Lia van Rijswijk

Occlusive dressings: Therapeutic agents and effects on drug delivery

Abstract Dressings have been applied to wounds and skin for diverse purposes throughout the centuries. In 1500 B.C., the Egyptians spread honey and ibex grease on an open-weave papyrus bandage, after packing with extra-absorbent lint for exudative wounds. 1 As time passed, a variety of imaginative measures 2 were applied to healing wounds, with the result that repair often occurred in spite of the dressings rather than because of them. Controlled studies were rare, so scientific knowledge about the effect of dressings on healing and the skin progressed little from the ancient Egyptians to the 19th century. The increasing scientific study of dressings in the 20th century, combined with new tools to measure various aspects of dressing performance and wound healing, spawned a growing awareness of the role of dressings as barriers in healing, debridement, sequestering of growth factors, drug delivery, and infection control and as skin replacements. Current knowledge of each of these areas is reviewed.

Wound-healing outcomes using standardized assessment and care in clinical practice.

INTRODUCTION Wound-healing outcomes applying standardized protocols have typically been measured within controlled clinical trials, not natural settings. Standardized protocols of wound care have been validated for clinical use, creating an opportunity to measure the resulting outcomes. PURPOSE Wound-healing outcomes were explored during clinical use of standardized validated protocols of care based on patient and wound assessments. DESIGN This was a prospective multicenter study of wound-healing outcomes management in real-world clinical practice. METHOD Healing outcomes from March 26 to October 31, 2001, were recorded on patients in 3 long-term care facilities, 1 long-term acute care hospital, and 12 home care agencies for wounds selected by staff to receive care based on computer-generated validated wound care algorithms. After diagnosis, wound dimensions and status were assessed using a tool adapted from the Pressure Sore Status Tool for use on all wounds. Wound, ostomy, and continence nursing professionals accessed consistent protocols of care, via telemedicine in home care or paper forms in long-term care. A physician entered assessments into a desktop computer in the wound clinic. Based on evidence that healing proceeds faster with fewer infections in environments without gauze, the protocols generally avoided gauze dressings. RESULTS Most of the 767 wounds selected to receive the standardized-protocols of care were stage III-IV pressure ulcers (n = 373; mean healing time 62 days) or full-thickness venous ulcers (n = 124; mean healing time 57 days). Partial-thickness wounds healed faster than same-etiology full-thickness wounds. CONCLUSIONS These results provide benchmarks for natural-setting healing outcomes and help to define and address wound care challenges. Outcomes primarily using nongauze protocols of care matched or surpassed best previously published results on similar wounds using gauze-based protocols of care, including protocols applying gauze impregnated with growth factors or other agents.

The traditions and terminology of wound dressings: Food for thought

During the past 40 years, health care professionals have witnessed an evolution of wound care traditions and terminology and an explosion in the number of wound care products and the amount of information. Unfortunately, these developments have not resulted in optimal wound care for all patients. Appropriate dressing selection and communication are hampered by a lack of clinically valid definitions, as well as ambiguous indications, contraindications, and instructions for their use. One method of setting the stage for a more therapeutic future would be to classify dressings based on their functions rather than the ingredients they contain.

Pressure ulcers: were they there on admission?

New Medicare payment rules are forcing hospitals to institute new assessment protocols.

Wound wise: Peristomal skin complications.

Successful treatment can mean a successful ostomy.

Measuring wounds to improve outcomes.

AJN ▼ August 2013 ▼ Vol. 113, No. 8 ajnonline.com Wound healing is a complex process, and it’s often thought of as a steady one with a typical course—until something goes awry or we’re suddenly faced with a long-standing, chronic wound. Wounds must be assessed and monitored to detect important changes, quantify progress, and guide treatment decisions. Assessment covers a variety of variables, such as the amounts of exudate, necrotic tissue, fibrin slough, and granulation tissue; the presence of undermining, tunneling, and epithelium; and the size of the wound.