Poster Abstracts
Don’t forget to vote for the most interesting, most useful and most thorough posters via the Wild On Wound Mobile Schedule
Thursday, September 8, 2022 Friday, September 9, 2022 11:45 am – 2:15 pm 11:45 am – 2:15 pm
App! Poster Session
We would like to extend our congratulations to all of the poster presenters and thank them for their contributions and hard work. Poster authors will be available for discussion and questions during designated poster session times.
Pressure Injury Incidence Monitoring: Revealing the Reality
Introduction or Problem: A healthcare challenge exists regarding pressure injury (PI) incidence data collection. The purpose was to examine baseline performance, create sustainable processes, and identify the effectiveness of prevention measures. Interprofessional activities to improve the quality of care were undertaken. Rationale: The Skin and Wound Care Committee drives best practices, has individual unit representation, and challenged the process to create an approach of collecting PI incidence data. Incidence monitoring reveals real time hospital acquired pressure injuries (HAPIs) and identifies quality improvement opportunities. Prior to project implementation, the organization primarily utilized PI prevalence audits (quarterly), which were not accurately capturing HAPIs. Therefore, an increase in HAPIs was anticipated. Method: Real time audits for HAPIs were not historically obtained. The Clinical Nurse Specialist (CNS), who chairs the Skin and Wound Care Committee, worked in collaboration with clinical nurses, Wound Care, and Information Systems (IS) to create a report that captured all documented PIs and HAPIs within the organization. The report was reviewed daily, evaluating PI stage (stages 1 through 4, unstageable, DTI, and device related) as well as mucosal membrane PIs, then compared to the previous day’s report to evaluate for progression of PIs. Committee representatives reviewed HAPIs monthly to identify gaps in care and trends. A standardized template was used to share unit specific opportunities with clinical nurses and unlicensed assistive personnel at Unit Practice Councils and department meetings.
Hannah Wyneken MSN, RN, AGCNS BC, CMSRN, WCC Hendricks Regional Health
POSTER #1
References: 1. European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, & Pan Pacific Pressure Injury Alliance. (3rd Ed). (2019). Prevention and treatment of pressure ulcers/injuries:
Result or Patient Outcomes: Over a seven year period (2012 2019), 86 HAPIs were identified by retrospective chart audit. As expected, a more specific PI incidence report identified 183 HAPIs from January 2020 to December 2021, establishing a baseline. Cumulative incidence was calculated for acute care (decrease 0.45%), critical care (increase 6.8%), and operating room (OR) (0.07%) settings. Despite these rates being within or below the literature predicted values, opportunities for further improvement existed. The CNS collaborated with clinical nurses to identify unit specific gaps in PI prevention and interventions. Individualized evidence based prevention measures, based on specific anatomical locations were developed. Conclusion: This project resulted in a reporting process that accurately trends PI incidence data. Accurately trending data is a best practice and necessary to identify practice gaps. Engaging clinical nurses in PI incidence and in review of HAPIs directly impacts care at the bedside and promotes the highest quality PI care and prevention. The PI incidence data will continue to be used to evaluate current and future interventions targeted at preventing PIs.
clinical practice Care Education (2020). Skin and wound management course workbook. Relias.
Institute.
guideline. 2. Wound
Results: 38 year old male with Chronic Sickle Cell leg ulcer previously treated for 6 months unsuccessfully now treated and closed over 7 month period with multi modality treatment plan. Multiple treatment modalities were utilized over 7 months which included: ultramist, topical O2, Biosurgical Debridement, Actigraft, and Amnioband. Pain management plays a large role in wound healing. Zynex was used successfully with this patient to address chronic pain.
Discussion: Although patients may receive continuous treatment to their sickle cell leg ulcers, they often suffer from ulcers becoming chronic wounds. With consistent treatment, including pain management, it is possible to heal.
Introduction: Treating Sickle Cell leg ulcers remains a challenge for everyone including both patient and Doctors. How do we decrease the chronicity of the sickle cell leg ulcer? Sickle cell leg ulcers are a severe, chronic, and recurrent complication of sickle cell disease. There are no official recommendations for treatment. A 38 year old male presents with a chronic non healing leg ulcer. After 6 months of treatment at a wound center the ulcer was increasing in size, so the patient sought out a second opinion to explore additional treatments available.
Dr. Steven Wells DPM, PHD, WCC, Favor Foot Ankle Leg and Wound Center, Brookdale University Medical Center, Richmond University Medical Center
Conquering The Chronicity of the Sickle Cell Leg Ulcer
POSTER #2
References: 1. Jean Benoît Monfort* and Patricia Senet, (2020). Leg Ulcers in Sickle Cell Disease: Treatment Update. Adv Wound Care (New Rochelle). June 2020; 9(6): 348 356. Published online 2020 Apr 8. doi: 10.1089/wound.2018.0918
2. Am J Hematol. (2011 Oct 1). Leg Ulcers in Sickle Cell Disease. Published in final edited form as: 3. Am J Hematol. 2010 Oct; 85(10): 831 833. doi: 10.1002/ajh.21838
Method: Practical treatment approach to treat Sickle cell leg ulcers may include compression therapy, local wound care, and sharp debridement. Pain management is necessary as these chronic wounds can be extremely painful. Nonsteroidal anti inflammatory drugs may be used for wound related pain. Topical lidocaine may be effective for local treatment of any leg ulcers.
An Innovative Technique Using Kinesiology Tape to Decrease Peristomal Skin Creases in Ostomy Care: A Case Study
“People living with obesity frequently have a stoma placed in a skin crease or fold and suffer from peristomal skin damage and unpredictable appliance wear time” (Colwell, 2005). An obese male presented with a flush stoma located in a deep crease. Ostomy barriers were leaking daily causing peristomal skin damage, anxiety, and excess supply usage. Various appliances, belts and caulks were trialed without success. The patient was willing to learn self care but frustrated that barrier would not adhere for 24 hours.
References:
POSTER
After exhausting all conventional tactics and products, an attempt was made to alter the topography of the patient’s abdomen using kinesiology tape. Kinesiology tape is an elastic adhesive cotton tape known to relieve pain, support function and reduce swelling (Langendoen & Sertel, 2011). With the patient in an upright position, kinesiology tape was placed on the skin about 1 ½ inches above the stoma and pulled the fascia upward to flatten the creases. With a flattened plane, a convex ostomy barrier was applied. Patient Outcomes:
1. Colwell, Janice C.; Fichera, Alessandro Care of the Obese Patient with an Ostomy, Journal of Wound, Ostomy and Continence Nursing: November 2005 Volume 32 Issue 6 p 378 383
2. Langendoen J, & Sertel, K. (2011). Kinesiology Taping: The Essential Step by Step Guide. Canada, Robert Rose Inc.
Clinical Approach:
Anita Prinz, MSN, RN, CWOCN, WCC, OMS Clinical Problem:
Using the kinesiology tape, ostomy wear time improved to a predictable 3 days. The patient was able to learn the procedure and became independent in ostomy self care. He also reported better comfort and support using the kinesiology tape. There were no skin reactions to the tape. The patient’s quality of life improved and he was able to return to work.
Conclusion: Kinesiology tape is a safe and effective method to mechanically decrease peristomal skin creases allowing the user to increase ostomy wear time, avoid peristomal skin damage, and decrease supply usage.
#3
Common means of compression in the home health arena include roll gauze, ACE wrap and Unna’s boots which are inconsistent and do not provide consistent measurable therapeutic compression. Often these modalities require a skilled clinician to change these multiple times per week. Using a non elastic long term compression garment provides consistent, measurable, graduated therapeutic compression to foot, ankle, and leg. This non disposable form of consistent compression provides ease of donning and doffing. Within the home health realm introducing and educating this compression modality provides skill for multiple disciplines within the home health arena. Subsequent independence provides decreased frequency of skilled visits and decreased lengths of stay.
Gretchen Arno BSN RN CWS, Libellen Wound Healing Consultants
Jennifer Bierhup WCC iRNPA CCM, DAPWCA FACCWS, Libellen Wound Healing Consultants
• Patient compliance
Outcome improvement and cost savings are not mutually exclusive. The case for securing proper therapeutic compression management for venous stasis ulcers in Skilled Home Health
• Overall cost savings from an Unna boot or two layer wrap
• Decreased length of stay
Rationale: In the home health field, VLUs are often managed with short term disposable compression appliance which is inconsistent and often counterproductive. Often home health agencies are apprehensive to pursue long term compression methods for their Medicare A and B patients per higher initial cost.
Conclusions: The gold standard of care for treating and healing venous leg ulcers (VLUs) is adequate consistent compression. Improved outcomes, lower actual costs, and faster healing can be the result. Compression garments have been demonstrated to increase complete healing of venous ulcers by 70% compared within 12 months. As non elastic long term compression garments are durable, reusable and
Problem: Venous leg ulcers (VLUs) are open lesions of the lower limb which represent 60 80% of all leg ulcerations which occur in the presence of venous disease. These affect approximately 600,000 Americans or 4% of adults over 65 years of age. 60% of VLUs are often healed within 12 weeks. Conversely once healed, 75% develop a recurrence within three weeks. At least 60% of VLUs result in a chronic wound. The prevalence of VLUs is expected to grow as the population ages.
Methods:
• Accuracy of application compared to Unna or two layer wrap
• Definable skilled need
Results: The early placement of non disposable long term compression creates patients who are more quickly independent. By transitioning a patient to this modality, the home health agency often will benefit from:
POSTER #4
• Consistent and measurable pressure regardless of who is applying it.
4. Probst, S., Weller, C. D., Bobbink, P., Saini, C., Pugliese, M., Skinner, M. B., & Gethin, G. (2021). Prevalence and incidence of venous leg ulcers a protocol for a systematic review. Systematic Reviews, 10(1). https://doi.org/10.1186/s13643 021 01697 3
5. Ratliff, C. R., Yates, S., McNichol, L., & Gray, M. (2016). Compression for primary prevention, treatment, and prevention of recurrence of venous leg ulcers. Journal of Wound, Ostomy & Continence Nursing, 43(4), 347 364. https://doi.org/10.1097/won.0000000000000242
2. Health Quality Ontario. (2019, February 19). Compression stockings for the prevention of venous leg ulcer recurrence: A Health Technology Assessment. Ontario health technology assessment series. Retrieved June 29, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6394515/?report=classic
user friendly, the patient can continue to use the garment as prescribed after discharge from skilled home health, thus reducing the chance of recurrence of VLUs.
References:
1. Grunwald, J., Korownyk, C., & Thomas, B. (2021, November 1). Under pressure: Compression Stockings for recurrent cellulitis? gomainpro Alberta College of Family Physicians. Retrieved June 29, 2022, from https://gomainpro.ca/wp content/uploads/tools for practice/1635783832_tfp301_compstockings.pdf
3. National Institute for Health and Care Excellence. (2015, March 15). Overview: The juxta cures adjustable compression system for treating venous leg ulcers: Advice. NICE. Retrieved June 29, 2022, from https://www.nice.org.uk/advice/mib25
6. Shi, C., Dumville, J. C., Cullum, N., Connaughton, E., & Norman, G. (2021). Compression bandages or stockings versus no compression for treating venous leg ulcers. Cochrane Database of Systematic Reviews, 2021(7). https://doi.org/10.1002/14651858.cd013397.pub2
Conclusion: The proteomic results reported in this porcine study support the improved wound healing progress seen with the use of a novel 7 day continuous wear dressing. Further investigation is required to assess relevance to clinical applications.
Wound healing associated cytokines/chemokines suggested differences between the two dressings. Tissue managed with the novel dressing trended toward higher expression of interleukin (IL) 2, IL 10 and IL 18. Significantly higher (p<0.05) values were evident for IL 1α (0.7pg/µg vs. 0.17pg/µg), IL 1beta(β) (6.2pg/µg vs. 1.3pg/µg), IL 1receptor antagonist(ra) (0.77pg/µg vs. 0.15pg/µg), IL 8 (3.5pg/µg vs. 0.55pg/µg), and IL 12 (8fg/µg vs. 0fg/µg) compared to ROCF managed wounds, respectively. There was greater granulation tissue formation in wounds managed with the novel dressing relative to ROCF managed wounds.
POSTER #5
Results: Levels of fibroblast growth factor (FGF) 1, FGF 2, heparin binding epidermal like growth factor (HB EGF), platelet derived growth factor (PDGF) AA and transforming growth factor alpha(TGFα) trended higher for novel dressing managed wounds. Only HB EGF was significantly higher compared to ROCF managed wounds (17fg/µg vs. 7fg/µg, respectively).
Samantha A. Mann, B.S., 3M Company Diwi Allen, M.S., Marisa Schmidt, B.S. Timothy Robinson, Ph.D. Kristine Kieswetter, Ph.D., M.B.A
Preclinical and proteomic assessment of a novel 7 day dressing used in conjunction with negative pressure wound therapy
Rationale: This study evaluated a novel dressing† for use with NPWT designed to utilize advantages of ROCF while addressing these drawbacks. Method: All work was approved by the Institutional Animal Care and Use Committee (IACUC). Animal care complied with applicable national and local regulations. Full thickness excisional wounds were created along the spine of 11 swine. Continuous negative pressure, 125mmHg, was applied to dressings for 7 days without dressing changes. Total protein was extracted from day 7 biopsies and analyzed using multiplex immunoassays. Histopathology and morphometry evaluations were completed to assess granulation tissue thickness and quality at day 7.
3M Company Introduction or Problem: Negative pressure wound therapy (NPWT)* using reticulated open cell foam (ROCF)^ is a widely accepted form of advanced wound care. Reported drawbacks include painful dressing changes associated with foam tissue ingrowth and dressing application challenges requiring some level of skill.
