Editorial Staff

Editor Barbara Zeiger

Associate Editor Kelsey Moroz

Web Editor Samantha Alleman

Editorial Correspondance

Barbara Zeiger, Editor, OWM

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May, 2003 Supplement | Volume 49 - Issue 5

Introduction to Bacteria and Pressure Ulcers: The Role of Silver versus Traditional antimicrobials

T his supplement is based on the satellite symposium proceedings of the European Pressure Ulcer Advisory Panel Meeting, held in Budapest on September 19, 2002. Gary Sibbald, MD, (Canada) and Marco Romanelli, MD, PhD, (Italy) chaired the meeting. Diagnosing infection in chronic wounds often is a difficult challenge for wound care practitioners. Lindholm reminds us that high morbidity and mortality are associated with infections in pressure ulcers, but if antimicrobials are overused, multiresistant bacteria may emerge. Many clinicians recognize the classical signs and symptoms of infection, b...

Continuing Education Information and Quiz

Release Date: May 31, 2003 Expiration Date: May 31, 2004 Instructions: Registered nurses may receive 3.0 contact hours by reading the articles in this supplement and successfully answering the questions in the following post-test. To obtain continuing education contact hours: 1. Read the supplement “Bacteria and Pressure Ulcers: The Role of Siver versus Traditional Antimicrobials” carefully, noting the tables and other illustrative materials that are provided to enhance your knowledge and understanding of the content. 2. Print out the CE Answer Form....

Pressure Ulcers and Infection – Understanding Clinical Features

K nown since antiquity, pressure ulcers represent substantial morbidity, major costs to society, and great human suffering.1,2 In one 3-month follow-up study of patients with pressure ulcers,3 a mortality rate of 35% was noted. Addressing infection - always a consideration - has been complicated by the relatively new problem of methicillin-resistant Staphylococcus aureus (MRSA) with a reported incidence as high as 30% and bacteremia occurring in 4% in hospitalized patients,4 along with vancomycin-resistant enterococci (VRE) in chronic wounds. Such findings have encouraged clinicians to focus...

Bacterial Swabs and the Chronic Wound: When, How, and What Do They Mean

T he ability to diagnose infection in chronic wounds should be a well-honed clinical skill grounded in knowledge of human physiology, immunology, and microbiology. Instead, it has become a topic mired in controversy. Although it has been suggested that much of this controversy arises from lack of evidence, more than 5,000 "wound infection" articles were published in peer-reviewed journals over the past 12 years. Confusion may be based not so much on lack of evidence but rather on lack of balanced interpretation of evidence. Poor clinical performance in diagnosing chronic wound infection may...

Topical Antimicrobials

T he clinician treating chronic wounds is faced with the dilemma of when to use topical agents - either antibiotics or other antiseptic agents - and when to use systemic antibiotics or related antibacterial compounds. When a patient with a chronic wound has increased bacterial burden (see Figure 1),1 the clinician must decide whether the harmful bacteria is superficial and can be managed with local wound care or is deep and requires a systemic approach. Assessing Host Factors The invading microbial organism is only one part of the equation leading to infection.2 Infection = Number of...

A Scientific Perspective on the Use of Topical Silver Preparations

T he use of silver as an antimicrobial agent reaches back into antiquity, when people first learned that water stored in silver vessels kept better than water stored in other types of containers. Those who settled the American west placed silver dollars in their wooden water barrels to preserve the water. Such occurrences predate Pasteur's Germ Theory of Disease (published in 1877) and knowledge of the role that micro-organisms play in disease. In 1884, Crede started using a 1% silver nitrate solution on neonates to prevent ocular infections.1 This was followed by Von Behring's work in 1887...

Systemic Antimicrobial Therapies for Pressure Ulcers

I n chronic wounds, an altered balance among the number of organisms present, their virulence, and host resistance leads to bacterial infection. Infected chronic wounds may manifest with a friable bright red granulating wound bed, localized pain, increased wound size, perilesional warmth and tenderness, erythema on the surrounding skin, malodorous base, and increased wound exudate. The final outcome of infected wounds depends on a balance between factors that promote further complications or lead to their resolution. Wound infection in the geriatric population merits especially assiduous cont...

Wound Bed Preparation: Future Approaches

W ith acceptance of the concept wound bed preparation comes the understanding that many different methods and procedures that were being used for the treatment of chronic wounds now can be incorporated in a unified approach. Reviewing the options for wound bed preparation allows clinicians to consider what lies beyond this concept and what must be considered in years to come in terms of therapeutic modalities based on solid scientific concepts. The Concept The history of wound bed preparation can be traced to the late 1990s, when certain advanced therapeutic products were receiving regul...

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