Archive for the ‘Moist wound dressing’ Category

Explore when to use a collagen wound dressing on your patients

Wednesday, September 9th, 2020
collagen wound dressing

As wound care certified (WCC) clinicians, you should be aware of the types of dressings available to treat patients in your care.

Wound care dressings come in various shapes, sizes and have indications for their use, including collagen wound dressings.

Let’s explore which types of dressings are focused on collagen.

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What’s all the fuss about wound dressing change frequency?

Wednesday, December 4th, 2019
A clinician maintains a patient's wound dressing change frequency.

Let’s take a one question wound care quiz.

What is more important for wound dressing change frequency?

  1. Expert application of a dressing
  2. Frequency of the dressing change

The correct answer is the frequency. Now let’s talk about why.

I do not want to take away from the importance of properly applying dressings because that certainly has its own merits. But when it comes down to it, the frequency wins hands down. 

As we teach in class, wound healing is a dynamic process. As the wound progresses through the phases of healing, all kinds of cellular activity is happening.

From the neutrophils and macrophages to the growth factors and fibroblasts, each phase has a job to do for the wound to move to the next phase and ultimately close.

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Don’t be a wound dabbler: Proper wound care must be science based

Monday, August 19th, 2019

proper wound care

Ever wonder where clinicians come up with some of the treatments we unfortunately see in wound care today?

wound care

By Bill Richlen, PT, WCC, DWC

Does it leave you scratching your head or pulling out your hair? I am sure there are plenty of wound care examples we could discuss for hours (with plenty of laughs).

Yet that doesn’t solve the problem or change the hearts and minds of clinicians — or wound dabblers — who feel those treatments are proper wound care.

Here’s a look at a few “inappropriate” treatments I have come across in my years as a wound specialist.

Let’s dissect them to understand what the “rationale” may have been and discuss why common sense, logic and scientific evidence doesn’t support them as proper wound care.

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Top 6 facts you need to know about pressure injuries today

Monday, May 27th, 2019

pressure injuries

Wound care is an exciting specialty that can sometimes prove challenging.

Carole Jakucs

By Carole Jakucs, MSN, RN, PHN

With various wound types and multiple wound care products and treatments available, clinicians strive to stay up to date on the best practices to ensure they are providing their patients with the current standard of care.

Managing pressure injuries is one area of wound care that many wound care professionals encounter regularly, as pressure injuries are pervasive across the healthcare continuum.

Whether you work in home health, acute care or long-term care, below are some of the top facts to know about managing pressure injuries today from Don Wollheim, MD, FAPWCA, WCC, DWC.

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What happened to practicing wound care basics?

Tuesday, April 30th, 2019

wound care basics

Having been involved in wound care for about 25 years, I have seen many changes in our understanding of wound healing, research evidence and technology.

wound care

By Bill Richlen, PT, WCC, DWC

As I hear my students describe common practices today and the many myths of wound care, I’m led to wonder, “What happened to starting with wound care basics for healing?”

A colleague of mine once stated there are basically two fundamentals to healing wounds: a healthy patient and a healthy wound environment. Once those are accomplished, topical treatments will not make that big of a difference.

However, clinicians often cling to some “holy grail” treatment in the form of a dressing or adjunctive modality that will somehow overcome the need to practice solid, evidence-based wound care.

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Case studies confirm effectiveness of honey for wound care

Thursday, March 21st, 2019

hone for wound care

When durable medical equipment Manuka honey isn’t available to treat a chronic wound, can over-the-counter (OTC) honey products serve as an effective substitute? Poster presenters from the 2018 Wild On Wounds national conference looked for evidence in two case studies.

By Keisha Smith, MA, CWCMS

Despite rapid developments in new wound care technology, clinicians are turning to an ancient approach to speed healing and control bioburden: honey.

As early as 3,000 BC, Egyptians and other civilizations relied on honey as a topical wound treatment. With the discovery of antibiotics, however, honey quickly fell out of favor.

