The Committee on the Robert Wood Johnson Foundation (RWJF) Initiative on the future of nursing at the Institute of Medicine (IOM) reported on the current crisis state of acute care nursing and the dysfunctional system in which clinicians have become “masters of work-arounds.”^1,2 Those of us working outside the acute care environment were not surprised the committee heard similar messages from nurses working in the community when they met again a few months later.³ I was fortunate to attend the community nursing forum — it was impressive, listening to nurses present innovative practice models to help meet the needs of our most vulnerable populations. For example, considerable amounts of “work-arounds” and creativity are required to fund the day-to-day operations of nurse-managed health clinics. Despite the fact that 46% of patients are uninsured and 37% are on Medicaid, many of these facilities have been able to keep their doors open for many years.

  Left ventricular assist devices (LVADs) are implanted into patients with severe heart failure. These mechanical circulatory support devices attach to the left ventricle and pump blood to the aorta. Although the devices have become smaller as technology advances, they still require transcutaneous drivelines to supply power to the pump. The driveline exits the patient’s left or right abdomen. Infectious complications are common in LVAD patients, occurring in up to 28% of patients within 3 months of implantation.^1,2 Infections may be local at the driveline site or systemic, occur at any time during the patient support period (up to five or more years), and result in overwhelming sepsis and subsequent mortality; they significantly increase the cost of LVAD therapy.³ Infections, particularly those associated with malodorous and/or highly exudating wounds, may negatively affect patient quality of life. Early eradication of infection is of paramount importance.

Incision management system available to US hospitals

  Kinetic Concepts Inc ([KCI] San Antonio, TX) announced the US launch of the Prevena™ Incision Management System, the latest addition to KCI’s negative pressure technology platform. The new system leverages the clinically proven effectiveness of negative pressure wound therapy that the company pioneered with the V.A.C.® Therapy System, which has been used to treat millions of complex open wounds since its introduction. The system is designed for linear incisions associated with general surgery, OB/GYN, orthopedic, and cardiothoracic incisions. Indicated for use over clean, closed incisions that continue to drain following sutured or stapled closure, the system removes exudate and potentially infectious material; protects the surgical site from external contamination; provides a clean, protected postoperative wound environment; and helps draw incision edges together. Portable and discreet, the system is designed for single-patient use and is applied as the last step of the surgical procedure. It may accompany the patient during transition from the hospital to the home.

  Cytotoxic antiseptics are ordered far too often for use in wound care. A key role of WOC nurses is to educate staff and patients by providing instruction on the use of these types of products.

  Cytotoxic products, including hydrogen peroxide, Dakin’s (diluted bleach) solution, acetic acid (diluted vinegar), and 10% povidone-iodine, interfere with fibroblast formation. Fibroblasts are responsible for producing growth and angiogenic factors necessary in the wound healing process. Hydrogen peroxide also has been linked to the formation of air emboli. Although Dakin’s solution frequently is ordered because it can decrease heavy bioburden and odor, it remains an impediment to the wound-healing cascade. Povidone-iodine 10% has been shown to be effective when dealing with gangrenous toes in speeding the drying process leading to auto amputation but only should be considered for longer use in such circumstances. Thus, these products, if used at all, need to be limited to short-term use.