Posts Tagged ‘Wound Care’

Wound Detective Series: Is It (Or Is It Not) Infected?

Friday, January 13th, 2017

How can you tell if a wound is really infected? Learn how to spot the signs of infection and be a skilled wound investigator.

Signs of infection

Are you ready, wound detectives, to tackle a new case? This time, we’re learning how to spot the signs of infection. Remember, the wound will tell us what we need to know, we just have to pay careful attention and know what to look for. After all, treatment depends primarily on our clinical assessment (and then a wound culture, if indicated). Sharpen up those investigative skills, and let’s get to work.

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Wound Detective Series: How to Get Away with Killing Biofilm

Friday, October 21st, 2016

Even the best wound care detectives are challenged by this sneaky culprit that delays healing. Here’s how to identify biofilm bacteria and solve the case.

Wound Detective Series: How to Get Away with Killing Biofilm

 

Ready for some serious detective work? In this wound-care case, we will try to find and invade the elusive biofilm bacterial hide-out. So the questions are: where are those microbes holed up, how do I know if they are even there, and how do I get rid of them?

Put on your Wound Detective hat – this one’s going to be tough. Even with your trusty magnifying glass, it’s not easy to spot the signs and symptoms of biofilm in your patients’ wounds.

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Real World Pressure Injuries: Staging Can Be Tricky

Tuesday, March 29th, 2016

This wound care Q&A answers five of the most common questions about pressure injury staging dilemmas (that you probably didn’t learn from textbooks).

Real World Pressure Injury Staging

 

In the world of wound care, just as in real life, the phrase, “Expect the unexpected” couldn’t be more appropriate. Clinicians can do everything exactly by the book, only to find that a wound just won’t heal, or the source of the problem appears to be one thing but then ends up being another. This is especially true with pressure injuries and often makes pressure injury staging a challenge.

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Essential Steps for Skin Tear Prevention

Thursday, February 11th, 2016

Skin tears are a common condition for the patients we care for, which is why it’s so important for clinicians to know who is at risk, and what can be done to minimize them. 

Skin Tear Prevention

Painful. Disfiguring. Traumatic. Skin tears are all of these things, plus they can lead to further complications and serious infections. Unfortunately, they also happen to be a very common condition for the patients we care for. In fact, an estimated 1.5 million skin tears occur each year – and that’s just among institutionalized adults.

In addition to causing pain and discomfort, skin tears can be difficult to treat, and are a direct reflection of the quality of care delivered at our facilities. This is why it is imperative for clinicians to know who is at risk for skin tears, and what we can do to prevent them from happening.

Who is at risk?

Although skin tears can occur among all ages, the youngest and oldest patients are at the highest risk. This is due to the structure of both immature and aging skin. In addition, those who are dependent on caregivers for daily activities are particularly vulnerable, since they are regularly positioned and transferred for such things as bathing and dressing. Others who are higher at risk include:

  • Older adults who ambulate independently
  • Those who are critically ill or have multiple risk factors
  • People with a history of skin tears
  • Anyone with impaired mobility
  • Those with sensory or cognitive deficits
  • Patients with visible changes in the skin such as edema, dry skin or purpura
  • Patients on four or more regularly prescribed medications
  • Patients on specific types of medications, including analgesics, antidepressants, anticoagulants, and steroids
  • People who are agitated and combative – they are more likely to bump into objects
  • Those with cardiac, pulmonary or vascular disorders

Skin tear prevention

The truth is that skin tears are not completely preventable. Since part of our job is to support our patients’ independence and improve their quality of life, at some point or another, skins tears will occur. The good news is that, as caregivers, there are things we can do to keep them at a minimum.

Improve patient environments

A patient’s environment can be modified in simple ways that can make a big difference when it comes to skin tear prevention. For instance, you can make sure there is adequate lighting in your patient’s room or living space. Seniors, for example, typically need more light in order to see clearly and avoid accidents. Next, pad furniture corners and other objects that may cause blunt force trauma when bumped, and remove throw rugs that may buckle or slip.  In addition, ensure that the patient is not wearing rings or other jewelry that can snag the skin.

Care for skin properly

Proper skin care can can go a long way in preventing tears. Skin is better able to resist tearing when it’s well-nourished and hydrated, which means nutrition plays a key role. Therefore, consult with a dietitian about the patient’s diet, and make sure they are receiving adequate fluids.

Frequent baths can dry out the skin, which increases the likelihood of skin tears. This can be a problem when facility regulations mandate that patients must have daily or weekly full baths.  If you find that frequent bathing is contributing to dry skin, adjust the full-bath schedule to twice a week, with spot baths in between.  Also, it’s important that when administering a bath, you:

  • Use lukewarm water (not hot)
  • Use soapless, pH-balanced solutions with no rinse or emollient soap
  • Pat the skin dry – do not rub

To keep the skin hydrated following a bath, apply a moisturizing agent. The stratum corneum – or outermost layer of the skin – needs at least 10% moisture. Moisturizers should be applied while the skin is still damp (not completely dry and not soaking wet) to trap that moisture.

