas en ambas extremidades inferiores, incluyendo una valoración enfermera, diagnósticos prioritarios, plan de cuidados, justificación del tratamiento elegido y la evolución posterior. La evidencia de infección de las úlceras planteó la necesidad de instaurar una terapia con cadexómero yodado para tratar localmente la infección, e hidrogel para evitar la formación de biopelículas. Transcurrido un mes del alta del paciente se realizó un seguimiento en el que se observó una evolución favorable con aumento de tejido de granulación y tejido epitelial en varias de las lesiones presentes, por lo que se valoró de forma favorable el procedimiento de cura en ambiente húmedo; la mejora en los hábitos higiénico-dietéticos se completó por parte del paciente

We present the clinical case of a patient with elephantiasis and superinfected ulcers in both lower limbs, including the Nursing assessment, primary diagnosis, plan of care, justification for the treatment selected, and subsequent evolution. The evidence of ulcer infection required to initiate therapy with cadexomer iodine in order to treat the infection locally, and hydrogel to prevent the formation of biofilms. Follow-up was conducted one month after the patient was discharged, and favourable evolution was observed, with an increase in granulation tissue and epithelial tissue in many of the lesions; therefore, the procedure of healing in a moist environment was assessed as favourable, and the improvement in hygienic-dietary habits was completed by the patient

Asociación entre olor y aislamiento social en pacientes con heridas tumorales malignas: estudio piloto / Associação entre odor e isolamento social em pacientes com feridas tumorais malignas: estudo piloto / Association between odor and social isolation in patients with malignant tumor wounds: pilot study

Objetivo: Analizar las asociaciones entre olores y aislamiento social en pacientes con heridas tumorales malignas.Material y método: Estudio piloto con corte transversal realizado con nueve pacientes con heridas tumorales malignas atendidas en un hospital universitario en el período de 2014 a 2016. Se recogieron datos por medio de aplicación de escala likert de cinco puntos para evaluación del aislamiento social relacionado con el olor de las heridas tumorales malignas durante las consultas de enfermería. Se analizaron los datos por estrategia estadística inferencial con cálculo de coeficiente de Spearman al nivel de significancia del 5% (α = 0,05).Resultados: Se constató correlación con significancia estadística entre el olor y las dimensiones psicosociales: constreñimiento y limitación en frecuentar locales públicos.Conclusión: El olor es el principal síntoma que genera constreñimiento y limita la convivencia social, favoreciendo el aislamiento social y la degradación de la calidad de vida de los pacientes oncológicos

Objetivo: Identificar as associações entre odor e isolamento social em pacientes com feridas tumorais malignas. Material e método: Estudo piloto com corte transversal realizado com nove pacientes com feridas tumorais malignas atendidos em um hospital universitário no período de 2014 a 2016. Coletaram-se dados por meio de aplicação de escala likert de cinco pontos para avaliação do isolamento social relacionado ao odor de feridas tumorais malignas, durante as consultas de enfermagem. Analisaram-se os dados por estratégia estatística inferencial com cálculo de coeficiente de Spearman ao nível de significância de 5% (α = 0,05). Resultados: Constatou-se correlação com significância estatística entre o odor e as dimensões psicossociais: constrangimento e limitação em frequentar locais públicos. Conclusão: O odor é o principal sintoma que gera constrangimento e limita a convivência social, favorecendo o isolamento social e a degradação da qualidade de vida dos pacientes oncológicos

Objective: To analysis associations between odor and social isolation in patients with malignant tumor wounds.Material and method: This is a cross-sectional pilot study performed with nine patients with malignant tumor wounds treated at a university hospital from 2014 to 2016. Data were collected using a five-point Likert scale for the evaluation of social isolation related to odor of malignant tumor wounds during nursing consultations. Data were analyzed by inferential statistical strategy with Spearman's coefficient at the significance level of 5% (α = 0.05).Results: Correlation was found with statistical significance between odor and psychosocial dimensions: constraint and limitation in attending public places.Conclusion: Odor is the main symptom that causes embarrassment and limits social coexistence, favoring social isolation and degradation of the quality of life of cancer patients

Wound Exudate.