†Novel Dressing (3M, San Antonio, TX); *3M™V.A.C.® Therapy; ^*3M™V.A.C.® Granufoam™ Dressing
References:
2. Patel, S., Maheshwari,A., & Chandra,A. (2016). JWound Care, 25(1), 46 55. doi:10.12968/ jowc.2016.25.1.46
1. Ligi, D., Mosti, G., Croce, L., Raffetto, J. D., et al. (2016). Biochim Biophys Acta, 1862(10), 1964 1974. doi:10.1016/j.bbadis.2016.07.018
3. Rohde, C., Chiang, A., Adipoju, O., Casper, D., et al. (2010). Plast Reconstr Surg, 125(6), 1620 1629. doi:10.1097/PRS.0b013e3181c9f6d3
4. Rohde, C. H., Taylor, E. M., Alonso, A., Ascherman, J. A., et al. (2015). Plast Reconstr Surg, 135(5), 808e 817e. doi:10.1097/prs.0000000000001152
5. Allen, D., Kendrick R., Schmidt, M., Robinson, T., Locke, C., Kieswetter, K., Stokes, B. Evaluation of a Novel Negative Pressure Wound Therapy Dressing: Usability and Preclinical Studies Show Potential Benefits and Ease of Use Compared to Standard Foam Dressing After 7 Days of Continuous Therapy. Poster presented at the WOCNext 2020| reimagined, 5 7 June 2020. Virtual.
POSTER #6
Rationale:
Home Health Nursing saw patients one day after physician visit. The ordered SS was not yet available. The dried petrolatum impregnated dressing, which was sticking to the burns, required more than an hour to remove. Home Health chose to intervene with polymeric membrane dressing rolls (PMDs), which was immediately available, until SS was available.
Conclusion: PMD wound management reduced total care cost by eliminating the expenses of typical hospital admission for sharp, painful debridement and grafting procedures. With PMDs, the burns healed faster than would have been expected with previous burn management approaches. There is no better product than PMDs for managing these burns.
References:
2. Jeschke M, van Baar M, Choudhry M, Chung K, Gibran N, Logsetty S. Burn injury. Nat Rev Dis Primers. 2020; 6(1):1 25.
Successful Management of 2nd Degree Scald Burns to Bi Lateral Lower Legs in a 92 Year Old Female, Expedited Healing and Avoidance of Hospitalization
Ronda Bowles RN, BSN, CWON, Regional Director Interim Healthcare
Method: Home health nurses managed the burns with hypochlorous acid wound soaks, barrier cream on periwound skin, polymeric membrane dressing rolls (PMDs) on the burns. Dressings to be changed 3x per week. Patient Outcomes: After two days of PMDs: inflammation reduced; pain 3 (0 10 scale); patient could now sleep. The SS was now available and applied on the left lower extremity but was removed 2 hours later by the on call nurse due to patient reporting severe burning sensation; PMDs were reapplied. 7 days after initial PMD application patient returned to physician’s office. The physician’s office inspected the wound but missed covering 3cm x 3cm burn area when reapplying PMDs. The missed area was black and necrotic when observed at next home health dressing change 2 days later, day 9. The necrotic area was covered again with PMDs. PMDs debrided the necrotic area, which closed in 105 days after the initial PMD application. All the rest of the burns closed in 60 days.
1. Hyland E, Connolly S, Fox J, Harvey J. Minor burn management: potions and lotions. Aust Prescr. 2015; 38:124 7.
Problem: A 92 year old female suffered blistering, 2nd degree, boiling water scald burns to legs bilaterally; pain 10 (0 10 scale). Oil emulsion gauze applied by emergency department (ED). The next day the primary care physician: prescribed antibiotics; wrapped legs with petrolatum impregnated dressings; referred her to home health with silver sulfadiazine (SS) application orders.
Jessica Weatherly RN, WCC, DWC Brittany Phillips, LVN
Conclusion:
• Working closely with an interdisciplinary team will allow the patient to achieve the greatest results.
Introduction : The primary focus is to shed light on the disease progression of Calciphylaxis, medication management, and wound care education/treatment while remaining patient focused and utilizing an interdisciplinary team approach. “Calciphylaxis is a rare but potentially devastating condition most often observed in patients with end stage renal disease. Calciphylaxis is associated with substantial morbidity due to severe pain, non healing wounds, and frequent hospitalizations. Calciphylaxis has a poor prognosis with 1 year mortality rates between 45% and 80%, and the response to therapy is also poor. Patients with ulcerated lesions are particularly prone to developing an infection, which is the leading cause of death.”
Management of Calciphylaxis utilizing an interdisciplinary team approach and remaining patient focused: An Informative Study
Rationale: A 34 year old female with a medical history of Depression, HTN, Anemia, Hypothyroidism, and Alcoholic Hepatitis. She was hospitalized for Alcoholic Hepatitis with liver failure when she began to break out with purple bruise like lesions on multiple sites of her body. These areas broke open quickly turning into necrotic tissue.
• Be an advocate for the patient and treat every case with an individualized focus on the goal/expectations of the patient.
Methods: Bloodwork revealed elevated Phosphate, Sed rate, and CRP. Creatinine and BUN were slightly elevated and Calcium level was normal, PTH Intact was not drawn at this point. The patient was admitted to home health to provide palliative wound care management. Lesions were being painted with iodine daily. The patient showed a quick decline with signs that the patient was heading towards a critical anemia state and infection risk. Hospice discussion was made with the patient on multiple occasions by several of her providers and the patient was made aware of disease progression and life expectancy of Calciphylaxis. The patient declined Hospice services along with an inpatient facility for wound management. Patient Outcome: Home Health nurse coordinated care with PCP for better control of nerve pain while addressing Depression to switch from Lexapro to Cymbalta, with results after 10 days of the switch with mood improvement and reduced pain with dressing changes. The Home Health nurse made recommendations to PCP for a full autoimmune workup along with PTH intact lab workup with no significant findings. Care was coordinated between wound care provider and home health nurse to focus on a reduced amount of dressing changes while maintaining antimicrobial control. IV infusion of Sodium Thiosulfate and IV ABX was initiated during a hospital stay and the patient continued those infusions until she reached optimal wound healing. Holistic Care was provided with each visit focusing on the patient's mental and spiritual wellbeing. With the support and education from the care team the patient reached complete optimal wound healing within 9 months and returned to work shortly after. She has continued to focus on living her life to the fullest and enjoying the little along with the big moments of her life.
POSTER #7
• The Home Health Care team played a vital role in this patient’s life by conducting a comprehensive assessment and identifying patients ’areas of knowledge deficit of disease process and outcome, providing the patient with education on those knowledge deficits, nutrition requirements, mental and spiritual needs, along with coordinating care between patient and providers.
• Patient testimony: "When you are in that dark, depressing time you don't see a light at the end of the tunnel. The turnaround was having someone very passionate about helping... I am so thankful that I have my life."
Références : Nigwekar, Sagar U, et al. “Calciphylaxis: Risk Factors, Diagnosis, and Treatment.” American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation, U.S. National Library of Medicine, July 2015, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4696752.
Perioperative acquired pressure injuries (POPIs) accounted for more than 30% of hospital acquired pressure injuries (HAPIs) at our cardiovascular procedural based hospital in spite of best practice pressure injury prevention interventions during and after surgery.
POSTER #8
Maria Hoffman, MSN, RN, WCC Tina Jackson, BSN, RN, CNOR
Rationale: Best practice prevention interventions recommended by the National Pressure Injury Advisory Panel (NPIAP) and the Association of perioperative Registered Nurses (AORN) include the placement of prophylactic silicone foam dressings to protect from friction and shear, pressure redistribution support surfaces, and comprehensive skin assessments prior to and after surgical procedures. Our facility was already using the sacral and heel prophylactic silicone foam dressings on our patients undergoing procedures greater than three hours so our project focused on the use of a pressure redistribution support surface on the operating room tables, improved skin assessments, and a multidisciplinary approach to pressure injury prevention interventions.
Conclusion: The use of the static air overlay during prolonged surgical procedures combined with increased staff awareness of patients’ risks for POPIs, and the consistent implementation of pressure injury prevention interventions can significantly reduce the incidence of POPIs.
Method: Using the Plan, Do, Check, Act method, we conducted a trial of a non powered reactive air support overlay on our surgical tables for cardiothoracic surgery patients undergoing planned surgical procedures of three hours or more. Prior to the trial, extensive pressure injury awareness education was provided to the pre op holding staff, the OR staff, and the bedside nurses. During the trial, the OR nursing staff identified which patients met the trial inclusion criteria and ensured proper placement of the overlay on the surgical table prior to surgery. OR staff completed pre operative skin assessments and bedside nurses completed post operative skin assessments. The certified wound care nurse conducted skin assessments post op day one through post operative day five. Purple colored door signs were placed outside the room to alert the entire medical team of the patients’ increased risk for POPIs.
Références :
Result or Patient Outcomes: Of the 24 patients participating in the trial, none of the patients developed a POPI. The OR nurse educator and the certified wound care nurse presented the trial results to the surgical services team and received approval for a practice change based on the trial results. Since the implementation of the non powered static air overlay on the surgical table, increased staff education on POPI prevention, and the use of the POPI risk door signs our incidence of POPIs has decreased to just 8% of our total number of HAPIs.
Decreasing Perioperative-Acquired Pressure Injuries (POPIs) in Cardiothoracic Surgery Patients Using a Static Air Overlay on OR Surface
Introduction or Problem:
6. Kimsey, D. B. (2019). A change in focus: Shifting from treatment to prevention of perioperative pressure injuries. AORN Journal, 110(4), 379 393. doi:10.1002/aorn.12806
1. AORN position statement on Perioperative Pressure Ulcer Prevention in the care of the surgical patient. (2016). AORN Journal, 104(5), 437 438. doi:10.1016/j.aorn.2016.08.011
2. Chen, H., Shen, W., Liu, P., & Liu, K. (2017). Length of surgery and pressure ulcers risk in cardiovascular surgical patients: A dose response meta analysis. International Wound Journal, 14(5), 864 869. doi:10.1111/iwj.12722
9. Padula, W. V., & Delarmente, B. A. (2019). The national cost of HOSPITAL‐ACQUIRED pressure injuries in the United States. International Wound Journal, 16(3), 634 640. doi:10.1111/iwj.13071
10. Riemenschneider, K. J. (2018). Prevention of pressure injuries in the operating room. Journal of Wound, Ostomy & Continence Nursing, 45(2), 141 145. doi:10.1097/won.0000000000000410
5. Haesler, E. (2019). Prevention and treatment of pressure ulcers: Clinical practice guideline. Perth, Australia: Cambridge media.
3. Engels, D., Austin, M., McNichol, L., & Fencl, J. (2016). Pressure ulcers: Factors contributing to their development in the OR. AORN, 103(3), 271 280. http://dx.doi.org/10.1016/j.aorn.2016.01.008
8. Martinez Garduno, C. M., Rodgers, J., Phillips, R., Gunaratne, A. W., Drury, P., & McInnes, E. (2019). The surgical patients’ pressure injury incidence (SPPII) study: A cohort study of surgical patients and processes of care. Wound Practice and Research, 27(2), 86 94. doi:10.33235/wpr.27.2.86 94
7. Kirkland Walsh, H., Teleten, O., Wilson, M., & Raingruber, B. (2015). Pressure mapping comparison of four or surfaces. AORN Journal, 102(1), 61.e1 61.e9. doi:10.1016/j.aorn.2015.05.012
4. Goudas, L., & Bruni, S. (2019). Pressure Injury Risk Assessment and Prevention Strategies in operating room patients findings from a study tour of novel practices in American Hospitals. Journal of Perioperative Nursing, 32(1), 33 37. doi:10.26550/2209 1092.1040
Rationale: With appropriate usage of moisturizers and moisture barriers, alterations of skin, including pressure injuries, skin tears and various forms of moisture associated skin damage (MASD) which are prevalent in the post acute setting may be prevented. It was questioned how much of both are utilized in current practice as there is little evidence that appropriate amounts are applied.
Result or Patient Outcomes: The 20 nursing home groups were composed of 34 164 homes/group with 25 486 beds/home. The 2019 data covered 9,249 177,568 patient days per home rolling up to a total of 23,590,802 patient days. Based on purchasing patterns, and assuming all product purchased was used, the average nursing home group applied 2.58 mL (or 4.3%) of the 60 mL of recommended moisturizer per day (30 mL applied twice daily). This is enough moisturizer to treat slightly less than the lower arm and hand of the average sized adult in one application. Using the same assumptions, the average nursing home group applied 3.22 mL (or 20.1%) of the 16 mL moisture barrier benchmark.
Chrystalbelle Rogers MSN, RN, CWCN, CENP
Conclusion: There is a significant shortfall between the amount of moisturizer and moisture barrier purchased and/or used in nursing homes relative to the census need. It is reasonable to hypothesize that many of the skin related issues with residents in nursing homes could be ameliorated with more thorough skin care regimens. Additional research is needed to document the impact of inadequate moisture and moisture barrier use on health care quality measures. Références : 1. Morgan, M, Milne, C, Atwater, E, Kelso, M, Krasner, D.L, Labiak, J.M, Maguire, J, Heer Nicol, N, Timko Progar, M. At Risk Skin: 21 Consensus Statements for the Coalition for At Risk Skin (CARS) 2022 Wounds Supplement, submitted
Method: Nursing home purchasing patterns were analyzed to estimate an upper limit of moisturizers and moisture barriers that might be available for clinical use in the post acute setting. The pre Covid 19 (2019) moisturizer and moisture barrier purchasing patterns of 20 nursing home groups were analyzed and compared to the number of patient days in each group to determine the average maximum amount of moisturizers and moisture barriers that could have been used per patient per day. These results were compared to the Coalition for At Risk Skin’s consensus daily recommendations of moisturizer use per patient per day of 60 mL. A quantity of 16 mL for moisture barrier was used as a benchmark.
Thomas A. Clopp BSED, MSEd
Moisturizers and Moisture Barriers in the Post-Acute Setting: We’re Not Using Enough
2. Beeckman D, Campbell J, LeBlanc K et al. Best practice recommendations for holistic strategies
POSTER #9
Thomas Koshy PhD Introduction or Problem: Acuity levels of individuals in post acute care has increased dramatically in recent years. The appropriate use of moisturizers and moisture barriers is important for skin health in the post acute setting. There is little evidence that appropriate amounts of moisturizers are utilized.
Wounds
4. Haesler, Emily, et al. “Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. The International Guideline. EPUAP/NPIAP/PPIA: 2019.” European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel and Pan Pacific Pressure Injury Alliance.
