Does the postoperative dressing regime affect wound healing after hip or knee arthroplasty?

OBJECTIVE: The aim of this literature review is to enable practitioners to make informed decisions about how to manage patients with hip or knee arthroplasty wounds. METHOD: A systematic critique of the evidence in relation to how the postoperative dressing regime may affect wound healing after hip or knee arthroplasty, was undertaken. RESULTS: No single treatment emerged as the ideal postoperative dressing regime for hip and knee arthroplasty wounds. CONCLUSION: A selection of dressings is recommended for hip and knee arthroplasty wounds, on the basis of reducing the incidence of postoperative blistering and wound infection.

Implementing a Locally Made Low-Cost Intervention for Wound and Lymphedema Care in Western Kenya.

In Western Kenya, the burden of chronic wounds and lymphedema has a significant impact on functionality and quality of life. Major barriers to provision of care include availability, affordability, and accessibility of bandages. At the Academic Model Providing Access to Healthcare, dermatologists and pharmacists collaborated to develop a 2-component compression bandage modeled after the Unna boot, using locally available materials, that is distributed through a revolving fund pharmacy network. In partnership with nursing, use of these bandages at a national referral hospital and a few county facilities has increased, but increasing utilization to an expanded catchment area is needed.

Adaptation of the stomatherapy service during the COVID-19 pandemic: an experience report.

OBJECTIVE: To report the experience of adapting the stomatherapy service during the COVID-19 pandemic. METHOD: Experience report related to adaptations in the work routine in times of COVID-19 pandemic, from March to May 2020, in a specialized stomatherapy center in a city in the South of Brazil. RESULTS: The work routines were adapted to suit the protection measures for workers and users who used stomatherapy services. Some assistance processes were implemented to make users' access to care more flexible, and to modify routines to increase the safety of health professionals and users. CONCLUSION: The need to adapt the physical area, rethink the dynamics of care, use personal protective equipment, and guidance for servers and patients were of fundamental importance to continue attending the population safely in times of pandemic.

Ward nurses' use of wound dressings before and after a bespoke education programme.

A survey of ward nurses in medical, surgical, orthopaedic and rehabilitation specialties in relation to their care of wounds and their choice and use of wound dressings was carried out in May and August 2009 at St Mary's Hospital. Isle of Wight, UK. The objectives were to find out the distribution of wound types, and their characteristics, that were treated by ward nurses in the hospital, and to assess clinical practice in the use of wound dressings, before and after a bespoke programme of education and training. A visual framework to aid the ward nurses in the choice of dressings and frequency of change was introduced after the May 2009 survey. Following the nurses' education and training programme a repeat survey, using the same methodology, was conducted in August 2009. In the initial survey, 172 wounds were included (mean number of wounds per patient 1.64) and in the repeat one, 159 (mean number of wounds per patient 1.54). In both phases of the survey, the most common wound type was pressure ulcers, followed by surgical wounds; over 60% of the wounds were pressure ulcers, of which around half were category 1, and one-third were category 2. No category 4 ulcers were recorded. About one-third of the wounds had a duration of more than 21 days. On average, wound dressings were left in place for between two and three days, with 35% of dressings being changed on a daily basis. The mean cost of dressings per wound per week was observed to be lower in the repeat survey than in the initial one (£9.02 and £11.23 respectively). The number of undesirable reasons for changing the dressing was lower in the second phase than the first. The methodology of the surveys provided meaningful and valuable results over a short timescale, and increased understanding of wound types, their characteristics, and clinical practice. The surveys showed that data that can be collected in a short period using a simple tool can yield complex and revealing data trends. They also showed that an education programme followed by a re-survey can improve practice and reduce the costs of wound care.

Managing wound exudate and promoting healing.

Exudate is a product of the normal wound healing process. It is usually clear or amber coloured but variations in the colour, consistency, odour and amount can indicate disruption to the normal healing process. Certain types of chronic wound commonly seen in the community can be associated with the production of excessive exudate. Copious exudate can be distressing for patients and expensive for community health-care providers. Effective management depends on the accurate diagnosis and treatment of the underlying condition and skill in selecting the most appropriate dressing regime.

Exudate, infection and patient quality of life.

Efficient and cost-effective management of excessive wound exudate continues to present unique challenges to nurses. Accurate patient and wound assessment is essential to inform the treatment and selection of suitable dressings. The wide range of modern wound management products should be sufficient to meet the needs of every wound type at all phases of healing, and as circumstances change. However, there are still situations in which nurses are having to change dressings a number of times in 24 hours to prevent maceration (i.e. the softening and whitening of skin that is kept constantly wet), soiling, and the potential for cross-infection. There is no easy solution to the problem, but as nurses become more knowledgeable about identifying and managing the causes of excessive exudate, the available management options, and, as dressing materials become more sophisticated, practice should improve in this area.

Barrier dressings in surgical site infection prevention strategies.

Healthcare-associated infections (HCAIs) are a matter of priority for the NHS. They are associated with significant morbidity, and frequently lead to increased length of hospital stay, pain and discomfort for the patient, and in some cases even permanent disability. It is estimated that surgical site infections (SSIs) constitute around 14% of all HCAIs. Any break in the skin affords a portal of entry for microbial pathogens, and hence places the patient at an increased risk of infection. To address the issue, a multi-factorial strategy for the prevention of SSIs is essential, with postoperative dressings playing a key part alongside universal precautions such as hand hygiene and aseptic technique. The available guidance specifies the need for a postoperative dressing which provides an effective physical barrier and a moist environment for optimal wound healing. Vapour-permeable barrier dressings appear to be effective in meeting both of these criteria and also offer additional advantages both to patients and practitioners, such as patient comfort and the ability to stay in place whilst the patient showers. However, regular wound assessment must be carried out to ensure the vapour-permeable postoperative dressing is the right choice for a specific patient at a given time.

