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Abstract Achromobacter spp. are increasingly recognized as emerging pathogens in immunocompromised patients or suffering cystic fibrosis, but unusual in immunocompetent hosts or individuals that underwent surgery. In this study we describe two simultaneous events attributable to two different Achromobacter spp. contaminated sources. One event was related to an episode of pseudo-bacteremia due to sodium citrate blood collection tubes contaminated with Achromobacter insuavis and the other to Achromobacter genogroup 20 infection and colonization caused by an intrinsically contaminated chlorhexidine soap solution. Both threatened the appropriate use of antimicrobials. Molecular approaches were critical to achieving the accurate species identification and to assess the clonal relationship, strengthening the need for dedicated, multidisciplinary and collaborative work of microbiologists, specialists in infectious diseases, epidemiologists and nurses in the control of infections to clarify these epidemiological situations.
Resumen Achromobacter spp. son reconocidas con mayor frecuencia como patógenos emergentes en pacientes con fibrosis quística e inmunodeprimidos, pero son inusuales en hospedadores inmunocompetentes o quirúrgicos. En este estudio describimos 2 eventos simultáneos atribuibles a 2 fuentes contaminadas con Achromobacter spp. Uno correspondió a un episodio de seudobacteriemia por tubos de citrato de sodio contaminados con Achromobacter insuavis y el otro a infecciones y colonizaciones debidas al uso de solución jabonosa de clorhexidina intrínsecamente contaminada con Achromobacter genogrupo 20. Ambos episodios pusieron en peligro el uso apropiado de antimicrobianos. Los enfoques moleculares fueron fundamentales para lograr la identificación precisa de las especies y evaluar la relación clonal de los aislamientos, lo que refuerza la necesidad del trabajo perseverante y multidisciplinario de microbiólogos, especialistas en enfermedades infecciosas, epidemiólogos y enfermeras en el control de infecciones para el esclarecimiento de estas situaciones epidemiológicas.
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The prescription of antibiotics empirically without confirmation of an infective etiology is on the rise. Administration of appropriate antibiotics can be guided by real-time fluorescence imaging using a point-of-care device. These composite images show the presence, type and the burden of infection. The time saved by this method over microbiological testing, especially in resource-poor settings, can lead to a paradigm shift in treatment by facilitating prompt and adequate antimicrobial therapy, surgical debridement as well as follow-up. Thumbnail sketches of a series of four cases highlighting different scenarios in which a fluorescent imaging device utilizing artificial intelligence and machine learning was found useful is presented in this report.
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Objective:To translate the Pressure Ulcer Quality of Life Questionnaire (PU-QOL) into Chinese and test its reliability and validity.Methods:The PU-QOL was translated, back translated, cross-cultural debugged and pre-investigated to form the Chinese version of PU-QOL. From August 2020 to November 2021, 405 patients with PU in wound clinics of two third-class hospitals in north and south regions of China were conveniently selected as the research objects.Results:The Chinese version of PU-QOL had 74 items. The content validity of the items was 0.80 to 1.00 and the content validity of the scale level was 0.95. Exploratory factor analysis extracted 7 common factors and the cumulative variance contribution rate was 60.79%. Each problem area is moderately correlated with the 12-Item Short Form Survey (SF-12), and the correlation coefficient between each dimension (0.13-0.28) was less than the correlation coefficient between each dimension and the total score of the scale and the difference was statistically significant( P<0.01). The Cronbach′s α coefficient was 0.84 and the retest reliability was 0.92. Conclusions:The Chinese version of PU-QOL questionnaire was proved to be a good instrument with acceptable reliability and validity, which can be used as a tool for evaluating quality of life of patients with PU in China.
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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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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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Pyoderma gangrenosum is a reactive inflammatory skin disease characterized by destructive skin ulcers accompanied by intense pain.The cause of the disease is unknown.According to the clinical identification of pyoderma gangrenosum wound treatment in this paper,analyze the difficulty of the wound treatment,the wound care according to the international guidelines recommends the"TIME"principle,we will review the status of wound care of pyoderma gangrenosum.
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The construction of wound treatment specialty (center) with Chinese characteristics began in the early 21st century. Based on my personal experience, this paper systematically reviews the key points and characteristics of the specialty (center) construction of wound treatment with Chinese characteristics and its phased progress. Its future development is also prospected.