3. LeBlanc K, Baranoski S; Skin Tear Consensus Panel Members. Skin tears: state of the science: consensus statements for the prevention, prediction, assessment, and treatment of skin tears©. Adv Skin Wound Care. 2011 Sep;24(9 Suppl):2 15. doi: 10.1097/01.ASW.0000405316.99011.95
to promote and maintain skin integrity. International. February 8, 2020. Accessed March 7, 2022. https://www.woundsinternational.com/resources/details/best practice recommendations holistic strategies promote and maintain skin integrity
Leshia Phillips, Medical Aesthetician, Laser Safety officer, Laser Technician professional Tattoo Removal
Problem: Common negative outcomes with tattoo removal processes include blistering and scarring. Tattoo procedures require customized treatment plans based on tattoo: type, size; ink; number of previous treatments; and current appearance. Laser light penetrates the top layer of the epidermis and reaches the middle layer of the dermis, where tattoo ink is settled, causing burning sensation, local redness, and extreme pain. Client #1: female (22 y.o.); tattoo behind left ear; present for 3 yrs. Client #2: female (51 y.o.); tattoo on left shin; present for 20 yrs.
2. Kent K, Graber E. Laser tattoo removal: A review. Dermatologic Surgery. 2012; 38(1):1 13.
POSTER #10 Take That, Tat 2!! Two Clients ’Tattoo Removal Journeys
Rationale: Clients often do not complete the treatment plan due to pain and complications. Polymeric membrane dressings (PMDs), recognized to reduce tissue injury pain, were selected as part of a procedure bundle to possibly improve clinical outcomes and treatment plan completion.
Method: Each client applied a polymeric membrane dressing (PMD) 24 hours prior to procedures to decrease inflammation caused by the laser procedures. PMDs were applied after treatment and left in place for 48 72 hours. Patient Outcomes: Treatments were interrupted for two years due to pandemic. Both Clients have returned for an evaluation of their tattoos. Client #1 has had 5 treatment procedures; tattoo is almost completely removed. Client #2 has had 6 procedures; tattoo is considerably lighter, but more procedures are required. PMDs worn for 24 hours prior to treatment substantially reduced pain during the procedures. Burning sensation resolved rapidly when PMDs were applied after treatment and all symptoms of tissue injury subsided within 6 hours, compared to 24 hours, or more with previous approaches. Clients experienced dramatic reduction in pain, inflammation, and redness, both during and after the procedures, when compared to previous best practices. The recovery process proceeded rapidly with minimal discomfort.
Conclusion: Tattoos are meant to be permanent, and tattoo removal is time consuming. PMDs resulted in excellent ink removal, improved comfort during treatment and allowed clients to return to normal routines quicker. PMDs also reduced clients ’apprehensions associated with tattoo removal while reducing complications. References:
1. Feng H, Christman MP, Geronemus RG. Application of cooled hydrogel dressing to minimize dyspigmentation from laser tattoo removal. Journal of the American Academy of Dermatology.2019; 81(3): e59 e60.
Rationale: Physician diagnosed a nail infection and prescribed oral antibiotics. The client sought alternative approach to injury management because the antibiotics were not affordable.
Leshia Phillips Medical Aesthetician, Laser Safety officer, Laser Technician professional Tattoo Removal
Conclusion: Wearing acrylic/fake nails is a personal choice. Unfortunately, consumers are not aware that these fashion statements may result in significant long term consequences.
1. Toles A. Artificial nails: are they putting patients at risk? A review of the research. Journal of Pediatric Oncology Nursing 2002;19(5):164 171.
3. Rockwell P. Acute and chronic paronychia. American Family Physician 2001; 63(6):1113 1117.
Problem: Acrylic nails are often associated with increased risk of nail bed infections due to poor fitting of the artificial nail, or damage to the artificial nail. Infectious microorganisms can accumulate in the space between the natural nail and the acrylic nail, the nail plate, nail bed and nail folds. Injuring a fingernail covered by an acrylic nail increases the risk of developing a nail bed infection.
Method: 60 yr. old female with acrylic nails developed a nail bed infection of her left ring fingernail. Subsequently the finger was injured, the acrylic nail was removed, and half of the natural nail was lost. The nail bed had erythema, edema, inflammation, infection, and pain. A polymeric membrane finger dressing (PMD) was applied to the finger after the nail had been lost. PMDs were used instead of previous best practices which were prescription drugs, over the counter drugs, and numerous home remedies.
References :
Patient Outcomes: PMDs reduced pain level from a 10 (0 10 pain scale) to 1 within 30 minutes. The erythema and inflammation decreased within 24 hours. Signs of infections were gone within 6 days of using PMDs without use of systemic or topical antibiotics. PMD was changed every three days for 17 days. The natural nail became pink and new growth began to occur within two weeks. Client returned to nail salon and received a new acrylic nail 6 weeks after PMDs initiated.
2. Malik S. Acrylic nail ripped off real nail! (Tips to fix broken acrylic nail). The Heart and Brain. https://theheartandbrain.com/acrylic nail ripped off real nail/ Accessed November 18, 2021.
.
POSTER #11 Ouch!! My Finger!
● New nurses will be required to attend Wound Care Workshop
● One to one education provided to non compliant staff members.
Method:
Marissa Guzman, DPA, RN, APN BC
Introduction or Problem:
POSTER #12
● Wound Care Team availability / visibility for any questions
The staff nurses at a Medical Surgical unit noted inconsistent pressure injury documentation on admission, wound measurement, and pressure injury intervention documentation. Research shows that the best method to reduce pressure injury and staff liability is to properly document the care rendered timely and accurately.
● Continued reinforcement at Wound Care Meetings, HAPI Huddles and unit based council meetings. Result: Wound measurement documentation in the electronic medical record was noted to be 100% for five consecutive months which was an 80% increase in compliance from the baseline data before the implementation of the new process.
Kathyrn Mccue BSN, RN Juvy Montecalvo Acosta, DNP, RN., ANP BC, CWCN
Utilizing the performance improvement Plan Do Check Act (PDCA) model, in March 2021, wound care and nursing education collaborated and conducted a retrospective random chart review of 10 patient electronic medical records and identified compliance rate of 20% with complete documentation of pressure injury assessment and measurement. Staff education included:
Rationale: To implement a standardized time frame for staff nurses in a Medical Surgical unit to document wound and skin assessment and measurement utilizing a Plan Do Check Act (PDCA) process improvement model.
● New process of wound documentation every Tuesday night (weekly)
Hackensack Meridian Riverview Medical Center
● Implemented a tool to monitor compliance of pressure injury measurements
● Engagement of Wound Care Champions
References: 1. Frank, L., & Danks, J. (2019). Perianesthesia nursing malpractice: Reducing the risk of 2. litigation. Journal of PeriAnesthesia Nursing, 34(3), 463 468.
Conclusion: The implementation of a standardized time frame for wound measurement and pressure injury related intervention documentation in a Medical Surgical unit has increased nurse documentation compliance from 20% to 100% for five straight months; however, continued staff re education of the process and staff engagement is needed to sustain success.
“Stop the Pressure, Measure It” a performance project initiative to standardize weekly wound assessment, measurement, and documentation.
● Monitoring of documentation compliance and remediate in real time if not completed
3. Kaucher, J., Bohnenkamp, S., Kennedy Evans, K. L., & Bohnenkamp, M. (2022). Legal documentation in pressure Ulcer/Injury cases. Medsurg Nursing, 31(2), 77 121.
Novel dressing used in conjunction with negative pressure wound therapy: preclinical evaluation and proteomic assessment
Conclusion: Elevated wound healing biomarker levels support the greater induction of granulation tissue formation with the novel dressing compared to ROCF and, interestingly, as a 7 day longer wear dressing.
Diwi Allen, M.S. Samantha A. Mann, B.S. Marisa Schmidt, B.S. Timothy Robinson, Ph.D. Kristine Kieswetter, Ph.D., M.B.A.
References:
2. Venture ML, et al. Mechanisms and clinical applications of the vacuum assisted closure (VAC) device: a review. Am J Clin Dermatol. 2005;6(3):185 194.
3. Scherer SS, et al. The mechanism of action of the vacuum assisted closure device. Plast Reconstr Surg. 2008;122(3):786 797.
Problem: While reticulated open cell foam (ROCF)^ is a well established dressing for use with negative pressure wound therapy (NPWT)*, tissue ingrowth may occur if ROCF is left in place for greater than 72 hours.
1. Morykwas MJ, et al. Vacuum assisted closure: A new method for wound control and treatment: Animal studies and basic foundation. Ann. Plastic Surg 1997; 38:553 562.
POSTER #13
Methods: All work was approved by the relevant Institutional Animal Care and Use Committee (IACUC). Animal care complied with all applicable national and local regulations. Full thickness excisional wounds were created along the spine of 22 swine and dressings applied with continuous negative pressure at 125mmHg for 7 days. Dressing changes were performed at Day 4 (4 Day dressing group) for 11 swine. The rest did not receive a dressing change (7 Day dressing group). At study termination, tissues were collected for histopathology evaluations and morphometry measurements for granulation tissue thickness and quality assessments. Total protein was extracted and evaluated via multiplex immunoassays.
Outcomes: The novel dressing induced significantly more granulation than ROCF (5.7mm versus 2.4mm for 7 Day dressing group and 4.8mm versus 1.8mm for 4 Day dressing group, novel dressing versus ROCF, respectively). There was significantly greater collagen deposition induced by the novel dressing in the 7 Day dressing group, but no difference found between treatment groups in the 4 Day dressing group. This was also the trend regarding vascularization. There were greater levels of fibroblast growth factors (FGF 1 and FGF 2), platelet derived growth factors (PDGF AA and PDGF AB/BB), transforming growth factor alpha (TGFα), heparin binding epidermal like growth factor (HB EGF, p<0.05), and the anti inflammatory cytokine interleukin (IL) 10 with the novel dressing.
4. McNulty AK, et al. Effects of negative pressure wound therapy on fibroblast viability, chemotactic signaling, and proliferation in a provisional wound (fibrin) matrix. Wound Repair Regen.
Objective : This study evaluated a novel dressing† for use with NPWT designed to utilize the advantages of ROCF while addressing tissue ingrowth.
2007;15(6):838 846. †Novel Dressing (3M, San Antonio, TX); *3M™ V.A.C.® Therapy; ^3M™ V.A.C.® Granufoam™ Dressing
POSTER #14
JoAnn Hager RN, MSN, CWOCN Barnes Jewish Hospital.
Rationale: Evaluation of the use of polymeric membrane dressings (PMDs) in the treatment of complex wounds.
Method: Pt.1: Silver polymeric membrane dressing cavity filler (PMD filler) covered by extra thick PMD both changed daily. Pt. 2: Silver PMD filler covered by extra thick PMD both changed daily for 1 week, then every other day. Pt. 3: Silver PMD filler covered by extra thick PMD, both changed every other day. PMDs temporarily paused for surgical debridement and hypochlorous acid wet to dry dressings, then PMDs resumed. Pt. 4: Silver PMD filler daily, thick gauze/light gauze wrap daily. All wounds cleansed with wound cleanser per facility protocol per dressing change.
Conclusion: PMD use resulted in elimination of daily collagenase application, total wound care cost savings and improved wound healing outcome, all of which were deciding factors in facility implementing PMDs.
3. Gefen A. Managing inflammation by means of polymeric membrane dressings in pressure ulcer prevention. Wounds International. 2018; 9(1): 22 28.
Patient Outcomes: Pt.1: 9 days of PMD use, 50% slough debrided. PMDs helped control inflammation and resolved new DTPI. 77 days 100% granulating tissue. Pt. 2: 29 days, sacral PI 100% granulated, ischial PI 80% granulated. Pt. 3: After PMDs resumed, discharged in 52 days 100% granulation tissue. Pt.4: After 10 days PMDs, the ulceration was beefy red with new tissue growth, no odor or pain at dressing changes. All patients discharged before closure.
2. Davies SL, White RJ. Defining a holistic pain relieving approach to wound care via a drug free polymeric membrane dressing. Journal of Wound Care. 2011; 20(5): 1 4.
From Nonhealing Wounds to Healing Wounds
Linda Mitchell RN, BSN, CWOCN
Problem: Four Inpatients: Pt.1 Male, quadriplegic with stage 4 sacral pressure injury (PI) which evolved from Deep Tissue Pressure Injury (DTPI); Pt. 2 Male, paraplegic, exposed bone, osteomyelitis, stage 4 sacral PI; and left ischial PI; Pt. 3 Female, fell at home, resulting in unstageable spine PI. Pt.4 Female with chronic painful odorous venous insufficiency ulcer. Past Management: Pt.1: cadexomer iodine gel/gauze daily 4 days; hydrogel/gauze daily 7 days; surgical debridement; collagenase daily 38 days. Pt. 2: prior care unknown. Pt. 3: anti sheer absorbent dressing/extra protective barrier cream daily 6 days. Pt. 4: metronizole topical; cellulose oxidized collagen; elastic bandage; radio frequency ablation and stab venectomy. All PI’s required debridement.
Tamara Morehouse RN, BSN, CWCN
References: 1. Ayello E, Dowsett C, Schultz G, et al. Time heals all wounds. Nursing. 2004;34(4): 36 42.
References :
Conclusion: The SSB has beneficial properties which may reduce prolonged exposure to moisture directly against the skin, having the potential to reduce peristomal MASD which could improve patient outcomes and quality of life.
An evaluation of the moisture management properties of Genii TM skin barrier with Sil2 Breathable Silicone Technology TM to improve peristomal skin
Marcus Del Bono, BSc, Trio Healthcare Ltd.
Rationale: This work aims to explore the mode of action of the Genii™ silicone skin barrier (SSB) and demonstrate how it maintains healthy moisture levels, protecting the skin against MASD.
Methods: Healthy volunteers were recruited to assess vapour loss through the SSB and an HSB. Both were compared to the trans epidermal water loss (TEWL) of each healthy volunteer. Absorbency of the SSB was compared to the HSB. Both barriers were then placed under a 10kg weight for 1 minute. The weight was removed, and fluid lost from each barrier was calculated.
Clinton Hill, BSc, BA, Trio Healthcare Ltd.
Water vapour transmission rate (WVTR) testing assessed how much fluid passed through the SSB as vapour. The effect of humidity on the WVTR was also investigated. Scanning electron microscopy (SEM) images of the SSB were obtained to demonstrate the mode of action for moisture management.