Tina Chambers, Independent Tissue Viability Consultant.

Era difícil imaginar que las úlceras y heridas fueran titular / No disponible

No disponible

Unidades de heridas / Units of wounds

Dentro de las respuestas que han surgido a la problemática ocasionada por las heridas crónicas, la creación de unidades clínicas especializadas ha sido una de las que mayor interés ha despertado en los últimos años. Estas unidades están conformadas por profesionales de diferentes disciplinas que se organizan de acuerdo con un servicio-departamento unificado. A través de enfoques interdisciplinarios-transdisciplinarios consiguen una atención integral a estos pacientes, identificando todos los factores que pueden afectar a la cicatrización de heridas crónicas y paliando los problemas asociados a la complejidad y heterogeneidad de estas lesiones. La implantación de este modelo todavía no está completamente desarrollada en nuestro país a pesar de su conveniencia y la creación de nuevas unidades de heridas a menudo acarrea dificultades y dudas. Este trabajo aporta algunas claves de las ventajas de la adopción de este modelo organizativo y sugiere algunas ideas para aquellas personas u organizaciones que estén planteándose la instauración de este modelo

Among the responses to the problems caused by chronic wounds, the creation of specialized clinical units has been one of the most interesting in recent years. These units are made up of professionals from different disciplines who are organized on the topic of a unified department-service. Through interdisciplinary-transdisciplinary approaches, they achieve comprehensive care for these patients, identifying all the factors that can affect the healing of chronic wounds and alleviating the problems associated with the complexity and heterogeneity of these lessions. The implementation of this model is not yet fully developed in our country despite its desirability and the creation of new wounds units often carry difficulties and doubts. This work provides some keys to the advantages of adopting this organizational model and suggests some key points for those people or organizations that are considering the establishment of this model

Efectividad de una nueva propuesta Clean & Close en el tratamiento de heridas de evolución tórpida / Clean and Close: an effective new treatment proposal for wounds with torpid evolution

Las heridas de evolución tórpida y compleja suponen un desafío para las enfermeras por su multicausalidad. Asimismo, la diferencia de criterios entre las profesionales podría generar una falta de continuidad en los tratamientos que comprometería su resolución. Por ello, es necesario unificar criterios para su prevención, diagnóstico y tratamiento con el fin de mejorar la continuidad de los cuidados. La curación de estas heridas es un proceso complejo y dinámico que implica la modificación del entorno de la herida según el estado de salud del paciente. El tratamiento local se basa en los principios de cura en ambiente húmedo (CAH) y en la preparación del lecho. El objeto de este artículo es describir los resultados de la aplicación de la propuesta Clean & Close, basada en la aplicación secuencial de dos nuevos apósitos, que, por un lado, estimulan el desbridamiento del tejido necrótico húmedo y el control de la infección (Kytocel: apósito de fibras de Quitosán) y, por otro, estimulan la producción de tejido de granulación y el proceso de angiogénesis, acelerando la cicatrización de las heridas (Trionic(R): apósito bioactivo con carga iónica). Consideramos que pueden ser una alternativa efectiva en el tratamiento de este tipo de heridas

Complex wounds with torpid evolution represent a challenge for nursing professionals due to their multicausality. Differences of criteria among professionals could eventually lead to treatment discontinuities compromising wound healing. It is therefore necessary to unify criteria for complex wound prevention, diagnosis and treatment in order to improve continuity of care. The healing of chronic wounds involves a complex and dynamic process, which requires modulating wound environment depending on the patient's state of health. Local treatment is based on the principles of moist wound healing (MWH) and wound bed preparation. The purpose of this article is to describe the results of the new Clean & Close treatment proposal. It is based on the sequential application of two new dressings which, on the one hand, stimulate the debridement of slough tissue and favor infection control (Kytocel: chitosan fibers dressing), and on the other, stimulate the production of granulation tissue and the process of angiogenesis, accelerating wound healing (Trionic(R): bioactive ionic dressing). We consider that the Clean & Close proposal can be an effective alternative treatment for these types of complex, chronic, hard-to-heal wounds

Identifying and managing wound infection in the community.

