IWII Wound Infection in Clinical Practice consensus document: 2022 update.

ABSTRACT: Wound infection is a major challenge for clinicians globally, with accurate and timely identification of wound infection being critical to achieving clinical and cost-effective management, and promotion of healing. This paper presents an overview of the development of the International Wound Infection Institute (IWII)'s 2022 Wound Infection in Clinical Practice consensus document. The updated document summarises current evidence and provides multidisciplinary healthcare providers with effective guidance and support on terminology, paradigms related to biofilm, identification of wound infection, wound cleansing, debridement and antimicrobial stewardship. Integral to the update is revision of wound infection management strategies which are incorporated within the IWII's Wound Infection Continuum (IWII-WIC) and management plan. The aim of the 2022 IWII consensus document update was to provide an accessible and useful clinical resource in at least six languages, incorporating the latest evidence and current best practice for wound infection and prevention. Dissemination techniques for the consensus are discussed and highlighted.

Ulcer dressings and management.

BACKGROUND: Chronic leg ulcers caused by venous disease, arterial disease or a combination of both need to be clearly identified before treatment can be commenced. Their management will depend on the diagnosis, combining direct management of the ulcer as well as management of patient factors. Other chronic wounds commonly observed in practice include pressure wounds, skin tears, atypical leg ulcers. OBJECTIVE: This paper will outline a simple way to manage people with chronic ulcers. CONCLUSION: Conclusion The prevalence of chronic wounds is expected to rise given that people are living longer and that the incidence of diabetes is increasing. There is a need is to clearly identify the underlying cause of any wound, including factors that may delay healing, and to treat appropriately. Treatment should address the wound environment, tissue base, presence of bacteria and the level of slough. If there is no improvement in wound healing after 4 weeks then seek help from a wound specialist. DISCUSSION: The prevalence of chronic ulcers in Australia has been estimated at 2-5%. Comprehensive assessment of the ulcer, the region and the whole person is an important first step in treatment. The aim of management is to promote healing and minimise the impact on the patient.

Oxygen tension assessment: an overlooked tool for prediction of delayed healing in a clinical setting.

Successful wound healing requires adequate transcutaneous oxygen tension (tcpO(2) ). TcpO(2) may not commonly be incorporated in clinical assessments because of variable measurement response at different sensory temperatures. This study aims to assess the relationship between changes in tcpO(2) , measured under basal (39°C) and stimulated (44°C) conditions and healing rate of chronic wounds over 4 weeks, to determine whether tcpO(2) measurement can predict delayed wound healing. TcpO(2) (Radiometer TCM400) measurements at sensor temperatures 39 and 44°C were recorded (twice, 4 weeks apart) adjacent to the ulcer site, and at a mirror image site on the contralateral leg. Ulcer outline was traced on clear acetate and perimeter and area measured (Visitrak™, Smith and Nephew). TcpO(2) measured at 44 and 39°C adjacent to all 13 wounds were lower compared to the contralateral site, significant at 44°C (P = 0·008). Significant correlation (r(2) = 0·8) occurred between wound healing rate and increased tcpO(2) at 44°C over 4 weeks. Importantly, the ratio of 39/44°C tcpO(2) , measured at the initial appointment, appeared to predict normal or delayed healing rate. TcpO(2) may provide clinicians with information regarding anticipated healing ability of wounds at the initial appointment, and hence identify wounds requiring early implementation of adjuvant therapies to accelerate healing.

Cost-effectiveness of multidisciplinary wound care in nursing homes: a pseudo-randomized pragmatic cluster trial.

OBJECTIVES: To evaluate the cost-effectiveness of a multidisciplinary wound care team in the nursing home setting from a health system perspective. METHODS: Pseudo-randomized pragmatic cluster trial with 20-week follow-up involving 342 uncomplicated leg and pressure ulcers in 176 residents located in 44 high-care nursing homes in Melbourne, Australia in 1999-2000. Twenty-one nursing homes (180 wounds in 94 residents) were assigned to the intervention arm and 23 to the control arm (162 wounds in 82 residents). Residents in the intervention arm received standardized treatment from a wound care team comprising of trained community pharmacists and nurses. Residents in the control arm received usual care. RESULTS: More wounds healed during the trial in the intervention arm than in the control arm (61.7% versus 52.5%, P = 0.07). A Cox regression with shared frailty predicted that the chances of healing increased 73% for intervention wounds [95% confidence interval (CI) 20-150%, P = 0.003]. The mean treatment cost was $A616.4 for intervention and $A977.9 for control patients (P = 0.006). Most cost reduction was obtained from decreases in nursing time and waste disposal. The mean cost saving per wound, adjusted for baseline wound severity and random censoring, was $A277.9 (95% CI $A21.6-$A534.1). CONCLUSIONS: Standardized treatment provided by a multidisciplinary wound care team saved costs and improved chronic wound healing in nursing homes. The main source of saving was in the cost of nursing time in applying traditional dressings and in the cost of their disposal.

A dressing history.

Over the past 30 years as caregivers, clinicians have been exposed to a plethora of new advanced wound dressings. The moist wound care revolution began in the 1970s with the introduction of film and hydrocolloid dressings, and today these are the traditional types of dressings of the advanced dressing categories. Wound-healing science has progressed significantly over the same period, as a result of intense clinical and scientific research around these product introductions. Today, the clinician understands moist wound healing, occlusion, cost effectiveness, wound bed preparation and MMP activity to name but a few of the many concepts in wound care that have flourished as a result of technology and product advancement. This review article presents a condensed history of dressing development over the past 30 years. However, in addition, such advancement is discussed in respect to its adoption in different parts of the world. The largest single markets of the world are generally the United States of America and Europe; as such, the development of both practice and technology generally begins there. Much has been written about these markets in previous review articles. For the purposes of this review, the development of wound care and the maturing of practice is discussed in respect to Canada, Japan and Australia representing smaller geographical areas where the development has been more recent but nonetheless significant.