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ObjectiveSurgical site infection (SSI)is a type of common hospital-acquired wounds. The purpose of this study is to understand its clinical characteristics and prognosis in order to provide evidence for taking appropriate measures.Methods132 wound patients who met the diagnostic criteria of surgical site infection in the wound care center in recent 3 years were enrolled. The patients were treated locally with nanosilver dressing combined with red light and infrared ray. Individualized nutritional recipes and activity prescriptions were given, and the skin was showered every other day to heal or last 2 months.Observation indicators: demographics and wound characteristics; changes of area and depth after14 days intervention; the posi-tive rate of bacteria before and after the intervention, and healing rate and healing time of 2 months were analyzed and compared.ResultsA total of 132 cases of SSI(52.27% superficial and 47.73% deep ) was identified. The average age was 48.33±16.90 years. The average age and gender of the two groups were similar (P>0.05).Peri-wound skin is contaminated in all cases. The mean onset time of SSIs was 19.82±5.64 days, and the median onset time was 20 days. The onset time and duration of deep SSIs were longer than that of superficial SSIs (P0.05), and the depth of deep SSIs was deeper than that of superficial SSIs (P<0.05).The positive rate of bacterial culture inthe deep SSI group (79.31%) was higher than that of the superficial SSI group (59.46%) (P<0.05). After 14 days treatment, the area was smaller, the depth was lower (P<0.05), and the positive rate of bacteria was significantly decreased in the two groups (P<0.05). The healing rate ofsuperficial SSI group (84.06%) was higher than that of deep SSI group (66.67%) (P<0.05) in two months, and the healing time of superficial SSI group was significantly shortened (35.46<11.12 days vs 41.08<11.33 days, P<0.05). Logistic regression analysis showed that negative bacterial culture before intervention increased the healing index (OR=0.190). Long-term use of antibiotics did not promote healing (OR=0.343).ConclusionSuperficial and deep SSIs are common types of SSIs. Gender and age are similar, and skin contamination may play a role in the development of SSI,which needs attention. Local and systemic interventions can effectively improve wound healing. Negative bacterial culture and proper use of antibiotics can improve the healingprobability.
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To preliminarily analyze the prevention and control of COVID-19, a general hospital outpatient service took six management measures, including setting up a leading group, building rules and regulations, infection control and supervision, special training, humanized service, public opinion propaganda. After nearly two months, the rates of both body temperature monitoring and epidemiological history screening are 100%, the medical staff infection rate is zero, and no cross infection between the patients due to adopting outpatient service comprehensive management measures which had strong organization and leadership, effective targeted training, effective control of all links in epidemic prevention and control work. During the fight against COVID-19, outpatient management played an important role in hospital management. The above approaches provide valuable experience for preventing the spread of infectious diseases effectively and winning the biological weapon wars in the future.
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ObjectiveIt is indefinited that oxygen-enriched negative pressure wound therapy, namely negative pressure wound therapy combined with topical oxygen therapy (NPWT+TOT), improve the effects of wound microenvironment in tissue proliferation and vascularization. The objective is to discuss effects of oxygen-enriched negative pressure wound therapy in improving wound microenvironment to tissue proliferation and vascularization.MethodsTo select sixty-four patients in the outpatient wound care center of the eastern theater general hospital from January to October, 2019, which were randomly divided into the experimental group (NPWT+TOT) and the control group (NPWT), 32 cases in each group. The patients were treated with oxygen-enriched negative pressure wound and negative pressure wound respectively for 2 weeks to observe the changes of wound temperature and PH before and during intervention. Bacterial culture and immunohistochemical staining which were made from wound secreta and wound bed tissues to observe bacterial culture results, tissue proliferation activity and microvascular density before intervention and 14 days after intervention. After the intervention, the patients were treated by standard wet therapy and followed up to wound healing or 3 months after the intervention to observe the wound healing rate and wound healing time.ResultsAfter two weeks' continuous intervention, wound temperature of patients increased and PH value decreased significantly between the experimental group and the control group. Meanwhile, the intervention group was more effective, and there were significant differences between the two groups (P<0.05). The positive rate of bacterial culture after intervention in the experimental group and the control group was 26.67% and 41.38% respectively, with no statistically significant difference (P=0.233). Compared with the control group, the increase of tissue activity and microvascular density in the experimental group was more significant (P<0.05). After three months' follow-up, the wound healing rate of the experimental group was increased by 12.5% compared with the control group, and the average wound healing time was shortened by 9.2 days.ConclusionOxygen-enriched negative pressure wound therapy can improve wound microenvironment, reduce the positive rate of wound bacterial culture, improve the proliferation activity of wound tissue and degree of vascularization, and promote wound healing.