As antibiotic resistance drives the search for alternatives today, therapeutic honey enjoys renewed attention from researchers.

Is Manuka honey the only effective option?

Most of the studies on medicinal honey focus on durable medical equipment products, which typically contain honey extracted from the nectar of a Manuka tree.

Based on the evidence, medical-grade Manuka honey has gained esteem among wound care professionals for its increased antimicrobial action compared to other types of honey. Studies also suggest medical-grade Manuka honey contains compounds that jump-start stalled wounds, reduce odor and accelerate healing.

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Wound Temperature and Healing

Friday, February 23rd, 2018

You’ve probably heard that it’s important to keep wounds moist and warm, But what’s the optimal temperature for healing a wound, and how do you maintain it? Read on for details.

Wound Temperature and Healing

 

When moisture evaporates from a surface, the surface cools. Sweat operates by this principle. So, unfortunately, do wounds. Whenever a wound loses moisture, the tissues of the wound drop in temperature.

The cells and enzymes of the body function best at normal temperature, around 37° C (98.6° F).  When wound temperature decreases by as little as 2° C, healing can slow or even cease. In short, when the temperature drops, the healing stops.

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Maceration and Hydrogels? Just Say Whoa

Thursday, July 21st, 2016

How do you use hydrogel dressings to keep wounds moist without causing maceration? Very carefully.  

 

Maceration and Hydrogels? Just Say Whoa

 

If you’ve ever taken a long bath or spent an afternoon in a swimming pool, you’re familiar with what happens to your hands and feet: they become soft, white, and wrinkled up like prunes. This is a classic case of maceration, which occurs when skin tissue is exposed to excessive moisture over a period of time.

As clinicians, we regularly treat patients with wounds (which need to be kept moist) that are surrounded by tissue that needs to be kept dry. So knowing how to properly treat the wound without causing maceration makes all the difference in the healing process.
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Moisture Associated Skin Damage: Know Your Type

Friday, March 4th, 2016

Know how to correctly identify these four common types of Moisture Associated Skin Damage (MASD) for best wound care practices.

Moisture Associated Skin Damage (MASD)

It might sound reasonable to assume that Moisture Associated Skin Damage (MASD) is the result of, well … moisture. The fact is that it takes more than just moisture to cause MASD, which is the inflammation and erosion of the skin that’s caused by prolonged exposure to various sources of moisture, including, urine, stool, perspiration, wound exudate, mucous, or saliva.  Skin does not break down in water alone.  However, when moisture on the skin is combined with friction, chemical irritants or bacterial/microbial factors, that’s when the real damage occurs.

For effective wound care, clinicians must be able to properly assess MASD from the onset – even if at first the diagnosis isn’t obvious. It all begins with good clue gathering, and knowing the characteristics of each of the four common types.

Identifying MASD

Because moisture on the skin increases skin permeability (which alters pH and cools the tissue), it compromises the barrier function of the skin’s protective acid mantle. This, in turn, makes the skin more susceptible to friction and shearing forces.

Correct MASD identification is critical for treatment, and should begin as soon as initial signs appear. The first step is to conduct a complete skin assessment. Don’t ever assume that you know what’s going on at first glance. Follow the general rule of thumb for any wound expert, and keep looking! Take your time, be methodical, and note the location, texture, moisture level, maceration, denuding and changes in skin color.

Know your type

Incontinence-Associated Dermatitis (IAD)

One of the most common forms of MASD is incontinence-associated dermatitis (IAD), which is the inflammation of the skin from extended exposure to urine or stool.  You may also know it as perineal dermatitis, irritant dermatitis or diaper rash (in children). The highest-risk patients are those that have both fecal and urinary incontinence.