Results: The SSB was more permeable to vapour than the HSB. TEWL through the SSB was closer to the surrounding skin TEWL than the HSB. Upon removal, the skin TEWL beneath the SSB increased by 4.65% compared to an increase of 140.54% under the HSB. The HSB absorbed more fluid than the SSB (239% weight increase vs. 87%). The HSB lost seven times more fluid than the SSB under compression. WVTR demonstrated how the SSB allows moisture to pass through the silicone as vapour and is able to adapt to changing humidity.
Madeleine Law, MSc Lic, Trio Healthcare Ltd.
Problem: Traditional hydrocolloid skin barriers (HSB) absorb and retain moisture directly against the skin1 . Excessive or prolonged exposure to moisture can often lead to peristomal Moisture Associated Skin Damage (MASD). MASD has been reported as the most common peristomal complication2,3,4 .
Kyle Turton, MEng BSc, Trio Healthcare Ltd. Andy Marxen, BAN, RN, CWCN, MBA, Trio Healthcare Inc.
POSTER #15
4. Metcalf C. (2018). Managing moisture associated skin damage in stoma care. British Journal of Nursing, 2018, Vol 27, (Stoma Supplement) No 22
1. Le Bar, F. (2020). Using a novel breathable silicone adhesive (Sil2TM technology) in stoma appliances to improve peristomal skin health: answering the key questions, British Journal of Nursing, 2020, Vol 29, No 16 (Stoma Care Supplement)
2. Gray, M., Colwell, J. C., Doughty, D., Goldberg, M., Hoeflok, J., Manson, A., Rao, S. (2013). Peristomal moisture associated skin damage in adults with fecal ostomies. Journal of Wound, Ostomy and Continence Nursing, 20(4), 389 399.
3. Salvadalena, G. (2016). Peristomal skin conditions. In J. E. Carmel, J. C. Colwell, & M. T. Goldberg (Eds.) Wound, Ostomy and Continence Nurses Society core curriculum: Ostomy management (pp. 176 190). Philadelphia, PA: Wolters Kluwer.
• User feedback was incorporated Result or Patient Outcomes: The module is a cloud based, mobile responsive solution that allows programs to build their own competencies or customize role specific wound care competency templates to onboard/train staff and manage clinician’s competencies. Use cases include:
Conclusion: A solution to accelerate wound care competency development, management and documentation was created. Users’ reported benefits include care standardization, increased efficiency in employee onboarding/orientation, and ability to track competencies for employee development, licensure, certification, and facility accreditation. Trademarked Items
• Evidence based competency templates were created within the module
• Onboarding/orientation: provision of initial training and information while assessing the competence of clinical staff relative to job responsibilities.
• Remote training: assignment of modules (e.g. debridement, compression) coupled with preceptor’s teleassistance.
• Clinical internship for professional certification: provision of framework/documentation of clinical internship required for certification (e.g., of hyperbaric technologists).
• Managers/clinicians ’needs, and role based competency areas in wound care were mapped
POSTER #16
Accelerating Wound Care Competency Development, Management and Documentation
Catherine T. Milne APRN MSN CWOCN AP Elaine H. Song MD PhD MBA Rafael Mazuz MBA BSc, Eilon Scheiner BA, Tiffany Hamm BSN RN ACHRN CWS, Jeff Mize RRT CHT CWCA
• Module was developed with robust programming language***/library****/framework*****
• Use cases were prioritized; workflows were designed
• Competency management: strengthening of knowledge, skills and ability in wound care areas of competence relevant to each role (e.g., medical assistant/nurse/nurse practitioner/ physician/etc), with documentation of preceptor feedback/oversight, pre and post assessment.
Rationale: Consistently ensuring clinicians ’competency is difficult, given time and resource constraints. We aimed to create a solution to overcome obstacles in wound care competency development, management, and documentation. Method: Using the Design Thinking methodology7 , the solution* was created as a module within a clinical/reimbursement decision support web application** for wound care/hyperbaric clinicians:
Introduction : Wound care professionals will continue to be in demand, as the population older than 65 years is projected to grow by 25% by 2060.1,2 Wound care clinicians usually have diverse training/experience/background, which can lead to inconsistent care and result in poor outcomes.3,4 To standardize and improve healthcare professionals' knowledge level, the Joint Commission recommends developing a competency program.5,6
References:
1. Sen, C. K. Human wound and its burden: updated 2020 compendium of estimates. Adv Wound Care (New Rochelle) 10, 281 292 (2021).
* Competency Tool, Wound Reference, Inc., San Francisco, CA ** WoundReference Clinical Decision Support Web App, Wound Reference, Inc., San Francisco, CA *** Microsoft C#, Microsoft Corporation, Redmond, WA **** jQuery, open source JavaScript Library ***** .Net4.5, Microsoft Corporation, Redmond, WA
2. U.S. Census Bureau. Older People Projected to Outnumber Children. U.S. Census Bureau https://www.census.gov/newsroom/press
4. Corriveau, G., Couturier, Y. & Camden, C. Developing competencies of nurses in wound care: the impact of a new service delivery model including teleassistance. J. Contin. Educ. Nurs. 51, 547 555 (2020).
8. Kielo, E., Suhonen, R., Salminen, L. & Stolt, M. Competence areas for registered nurses and podiatrists in chronic wound care, and their role in wound care practice. J. Clin. Nurs. 28, 4021 4034 (2019).
releases/2018/cb18 41 population projections.html (2018).
3. Williams, E. M. & Deering, S. Achieving competency in wound care: an innovative training module using the long term care setting. Int. Wound J. 13, 829 832 (2016).
6. The Joint Commission. About Our Standards | The Joint Commission. https://www.jointcommission.org/standards/about our standards/ (2021).
5. Mize, J. & Hamm, T. Quality of Care Requires Ongoing Competency Evaluations. Woundreference.com https://woundreference.com/blog?id=competency assessments (2021).
7. Ferreira, F. K., Song, E. H., Gomes, H., Garcia, E. B. & Ferreira, L. M. New mindset in scientific method in the health field: Design Thinking. Clinics 70, 770 772 (2015).
• Document the risk assessment process and comply with the NFPA requirements
• Risk score calculators were created
Eugene R. Worth, MD, FABA, UHM/ABPM
Conclusion: We have previously shown that utilization of the dRAT significantly improves the number of hyperbaric treatments with complete risk assessment documentation.5 The combination of the two approaches (NFPA Risk Assessment Algorithm and the Burman Risk Scoring System) and a user friendly digital interface as described above, further provides the hyperbaric facility with a robust go/no go
• For each question of the NFPA Algorithm (e.g., “Does the product produce heat?”), a method was added to quantify pertinent risks (i.e., risk of fire, mechanical or physiological), by assigning scores to the 'probability' of an accident, the frequency of 'exposure' to the risk, and the magnitude of the 'consequence' should an accident happen
POSTER #17 GO/NO GO: A Tool to Eliminate The Guesswork in Determining Which Items May Be Allowed in a Hyperbaric Chamber
Elaine H. Song, MD, PhD, MBA
Francois Burman, BSc Eng, MSc Medical Sciences
Catherine Milne, APRN, MSN, CWOCN AP Jeffrey Mize, RRT, CHT, CWCA
Result:
Tiffany Hamm, BSN, RN, ACHRN, CWS
• Consult previous risk assessments
Introduction : Approximately 80% of fires in hyperbaric chambers occur due to the presence of prohibited items in the chamber.1 The NFPA recommends that facilities utilize the NFPA Risk Assessment Algorithm for assessment of products that have not been evaluated or deemed safe for use in the hyperbaric chamber.2 Rationale: Several challenges prevent widespread use of the NFPA Algorithm.3 Most importantly, completion of this algorithm does not provide enough details to identify the level of risk, exposure potential, and consequences if the item is allowed into the chamber. To address this gap, we created a Tool that combines the NFPA Algorithm and the Burman Risk Scoring System a practical scoring approach that quantifies risk to objectively determine whether patient care items may be allowed into the chamber.4
• Collaboratively create their facility specific digital "use list" and "do not use list" (i.e., "Go/No Go lists")
Method: The Burman Risk Scoring System was integrated into an NFPA algorithm based digital risk assessment tool (dRAT) within a clinical decision support web application* for wound care/hyperbaric clinicians, as follows:
• Usability of the tool was validated and user feedback was incorporated
• Perform new risk assessments using an objective scoring approach
3. Burman F, Mize J. Prohibited Item Risk Assessment. In: Worth E, Song E, editors. WoundReference. 2021.
* Go/ No Go Tool, Wound Reference, Inc., San Francisco, CA
1. Sheffield PJ, Desautels DA. Hyperbaric and hypobaric chamber fires: a 73 year analysis. Undersea Hyperb Med. 1997 Sep;24(3):153 64.
2. Technical Committee on Hyperbaric and Hypobaric Facilities (HEA HYP). 14. Hyperbaric Facilities (Figure A.14.3.1.6.4.3). In: (NFPA) National Fire Protection Association, editor. NFPA 99: Health Care Facilities Code Handbook 12th ed. Quincy, MA: NFPA; 2021.
5. Mize J, Hamm T, Worth E, Song EH, Oberle K, Ezzel A, et al. GO/NO GO: The Impact of a Digital Risk Assessment Tool* and Training on Accurate Completion of Risk Assessment Process for Prohibited Hyperbaric Items. The UHM Journal. 2020 Jun 16;47(2).
documentation and risk mitigation Tool that helps objectively determine which items may be safely allowed in a hyperbaric chamber.
4. Burman F. Risk Assessment Guide For Installation and Operation of Clinical Hyperbaric Facilities. 6th ed. San Antonio, Texas USA: International ATMO, Inc.; 2019.
References :
Traditionally composed of hydrocolloid materials combined with an adhesive, these are associated with skin stripping, and often lead to residual material on the skin.1 Additionally, hydrocolloid materials swell as they absorb moisture and adversely impacting skin health.
*SilkenTM Silicone Stomal Gel, Trio Healthcare, Knutsford, Cheshire, UK
Using a Novel Breathable Silicone Gel in Stomal and Peristomal Skin Management
References:
POSTER #18
1. Swift T, Westgate G, Van Onselen J, Lee S. Developments in silicone technology for use in stoma care. British Journal of Nursing. 2020;29(6):7 18.
Conclusion: Silicone gel* technology is now a viable alternative for use in the patient with stomal complications and abdominal topography challenges where hydrocolloid materials such as barrier strips or pastes have been traditionally used.
Result: Use of soft silicone gel* alone or with traditional hydrocolloid materials prolongs faceplate wear time, allows visualization of stomal complications such as mucocutaneous separation, prevents the buildup of residual materials on the skin, and decreases pain, supporting reports in the literature.3,4
3. Le Ber F. Using a novel breathable silicone adhesive (Sil2 technology) in stoma appliances to improve peristomal skin health: answering the key questions. British Journal of Nursing. 2020;29(6):19 24.
Catherine T. Milne MSN, APRN, ANP/ACNS BC, CWOCN AP
2. Gefin A. Foreword: the prospects of new silicone based biomaterial technologies in stoma care. British Journal of Nursing. 2020;29(6):5 6.
Introduction or Problem: Ostomy accessory items such as hydrocolloid pastes, barrier strips and rings are commonly used in both prevention and management of peristomal skin alterations caused by abdominal topography (e.g., creases, folds or parastomal hernias) and stomal complications (e.g. mucocutaneous separation).
4. Lager P and Lox L. Use of breathable silicone technology in an ostomy appliance flange. British Journal of Nursing. 2020;29(6):25 35.
Method: This practice innovation reports the application and evaluation of transitioning to soft silicone gel* from traditional hydrocolloid accessories for the use in the management of patients with stomal complications and/or abdominal topography challenges.
Rationale: While soft silicone has been used in wound management, the leap to its use in ostomy accessories has been limited to barrier wipes. Recent advances in biomaterial technologies now make soft silicone available in a gel formulation to address these issues.2 4 This practice innovation reports the application and evaluation of transitioning to soft silicone gel* from traditional hydrocolloid accessories for the use in the management of patients with stomal complications and/or abdominal topography challenges.
Introduction: Skin moisturizers are available in lotions, creams, ointments, and gel formulations for at risk skin. Several literature reviews cite the difficulty in identifying differences between moisturizers affecting application and dosage recommendations.2, 3 A proactive approach needs to be taken to guide appropriate moisturizer use and preventative care for at risk individuals with fragile skin.4
Expert Panel Review of Care Practices Associated with At Risk Skin
Result: A total of 21 at risk skin care consensus statements were developed. Six consensus statements identified skin strategies, ongoing skin assessment, risk mitigation, and personalized product category requirements. Ten consensus statements identified the appropriate use of skin moisturizers and skin barriers, frequency of application, and dosage. Five consensus statements addressed organizational guidelines, best practices, standardized formulary products category recommendations and skin care education. Conclusion: A total of 21 consensus statements were developed to address the needs of at risk skin care for prevention of skin damage and improved evidence based care.
2. Sethi A, Kaur T, Malhotra SK, Gambhir ML. (2016) Moisturizers: The Slippery Road. Indian J Dermatol May Jun; 61(3):279 87.
Rationale: A panel of nine skin care experts were assembled to address the current status of skin care and definition of at risk skin. We report on the current deficiencies in the at risk skin population and the recommendations of the expert skin care panel.
Method: Consensus statements addressing at risk skin care practices were developed. Existing strategies for at risk skin care were discussed including preventative skin care measures, types of skin care products, moisturizers, barriers, ingredients, intended use of the products and data comparing skin care product purchasing patterns to the number of residents in a facility. The panel members also reviewed organizational approaches and educational resources related to at risk skin practices. Each statement was reviewed independently until 100% consensus was reached by all nine panel members.
1. Purnamawati S, Indrastuti N, Danarti R, Saefudin T. (2017) The Role of Moisturizers in Addressing Various Kinds of Dermatitis: A Review. Clin Med Res Dec; 15(3 4):75 87.
POSTER #19
References:
Catherine Milne, APRN, MSN, ANP/ACNS BC, CWOCN AP
Melissa Morgan, MSN, RN, CWCN Edna Atwater, BSN, RN Martha R. Kelso, RN, LNC, Diane L. Krasner, PhD. RN, FAAN, FAAWC, Joanne M. Labiak, MSN, CRNP, CWOCN, CWS, DAPWCA Jeanine Maguire, MPT, CWS Noreen Heer Nicol, PhD, RN, FNP, NEA Monica Timko Progar, BSN, RN, ET, CWS, FACCWS
3. Lodén M. (2005) The clinical benefit of moisturizers. J Eur Acad Dermatol Venereol. Nov; 19(6):672 88.
4. Beeckman, D., Campbell, KE, LeBlanc, K. Campbell, J, et al (2020). Best Practice Recommendations for Holistic Strategies to Promote and Maintain Skin Integrity: 2020 Recommendations from an Expert Working Group. Wounds International, 2020.