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ObjectiveWearing protective masks for a long time causes a large number of frontline health care workers to suffer different degrees of pressure injury or facial skin rupture in response to COVID-19. This paper aims to analyze the occurrence characteristics and related factors of pressure injury related to devices, and provide the basis for taking countermeasures. Methods There was online investigation of skin injuries caused by wearing protective equipment in medical staff. Descriptive analysis was carried out on the occurrence characteristics of pressure-induced injury, and influencing factors were analyzed through logistic regression model. ResultsThere were a total of 2901 valid questionnaires. The results showed that the incidence of pressure injury caused by protective equipment was 26.34%, mainly in the bridge of the nose (20.41%), cheek (20.23%), auricle (17.82%) and forehead (8.86%). Multivariate Logistic regression model analysis showed that the major associated factors, which presented increasing risk, were sweating and dampness (OR=12.72, 95%CI 8.36-17.30), wearing level-3 protective equipment (OR=3.55, 95%CI 2.47-5.08), wearing level-2 protective equipment (OR=3.37, 95%CI 2.47-4.60), wearing time (OR=1.29, 95%CI 1.05~1.58) and occupation (OR=1.57, 95%CI 1.00~2.49). Conclusion There is the high incidence of pressure injuries to health care workers caused by protective equipment against COVID-19. The main risk factors for facial stress injury of medical staff are sweating and dampness, wearing level-3 and level-2 protective equipment and wearing time.
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Intraoperatively acquired pressure ulcer, also named intraoperatively acquired pressure injury, is one of the most common hospital-acquired pressure injuries. It is not only aspect rehabilitation of patients after surgery, but also increase the length of hospital stay, related costs , as well as hidden risks of medical disputes. In recent years， more and more studies attached high-frequency time and site, prevelance and incidence, clinical characteristics, risk factors and risk assessment for the intraoperative acquired pressure injuries around the world. It is benificial to do targeted prevention. This article reviewed the current studies in order to provide some basis for preventing the intraoperative acquired pressure injuries in China.
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Objective The purpose of this study is to use nano-silver dressing as filling dressing for negative pressure wound therapy, and to observe the effect of treating traumatic infected wounds, so as to provide a basis for optimizing negative pressure wound therapy technology. Methods Eighty patients with physical traumatic wounds were enrolled in the outpatient wound care center. They were randomly divided into the intervention group and the control group (n=40 in each group). In the intervention group, the filling dressing for negative pressure wound therapy used nano silver dressing. In the control group, the standard negative pressure wound therapy with normal saline gauze as filling dressing was adopted. All patients were treated with negative pressure for at least 14 days, and then were treated with moist wound therapy until followed up for wound healed. The wound volume reduction rate was the main outcome indicator 14 days after intervention in the two groups. The bacterial positive rate and the wound healing rate at the end of 3 months follow-up, and final healing time were the secondary outcome indicators. Results 36 cases in the control group and 40 cases in the intervention group completed the expected negative pressure wound therapy time and follow-up. The baseline data of the two groups had no difference. The wound volume reduction rate (70.95±20.73)% in the intervention group after 14 days of treatment was significantly higher than that in the control group (64.42±22.33)% (P< 0.05), and the bacterial positive rate (20%) was lower than that in the control group (44.44%)(P< 0.05). At the end of the follow-up, the healing rate of the intervention group (97.50%) was higher than that of the control group (66.67%)(P<0.001). The healing time of the intervention group（50.85±15.81d）was shorter than of the intervention group (62.58±16.18d)(P<0.05). Conclusion Improving the filling dressing for negative pressure wound therapy can effectively reduce the volume of traumatic wound and the positive rate of pathogenic bacteria, and help to control wound infection and improve wound healing outcomes.