As mentioned earlier, moisture requires an additional irritant in order to produce MASD. Urine contains ammonia, which increases the skin’s pH and destroys the protective acid mantle.  Adding to the problem, frequent skin cleansing in response to urinary or fecal incontinence can increase the risk of breakdown. Even incontinent briefs can contribute to IAD by causing perspiration in the affected area. Although the briefs pull the actual fluids away, the microclimate remains moist and warm.

So how do you know if it’s IAD? Here are typical characteristics:

  • Found over fatty tissue of the buttocks, perineum, inner thigh and groin (though they can occur over bony prominences).
  • Distributed in a consolidated or patchy formation.
  • Covers diffuse areas, shaped like a mirror image in the skin fold or linear area in the anal cleft.
  • Is superficial or partial thickness in depth. Note: if there’s tissue destruction into the subcutaneous tissue or deeper, it must be staged as a pressure ulcer (for more information, see the WCEI blog “Will the Real Pressure Ulcer Please Stand Up?”)
  • Presents with non-uniform redness in the wound bed, maceration in the surrounding skin and peri-anal redness. No necrosis.
  • Has diffuse and irregular wound margins.

Intertriginous Dermatitis (ITD)

Intertriginous dermatitis, also called intertrigo, is an inflammatory condition of opposing skin surfaces caused by moisture.  You’ll find it in skin folds, such as under the breasts, in the axillary (armpit) area, or inguinal (groin) region. It’s particularly common in obese patients.

Moisture can become trapped in the skin fold, where there is a lack of air circulation.  The excess moisture causes the dead cells in the uppermost layer of the skin (the stratum corneum) to become saturated and then puff up. The result is rough textures (which means they won’t glide very well), and the result is skin-on-skin friction.

Characteristics of ITD:

  • Found in the skin folds.
  • Distributed in a linear, mirror image on each side of the fold
  • Always partial thickness.
  • Presents as mild erythema (redness) that can quickly progress to erosion, oozing, maceration or crusting.
  • Surrounding skin is often macerated and prone to bacterial and fungal infections such as candidiasis.
  • Can be painful, itchy and may produce odor.

It’s important to realize that a patient can suffer from both IAD and ITD at the same time, coexisting side-by-side.

Periwound Moisture-Associated Dermatitis

Periwound moisture-associated dermatitis occurs when the skin adjacent to a chronic wound becomes exposed to exudate or toxins from bacteria in the wound bed, causing inflammation and erosion. This is a result of too much exudate that hasn’t been properly managed. Left untreated, the periwound will eventually break down and the wound will enlarge.

Infected wounds are especially prone to periwound moisture-associated dermatitis because they produce more exudate.  The condition is more common in the elderly and immunocompromised, but our clinical practices can contribute as well. This can be due to a number of risk factors, including improper dressing selection, infrequent dressing changes, and aggressive tape removal.

Peristomal Moisture-Associated Dermatitis

The final common type of MASD is peristomal moisture-associated dermatitis.  This form of inflammation and skin erosion occurs only in ostomy patients.  It begins at the stoma/skin junction, and can extend outward as much as 4 inches in any direction.  As many as 50% of patients with a stoma experience this condition, which can be extremely detrimental to their quality of life.

Peristomal moisture-assisted dermatitis can happen around any stoma, including tracheostomies, gastrostomies, urostomies, and colostomies.  However, ileostomy patients – those with stomas at the small intestine – have the highest risk since the effluent (output from the stoma) is watery and caustic.  When the pouching system leaks due to improper sizing, an uneven peristomal plane or incorrect wear time, the effluent causes skin irritation and potential breakdown.

Pay close attention to the area around the stoma, keeping a close eye out for potential problems, including well-defined erythema, edema, and loss of the epidermis. You may also see papules, vesicles, itching, crusting and oozing. As with other forms of MASD, it’s important to address the problem early.

Do you know your MASD types?

What types of MASD have you encountered the most in your facility, and have you ever had trouble identifying them? Do you have any tips for MASD identification, and has early identification made a difference in patient outcome? Please tell us about your experiences by leaving your comments below.