A large proportion of community wound care consists of managing chronic wounds. Given the increasingly complex patient comorbidities, early identification and treatment of wound infection can impact greatly not only on wound healing but also on the patient physically, psychologically and socially. Identifying wound infection can be challenging for clinicians, particularly in the chronic wound where infection may not always present itself as it does in acute wounds. The management of infected wounds can be complicated. Managing multiple symptoms and recognising these as being due to infection is not always straightforward and relies on the practitioner's knowledge and skills. An understanding of more commonly used antimicrobial treatments and when to employ these is paramount in enabling the practitioner to provide care that is effective, evidence based and cost efficient.

When and How to Perform Cultures on Chronic Wounds?

PURPOSE: The purpose of this Evidence-Based Report Card was to examine current best evidence related to when and how to perform cultures on chronic wounds to guide clinicians in determining the appropriate treatment. QUESTION: (1) When should cultures be performed on chronic wounds? and (2) What is the best method or technique to perform a culture on a chronic wound? SEARCH STRATEGY: A search of the literature was performed, resulting in 45 publications relevant to the topic. Following a review of titles and abstracts, 7 studies were identified that met inclusion criteria. Key search terms used were "chronic wound," "chronic infected wound," "wound culture," "specimen collection," and "wound swab." Strength of the evidence was rated based on the methodology from Essential Evidence Plus: Levels of Evidence and Oxford Center for Evidence-Based Medicine, adapted by Gray and colleagues. FINDINGS: Seven studies were identified as pertinent to the topic on wound culture and meeting inclusion criteria. The study designs included 1 randomized controlled trial, 1 quasi-experimental comparative study, 1 systematic review, 1 scoping literature review, 1 integrative literature review, and 2 professional organization expert panel reviews (consensus statement and position statement). Of the 7 studies, 3 studies suggest that classic signs of infection may not always be present but culturing may be indicated when additional signs such as pain, necrotic tissue, prolonged or delayed healing, and wound bed deterioration occur. Four studies report that a quantitative culture of wound tissue is the gold standard to obtain a wound culture, but the swab method is an acceptable alternative option. Two articles demonstrate the Levine technique is more reliable than the Z-technique to determine microbial load in the wound bed. The strength of the evidence was identified as 2 level A studies, 1 level B study, and 4 level C studies. Using Johns Hopkins methodology, the quality of the studies was deemed either high quality or good quality. CONCLUSION/RECOMMENDATION: Evidence indicates that identification of potential chronic wound infection should be considered early using clinical signs such as pain, necrotic tissue, delayed healing, and wound deterioration (in addition to classic signs of infection) to determine the need for collecting a culture (Strength of Recommendation Taxonomy [SORT] level 2); and when a culture is deemed necessary, swab culture using the Levine method is a clinically practical alternative if performed correctly (SORT level 1).

Teaching Wound Care to Family Caregivers.

: This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home.The articles in this new installment of the series provide simple and useful instructions that nurses should reinforce with family caregivers who perform wound care tasks. Each article also includes an informational tear sheet-Information for Family Caregivers-that contains links to instructional videos. To use this series, nurses should read the article first, so they understand how best to help family caregivers, and then encourage caregivers to watch the videos and ask questions. For additional information, see Resources for Nurses.

Early wound infection identification using the WIRE tool in community health care settings: An audit report.

Wound infection is proving to be a challenge for health care professionals. The associated complications and cost of wound infection is immense and can lead to death in extreme cases. Current management of wound infection is largely subjective and relies on the knowledge of the health care professional to identify and initiate treatment. In response, we have developed an infection prediction and assessment tool. The Wound Infection Risk-Assessment and Evaluation tool (WIRE) and its management strategy is a tool with the aim to bring objectivity to infection prediction, assessment and management. A local audit carried out indicated a high infection prediction rate. More work is being done to improve its effectiveness.