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Two protocols were developed based on existing practice guidelines and reviewed by the interdisciplinary skin and wound care team and a geriatrician. First, a protocol on prevention of pressure ulcers was introduced to the units' teams through a series of sponsored pizza lunches. Excellent attendance by both professionals and unregulated workers was gratifying, especially because the latter group is responsible for identifying and communicating potential ulcer problems to the team. The second phase of the project included education of seven registered nurses identified as unit resources. They attended a 1-day workshop on protocol for wound management and accessed supports such as journal articles, individual coaching from the Advanced Practice Nurse for Wound Care, and bimonthly seminars. Six months later, the resource RNs demonstrated increased independence with pressure ulcer assessment and management. In addition, written plans of care and summaries reflected current practice as outlined by the new protocols. The project's impact on pressure ulcer prevalence has been compounded by the admission of several patients with severe ulcers.
Occlusive and Semi-Occlusive Dressings: Reality versus Myth
K. Laforet, 3M Canada, London, Ontario, Canada, and G. Berardinucci, 3M Canada, Montreal, Quebec, Canada
Since the advent of moisture-retentive wound dressings in the 1970s, the terms occlusive, semi-occlusive, semi-permeable, oxygen permeable, or oxygen impermeable dressings have been used interchangeably. The result is inconsistent use of the terms and confusion regarding occlusive versus semi-occlusive dressings in chronic wound care management. This study intended 1) to identify how occlusive versus semi-occlusive wound dressings are defined in the literature, and 2) to determine the clinical evidence to support the use of occlusive dressings versus semi-occlusive dressings in chronic wound care. An English language literature MEDLINE search, using the terms wound dressings, occlusive, semi-occlusive, semi-permeable, oxygen permeable, and oxygen impermeable was completed. Manufacturers' literature was reviewed to determine how dressings were categorized. Randomized, controlled clinical trials for chronic wound care and experimental trials that objectively measured wound-dressing performance were emphasized. The study reviewed 26 English language articles in the literature specific to chronic wound care that utilized more than one term for dressings as identified above. Of the 26 articles, 10 (38%) clearly defined the terms used, 16 (62%) used terms without defining them, and 16 (62%) used the terms interchangeably. No studies showed a statistically significant difference in clinical outcomes with occlusive versus semi-occlusive dressings. The authors concluded that the terms occlusive and semi-occlusive are not consistently used in the chronic wound care literature. No clinical evidence supports the use of occlusive versus semi-occlusive dressings in the treatment of chronic wound care. A consensus on the definitions of chronic wound care dressings is needed.
The Impact of Nanocrystalline Silver Dressings on the Activity of Matrix Metalloproteinases in Chronic Wounds
H.L. Orsted, Calgary Regional Health Authority, Calgary, Alberta, Canada; J.B. Wright, Westaim Biomedical Corporation, Fort Saskatchewan, Alberta, Canada; K. Lam, Westaim Biomedical Corporation; and R.E. Burrell, Westaim Biomedical Corporation
Excessive activity of matrix metalloproteinases has been associated with impaired healing of wounds. This association is particularly well established in venous stasis ulcers. Therefore, research efforts have been directed toward finding different mechanisms of inhibiting matrix metalloproteinases activity and determining the effect of such inhibition on wound healing.