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Hospital-acquired pressure injury is known as a severe adverse event and as an important safety problem of patients around the world. Studies indicated that nursing sensitive indicators are key points for monitoring and managing the effect of preventing pressure injury. The article reviews how to monitor the outcome sensitive indicators for preventing pressure injury. The aim is to provide evidence for managing and researching pressure injury in our country.
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Objective Incontinence-associated dermatitis(IAD) is a common skin disease, but there is still lack of evidence on which kind of skin proctectant can provide effective prevention and cost reduction. The article aimed to explore the clinical effect and cost-effectiveness of two skin protectants based on structured skin care regimens in the nursing care of incontinent patients and provide evidence for effective prevention of IAD.Methods A total of 124 patients with incontinence were randomly selected and divided into observation group (62 cases) and control group (62 cases). On the basis of the structured skin care program which focused on incontinence management, cleansing and protection, the patients in the observation group were treated with the composite zinc oxide ointment for 7 days, while patients in control group were treated with ostomy powder combined with skin barrier film for 7 days. The main observation indicators were the incidence of IAD and the cost of nursing materials.Results All 62 patients in the observation group completed the study, while in the control group 2 patients fell off because of death and discharge from hospital and 60 patients completed the study. The per-protocol analysis showed that the incidences of IAD in two groups were 6.45% and 20.00%, the intention-to-treat analysis showed 6.45% and 22.58%, and there was significant difference between groups (P<0.05). The nursing cost of the observation group (239.71±48.55) was lower than that of control group (264.35±61.55), and the difference was statistically significant (P<0.05).Conclusion The use of the composite zinc oxide ointment based on a structured skin care regimen can improve the preventive effect of IAD and reducing costs.
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Objective Skin tears are one of the skin adverse events in hospitalized patients which increased the length of stay and cost.How to intervene effectively is one of the global research priorities.The article aimed to study effective treatment for skin laceration by analyzing the characteristic and classification and applying grading nursing care for skin laceration.Methods From the first visit of 26 patients,the wound care center assessed the site,cause,severity classification and duration of skin laceration and managed wounds with individualized grading nursing care and overall intervention.Measurement was done on the area reduction once a week with dynamic adjusting interventions until healing.Results 26 patients with skin laceration were mainly grade 3,accounting for 76.92％ (20/26).Extremities were the main injured sites,accounting for 84.62％ (22/26).All wounds healed within 60 days and the average healing time was (22.38-±13.56)days.Median healing time was 20 days.No significance was found in the reduction rate of wounding site in 3 weeks and healing time for different severity grades,different durations and different sites of skin laceration (P＞0.05).Conclusion Individualized grading nursing care can efficiently treat skin tears with different severity,durations and sites.
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Objective This paper aims at developing a survey tool for pressure ulcer prevention and testing its reliability and validity. Methods Through reviewing the domestic and foreign literatures and discussing repeatedly, item pool for pressure ulcer prevention and initial survey tool were developed.3 rounds of Delphi consultation were used to acquire experts′opinions for amending, perfecting the survey tool and calculating the content validity index. Investigations were performed by 70 nurses who were trained with the cross sectional survey on pressure ulcer prevention of 2047 patients from a top three hospital. The consistency reliability and con-struct validity of survey tool were then analyzed based on the survey results. Results The positive coefficient of experts in the 3 rounds of consultation were all 100%. The authority degree of the experts was 0.830. The coefficient of variation in the 3 rounds of con-sultation were 0.000-0.241,0.000-0.235 and 0.000-0.234 respectively. Kendall′s coefficient of concordance W were 0.115,0.174 and 0.214(P<0.001). The content validity index was 0.954. The Cronbach′s alpha was 0.824 from 2047 patients investigated by the 70 nurses. Exploratory factor analysis got two common factors which explained 75.351% of the total variance. The factor loading was 0.585-0.857(>0.400) respectively. Conclusion The survey tool for pressure ulcer prevention has good reliability and validity. It can be used to investigate pressure ulcer prevention of Chinese hospitalized patients.