Wound Care Education Institute® provides online and onsite courses in the fields of Skin, Wound, Diabetic and Ostomy Management. Health care professionals who meet the eligibility requirements may sit for the prestigious WCC®, DWC® and OMS national board certification examinations through the National Alliance of Wound Care and Ostomy® (NAWCO®). For more information see wcei.net.

Warm Wound Healing? It’s All About Foam Dressings

Thursday, February 4th, 2016

Keeping a wound warm is an important part of wound care treatment, and foam dressing does the trick because it effectively maintains optimum temperatures and promotes healing. 

Foam for Warm Wound Healing

 

For wound care clinicians – and anyone else who ever treats wounds – it’s important to know that moist wounds heal faster. However, moisture on any surface (including wounds) will begin evaporating when exposed to air, and at a quicker rate as the surface cools. So the challenge of healing wounds effectively is to keep a wound moist and warm. Fortunately, foam dressings maintain optimum healing conditions, and help our patients heal faster.

Why warm is better

As wound tissues lose moisture, a cooling effect occurs in the wound. Because cells and enzymes function optimally at normal body temperature, a drop of just 2 °C is sufficient enough to negatively affect the biological healing process.

In fact, when a wound dressing is changed, it can take a wound base temperature up to four hours before it returns to normal. This is an important factor to consider when anticipating healing times, as well as when prepping your patient for a dressing change. Additionally, when tissue cooling occurs, it can lead to a higher risk of infection due to vasoconstriction, and hemoglobin’s increased need for oxygen. This, in turn, decreases the amount of oxygen available for neutrophils, which fight infection.

So how does this all tie in to dressings? By using the right type of dressings – and applying them properly – you can create an optimum environment for wound healing. The dressing that keeps the wound bed the warmest is foam.

Foam Dressing

Semipermeable polyurethane foam dressing is nonadherent and nonlinting. It has a hydrophobic or waterproof outer layer, and provides a moist wound environment. Other characteristics of foam dressing include:

  • It is permeable to water vapor, but blocks the entry of bacteria and contaminants
  • It can be purchased in various thicknesses, with or without adhesive border
  • It is available in pads, sheets, and cavity dressings

Consider using foam as primary or secondary dressing for partial- and full-thickness wounds, with minimal to heavy drainage. In addition, foam dressing:

  • Works well for granulating and epithelializing wounds
  • Provides insulation to keep wounds warm
  • As secondary dressing for wounds with packing
  • Can be used to absorb drainage around tubes
  • Helpful for hypergranulation tissue along with compression

The advantages to using foam dressing on wounds are that it:

  • Provides moist wound healing
  • Doesn’t adhere to the wound
  • Provides cushioning
  • Is easy to apply and remove
  • Can be used with infected wounds
  • Provides a bacterial barrier
  • Is effective with hypergranulation
  • Can be used under compression
  • Can be cut to accommodate tubes

The disadvantages to using foam dressing on wounds include:

  • It could be expensive if exudate requires daily dressing changes
  • Wound beds may desiccate if there is no exudate from the wound
  • A secondary dressing might be required
  • If it becomes saturated, it can lead to maceration of the periwound
  • It is contraindicated for use with third-degree burns, dry eschar, and sinus tracts

What do you think?

Knowing that moist and warm wounds heal faster obviously makes using the right dressings (and applying them properly) crucial to effective wound care. Do you regularly use foam dressings, and have you noticed a difference in healing time? And have you learned any special application techniques that help keep wounds at an optimum body temperature? We’d love to hear about your experiences – please leave your comments below.

Wound Care Education Institute® provides online and onsite courses in the fields of Skin, Wound, Diabetic and Ostomy Management. Health care professionals who meet the eligibility requirements may sit for the prestigious WCC®, DWC® and OMS national board certification examinations through the National Alliance of Wound Care and Ostomy® (NAWCO®). For more information see wcei.net.