Volume 60 - Issue 4 - April 2014 ISSN 1943-2720

An In vitro Analysis of the Effects of Various Topical Antimicrobial Agents on Methicillin-resistant and Methicillin-sensitive Strains of Staphylococcus aureus

Index: Ostomy Wound Manage. 2014;60(4):18–28.

Keywords: Staphylococcal skin infection, methicillin-resistant Staphylococcus auerus, drug resistance, bacteria, wound

Abstract

  Infections of acute and chronic wounds have a substantial negative impact on patient outcomes. Because bacterial resistance to traditional antimicrobials continues to increase, an in vitro study was conducted to examine current sensitivities of various methicillin-resistant and methicillin-sensitive strains of Staphylococcus aureus (MRSA and MSSA) to commonly used topical antimicrobial agents. Using fresh cultures of eight strains of MRSA and MSSA, the area of the zone of inhibition produced by various topical antimicrobials, including an aminoglycoside antibiotic, monocarboxylic acid antibiotic, pleuromutilin antibiotic, triple antibiotic ointment, and petrolatum ointment, was examined.



A Prospective Two-armed Trial Assessing the Efficacy and Performance of a Silver Dressing Used Postoperatively on High-risk, Clean Surgical Wounds

Index: Ostomy Wound Manage. 2014;60(4):30–40.

Keywords: clinical study, surgical site infection, dressings, silver dressing

Abstract

  Surgical site infections (SSI) are a known complication of surgery. Silver-containing wound treatments are popular, despite the lack of evidence of SSI reduction. A two-armed study was conducted between July 2007 and November 2008 to evaluate the efficacy and ease of use of a postoperative silver dressing. In the first arm of the study, patients undergoing clean general, vascular, orthopedic, and neurosurgical procedures were allocated to receive a postoperative silver dressing (POSD) or a standard dressing of nonstick gauze under a fluid occlusive dressing.



A Retrospective Comparison of Perforator and Rotation Flaps for the Closure of Extensive Stage IV Sacral Pressure Ulcers

Index: Ostomy Wound Manage. 2014;60(4):42–48

Keywords: case series, pressure ulcers, perforator flap, rotation flap, postsurgical complications

Abstract

  Wound coverage using a flap, most commonly a perforator or rotation flap, often is required for the closure of extensive sacral pressure ulcers. To assess the duration of wound healing and postsurgical complications following two types of surgical closure procedure, perforator and rotation flaps, a retrospective study was conducted among a convenience sample of 20 patients (10 men, 10 women) with Stage IV sacral pressure ulcers. All ulcers were repaired in 2011 and 2012 by the same surgical group and included nine perforator and 11 rotation flaps. Patient demographic and wound outcomes data were abstracted, and data were analyzed using Wilcoxon signed rank and chi-squared tests.



Interchangeable Skin Grafting to Camouflage Self-inflicted Wound Scars on the Dorsal and Volar Forearm: A Case Report

Index: Ostomy Wound Manage. 2014;60(4):50–52.

Keywords: case study, self-mutilation, scars, skin transplantation

Abstract

  Scars from self-inflicted wounds to the upper extremities are the hallmark of self-mutilation. They are easy to recognize and difficult to hide. Camouflaging these scars can be an onerous task. In this case study, a 23-year-old woman who has major depressive disorder with comorbid borderline personality disorder presented for scar repair of self-inflicted wounds on the volar and dorsal forearm (each approximately 10 cm2 x 15 cm2). Following a psychological and physical evaluation, split-thickness skin grafts (10/1,000 inches in thickness) were obtained from both areas and switched. The grafts were fixed with staples, immobilized with a short arm splint, and dressed daily with gauze and neomycin ointment. Staples were removed after 10 days; at the 6-month follow up, the wounds resembled burn wound scars. The patient was satisfied with this more socially acceptable result. This method might offer a simple camouflage option in appropriately selected cases.



From the Editor: Do Overs

  Can we be 9 years old again for a moment? If you could have a do over — an interlude, a day, a decision you could change — what would it be? Would the decision involve regret (I wish I’d appreciated my grandparents more), a career choice (if I’d majored in Radio, Television, and Film at Temple University, maybe I now would be a lyricist for Disney), or an avoidable mishap (I never should have let our daughter keep an eye on the lamb chops when General Hospital was on)?



Pearls for Practice: Hypochlorous Acid and Hydroconductive Dressing Used in Conjunction for Management of Complex Wounds

  Hypochlorous acid (HOCl) is a substance in the body that kills invading pathogens by the oxidative burst in neutrophils. It has been demonstrated to decrease bacteria both in vitro and in vivo and to be noncytotoxic.1 Other antiseptics, such as sodium hypochlorite or hydrogen peroxide, are cytotoxic to fibroblasts. The HOCl used in this series, Vashe Wound Therapy (SteadMed Medical LLC, Fort Worth, TX), has a pH similar to skin and has been demonstrated to be useful in a variety of wounds.2



Nutrition 411: Managing Low Blood Glucose Levels in Patients Undergoing Hyperbaric Oxygen Therapy

  Studies show all patients undergoing hyperbaric oxygen therapy (HBOT) experience a reduction in blood glucose levels compared to prehyperbaric oxygen treatment levels. This expected physiological reaction may result in a range of challenges for both patients and treatment centers, including hypoglycemic events, liability, schedule changes, cancellations, and ultimately delayed healing and a loss of revenue. Reduction in blood glucose level tends to be more pronounced in patients with diabetes when compared to patients without diabetes.1 For example, one observational study2 of patients with diabetes (including insulin-dependent and noninsulin-dependent participants) showed a mean drop of 36 mg/dL in blood glucose during HBOT. Insulin-dependent patients experienced an even more severe drop — 19% had a drop of 72 mg/dL or more, requiring intervention before HBOT.

  This article describes the mechanisms of HBOT, its effects on glucose levels, and how to address related concerns.



Special to OWM: A Caring Tribute

  Norma Justus Mash died February 17, 2014. She was a pioneer ET nurse whose passion grew as the specialty developed and proliferated over her lifetime. Over the years, she provided specialty ET nursing services across the spectrum of CARE: she was a Clinician, Administrator, Researcher, and Educator who championed prevention, preservation, prescription, and palliation. She served the majority of her nursing career at Kennestone Hospital in Marietta, GA. She began the ostomy, wound, and continence program, including an ostomy support group. She was a member of the SouthEast Region and served as the Regional President and their National Trustee to the International Association for Enterostomal Therapy (IAET). In the latter capacity, she chaired the Standards Committee for the organization, which developed and published nationwide standards for the nursing care of patients with ostomies, wounds, and incontinence as well as for ET nursing practice. Norma spiritedly and conscientiously typified the CARE-ing model of professional ET nursing practice (ostomy, wound, and continence nursing).



My Scope of Practice: The Industry Side of Passion

“Your work is to discover your work and then with all your heart to give yourself to it.” — Buddha

  My Scope of Practice usually focuses on wound, ostomy, and continence care providers — professionals serving at the bedside in hospitals, long-term care facilities, and clinics. In this column, we rarely lift the veil between industry and practice to present innovative persons who, rather than personally treat patients, create a product to enhance patient treatment. Is their passion any less than the nurses and doctors providing patient care? Do the long hours spent developing and testing new products mean less than the hours a clinician spends at bedside? Or does it take a different kind of passion, a different kind of determination, to dedicate your life and work in an industry where you don’t get to experience the immediate day-to-day feedback or the instant gratification of seeing a patient smile and thank you?