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Common chronic wounds encountered by Family Physicians in the home care setting include pressure ulcers, diabetic foot ulcers, venous ulcers and arterial ulcers. Wound care management starts with a comprehensive wound assessment to determine wound characteristics and identify risk factors for non-healing. This is followed by optimising the wound bed using TIME principles that emphasises judicious debridement, management of exudate, and resolution of bacterial imbalance. An appropriate wound dressing is then selected based on wound characteristics and dressing properties. Finally, it is important to remember that chronic wounds are part of a patient's multiple medical comorbidities, and interacts closely with the patient�s social circumstances and functional status.The underlying aetiology and patient risk factors need to be addressed to optimise wound healing
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Given the myriad of choices available on the market, selecting the appropriate wound dressing remains a challenge for most healthcare workers. It is important to exercise discretion and adopt a systematic approach in dressing selection following wound assessment, as this will directly impact on rates of wound healing, which in turns affects the patient’s quality of life and overall healthcare costs. This paper provides an overview of the common types of wound dressings in use currently and gives a brief synopsis of some of the latest advances in wound care technology and their applications in management of complex wounds. The consensus to date is for the use of hydrogels in the debridement stage, foams and low-adherence dressings in the granulation stage and hydrocolloids and low-adherence dressings for the epithelialization stage. Additional studies and research need to be undertaken to further evaluate the application of advanced wound technology in clinical practice.
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Objective To study the feasibility of regional network platform for wound care technical training.Methods Micro-letter pubic number and internet technologies were used to develop a regional network platform of wound care which has one center with multiple branches,training nurses how to take care of wound by the educational column.Results There were 383 nurses had browsed the web site and took part in the learning since regional network platform was working 3 months,931 nurses paid close at-tention to Micro-letter pubic number.Performance examination was improved obviously after training,the percent of pass was 17.8% before training and 80.7% after training,the difference was with statistical significance (χ2=303.629,P<0.01).Conclu-sion The regional network platform of wound care based on micro-letter and internet technologies has a promising application.
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BACKGROUND: Because cosmetic laser treatments are getting popular, post-laser wound care becomes more important. Currently, topical moisturizers are reported to be sufficient to accelerate re-epithelialization and reduce downtime in post-laser wound care. OBJECTIVE: This study was performed to evaluate the effects of the moisturizer APDDR-1001 for post-laser wound care, after ablative fractional laser on the face. METHODS: In this double-blind, split-face study, 41 patients with photo-aged face received ablative fractional laser. They were divided into two groups, APDDR-1001 and vehicle (group 1) or control moisturizer (group 2), which were applied to the opposite sides of the face for 1 week after the laser treatment. The treatment efficacy was evaluated by the transepidermal water loss (TEWL), erythema index, investigator's assessment for recovery in erythema and overall improvement of the wound. Subjects ranked irritating symptoms and overall satisfaction ratings in the overall improvement. RESULTS: APDDR-1001 was well-tolerated and showed improvement in the erythema index and TEWL during the 7 days of treatment. In group 2, improvement in erythema graded by investigators was significantly higher for APDDR-1001 on day 3 (p<0.05). The overall improvement of wound ranked by investigators was significantly higher for APDDR-1001, compared with the controls in both groups. Subjective assessment demonstrated significantly less erythema (p=0.043), edema (p=0.041) and overall satisfaction ratings in the overall improvement (p<0.048) with APDDR-1001; however, no differences were detected in pain and edema between APDDR-1001 and vehicle (group 1). In group 2, subjects ranked 'much or very much improved' in 75 % of APDDR-1001 side and 55% of control moisturizer side. No significant differences in erythema, edema, pain and itching were reported between APDDR-1001 and control moisturizer in group 2. CONCLUSION: The moisturizer APDDR-1001 demonstrated effective improvements in wound healing and subjective symptoms after ablative fractional laser therapy.
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Humans , Cosmetics , Edema , Erythema , Laser Therapy , Pruritus , Re-Epithelialization , Research Personnel , Treatment Outcome , Wound HealingABSTRACT
O desenvolvimento da cirurgia minimamente invasiva, mediante emprego da via endoscópica, da radiologia intervencionista, da cirurgia video endoscópica e da robótica tem induzido à revisão dos conceitos, das práticas e da organização dos serviços de cirurgia. Por outro lado, a incorporação da evolução tecnológica e científica aos procedimentos cirúrgicos, dos mais simples aos mais complexos, ainda envolve o conhecimento dos fundamentos básicos para a cirurgia e cuidados perioperatórios.
The development of minimally invasive surgery by use of endoscopy, interventional radiology, endoscopic surgery and robotics has led to the revision of concepts, practices and organization of surgical services. On the other hand, the incorporation of technological and scientific surgical procedures from the simplest to most complex, yet involves knowledge of the basics of surgery and perioperative care.