3. Hunt R, Kelleher K, Coffey JC, Clarke Moloney M, Ahern M, Conway E, Hannigan A, Erwin Toth P, OʼSullivan LW. Changes in Peristomal Skin Condition and User Experience of a Novel Ostomy Barrier Ring With Assisted Flow: A 6 Week Feasibility Study. J Wound Ostomy Continence Nurs. 2018 Sep/Oct;45(5):444 448. doi: 10.1097/WON.0000000000000463. PMID: 30188392
POSTER #20
Catherine T. Milne MSN, APRN, ANP/ACNS BC, CWOCN AP
Rationale: A newly available barrier seal* designed with an assisted flow mechanism to divert effluent was initiated on patients with PSCs or at risk for PSCs due to peristomal topography or stomal construction.
Method: This practice innovation reports both the patient/significant other perception and healthcare provider experience with this novel barrier seal using a 1 5 Likert Scale and noting additional comments to evaluate ease of use and evaluation of peristomal skin condition.
Conclusion: Use of an innovative combination ostomy barrier ring with an assisted flow design is a viable option to prevent and manage peristomal skin complications, supporting the existing literature reports. *OstoForm Barrier Rings with Flow Assist TechnologyTM , Ostoform LTD., Westmeath, Ireland
References:
5. Quigley M, Hannigan A, Dowling C, Stuart A, McGovern S, Untoy L, Joyce M, Larkin J, Kavanagh D. Evaluation of a Novel Ostomy Barrier Ring with Assisted Flow for Individuals with an
An Innovative Combination Ostomy Barrier Seal and Spout to Reduce Peri Stomal Skin Complications
Result: All patients reported ease of use as 4.2 on a 1 5 Likert Scale with positive comments specifically addressing improved quality of life and reduction in PSCs. Significant others assisting the patient with an ostomy rated these factors at 4.8. Nurses initially rated ease of use experience at 3.9, improving to 4.3 after four weeks. These same providers rated high satisfaction (4.7) with peristomal skin condition.
1. Salvadalena, Ginger; Colwell, Janice C.; Skountrianos, George; Pittman, Joyce Lessons Learned About Peristomal Skin Complications, Journal of Wound, Ostomy and Continence Nursing: July/August 2020 Volume 47 Issue 4 p 357 363. doi: 10.1097/WON.0000000000000666
2. LeBlanc K, Whiteley I, McNichol L, Salvadalena G, Gray M. Peristomal medical adhesive related skin injury: results of an international consensus meeting. J Wound Ostomy Continence Nurs. 2019;46(2):125 136. doi:10.1097/WON.0000000000000513.
Introduction: Seventy five percent of all adverse events associated with patients with an ostomy are related to peristomal complications (PSCs).1 While most PSCs are classified as peristomal moisture associated dermatitis (PMASD) from leakage under the skin barrier, mechanical device related skin injury has also been reported (MARSI).2 Rings and seals are the most commonly employed intervention to offset PSCs, followed by convexity.1 The lack of significant innovation using these products for managing and preventing PSCs have limited intervention options, though the literature is reporting these advances.3 5
4. Kelleher K, Hunt R, Hannigan A, et al. A single arm practical application assessment of user experience and peristomal skin condition among persons with an ileostomy. Wound Manage Prevent. 2019;65(1):14 9.
Ileostomy. Adv Skin Wound Care. 2021 Jun 1;34(6):1 5. doi: 10.1097/01.ASW.0000734368.48756.20. PMID: 33660660.
1. Silver (Level I: 9,13; Level II: 11) and amniotic membranes (Level I: 9,13) are consistently superior to other dressings.
4. Metrics for measuring wound healing include Pressure Ulcer Scale for Healing (PUSH) tool (Level I: 5; Level IV: 1, 3); complete healing (Level I: 4,6,9; Level II: 7,11; Level IV: 1); ulcer size reduction (Level I: 9); infection (Level I: 9; Level IV: 1; Level V: 10, 12); and wound measurement (Level I: 6; Level II: 7; Level IV: 1) .
Introduction or Problem: Choosing the correct wound care dressing is important for optimal patient outcomes. Wound dressings are recommended to aid in healing and for the reduction of dressing associated complications (such as unnecessary distress to the patient, trauma to the wound, and delayed wound healing).
An Evidence Based Practice Project
POSTER #21
Rationale:
3. Advanced dressings are preferred over basic dressings (wet to dry) due to adverse effects including pain, retention of gauze, infection, and higher costs (Level I: 13; Level II: 7,11; Level IV: 3) .
Michelle Thurby BSN, RN, CWON, Sarasota Memorial Hospital
Jen Bonamer PhD, RN, AHN BC, NPD BC, Sarasota Memorial Health Care System
There exists a lack of clear evidence among current professional guidelines for a standardized approach to default wound care in a hospital setting. Therefore, the purpose of this project was to evaluate evidence to guide selection of a standardized wound care dressing as a default order for hospitalized adults. Method: The Johns Hopkins Nursing EBP Model and Tools were used to guide this project with the following PICO question: “Among hospitalized adults, what wound care dressing is most appropriate as a default standardized approach for managing moisture and microbial content across wound types?”
PubMed, CINAHL, professional organizations, and reference lists were searched with a preference for systematic reviews and clinical practice guidelines. Result or Patient Outcomes: The Johns Hopkins Nursing EBP Model and Tools were used to guide this project2 . A comprehensive search retrieved a total of thirteen pieces of evidence, eleven of which were deemed to be of good to high quality and retained for this project (5 - Level I4,5,6,9,13; 2 Level II7,11; 2 Level IV1,3; 2 - Level V10,12)*. The evidence was appraised, summarized, and synthesized and yielded the following practice recommendations:
5. Fill wounds loosely with a single piece of gauze to reduce pressure and promote granulation (Level IV: 3) .
2. Honey (Level 1: 4,5,9,13; Level II: 7,11) and hydrogel (Level I: 9,13) appear to be broadly effective. Honey with a Unique Manuka Factor (UMF) of 12+ may be effective in managing diabetic ulcers (Level I: 9,13; Level II: 11) , leg ulcers (Level I: 4; Level II: 7) , pressure injury (Level I: 5; Level II: 7) , and bacterial infections (Level II: 7,11)
Conclusion: In translating the practice recommendations for this organization, honey was selected as the standard medium for default wound care to replace the current wet to dry dressings. Silver and amniotic
Jovan Huss MSN, RN, NPD BC, COCN, WCC (project lead), Sarasota Memorial Hospital
Selection of a Standardized Dressing for Open Wounds to Manage Moisture and Microbial Content:
4. Evaluate product and submit for practice change approval.
References:
2. Dearholt & Dang. (2018). Johns Hopkins Nursing Evidence Based Practice: Model and Guidelines (3rd ed). Indianapolis, IN: Sigma Theta Tau International.
4. Gulati, S., Qureshi, A., Srivastava, A., Kataria, K., Kumar, R., & Ji, A. (2014). A Prospective Randomized Study to Compare the Effectiveness of Honey Dressing vs. Povidone Iodine Dressing in Chronic Wound Healing. Indian Journal of Surgery, 76(3), 193 198 DOI: 10.1007/s12262 012 0682 6 5. Günes, Ü Y., & Eser, I. (2007). Effectiveness of a honey dressing for healing pressure ulcers. Journal of Wound Ostomy & Continence Nursing, 34(2), 184 190.
3. Create a quality audit tool.
2. Create an evidence based procedure for clinical nurses.
6. Imran, M., Hussain, M. B., & Baig, M. (2015). A randomized, controlled clinical trial of honey impregnated dressing for treating diabetic foot ulcer. J Coll Physicians Surg Pak, 25(10), 721 725.
10. Vandamme L, Heyneman A, Hoeksema H, Verbelen J, Monstrey S. Honey in modern wound care: a systematic review. Burns. 2013 Dec;39(8):1514 25. doi: 10.1016/j.burns.2013.06.014. Epub 2013 Jul 26. PMID: 23896128.
membranes were not selected due to cost and availability considerations. For organizational implementation, the following steps are in process:
11. Wang C, Guo M, Zhang N, Wang G. Effectiveness of honey dressing in the treatment of diabetic foot ulcers: A systematic review and meta analysis. Complement Ther Clin Pract. 2019 Feb; 34:123 131. doi: 10.1016/j.ctcp.2018.09.004. Epub 2018 Sep 21. PMID: 30712715.
9. Tsang, K. K., Kwong, E. W. Y., To, T. S. S., Chung, J. W. Y., & Wong, T. K. S. (2017). A pilot randomized, controlled study of nanocrystalline silver, manuka honey, and conventional dressing in healing diabetic foot ulcer. Evidence Based Complementary and Alternative Medicine, 2017.
5. Revise procedure to remove wet to dry practices.
12. Weller, C., Team, V., & Sussman, G. (2020). First Line Interactive Wound Dressing Update: A Comprehensive Review of the Evidence. Fronteirs in Pharmacology, 11(155), eCollection. DOI: 10.3389/fphar.2020.00155
7. Jull, A. B., Cullum, N., Dumville, J. C., Westby, M. J., Deshpande, S., & Walker, N. (2015). Honey as a topical treatment for wounds. Cochrane Database of Systematic Reviews, (3).
3. European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, & Alliance, Pan Pacific Pressure Injury Alliance. (2019). Prevention and Treatment of Pressure Ulcers/injuries: Clinical Practice Guideline: The International Guideline 2019. EPUAP, NPIAP, PPPIA.
1. Identify honey application product for use across wound types.
1. Clark, M., & Adcock, L. (2018). Honey for Wound Management: A Review of Clinical Effectiveness and Guidelines. Ottawa: CADTH; 2018Nov. (CADTH rapid response report: summary with critical appraisal).
8. Kateel, R., Adhikari, P., Augustine, A. J., & Ullal, S. (2016). Topical honey for the treatment of diabetic foot ulcer: a systematic review. Complementary therapies in clinical practice, 24, 130 133.
6. Provide education and support for de implementation of wet to dry dressings with flyers and meeting announcements.
13. Zhang, X., Sun, D., & Jiang, G. C. (2019). Comparative efficacy of nine different dressings in healing diabetic foot ulcer: A Bayesian network analysis. Journal of diabetes, 11(6), 418 426.
Method: The three armed 12 week evaluator blinded randomized controlled trial compared improvised dressings to a negative control (wet to moist dressings, equal or superior to usual practice), and a positive control (the advanced wound dressings with the strongest evidence supporting use in a tropical climate, which are polymeric membrane dressings). All three protocols were rigorously defined. After they were taught their respective dressing protocols at their initial clinic visit, dressing changes were conducted by the patients. Patients WhatsApped wound photos and other data to the investigators weekly and received in person guidance and encouragement at least monthly.
Conclusion: The improvised dressings performed well in the tropical environment. Participants could perform dressing changes unaided. The improvised dressings did not promote infection or clinically significant maceration. The improvised dressings did promote healing, pain relief, and improved quality of life.
An extensive literature review (Benskin 2013) and usual practice studies (Benskin, 2013, 2019) led the researcher to design a possible solution: a cut to fit perforated food grade plastic based improvised dressing with a peri wound moisture barrier cream and an absorbent over the perforations. Clear thin plastic bags were chosen because they are semi permeable membranes, and because they are used to keep water, soup, and other food clean and contained when transported to the fields, they are found in village settings worldwide. We needed to ensure that this improvised dressing method would be safe, effective, and acceptable in a topical setting. We expected it to also decrease pain and improve quality of life because it would be occlusive, would promote appropriate moisture balance, and would not adhere to the wound bed at dressing changes. In order to ensure that the wounds in the study were relatively homogenous, a single wound type was chosen for this study: chronic sickle cell leg ulcers.
Trial of an Improvised Dressing for Remote and Conflict Areas of Tropical Developing Countries
Result or Patient Outcomes: All three groups saw improvement when compared with their previous usual practice. Improvised dressing participants’ pain and quality of life were improved when compared with these participants’ previous dressings, and when compared with the experience of participants in the wet to moist dressings study arm. Compared with the wet to moist dressings group, participants in the improvised dressings group were far less likely to develop wound infections and their wounds were far more likely to decrease in size. The improvised dressings were not dramatically inferior to the advanced wound dressings, and they were significantly less expensive. Participants in all three groups found the improvised dressings acceptable.
References:
POSTER #22
Rationale:
Introduction or Problem: This research is part of a decades long quest to provide an evidence based solution for wound management in remote and conflict areas of tropical developing countries. In this setting, up to 20% of adults suffer from a disabling chronic wound, most often caused by poor management of an acute wound. The solution must use only materials available in village markets, and must perform well in the tropics, where heat and high bioburden cause most wound dressings to fail.
Linda Benskin, PhD, RN, SRN (Ghana), CWCN, CWS, Independent Researcher and Ferris Mfg. Corp.
