I'm interested in taking the CWCA exam, but a friend of mine mentioned that the WCC is better. What is the difference between the two?
Volume 54 - Issue 8 - August, 2008
Gaining the Patient's Perspective
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A few years back, I had a mole removed and covered the resulting wound with a hydrocolloid bandage. My first dressing change was uneventful. During a subsequent dressing change a few days later, I cleaned the exudate and dressing residue and saw a clean, granulating wound. Suddenly, I felt flushed and light-headed and needed to sit down before I passed out. Although I am a wound specialist who regularly works with large, necrotic, infected wounds, I couldn't handle a clean, tiny wound the size of a pencil eraser. But this was an entirely different experience. I wasn't clinically detached from the wound or the patient – this wound was on me.
Improving Wound Care Simulation with the Addition of Odor: A Descriptive, Quasi-experimental Study
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Index: Ostomy Wound Mange. 2008;54(8):36-43.
Acquisition of expertise in any area requires practice. The introduction of high-fidelity simulation into healthcare professionals' education programs has created many new opportunities for training. In addition to providing a safe learning environment – ie, one in which students' actions, if incorrect, will not result in patient harm – simulation has the potential to increase enrollment by improving "access" to patient care situations when clinical sites are in high demand and/or difficult to secure.1 In addition, clinical procedures require two skill sets: the ability to communicate with the patient and the ability to perform the task. Consequently, performing clinical procedures can be a source of anxiety for students and may pose risks to patients. Simulation may help offset the stress of learning at the bedside. Adult learning principles convey the importance of immediate, focused feedback,2 underscoring the need for creating realistic clinical experiences that link concepts with patients. Simulation provides for these considerations.
Acoustic Pressure Wound Therapy to Facilitate Granulation Tissue in Sacral Pressure Ulcers in Patients with Compromised Mobility
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Pressure ulcers are an ever-present concern for patients with compromised mobility resulting from spinal cord injuries or other conditions that severely restrict mobility. These chronic wounds, which occur in an estimated 1.3 to 3.0 million Americans,1 are associated with fatal septic infections and are reported as a cause of thousands of deaths each year in the US.2 Incapacitating conditions, such as paralysis and neurodegenerative diseases, increase risk not only of developing a pressure ulcer, but also of pressure ulcer-associated death.2
Current clinical practice guidelines from the Wound Healing Society and the Consortium for Spinal Cord Medicine3 indicate that high-voltage electrical stimulation (ES) can be effective for treatment of pressure ulcers refractory to conventional therapy and specifically in patients with spinal cord injury. However, ES use may be limited by clinical contraindications, such as osteomyelitis or infection. Acoustic pressure wound therapy (APWT), a low-frequency, noncontact, nonthermal ultrasound therapy indicated to promote healing through cleansing and maintenance debridement of yellow slough, fibrin, tissue exudates, and bacteria,4 has no known contraindications related to wound status.4,5
A Retrospective Evaluation of Hydrocellulose Dressings in the Management of Chronic Wounds
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Healing chronic wounds is a multifactorial process.1 Treatment of the underlying disease and extrinsic factors such as patient adherence to regimens2 and concomitant medication3 must be addressed, along with several wound-based parameters, such as infection,4 bone involvement, or ischemia5 that will interfere with healing. Thus, comprehensive wound care protocols are indicated in the management of nonhealing wounds.6-10 One major goal of these protocols is to improve the wound environment in order to create a moist wound that facilitates granulating tissue formation and reduces pain and odor.11 Modern wound dressings that have optimal exudate management properties have the potential to achieve this goal.12
Reforming Healthcare in America
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Healthcare costs in the US continue to rise two to three times the consumer price index.1 Yet while healthcare spending per capita in the US far exceeds every major industrialized nation, our healthcare system lags,2 with large numbers of premature3 and preventable4 deaths. The US is ranked 37th in the World Health Organization’s5 (WHO) rating of 191 countries in the year 2000. Recent articles in the New York Times6 and Newsweek7 and the PBS TV series Frontline8 underscore such information.
Although medical science and technology in the US are among the most advanced in the world and we have the facilities and physical infrastructure to adequately care for our citizens, we lack the ability to provide quality care to all Americans at sustainable costs. The US Census Bureau9 reports that in 2006, 47 million US citizens were uninsured. As costs rise, many people with insurance find out-of-pocket expenses (share of premium, co-pays, deductibles, in- or out-of-network, pharmacy expenses, and the like) so expensive they will forego medical visits, tests, and prescribed treatment; thus, the number of these underinsured Americans also has risen exponentially.10
Enzymatic Debriding Agents: An Evaluation of the Medical Literature
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Index: Ostomy Wound Manage. 2008;54(8):16-34.
Debridement — the process by which devitalized tissue is softened or liquefied and removed — is an essential part of effective wound care. Debridement prepares the wound bed for healing.1-3 Results from a 55-patient venous leg ulcer study2 showed that, compared to ulcers that were not debrided, one session of sharp debridement significantly increases the rate of ulcer healing (P <0.05).
The intention of clinical debridement is the removal of devitalized or infected, contaminated tissue from a wound until surrounding healthy tissue is exposed. Wound care specialists may select from a variety of debridement methods.1,4-11 Ayello and Cuddigan7 review four methods of debridement: surgical/sharp, mechanical, autolytic, and enzymatic. A fifth method — biological — is also available and involves larval or maggot therapy.
Iliopsoas Muscle Abscess Secondary to Sacral Pressure Ulcer Treated with Computed Tomography-Guided Aspiration and Continuous Ir
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Index: Ostomy Wound Mange. 2008;54(8):44-48.
Iliopsoas abscess is a life-threatening infection usually associated with urinary tract infections, Crohn’s disease, spinal tuberculosis, or a septic hip joint.1-3 Secondary iliopsoas abscess tends to develop in spinal cord injury patients because hip joint infection sometimes occurs as a result of a deep ischial pressure ulcer. 
Rubayi et al1,2 reviewed the records of 72 patients with iliopsoas abscess; nine were spinal cord injury patients. When iliopsoas abscess develops secondary to a pressure ulcer, it usually is caused by an ischial pressure ulcer because ischial infection can extend to the hip joint and iliopsoas muscles. Thus, iliopsoas abscess originating in a sacral pressure ulcer is considered unusual.1,2
Prevention Intervention Problems
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Experts agree that prevention measures are essential to reducing the occurrence of pressure ulcers. Still, the literature suggests that implementation of prevention interventions is not always what it should be,1 is sometimes unrelated to risk assessment data,2 and at times is haphazard and erratic.3 Although somewhat loosely described, prevention intervention problems (PIPs) are obvious.
The Institute of Medicine Report on Keeping Patients Safe4 suggests that preventable conditions such as pressure ulcers might occur as a result of errors of planning (not knowing what to do) or errors of execution (knowing but not implementing a plan of action). Whether PIPs occur as a consequence of errors of planning, errors of execution, or some combination of both is not entirely clear. Moreover, little is known about PIPs beyond the fact that they continue to occur despite widespread (and often creative) efforts to introduce pressure ulcer prevention protocols and educate caregivers in their use.
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