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Antibiotic Prophylaxis , Bandages , Preoperative Care , Hemostasis , Minimally Invasive Surgical Procedures , Surgical Procedures, OperativeABSTRACT
PURPOSE: This study developed a web-based wound care course for undergraduate nursing students and evaluated the course's content, system, and student-satisfaction. METHODS: This study was done in three stages, the development of the web-based wound care course, the implementation and evaluation of the course. The course was developed based on the ARCS model. 80 undergraduate nursing students to Y University in Korea used the web-based wound care program during four weeks. After that, they completed questionnaires, evaluating the contents, system, and their satisfaction. RESULTS: Eighteen learning objectives were used to create the web-based wound care course and the course was developed with 7 chapters and 20 subsections. The analysis of the questionnaires showed a mean score for content and system-related items of 3.04 each, out of a possible 4 points. Student satisfaction items had a mean score of 2.89. CONCLUSIONS: The web-based course allowed students access to the course anytime and anywhere, and according to their own learning abilities. However this advantage would only be possible when nurse educators develop qualitative web-based course to meet the demand of a complex health care system as well as the needs of the students and the effectively incorporate it into traditional lectures.
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Humans , Attitude of Health Personnel , Attitude to Computers , Causality , Computer-Assisted Instruction/methods , Curriculum , Education, Nursing, Baccalaureate/organization & administration , Internet/organization & administration , Korea , Models, Educational , Needs Assessment , Nursing Assessment , Nursing Diagnosis , Nursing Education Research , Patient Care Planning , Practice Guidelines as Topic , Program Development , Program Evaluation , Surveys and Questionnaires , Skin Care/nursing , Students, Nursing/psychology , Wound Healing , Wounds and Injuries/etiologyABSTRACT
Objective:Pyoderma gangrenosum(PG) is regarded as a possibly immunity-mediated ulcerative skin disease,which is difficult to be managed and easy to relapse.Few cases of PG have been reported to be treated successfully in the world.This study aimed to investigate the clinical characteristics and difficulties and strategies in the management of mosquito bite-induced ulcer by PG.Methods: We analyzed the clinical characteristics and difficulties in the treatment of a case of mosquito bite-induced leg ulcer complicated by PG.Following the TIME(tissue removal,infection/inflammation control,moisture imbalance correction,and edge of wound revision) principles of wound bed preparation,we treated the ulcer by silver ion dressing + infrared rays,hypertonic saline dressing + infrared rays,hypertonic saline dressing + electrotherapy,and honey dressing + medication at different times.The ulcer size and scores on pain and healing were assessed before each wound care,and the results of each method were analyzed by the SPSS11.0 software.Results: The pain score was continuously reduced with the treatment and the ulcer size and healing score were gradually decreased in the later stage,while in the earlier stage,the ulcer size was even enlarged,with one ulcer becoming two,and the healing score obviously increased.The differences were statistically significant(P
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Objective: To investigate the reasonable establishment of functions and processes in the Wound Care Center,and discuss the duties and roles of its enterostomal therapists(ET).Methods: According to the army's related infection management rules and nosocamiol infection control criteria,our Wound Care Center is divided into 8 areas,each with its set function and corresponding equipment and materials.We have laid out the consulting process for patients,stoma and wound management processes for nurses,responsibilities for ET and an operation mode for the Wound Care Center.The targets attained in work,teaching and research in the previous two years were analyzed and compared.Results: The index of the attainment of the tangets increased dramatically,with a growth rate of more than 20% in 8 of the 9 targets,most obviously in teaching and research.Conclusion: The division of the functional areas has proved to be reasonable,each operational process capable of meeting patients' needs and technical requirements,which enables ET to play important professional roles in the specialized field.
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Management of diabetic foot ulcer is a multi-disciplinary, time-consuming work. In order to obtain a proper recording, better communication, and fair comparative study, effective method of recording system for diabetic foot ulcer is required. Wagner classification and NPUAP (National Pressure Ulcer Advisory Panel) chronic ulcer staging are widely used but have a drawback that they only consider the depth of the ulcer. Authors devised a recording system for the diabetic foot ulcer and applied it to the patients to examine any problems associated with its use. From September 1999 to January 2001, diabetic foot ulcer recording form was applied to 92 patients with diabetic foot ulcer. The form has 8 fields of recording: date, location, depth, size, status of ulcer, status of margin, interval change, recorder. These fields are for recording itself, treatment plan, or prognostic value. The data were collected and analyzed in detail. Authors proposed criteria for the ideal recording system in the management of diabetic foot ulcer. In conclusion, the diabetic foot ulcer recording system proved to be highly efficient, simple and easy to document the ulcer. In addition, it could help surgeons decide the treatment plan and predict the outcome.