2. Benskin, L. (2013). Discovering the Current Wound Management Practices of Rural Africans: A Pilot Study [Dissertation, University of Texas Medical Branch]. https://utmb ir.tdl.org/handle/2152.3/538
5. Benskin, L. L. (2016). Polymeric Membrane Dressings for Topical Wound Management of Patients With Infected Wounds in a Challenging Environment: A Protocol With 3 Case Examples. Ostomy/Wound Management, 62(6), 42 50. https://www.researchgate.net/publication/304629707_Polymeric_Membrane_Dressings_f or_Topical_Wound_Management_of_Patients_With_Infected_Wounds_in_a_Challenging_ Environment_A_Protocol_With_3_Case_Examples
3. Benskin, L. L. L. (2013). A review of the literature informing affordable, available wound management choices for rural areas of tropical developing countries. Ostomy/Wound Management, 59(10), 20 41. https://www.researchgate.net/publication/257535858_A_Review_of_the_Literature_Infor ming_Affordable_Available_Wound_Management_Choices_for_Rural_Areas_of_Tropical_ Developing_Countries
1. Benskin, L. (2021). A Test of the Safety, Effectiveness, and Acceptability of an Improvised Dressing for Sickle Cell Leg Ulcers in a Tropical Climate (Clinical Trial Registration No. NCT04479618). clinicaltrials.gov. https://clinicaltrials.gov/ct2/show/NCT04479618
4. Bolton, L. L. (2012). Common Nonsense: Rediscovering Moist Wound Healing | Wound Management & Prevention. Wound Management & Prevention Journal. https://www.o wm.com/blog/common nonsense rediscovering moist wound healing
6. Benskin LLL. (2019) The Quest for a Sustainable Wound Management Solution for Rural Areas of Tropical Developing Countries: What We Have Learned So Far. Poster #18 presented at: 29th Annual Nursing & Midwifery Research Conference and 30th Mary J. Seivwright Day; 2019 May 30; Kingston, Jamaica. https://www.researchgate.net/publication/342938327_THE_QUEST_FOR_A_SUSTAINABLE _WOUND_MANAGEMENT_SOLUTION_FOR_RURAL_AREAS_OF_TROPICAL_DEVELOPING_C OUNTRIES_WHAT_WE_HAVE_LEARNED_SO_FAR
Linda Benskin, PhD, RN, SRN (Ghana), CWCN, CWS, Independent Researcher and Ferris Mfg. Corp.
Problem: Methicillin resistant staphylococcus aureus (MRSA) often causes painful, inflamed, deep, narrow, challenging to dress ulcers. Due to COVID 19, face to face wound management has been limited. Because MRSA ulcers often recur, many patients prefer self care. However, procedural pain and prescription needs block this goal. Example patients include: a middle aged man whose first two MRSA ulcers required hospitalization for IV antibiotics, and a young man and young woman, both of whose first MRSA ulcers required outpatient incision and drainage plus oral antibiotics.
Results: More patients have used this method than the three described in detail here. Each patient was empowered to provide their own MRSA ulcer care, reducing healthcare system burden. PMDs reduced pain and inflammation, allowing each patient to perform their own dressing changes. The infections consistently cleared quickly. Every ulcer each patient developed has closed without incident using mesh reinforced PMDs The two young patients no longer suffer from MRSA ulcers. The middle aged patient manages all new ulcers promptly with PMDs, with no complications and consistently quick healing.
Conclusion: Using dressings that safely increase patient independence, with initial tele guidance from a health care professional, decreased the burden of MRSA ulcers on the health care system while improving patient satisfaction. PMD silver rope cavity filler consistently provided an elegant solution for a frustrating, painful, wound problem: MRSA ulcers.
Empowering Patients to Manage Their Own Recurrent MRSA Ulcers An Innovative, Effective Solution
Rationale: All polymeric membrane dressings (PMDs) relieve pain and control inflammation, continuously clean wounds, and partner with the body to balance moisture throughout the wound. Because PMDs slide off easily and control inflammation, dressing changes are atraumatic and usually so pain free that patients can perform them independently. Mesh reinforced antimicrobial rope cavity filler remains intact, even when saturated, making it the logical PMD configuration choice for MRSA ulcers.
References:
2. Tamir, J. (2010, June 13). Surgical Infected Wounds with Deep Narrow Cavity Managed with Silver Rope Dressing [Poster #4381]. 2010 WOCN/WCET Joint Conference, Phoenix, AZ USA. https://www.researchgate.net/publication/268106122_Acute_Infected_Cavity_Wounds_treate d_with_New_Reinforced_Rope_Dressing
3. Cahn, A., & Kleinman, Y. (2014). A novel approach to the treatment of diabetic foot abscesses
1. Benskin, L. L. (2018). Evidence for Polymeric Membrane Dressings as a Unique Dressing Subcategory, Using Pressure Ulcers as an Example. Advances in Wound Care, 7(12), 419 426. https://doi.org/10.1089/wound.2018.0822
POSTER #23
Methods: After initial irrigation, PMD silver rope cavity filler is cut to fit and inserted into the narrow tunnel, with about 0.5 cm protruding from the tunnel. The rope protruding out of the tunnel is folded over and covered with an adhesive bordered standard PMD. Dressings are changed when the center of the outer PMD becomes a darker color, indicating that the rope is saturated. Dressing changes consist of removing the outer PMD and saturated rope and replacing them with new PMDs. Excess rope is stored in a freezer zipper bag for future dressing changes.
A case series. Journal of Wound Care, 23(8), 394, 396 399.
4. Benskin, L. L. (2012). PolyMem Wic Silver Rope: A Multifunctional Dressing for Decreasing Pain, Swelling, and Inflammation. Advances in Wound Care, 1(1), 44–47. https://doi.org/10.1089/wound.2011.0285
5. Benskin, L. L. (2016). Polymeric Membrane Dressings for Topical Wound Management of Patients With Infected Wounds in a Challenging Environment: A Protocol With 3 Case Examples. Ostomy/Wound Management, 62(6), 42 50. https://www.researchgate.net/publication/304629707_Polymeric_Membrane_Dressings_for_T opical_Wound_Management_of_Patients_With_Infected_Wounds_in_a_Challenging_Environm ent_A_Protocol_With_3_Case_Examples
https://doi.org/10.12968/jowc.2014.23.8.394
Madeleine Law, Lic, M.Sc. Andy Marxen, BAN, RN, CWCN, MBA
2. Nichols T et al. Comparing the skin stripping effects of three ostomy skin barriers infused with ceramide, honey, or aloe. Journal of Stomal Therapy Australia 2019; 39(2):14 18. DOI
References:
Kyle Turton, MEng BSc Clinton Hill, BSc BA Marcus Del Bono, BSc Introduction or Problem: Quality of Life (QOL) for an ostomate should be as care free as a person not living with a stoma. However, many live with fear that their ostomy seal may fail or cause skin irritation on removal.
1. Dabirian A, Yaghmaie F, Rassouli M, Tafreshi MZ. Quality of life in ostomy patients: a qualitative study. Patient Prefer Adherence. 2011;5:1 5. doi.org/10.2147/PPA.S14508
POSTER #24
In Vitro Evaluation of Breathable Silicone Ostomy Seal in Comparison with Hydrocolloid Seals for Absorption, Swelling and Deformation.
Rationale: The aim for this research is to evaluate Ostomy Seals with Sil2 Breathable Silicone Technology™ and compare in vitro with three traditional hydrocolloid based ostomy seals for degradation patterns.
Method: An in vitro method was developed to evaluate absorbency, swelling and deformation of ostomy seals. Prior to testing, dimensions and weights of each sample were measured. After exposure to 37°C simulated body output, seal dimensions and weights were measured again at 24h intervals, up to, and including 72h. Result or Patient Outcomes: In absorbency, the hydrocolloid absorbs up to 15 times more output in weight% than the breathable silicone ostomy seals. Swelling, measured by increased % area, was 68 times larger compared to the breathable silicone ostomy seals. Breathable silicone ostomy seals retain their shape while the hydrocolloid seals break down, are easily torn, and do not keep their original shape following 72h of absorbency testing.
Additionally, reports show QOL reduction in pleasurable activity and an increase in depression linked with Seals failure[1]. The peristomal skin is known to be very sensitive and is a point of risk for injury[2]. Breakdown and disintegration of hydrocolloid seals may lead to leakage and a decrease of QOL. Therefore, it is important that seals are non degrading and hold their shape while in use.
Conclusion: The use of breathable silicone ostomy seals may lead to a decrease potential for leakage and improved QOL for ostomates. With a tight seal and little absorption, the peristomal skin would not be subjected to excess output as in hydrocolloid seals. Translation of these in vitro data needs to be validated in real life scenarios
Rationale:
2. Taggart, E., & Spencer, K. (2018). Maintaining peristomal skin health with ceramide infused hydrocolloid skin barrier. World Council of Enterostomal Therapists Journal, 38(1 (Supplement)). doi/10.3316/informit.662171290609374
Using a tensometer, the force required to stretch the inner hole of the SSB and Hydrocolloid skin barriers (HSB) was also calculated. Result or Patient Outcomes: The telescoping model was extended up to 3cm and left for 24 hours. After 24 hours the model was returned to its original position. The SSB maintained adhesion and conformability to the model, recovering back to its original shape after the 24 hour extension time. The force required to stretch the inner hole of the SSB and HSB products were assessed at 10mm 50mm. The SSB at 10mm extension produced a force of 0.19N, at 50mm a force of 1.69N. Other HSB products 1158% more force to reach 10mm extension and 478% more force to reach 50mm.
Clinton Hill, BSc., BA. Trio Healthcare Madeleine Law, MSc., Lic. Trio Healthcare Kyle Turton, MEng., BSc. Trio Healthcare Andy Marxen, BAN., RN., CWCN., MBA. Trio Ostomy Care
The study aims to highlight that a Genii Silicone skin barrier (SSB) placed in contact to the stoma would alleviate leaks and skin damage with very little force applied to the stoma. Method: An SSB was tested using a custom stoma model. It was stretched around the stoma and moved in a telescoping motion to assess the conformability and extensibility of the SSB at set extension points to closely simulate stoma peristalsis.
Marcus Del Bono, BSc. Trio Healthcare
Conclusion: The inner hole of a SSB can be stretched around a stoma to create a seal and protect the peristomal skin. The SSB can support the telescoping and peristaltic motion of the stoma up to 3cm.
POSTER #25
Assessment of Genii™ Skin barrier with Sil2 Breathable Silicone Technology® for its ability to create a seal around a stoma.
Introduction or Problem: During the application of a skin barrier, an area of peristomal skin may be left between product and stoma to protect it from damage caused by the rough edge of a product during peristalsis. This could be avoided if the product was stretched by the inner hole around the stoma itself to create a secure fit. Historically, creating a seal with hydrocolloid products has limitations due to product disintegration 1,2,3 .
3. Steinhagen E, Colwell J, Cannon L. Intestinal Stomas Postoperative Stoma Care and Peristomal Skin Complications. Clin Colon Rectal Surg. 2017;30(03):184 192.
1. Dabirian A, Yaghmaei F, Rassouli M, Tafreshi MZ. Quality of life in ostomy patients: a qualitative study. Patient Prefer Adherence. 2010;5:1 5. Published 2010 Dec 21. doi:10.2147/PPA.S1450
References:
doi:10.1055/s 0037 1598159.
Rationale: This project purpose was to investigate best practices in technology for identification of damage beneath the skin surface and proactive activation of pressure injury prevention strategies to decrease hospital acquire pressure injury incidence. Using the Johns Hopkins Nursing Evidence Based Practice (JHNEBP) model 10 articles were appraised on strength and quality of evidence. The evidence explored the use of subepidermal moisture or (SEM), thermal, and ultrasound technologies.
Conclusion: Therefore, the pilot results support SEM technology identification of high risk patients versus standard practice of routine visual skin assessment and/or use of the Braden Scale®. Based on the findings of the pilot this units HAPI incident rate could be reduced by nearly 40% through clinical nurse use of SEM technology.
2. AHRQ. (2014). Preventing Pressure Ulcers in Hospitals: Section 7 Tools and Resources. http://www.njha.com/qualityinstitute/pdf/pubrochure.pdf
Introduction or Problem: Deep tissue injuries (DTI) result from pressure ischemia and/or shear stress that leads to cell deformation and ultimately cell death. There are varying reports of how long it takes DTIs to manifest visually from time of tissue injury ranging from 1 7 days (Koerner et al). Visual skin inspection for DTI is unreliable as characteristics are often not visible on the skin surface. Early identification of skin damage is critical to prevent hospital acquired pressure injury (HAPI).
Method: SEM technology consistently exhibited statistically significant HAPI reduction through DTI early identification, partnered with rapid HAPI prevention strategies. Technology that is clinically user friendly was explored. The SEM technology was utilized in combination with visual skin assessment during a pilot on an acute medical/rehabilitation unit in January 2022.
Deep Tissue Injury (DTI) Technology: Assessing Beyond the Skin Surface
Result or Patient Outcomes: 28% of patients were identified as higher DTI/HAPI risk using SEM technology versus skin assessment and or risk assessment alone.
POSTER #26
Katie Nolan, MSN, RN, WCC Victoria Sowards, BSN, RN Helen Copenheaver, BSN, RN, ONC, NPD BC
1. AHRQ. (2013). Pressure Ulcer Risk Assessment and Prevention: Comparative Effectiveness (Executive Summary) (pp. 1 19).
3. Cai, F. et. Al (2020). Application of infrared thermography in the early warning of pressure injury: A prospective observational study. Journal of Clinical Nursing, 00, 1 13. DOI: 10.111/jocn.15576
References:
7. Lilly, D., Estocado, N., Spencer Smith, J. B., & Englebright, J. (2014). Validation of the NE1 Wound Assessment Tool to Improve Staging of Pressure Ulcers on Admission by Registered Nurses. Journal of Nursing Measurement, 22(3), 438–450. https://doi.org/10.1891/1061 3749.22.3.438
9. NDNQI Webinar (2021) Press Ganey Advancing Care Quality Through Pressure Injury Prevention, Nationak Pressure Injury Advisory Panel Guidelines
15. Saindon K., Berlowitz, D. (2020). Update on pressure injuries: A review of the literature. Advances in Skin and Wound Care, 33, 403 409. DOI: 10.1097/01.ASW.0000668552.48758.1c
6. Koerner, S., Adams, D., Harper, S.L., Black, J. M., & Langemo, D.K. (2019). Use of thermal imaging to identify deep tissue pressure injury on admission reduces clinical and financial burdens of hospital acquired pressure injuries. Adv Skin Wound Care, 32, 312 320
17. The Joint Commission. (2016). Preventing Pressure Injuries.
16. Scafide, K. N., Narayan, M. C., & Arundel, L. (2020). Bedside Technologies to Enhance the Early Detection of Pressure Injuries. Journal of Wound, Ostomy and Continence Nursing, 47(2), 128 136. https://doi.org/10.1097/won.0000000000000626
4. Conley et al. European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel and Pan Pacific Pressure Injury Alliance. (2019). Prevention and Treatment of Pressure Ulcers/Injuries: Quick Reference Guide. Emily Haesler (Ed.). EPUAP/NPIAP/PPPIA.
