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Pressure ulcer prevention requires assessment and intervention from the entire healthcare team, from clinical assistants to attending physicians.
Since 1998, a tertiary care hospital in Toronto has implemented a pressure ulcer prevention and treatment program, utilizing the Braden Scale, National Pressure Ulcer Advisory Panel pressure ulcer staging system, the AHCPR guidelines, and most recently the Canadian Association of Wound Care best practice guidelines for the prevention and treatment of pressure ulcers.
Through the education of healthcare providers, the primary goal is reduce the incidence of pressure ulcers by 50%. The Kinexus (KCI Medical, Inc.) program has been utilized to monitor pressure ulcer prevalence and incidence outcomes since 1997. Statistically significant reductions in both prevalence and incidence of pressure ulcers have been achieved with the implementation of the Wound Healing and Skin Ulcer Prevention Program. The results of this evolving hospitalwide program are presented.
The Use of Nanocrystalline Silver under a Three-Layer Compression Bandaging System to Treat Chronic Venous Stasis Ulcers in a Diabetic Patient
L.J. D'Souza, Royal Victoria Hospital Pavilion, McGill University Health Center, Montreal, Quebec, Canada
Chronic venous stasis ulcers impact the patient (especially the elderly person with diabetes) quality of life and can present a challenge to the wound healing professional. The effort to attain and maintain a low or nonexistent bioburden while providing tolerable maximum compression may limit patient mobility and comfort and alter quality of life. This may lead to a cycle of noncompliance and delayed wound healing. State-of-the-art technology and ingenuity can help overcome the challenge.
An 80-year-old female who had type II diabetes for 40 years presented with an 11-month chronic malodorous venous stasis ulcer proximal to the left external malleolus (ankle brachial pressure index = 0.83). One month earlier, the wound cultured 3+ for Pseudomonas. Dressing the wound with silver sulfadiazine covered with a foam dressing and a four-layer compression bandage had been attempted on numerous occasions but the patient removed it, complaining of continuous irritation and restriction. The periwound appeared red, raw, and irritated. A multiphase plan was initiated. Applying a topical corticosteroid to the periwound along with a hydrofiber helped control the irritation; however, a large amount of exudate, edema, colonization, and size of the wound remained constant. The wound was cleansed with saline and a semiquantitative swab was taken. A nanocrystaline silver dressing under a three-layer compression bandage was applied and the patient was seen the next day. A dramatic reduction in size, odor, and exudate was noted. Although the patient complained of some discomfort, she was encouraged by the progress and agreed to continue the same treatment. The patient was seen every 3 days for the first few weeks and subsequently once per week. Complete closure was achieved by the end of the twelfth week. The patient was then measured and fitted for 30 mm Hg compression stockings. Application devices were supplied along with teaching and a promise of support and weekly phone calls from the clinic nurses. Attention to patient needs and ingenious use of state-of-the-art technology may help wound care providers meet the challenge of wound healing.
Development of Best Practice Guidelines for Nurses in Ontario: Pressure Ulcer Prevention
F. MacLeod, West Park Healthcare Centre, Toronto, Ontario, Canada, and T. Virani, Registered Nurses Association of Ontario, Canada
Older adults who experience an illness or surgery are particularly at risk of developing pressure ulcers. The need for staff to have current knowledge about pressure ulcer prevention is paramount.