An overview of the prevention and management of wound infection.

A wound can be defined as infected when the presence and subsequent proliferation of microorganisms leads to a local or systemic response in an individual. Wound infection is associated with delayed healing, wound chronicity, increased risk of hospital admission, loss of limb or digit and increased healthcare costs. The presence of biofilm is also recognised as a challenge in infected wounds and is associated with chronicity and delays in healing. Identifying and managing wound infection early can contribute to faster wound healing, thus reducing the risk of negative outcomes. This article details the pathophysiology, risk factors and signs and symptoms of wound infection. It also outlines various prevention and management options for wound infection.

A Healthier Future for Tissue Viability - An initiative to improve outcomes for patients with lower limb issues.

Reducing unwarranted variation in clinical care and access to care was a central goal of the Five Year Forward View, and the later Long Term Plan. Variation in provision and access to lower limb services in one Sustainability and Transformation Partnership were apparent. Through networking and collaboration of STP wide tissue viability and related specialist services a programme of service development was accepted as part of wider Frailty service provision. This led to a public health needs assessment of the problem being commissioned; 6 clinical pathways being produced; and clear recommendations for improvement in service provision being made. The public health needs assessment is believed to be the first of its kind considering the issues of leg ulceration, cellulitis of the lower limb, lymphoedema of the lower limb (excluding cancer related), chronic oedema of the lower limb, diabetic foot ulceration and foot ulceration. Data from local hospital episode statistics, community services data and extrapolation from national data sources has been used to understand the local impact. This provided an idea of the numbers of the population affected, the costs to the local health economy and a baseline for improvement outcome measurement in the future. It also prompted widespread service provision changes to meet the needs of those living with lymphoedema and chronic oedema and pathways for skin tear and leg ulceration have been designed for implementation. The public health needs assessment is fully published and freely accessible elsewhere. This article describes the process followed to undertake the work.

Development of a generic wound care assessment minimum data set.

BACKGROUND: At present there is no established national minimum data set (MDS) for generic wound assessment in England, which has led to a lack of standardisation and variable assessment criteria being used across the country. This hampers the quality and monitoring of wound healing progress and treatment. AIM: To establish a generic wound assessment MDS to underpin clinical practice. METHOD: The project comprised 1) a literature review to provide an overview of wound assessment best practice and identify potential assessment criteria for inclusion in the MDS and 2) a structured consensus study using an adapted Research and Development/University of California at Los Angeles Appropriateness method. This incorporated experts in the wound care field considering the evidence of a literature review and their experience to agree the assessment criteria to be included in the MDS. RESULTS: The literature review identified 24 papers that contained criteria which might be considered as part of generic wound assessment. From these papers 68 potential assessment items were identified and the expert group agreed that 37 (relating to general health information, baseline wound information, wound assessment parameters, wound symptoms and specialists) should be included in the MDS. DISCUSSION: Using a structured approach we have developed a generic wound assessment MDS to underpin wound assessment documentation and practice. It is anticipated that the MDS will facilitate a more consistent approach to generic wound assessment practice and support providers and commissioners of care to develop and re-focus services that promote improvements in wound care.