5. Gefen, A., Gershon St (2018). An observational, prospective cohort pilot study to compare the use of subepidermal moisture measurements versus ultrasound and visual skin assessments for early detection of pressure injury. Ostomy Wound Management, 64(9), 12 27. DOI: 10.25270/owm.2918.9.1227
8. Moore, Z., Patton, D., Rhodes, S., and Conner, T. (2016). Subepidermal moisture (SEM) and bioimpedance: a literature review of a novel method for early detection of pressure induced tissue damage (pressure ulcers). International Wound Journal, 331 337. Doi: 10.111/iwj.12604
11. Oliveira, A.L., Moore, Z., O’Connor, T.O., & Patton D. (2017). Accuracy of ultrasound, thermography and subepidermal moisture in predicting pressure ulcers: a systematic review. Journal of Wound Care, 26(5). DOI: 10.12968/jowc.2017.26.5.199
12. Okonkwo, H., Bryant, R., Milne, J., Molyneaux, D., Sanders, J., Cunningham, G., Brangman, S., Eardley, W., Chan, G.K., Mayer, B., Waldo, M., Ju, B. (2020). A blinded clinical study using a subepidermal moisture biocapacitance measurement device for early detection of pressure injuries. Wound Repair and Regeneration 28(3), 364 374. https://doi.org/10.1111/wrr.12790
14. Rogers, C. (2013). Improving processes to capture present on admission pressure ulcers. Wound Care Journal 26(12), 566 572.
10. O’Brien, G., Moore, Z., Patton, D., & O’Connor, T. (2018). The relationship between nurses assessment of early pressure ulcer damage and sub epidermal moisture measurement: A prospective explorative study. Journal of Tissue Viability 27(4), 232 237. https://doi.org/10.1016/j.jtv.2018.06.004
13. Ratliff, C., & Droste, L.R. (2017). WOCN 2016 Guideline for Prevention and Management of Pressure Injuries (Ulcers). J Wound Ostomy Continence Nurs., 44(3doi.), 241 246. https://doi.org/10.1097/WON.0000000000000321
18. The Joint Commission. (2020). National Patient Safety Goals Effective July 2020 for the Nursing Care Center Program (pp. 1 7).
19. Wellspan Health. (2020). Adult Inpatient Nursing Documentation Policy.
20. Wellspan Health. (2020). Assessment Policy. 21. Young, D. L., Shen, J., J., Estocado, N., & Landers, M. R. (2012). Financial impact of improved pressure ulcer staging in the acute hospital with use of a new tool, the NE1 Wound Assessment Tool. Advances in Skin & Wound Care 25(4), 158 166.
References: 1. Leblanc, Kimberly & Whiteley, Ian & Mcnichol, Laurie & Salvadalena, Ginger & Gray, Mikel. (2019). Peristomal Medical Adhesive Related Skin Injury: Results of an International Consensus Meeting. Journal of Wound, Ostomy and Continence Nursing. 46. 125 136.
POSTER #27
2. McNichol L, Bianchi J (2016) Medical adhesive related skin injuries (MARSI) made easy. London: Wounds UK. Available from: www.wounds uk.com
3. Sian Fumarola, Rachel Allaway, Rosie Callaghan, Mark Collier, Fiona Downie, Jemell Geraghty, Sarah Kiernan, Fran Spratt, Janice Bianchi, Elaine Bethell, Annette Downe, Jackie Griffin, Maria Hughes, Brenda King, Kimberly LeBlanc, Louise Savine, Nikki Stubbs, and David Voegeli, Overlooked and underestimated: medical adhesive related skin injuries, Journal of
Method: Multiple materials were evaluated using a tensometer to ascertain which behaved similarly to human skin upon removal. Selected materials were used to test various skin barriers including SSB and traditional hydrocolloid skin barriers (HSB). The clinical relevance of the model was improved by the addition of simulated urine to evaluate efficacy in this corrosive environment.
Development of a clinically relevant model to demonstrate the benefits of Trio Genii™ ostomy bags with Sil2 breathable technology™ to reduce Medical Adhesive Related Skin Injury
Result or Patient Outcomes: Of eight materials evaluated, stainless steel and silicone rubber showed the closest behavior to human skin on the model. When tested on steel, the SSB showed significantly reduced peel force (p > 0.05) versus 3 HSBs, whilst silicone rubber showed similar results across all four products tested. The SSB showed better stability, less residue and more consistent peel force than the majority of HSBs evaluated after being soaked in simulated urine for 24 hours.
Kyle Turton MEng, Trio Healthcare Clinton Hill BSc, Trio Healthcare Marcus Delbono BSc, Trio Healthcare Andy Marxen BAN RN CWCN MBA, Trio Healthcare Introduction or Problem: Medical Adhesive Related Skin Injury (MARSI)1 in ostomates leads to pain, risk of infection and delays to healing, all of which negatively impacts quality of life.2 Soft silicone has been well documented as contributing to a reduction in MARSI in other spaces such as wound care and incontinence.3,4 Benefits of silicone include flexibility, atraumatic removal, and ability to reapply5,6 .
Rationale: This study aims to develop a method for the comparison of the adhesive qualities of different ostomy skin barriers, including a novel breathable silicone skin barrier (SSB) when dry and in the presence of corrosive fluids. Iterative improvements were made to the method with a view to improve clinical relevance.
Conclusion: The ability of the SSB to stay in place in the presence of urine and the reduction of force during removal may help reduce the incidence of MARSI and improve quality of life for ostomates. This is theorized to be a benefit of the unique mode of action of the breathable silicone formulation
4. Ling Antonia Zeng, Sui An Lie, Shin Yuet Chong, “Comparison of medical adhesive tapes in patients at risk of facial skin trauma under anasthesia”, Anesthesiology Research and Practice (2016), Volume 2016 5. André Soares Santos1, Aline Cunha Terra, José Luiz dos Santos Nogueira, Kenya Valéria Micaela de Souza Noronha, Juliana de Oliveira Marcatto, Mônica Viegas Andrade, “Silicone tape versus micropore tape to prevent medical adhesive relaed skin injuries:systemix review and meta analysis”, J Bras Econ Saúde 2019;11(3): 271 82 6. Swift T, Westagte G, Van Onselen J et al (2020) Developments in silicone technology for use in stoma care. British Journal of Nursing. 29(6).
Wound Care 2020 29:Sup3c, S1 S24
Rationale: The purpose of this study was to examine the efficacy of a new Turning and Positioning System related to caregiver (staff) effort required for patient mobility in 5 movements in the ICU patient, the number of caregivers (staff) required to mobilize the patient, and patient comfort in a hospital bed and maintaining a position in a chair on this system.
“SLING”ing the Critically Ill Patient into Position
Method: Prospective observational pilot study of 25 caregivers which included Registered Nurses, Physical Therapists, Respiratory Therapists, and Nursing Assistants in the ICU unit in a US hospital the Northeast. A collection form was used that included questions related to caregiver ease of use and patient benefits. In addition to the survey questions, additional clinical and patient feedback was obtained.
2. Leditschke, I. A., Green, M., Irvine, J., Bissett, B., & Mitchell, I. A. (2012). What are the barriers to mobilizing intensive care patients? Cardiopulmonary Physical Therapy Journal, 23(1), 26 29 Print.
POSTER #28
1. European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, & Pan Pacific Pressure Injury Alliance. (2019). Prevention and treatment of pressure ulcers/injuries: Clinical practice guideline. The International Guideline. Emily Haesler (Ed.), EPUAP/NPIAP/PPPIA, 55 56, 132 133.
Cheryl Brach Rothermel BSN, RN, CWOCN, Sr. Clinical Marketing Manager, Post Acute, Molnlycke
• Easier to help move the patient with airway needs than other products.
• 87.50% of caregivers/staff said the product required only 1 2 caregivers (staff) for patient mobility.
• Patient stated: It was very comfortable, and the sling had helped with pain when repositioning.
• 2 critically ill patients who were bed bound for 4 months were able to be lifted to a recliner without pain or discomfort and remained comfortable when placed in a chair.
Result or Patient Outcomes: Five positioning movements: bed to chair, vertical and lateral transfer, boosting, and turning can easily be done with very light effort. The number of caregivers (staff) required for patients mobility with the new system showed only 1 2 caregivers (staff) needed. Lastly, 100% of caregivers (staff) noted that the patient’s seated position was maintained while in the chair and the patient appeared to be comfortable in the bed and/or chair.
• No pressure injuries had developed while using the product.
References:
3. Product Reference: Molnlycke® Tortoise® Sling Turning & Positioning System.
Healthcare Introduction or Problem: Critically ill patients are very difficult to mobilize comfortably and safely and the need for the additional healthcare staff to mobilize this population are needed to turn, boost, vertically and laterally transfer, and lift from bed to chair.
Conclusion: The use of the new Turning and Positioning System showed safe and effective delivery of mobilization of the patient.
POSTER #29
Problem, Rationale, and purpose: The term necrotizing fasciitis (NF) describes a group of relatively uncommon, but life threatening infections of the skin, soft tissues ,and muscles, which tend to progress rapidly through the fascia planes, causing gradual destruction of the fascia at a rate reaching 2 3 cm/h. The annual incidence of NF is estimated at 500 1,000 cases annually. The disease affects all age groups, although middle aged and elderly patients (over50 years of age) are more likely to be infected. Trauma: Appendicitis with perforation, infection following the repair of an incarcerated hernia, perforated diverticulitis, necrotic cholecystitis, gastroduo denal perforation, small bowel perforation, and obstructive colon cancer with perforation rank among the most frequent causes of complicated intra abdominal infections that can lead to NF. The diagnosis of NF can be secured faster with the use of laboratory based scoring systems, such as the LRINEC score and imaging tests:[CT MRI],or frozen section biopsy. TREATMENT: antibiotics therapy and at a higher dosage. Intravenous immunoglobulin (IVIG) has recently been described as a reasonable and desirable option for neutralizing streptococcal toxins. Emergency surgical debridement of the affected tissues is the primary management modality for NF. using vacuum assisted closure(VAC) therapy for fast and effective wound closure. The VAC dressing must be changed every 24 72 h. VAC therapy has several benefits in wound management, with wound area reduction and formation of granulation tissue being the most prominent. Other benefits, such as effective wound cleaning and the ability to remove the exudate render VAC a promising adjuvant therapy for wound closure.
References: 1. Wound, Ostomy and Continence Nurses Society® Core Curriculum: Wound Management 1st Edition 2. https://www.ncbi.nlm.nih.gov/books/NBK430756
Necrotizing Fasciitis in Adults and nursing management: A Systematic Review
Methods: This study is the result of clinical and informational research. In this systematic review and meta analysis study, four online databases (PubMed, Scopus, web of Science, ProQuest) from related articles from 2017 2021 were searched for related keywords. The quality of articles was evaluated using the Newcastle Ottawa (NOS) criterion. Results: The objective of this systematic review was to collect and analyze data regarding demographics, epidemiology, etiology, associated systemic disorders, initial clinical manifestations, diagnosis, and treatment of NF cases reported through the last decade. A total of 25 articles, describing 19 adult patients with NF were included. In order of appearance, swelling and pain were the most common initial clinical manifestations.
Conclusion: Necrotizing fasciitis is a rare but life threatening condition, with a high mortality rate (median mortality 32.2%) that approaches 100% without treatment. Unfortunately ,there are no single new therapies that can manage NF; they all seem to play an assistive role. Undoubtedly ,the use of VAC has many benefits in wound healing ,and it will be adopted by more physicians in the future. The use of VAC therapy and nursing role in wound management has greatly improved the results of postoperative management.
Hamed Savadkoohi/MSc geriatric nursing/WOC specialist nurse
Keywords: Necrotizing fasciitis, nursing management, adults patients.
3. https://dermnetnz.org/topics/necrotising
fasciitis fasciitis.html
4. https://www.cdc.gov/groupastrep/diseases public/necrotizing
Frank Aviles Jr, PT, CWS, FACCWS, CLT LANA, ALM, AWCC, MAPWCA, Natchitoches Regional
Introduction of Problem: Skin is an indicator of general health as it mirrors our internal health. Recognizing this in darker patients is challenging. A visual skin assessment is the gold standard in detecting problems. Classic signs of skin damage include visual and tactile changes such as warmth, edema, induration, redness, bruising, and inability to identify a blanching response. A visual assessment may be difficult to assess on dark skin.
Rationale: An inflammatory response creates tissue temperature differentials creating an increase in thermal energy. This increase may occur because of an inflammatory response initiated by a possible concomitant active metabolic bacterium.
Result or Patient Outcome: Skin assessment using LWIT validated noted color changes in darker skin based on increased/decreased thermal energy resulting in recognition of various types of inflammatory/infectious conditions in the 5 cases presented. This case series demonstrated the impactful recognition of skin damage thermographically by providing clinicians with an image of a body area noting an objective, quantified, normal, or abnormal thermal response.
POSTER #30
Early Detection of Darkly Pigmented Skin Abnormalities with LWIT: It’s All Relative!
Conclusion: LWIT can help detect early signs of skin damage regardless of the amount of pigmentation. Studies have demonstrated how clinicians have difficulty recognizing skin damage in darker compared to lighter pigmented individuals. Now we have technology, LWIT, that is not only being used for prevention but ideal for early recognition of skin damage, especially in darker individuals which is a powerful bedside tool that provides advocacy for our patients.
2. Staffa E, Bernard V, Kubíček L, et al. Using Noncontact Infrared Thermography for Long term Monitoring of Foot Temperatures in a Patient with Diabetes Mellitus. Ostomy Wound Manage 2016;62(4):54 61.
References: 1. Chanmugam, Arjun MD, MBA; Langemo, Diane PhD, RN, FAAN; Thomason, Korissa MS, BSSN, RN; Haan, Jaimee PT, CWS; Altenburger, Elizabeth A. PT, MSPT, CWS; Tippett, Aletha MD; Henderson, Linda RN; Zortman, Todd A. RN Relative Temperature Maximum in Wound Infection and Inflammation as Compared with a Control Subject Using Long Wave Infrared Thermography, Advances in Skin & Wound Care: September 2017 Volume 30 Issue 9 p 406 414, doi: 10.1097/01.ASW.0000522161.13573.62.