There are three types of moisturizers:

  • Humectants promote the retention of moisture, replacing the oils in the skin
  • Occlusives provide a layer of oil on the skin surface, slowing water loss
  • Emollients soften and spread easily on the skin.

A humectant will pull the moisture up from the dermis into the epidermis to help keep skin intact (it’ll even pull moisture out of the air in the room). But humectants need to be coupled with an occlusive product to trap the moisture. In other words, you need to add a layer of oil on the skin’s surface to slow down evaporation.

Meanwhile, we want our skin to be able to slide, right? And that’s the role of emollients. They make the stratum corneum smooth and less susceptible to friction, which can create that skin tear.

More strategies for prevention are to cover fragile skin with long sleeves, pants and knee-high socks, or products such as DermaSaver® or Posey® SkinSleeves™.  If something rubs up against the patient, the clothing or the device will move and hopefully not tear the epidermis from the dermis.

Be gentle, learn more

It goes without saying that we should be extra gentle when lifting, repositioning or transferring patients. By taking your time and softening your touch when caring for those at higher risk of skin tears, the frequency of such occurrences can be decreased.

Educating ourselves and our patients is also an important part of preventing skin tears. We need to understand the risk factors, keep the skin as nourished and moisturized as possible, avoid dangerous edges and surfaces in the environment, and treat patients gently.Skin Tear Webinar Coupon Code

For even more details on the prevention, staging and treatment of skin tears, view this free one-hour webinar recorded at the 2015 Wild On Wounds (WOW) National Conference. For access, click here and use the code SKINTEARS.

What do you think?

Were you already aware of who is most at risk for skin tears, and does this affect how you treat patients? And are there any preventative measures you regularly put in place that seem to help? If you have additional ideas, or any stories to share, please leave them 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.

NPWT in Home Care Under Spotlight by CMS

Saturday, June 11th, 2011

Nancy Morgan RN Message About NPWT and Home Care

This is for Clinicians that use Negative Pressure in the Home Care Environment ONLY.

CMS (Medicare) Competitive bidding process continues with Negative Pressure Wound Therapy (NPWT) under the spotlight. As seen with previous competitive bidding processes, companies and products with the lowest price will prevail. In order to bid competitively many NPWT companies will have to cut back on education, clinical support and other value added services so they can keep their pricing low enough to stay in the game. NPWT companies do not want to lose the bidding process, because losers will no longer receive Medicare reimbursement. (This will cut back your options for NPWT choices)

We must act now to make sure that our options for quality, not just cheapest, NPWT are available. Simply call, write, or email your local congressman at:https://writerep.house.gov/writerep/welcome.shtml

Tell your representative who you are, what you do and why they should ensure the CMS should institute accreditation & quality standards for NPWT suppliers, prior to bidding for a government contract.

These standards will ensure suppliers can deliver the essential elements for safe and effective use of NPWT in the home, such as requiring 24/7 clinical support along with educational support available to home care patients.”

ANCC- Accredited Nursing Skills Competency at Wild on Wounds

Friday, June 3rd, 2011

Wild On Wounds National Conference

ANCC- Accredited Nursing Skills Competency 3 Part Certification Sessions (Non-Accredited)

Ok Wound Care Professionals, here is your chance to get up to speed or improve your skills!

Jana Stewart BSN, RN, WOCN and Josie F. Shantz MSWN, RNC, WCC, Regional Professional Education Manager will be presenting a session at this year’s Wild On Wounds National Conference. The program is designed to confirm the competency of wound carepracticioners providing V.A.C. Therapy through the administration of the ANCC (American Nurse Credentialing Center) Accrediting Nursing Skills Competency Program.

In this 3-part certification session, the participant will learn assessment and proper application of the V.A.C. There will be a focus on learner accountability with lab-based specific skills.

Participant prerequisites: Clinicians experienced in the use of  V.A.C Therapy in the management of patients with wounds. Join us in the session and obtain your certification at the completion of the session!

For more information Check out Wild on Wounds 2011 National Conference

Hydrogel and Maceration don’t go together!

Monday, January 31st, 2011

Maceration

Hydrogel & Maceration don’t go together!

The Application of Wound Gels:
Maceration is when the skin tissue is exposed to excessive moisture over a period of time. A great example would be if you have been in the bath tub too long and your fingers get pruney. You know how it turns white and softens up? We may see this sometimes in our practice around the wound edge and/or periwound skin. When this happens skin breakdown occurs and may make the wound larger. Maceration can be caused by several different things such as; excessive wound drainage, urinary incontinence, sweating and improper use of wound treatments.

When using a hydrogel to a wound we need to make sure it stays in the wound bed and not on the edges or periwound area. Using a cotton swab gives you easy control of where the hydrogel should be applied.

Sometimes you will see clinicians just taking the tube of hydrogel and start squirting it in to the wound, but when they place the secondary dressing over top of the wound the hydrogel may tend to ooze over the edges and on to the good tissue and cause maceration. Not good you always want to maintain control of where the hydrogel is going. Your goal is to keep the hydrogel in the wound bed only.

TIP: Use moisture barrier, like skin prep, around the wound edges to prevent from maceration-this is just a good habit to do every time you use hydrogel as a treatment.