Key principles involved in applying and removing wound dressings.

This article aims to help practitioners consider a variety of wound dressings and develop their knowledge about the use of dressings to ensure patients are protected and care is cost-effective. The article focuses on which dressing should be used depending on wound type and how different dressings should be applied and removed. Author

Vascular access devices: securement and dressings.

Many patients admitted to hospital will require a vascular access device (VAD). Insertion of VADs is often viewed as a routine procedure, with little attention given to the importance of appropriate securement and dressing and how these factors can affect patient outcomes. This article discusses the types of VAD available and the rationale for VAD securement and appropriate dressings to minimise complications.

[Treating wounds in pediatrics, new practices]. / Traitements des plaies en pédiatrie, nouvelles pratiques.

The treatment of wounds has been the subject of a number of research works and a wide range of dressings is now available. However, few studies have been carried out into their application in and suitability for paediatrics. Protocols have however been put in place, as an extension to their use with adults, to meet the specific needs of this section of the population.

A review of the literature on topical therapies for diabetic foot ulcers. Part 2: Advanced treatments.

Following part one, which presented background to diabetic foot ulcers and the principles thought to explain hard-to-heal wounds, part two of this series reviews the efficacy and cost data indicating that certain wound treatments may be of benefit.

Assessment of human and material resources available for primary eye-care delivery in rural communities of southwestern Nigeria.

Integration of primary eye-care (PEC) into the existing primary healthcare (PHC) system is efficient in reaching rural communities. Baseline assessment of human and material resources for primary eye-care delivery in a rural local government area of southwestern Nigeria with projected population of 126,625 was conducted. Data on number and cadre of all PHC facilities and health-workers were collected. All facilities were visited and materials required for basic PEC inspected. Forty-one (42.3%) community health extension workers, 42 (43.3%) health assistants, 3 (3.1%) community officers of health and 11 (11.2%) registered nurses administered PHC in 27 health facilities. No worker had training in PEC and none of the centres had all the materials for basic PEC delivery. Although procurement of materials and training of health-workers in basic PEC delivery is required, the healthcare facilities and workers currently available are adequate to commence integration of PEC into the PHC system.

Using ActivHeal dressings in a London teaching hospital: a cost analysis.

Lower-cost 'generic' wound dressings are now available in the dressing categories of foams, films, alginates, gels and hydrocolloids. This offers the possibility of achieving significant financial savings while retaining good clinical standards of wound care. To test the potential for cost saving in a typical London teaching hospital, the ActivHeal range of dressings was substituted for normal 'branded' dressings over a 3-month period, during which dressing cost and clinical effectiveness were assessed. The result was an equivalent yearly cost saving of pound55 221 (54%), with retention of performance standards across the dressing range. Two years after the trial, wards in University College London Hospitals NHS Foundation Trust continue to benefit from significant annual cost savings on dressings by using the ActivHeal range of products, while maintaining a high standard of clinical care.

Impact of adhesive surgical tape and wound dressings on the skin, with reference to skin stripping.

Age- and disease-related factors can cause the skin to become susceptible to damage, particularly at dressing change. This review recommends ways of avoiding skin trauma when removing adhesive dressings and surgical tapes.

Exudate management: a patient-centred approach.

This article, the first in a series of three, explores exudate management using a patient-centred approach. It outlines the challenges in achieving an optimum moisture balance and the implications for the patient when this does not occur.

Evidence review: the clinical benefits of Safetac technology in wound care.

Common causes of trauma and wound pain include: the removal of dressings that become stuck to the wound bed; skin stripping of peri-wound skin, as a result of the repeated application and removal of adhesive dressings; and tissue excoriation and maceration of the peri-wound skin, due to inadequate management of wound exudate. This supplement outlines how dressings with Safetac adhesive technology can help clinicians to avoid these problems. A review of the clinical and scientific evidence relating to dressings with Safetac clearly demonstrates that they can be used to prevent trauma and minimise pain on a wide range of wound types and skin injuries.

A community nursing guide: multilayer lymphoedema bandaging.

Multi-layer lymphoedema bandaging (MLLB) has been clinically proven to reduce oedema, improve skin complications and reduce infection. MLLB differs from four layer bandaging traditionally used to treat leg ulceration. This article identifies some of the differences between the two methods, suggests when best to use MLLB, describes an MLLB technique and considers the implications for training.

Dressing remedies: a concept for improving access to and use of dressings in nursing homes.

Delays in accessing dressings prescribed by general practitioners can result in the inappropriate use of dressings on more than one resident in nursing homes. The dressing remedies concept was developed to overcomes this problem.

Pediatric skin care: guidelines for assessment, prevention, and treatment.

The review of the literature suggests the pediatric population is at risk for skin breakdown and therefore pressure ulcer development. The literature reveals limited information on pediatric skin care issues in comparison to the adult population. The prevention and treatment of pressure ulcers and maintenance of skin integrity in the pediatric population often is not a high priority, especially in the critically ill child. Research has demonstrated that children differ from adults in the anatomical sites of skin breakdown; however, treatment remains the same. It is important to have an understanding of the underlying physiology of ulcer formation, the factors responsible for ulcer development, and the factors that put infants and children at risk for developing pressure ulcers. Accurate assessment, documentation, prevention, and treatment are all key factors.