Methods: LWIT images were taken as an assessment adjunct of 5 darkly pigmented patients. Infrared cameras measure the radiation being emitted by the human body which is translated into a temperature gradient producing a colorful and powerful image. Specialized LWIT cameras detect radiation emitted in electromagnetic waves not visible to the human eye in the range of 8 14 microns in wavelength. The radiation that the human body emits is 12 microns. Setting a control point relative (the home run tying into the title) to the patient quantifies the temperature in degrees Celsius removing intrinsic and extrinsic variables
4. Mufti A, Somayaji R, Coutts P, Sibbald RG. Infrared Skin Thermometry: Validating and Comparing Techniques to Detect Periwound Skin Infection. Adv Skin Wound Care 2018;31(1):607 611. doi:10.1097/01.ASW.0000527352.75716.70.
3. Ramirez GarciaLuna JL, Bartlett R, Arriaga Caballero JE, Fraser RDJ, Saiko G. Infrared Thermography in Wound Care, Surgery, and Sports Medicine: A Review. Front Physiol 2022;13:838528. Published 2022 Mar 3. doi:10.3389/fphys.2022.838528.
J.D. Cobb MD
Michelle Moore MSN, RN, CWCN, AWCC, WCC
Conclusion: Adding hypochlorous acid (HOCl) solution to the surgical regimen for traumatic orthopedic wounds may Help decrease SSI rates, hardware revisions and healing times, although further studies are recommended.
Crystal Glenn Summer Martin RN Christine Tanner PA Introduction or Problem: A common challenge with ORIF is a higher infection rate, trialing HOCl as a soak rinse and final rinse during procedure tracked with results formatted.
Method: Retrospective data was collected from a random selection of post ORIF tib/fib patients over a 3 year period for analysis. During this 3 year period, hypochlorous acid (HOCl) was consistently used during the surgical procedures for both wound irrigation and hardware soaks. Areas of focus included hospital admissions, surgical prep and procedures and post operative care. Various data points were obtained, including co morbidities, medications administered, and healing progression. While patients were prepped for surgery, the various hardware was soaked in hypochlorous acid (HOCl) solution. During the surgical procedure, the wound was first irrigated with HOCl, followed by hardware implantation, and then the wound pocket was rinsed again with HOCl before primary closure of the incision.
A Retrospective Analysis of 15 ORIF Cases and SSI Rates
Hypochlorous Acid (HOCl) Solution Used in Orthopedic Surgery for Traumatic Wound Irrigation:
Rationale: Background: Surgical Site Infection (SSI) rates for post op Open Reduction Internal Fixation (ORIF) tibia/fibula fractures range from 13 88%. Post op infection has been associated with a heavy cost burden of approximately $20,785 per infection and is affiliated with hospital readmission penalties, infection control issues, and a complicated and extended patient recovery. Because of this, surgeons and hospital administrators alike are constantly evaluating ways to decrease post op infection, related costs, and associated risks. This includes selection of antimicrobial wash, methods of antimicrobial irrigation, and even whether to possibly soak hardware prior to implantation. To date, the effects of hypochlorous acid (HOCl) solution as a surgical irrigation tool for ORIF cases have not been thoroughly investigated in the United States.
POSTER #31
Result or Patient Outcomes: Data analysis showed that incorporating hypochlorous acid (HOCl) solution into standard surgical protocols demonstrated an SSI rate of 0 6.6%* and a timeline of healed incision site at an average of 11 days.
References: 1. Magill SS, O’Leary E, Janelle SJ, et al. Changes in Prevalence of Health Care–Associated Infections in U.S. Hospitals. New England Journal of Medicine. 2018;379(18):1732 1744. doi:10.1056/NEJMoa1801550
Erica Truitt
5. Martin C. Robson M. Treating Chronic Wounds with Hypochlorous Acid Disrupts Biofilms. Today's Wound Clinic. 2014;8(9)
2. Wolcott R, Dowd S. The role of biofilms: are we hitting the right target? Plast Reconstr Surg. Jan 2011;127 Suppl 1:28s 35s. doi:10.1097/PRS.0b013e3181fca244
7. Armstrong DG, Bohn G, Glat P, et al. Expert Recommendations for the Use of Hypochlorous Solution: Science and Clinical Application. Ostomy Wound Manage. May 2015;61(5): S2 s19.
4. Wang L, Bassiri M, Najafi R, et al. Hypochlorous acid as a potential wound care agent: part I. Stabilized hypochlorous acid: a component of the inorganic armamentarium of innate immunity. J Burns Wounds. Apr 11, 2007;6: e5.
9. Hiebert JM, Robson MC. The Immediate and Delayed Post Debridement Effects on Tissue Bacterial Wound Counts of Hypochlorous Acid Versus Saline Irrigation in Chronic Wounds Eplasty. 2016;16: e32. Published 2016 Dec 1.
6. Chen CJ, Chen CC, Ding SJ. Effectiveness of Hypochlorous Acid to Reduce the Biofilms on Titanium Alloy Surfaces in Vitro. Int J Mol Sci. Jul 19, 2016;17(7) doi:10.3390/ijms17071161
3. Fany Reffuveille JJ, Quentin Vallé, Céline Mongaret and Sophie C. Gangloff. Staphylococcus aureus Biofilms and their Impact on the Medical Field. In: Enany S, ed. The Rise of Virulence and Antibiotic Resistance in Staphylococcus aureus. IntechOpen; 2017: chap 11.
8. Wongkietkachorn, Apinut MD*; Surakunprapha, Palakorn MD†; Wittayapairoch, Jakrapan MD‡; Wongkietkachorn, Nuttapone MD§; Wongkietkachorn, Supawich MD. The Use of Hypochlorous Acid Lavage to Treat Infected Cavity Wounds, Plastic and Reconstructive Surgery Global Open: January 2020 Volume 8 Issue 1
10. Granick MS, Paribathan C, Shanmugam M, Ramasubbu N. Direct Contact LowFrequency Ultrasound Clearance of Biofilm from Metallic Implant Materials. Eplasty. 2017;17: e13. Published 2017 Mar 29.
POSTER #32 INCORPORATING HYPOCHLOROUS ACID INTO TREATMENT PROTOCOL FOR DEHISCED BREAST IMPLANT INCISION
Rationale: The patient was a 41 year old female who underwent breast implant surgery outside of the United States. Upon return, her incision lines dehisced bilaterally at the points of Keller funnel insertion and a wound specialist was called in for a consultation Method: Initial Assessment:
References:
3. Fany Reffuveille JJ, Quentin Vallé, Céline Mongaret and Sophie C. Gangloff. Staphylococcus aureus Biofilms and their Impact on the Medical Field. In: Enany S, ed. The Rise of Virulence and Antibiotic Resistance in Staphylococcus aureus. IntechOpen; 2017: chap 11.
6. Chen CJ, Chen CC, Ding SJ. Effectiveness of Hypochlorous Acid to Reduce the Biofilms on Titanium Alloy Surfaces in Vitro. Int J Mol Sci. Jul 19, 2016;17(7) doi:10.3390/ijms17071161
• Right breast shows tunneling below the incision line as well • as undermining from 12 o’clock to 3 o’clock position with initial treatment of loosely packing Hypochlorous acid soaked gauze, covering with a dry, sterile dressing.
Michelle Moore MSN, RN, CWCN, AWCC, WCC Introduction or Problem: The dehiscent rate for breast implants is averaging at 5%, the rate increases with other co morbidities. Current antimicrobials washes are not standard plan due to interaction of products and breast implant ingredients until HOCl which shows no interaction.
• Left breast shows a slough covered wound bed with initial treatment of Hypochlorous acid soaked gauze, changing daily until slough removed.
• Midway through treatment, the protocol was changed due to slough removed on left breast and tunneling and undermining granulated to wound base. Treatment was changed to incorporate collagen to further stimulate granulation until the wound closed Result or Patient Outcomes: Patient healed out without incident in 4 weeks.
1. Magill SS, O’Leary E, Janelle SJ, et al. Changes in Prevalence of Health Care Associated Infections in U.S. Hospitals. New England Journal of Medicine. 2018;379(18):1732 1744. doi:10.1056/NEJMoa1801550
2. Wolcott R, Dowd S. The role of biofilms: are we hitting the right target? Plast Reconstr Surg. Jan 2011;127 Suppl 1:28s 35s. doi:10.1097/PRS.0b013e3181fca244
Conclusion: Adding hypochlorous acid (HOCl) solution to the surgical regimen for plastic surgery may help decrease SSI rates and healing times, although further studies are recommended.
4. Wang L, Bassiri M, Najafi R, et al. Hypochlorous acid as a potential wound care agent: part I. Stabilized hypochlorous acid: a component of the inorganic armamentarium of innate immunity. J Burns Wounds. Apr 11, 2007;6: e5.
5. Martin C. Robson M. Treating Chronic Wounds with Hypochlorous Acid Disrupts Biofilms. Today's Wound Clinic. 2014;8(9)
8. Wongkietkachorn, Apinut MD*; Surakunprapha, Palakorn MD†; Wittayapairoch, Jakrapan MD‡; Wongkietkachorn, Nuttapone MD§; Wongkietkachorn, Supawich MD. The Use of Hypochlorous Acid Lavage to Treat Infected Cavity Wounds, Plastic and Reconstructive Surgery Global Open: January 2020 Volume 8 Issue 1
10. Granick MS, Paribathan C, Shanmugam M, Ramasubbu N. Direct Contact LowFrequency Ultrasound Clearance of Biofilm from Metallic Implant Materials. Eplasty. 2017;17: e13. Published 2017 Mar 29.
9. Hiebert JM, Robson MC. The Immediate and Delayed Post Debridement Effects on Tissue Bacterial Wound Counts of Hypochlorous Acid Versus Saline Irrigation in Chronic Wounds. Eplasty. 2016;16: e32. Published 2016 Dec 1.
7. Armstrong DG, Bohn G, Glat P, et al. Expert Recommendations for the Use of Hypochlorous Solution: Science and Clinical Application. Ostomy Wound Manage. May 2015;61(5): S2 s19.
Results: In collaboration with pharmacy, clinical nursing leadership, and wound care nurses, Telemetry nurses were educated and trained on hyaluronidase intradermal therapy. Telemetry nurses assessed for potential amiodarone extravasation and consulted the Wound Care Department when an amiodarone extravasation was suspected. Once an amiodarone extravasation was identified, the primary nurse injected 15mL of hyaluronidase intradermally at the site of extravasation. Redness, swelling, induration, and pain at the site decreased after 24 hours in all patients. No further tissue damage was seen.
Purpose: Amiodarone a commonly used anti arrhythmic drug, is a vesicant. Patients require intravenous amiodarone therapy for arrhythmia control for 24 hours before transitioning to oral therapy. Amiodarone is primarily given through a peripheral line where ideally should be administered through central venous catheter. Recognizing need for prompt treatment is
References: Fox, A N., Villanueva, R., & Miller, J L. (2017). Management of amiodarone extravasation with intradermal hyaluronidase. American Journal of Health System Pharmacy, 74(19):1545 1548. Jung, F. (2020). Hyaluronidase: An overview of its properties, applications, and side effects. Archives of Plastic Surgery, 47(4): 297–300.
POSTER #33 Changing the Concentration
Approach: In 2020, the concentration of intravenous amiodarone changed from 500mg/500ml to 500mg/250ml in an effort to decrease the amount of fluid patients were receiving. Increased concentration allows for more medication to enter the tissues and possible extravasation to occur, tissue injury is due to the acidic pH of amiodarone. Treatment for amiodarone extravasation is intradermal injections of 15 units of hyaluronidase in the area of infiltration. Hyaluronidase degrades hyaluronic acid thus increasing the distribution and absorption of locally injected substances. Prompt treatment with hyaluronidase is essential in preventing tissue injury. Staff education and training were needed for this practice given the importance of prompt hyaluronidase therapy.
Megan Parise, RN, T LaCorte, BSN RN WCC, A Casano, BSN, RN, S. Desrosiers, MA MSN RN Penn Medicine Princeton Medical Center
Conclusion: IV amiodarone patients are at risk for extravasation. When extravasation occurs, prompt treatment with hyaluronidase can decrease tissue damage. Staff training is essential in delivering prompt hyaluronidase therapy.
Objective: Patient safety is the upmost concern when delivering potentially caustic medications intravenously. In order to ensure hyaluronidase therapy was given promptly after amiodarone extravasation, education and training was initiated among Telemetry staff nurses to assess for amiodarone extravasation and prompt hyaluronidase treatment. Of 45 patients, 12 were IV amiodarone with 5 being extravasation and injections provided.
• TwoPress2® Lite Rationale: This poster will show the results of a 12 week study, displaying how our products work together to improve healing rates for both diabetic foot ulcers (DFU) and venous leg ulcers (VLU). It will also outline the simplified experience for both patients and clinicians.
POSTER #34
Problem: Chronic wounds are a challenge, both for the patients experiencing them, and the clinicians who treat them. For the patients, this can greatly affect their quality of life. One contributing factor to the chronic wound challenge is managing exudate. Exudate in the wrong composition, wrong quantity, or wrong place can both complicate and delay wound healing. Hartmann has recently released several new products, as part of our drive to provide a comprehensive Advanced Wound Care portfolio. Our goal is to make wound care simplified, categorizing our products for In, On, and Around the Wound. These products include: • ColActive® Plus Ag Powder • Zetuvit® Plus • Zetuvit® Plus Silicone Border
Dr. Dean Vayser, DPM ILD Consulting LLC, San Diego, CA
Wound Healing, Simplified: A Case Series Highlighting the Effectiveness of Hartmann Dressings on Chronic Wounds
Method: This study is comprised of 10 patients, split into 2 groups based on their wound type (DFU or VLU). The patients with a DFU use ColActive® Plus Ag Powder and Zetuvit® Plus Silicone Border for treatment. The patients with a VLU use ColActive® Plus Ag Powder, Zetuvit® Plus, and TwoPress2® or TwoPress2® Lite for compression, depending on their ABPI. Prior to data collection, patient demographics, wound measurement, and previous treatment was recorded.
2. Hartmann USA. (2021). TwoPress2® Lite: Instruction manual. Rock Hill, SC: Author.
Results/Conclusions: Data and results from both patients and clinicians will be documented and presented. Results will be shown in a progression of photos from each dressing change, documenting wound reduction and tissue health. Social, emotional, and financial impact on the patient will be documented in conjunction with wound healing.
3. World Union of Wound Healing Societies (WUWHS) Consensus Document. Wound Exudate: effective assessment and management Wounds International, 2019.
References: 1. Hartmann USA. (2019). TwoPress2®: Instruction manual. Rock Hill, SC: Author.