Always follow the manufacturer’s instructions and make sure the products you are using in the wounds are appropriate.

For more information about becoming Wound Care Certified and our New Diabetic Wound Certification Courses, please visit http://www.wcei.net

ALTRAZEAL promotes the healing of exuding wounds

Monday, October 18th, 2010

Altrazeal Transforming Powder
ULURU Inc.

Description: Sterile white powder in a single-use, sterile foil laminate pouch.  The powder interacts with wound exudate and hydrates when applied to wound. Hydration with exudate causes powder to aggregate and form a moist wound dressing which seals the wound and conforms to the surface of the wound bed.

Actions: Promotes moist healing environment, high moisture vapor transpiration rate creates capillary action against the wound surface – believed to stimulate cell growth and fibroblast mobility.

Indications:

  • Exuding superficial acute wounds such as skin graft donor sites and second-degree burns (partial thickness burns with exudates, maximum 10% of body surface area).
  • Surgical wounds, such as post-operative wounds or dermatological excisions (only as a primary dressing over wound, not to be used as replacement for sutures).
  • Chronic, slow-healing wounds such as leg ulcers, pressure ulcers, and diabetic ulcers.

Precautions:

  • Wear sterile gloves to apply ALTRAZEAL dressing.
  • ALTRAZEAL dressing should only be applied to a clean, moist wound surface. Apply sterile saline or similar product to moisten the wound surface before application if required.
  • Do not use solutions other than sterile normal saline or equivalent to induce aggregation of dressing.
  • This wound dressing should not be applied with oil-based products on the wound surface, particularly ointments, salves, or other treatments. These oil-based products will prevent proper hydration and aggregation at the wound surface.
  • The dressing can be used on wounds with infection only under medical supervision with appropriate therapy and frequent monitoring.
  • The dressing should be removed, e.g. with forceps or similar instruments following thorough saturation with sterile saline.
  • Does not require a secondary dressing unless determined to be necessary by health care professional.   If a secondary dressing is required a non-adhesive, vapor-permeable dressing is preferred.   Petroleum based dressings and occlusive or surface contact adhesives should be avoided.
  • Can remain in place up to 30 days as long as the wound produces exudate. However, the dressing should be changed if clinically necessary.   ALTRAZEAL will remain in intimate contact with the wound surface until the skin underneath heals. Areas of dressing covering intact skin will detach from the remaining dressing and flake off as particles similar to a scab.

Website:  http://www.altrazeal.com

Video :http://bit.ly/R888G

For more information about Wound Care Products or to become Wound Care Certified, Please visit http://www.wcei.net

Microcyn Skin and Wound Cleanser

Sunday, October 17th, 2010

Microcyn Skin and Wound Cleanser
Oculus Innovative Sciences

Description: Microcyn Wound Care is designed to clean, assist with debriding and moisten a wide spectrum of acute and chronic wounds without harming healthy tissue. Microcyn® is available by prescription only.

Actions: Effective in cleaning biofilms: removes proteins and organic loads from wound bed.  Rapid activity against a broad spectrum of gram-positive, gram-negative and yeast species including MRSA and VRE with the  in vitro time kill of 30 seconds.

Indications: Acute and chronic dermal lesions, Stage I-IV pressure ulcers, Stasis ulcers, Diabetic ulcers, Post-surgical wounds, Abrasions and Minor irritations of the skin.

Information:

  • No known drug/treatment interactions or contraindications
  • No rinsing required: can be used directly on the wound or in combination with gauze and other absorbent wound dressings
  • Non-irritating: safe to use around the nose, mouth and eyes
  • Ready to use: no mixing, dilution or rinsing necessary
  • Compatible: can be safely and effectively used prior to treatment with silver dressings, skin substitutes, growth factors, negative-pressure therapy and others wound care treatments
  • Stable: 18 to 24 months depending on bottle type

Website:  http://www.oculusis.com/us/index.php

Wound Photos Resource

Tuesday, August 17th, 2010

Wound Central

As Wound Care Certified professionals, one of our responsibilities is to educate our patients and peers as well as staying informed. In a series of upcoming blog posts, Wound Care Resources Series, we will be sharing information about available resources to our Wound Care Certified and Health Care provider community.

Today we will be sharing information about a Wound Photo CD Resource that is available through WoundCentral.com. This CD is filled with various images of wounds and skin conditions for use in educational and training programs. On this CD you will find images of pressure ulcers, lesions, venous and arterial wounds, diabetic wounds and close up pictures of tissue types. This CD is a great for adding visual reinforcement to you educational activities.

The Wound Photo CD has over 150 photographic images in high quality JPEG Format. All images can be downloaded into other programs or printed. This is perfect for Powerpoint Presentations.

Image Categories include:

  • Skin Lesions
  • Lower Extremity Wounds
  • Tissue Types
  • Surgical Wounds
  • Tissue Types
  • Other Wounds
  • Miscellaneous

You can find more information about this Wound Photo CD or purchase this resource at WoundCentral.com

For more information about becoming Wound Care Certified and our Skin and Wound Management Course, please visit http://www.wcei.net/course_info