Prospective, nonrandomized controlled trials to compare the effect of a silk-like fabric to standard hospital linens on the rate of hospital-acquired pressure ulcers.

Hospital bedding and gowns influence skin moisture, temperature, friction, and shear, which in turn may affect the development of pressure ulcers. To evaluate the effect of a new silk-like synthetic fabric on the incidence of pressure ulcers in an acute care setting, two consecutive 6-month clinical trials were conducted among 307 consecutively admitted patients in a Medical Renal Unit (August 2008 and March 2010) and in 275 patients admitted to a Surgical Intensive Care Unit (ICU) (September 2009 to March 2010). During the first 8 weeks, all patients used standard hospital bed linens, reusable underpads, and gowns. During the second 8 weeks, all admitted patients used the intervention linens (a silk-like fabric) followed by another 8 weeks of control (standard linen) use. Demographic variables and the prevalence of pressure ulcers on admission were statistically similar for control and intervention groups in both study populations with the exception of gender in the Renal Unit study (13% higher proportion of men in intervention group). Average Braden Scores were also similar and low (<18) in all study patients. Upon admission to the Medical Renal Unit, 21 of 154 patients (13.6%) in the control and 26 of 153 patients (17.0%) in the intervention group had a pressure ulcer. The incidence of new ulcers was 12.3% in the control and 4.6% in the intervention group (P = 0.01); average length of stay was 5.97 days (σ = 4.0) for control and 5.31 days (σ = 3.8) for intervention patients (P = 0.07). In the Surgical ICU group, 18 of 199 patients in the control (9.1%) and four of 76 patients in the intervention group (5.3%) were admitted with a pressure ulcer; the incidence of new pressure ulcers was 7.5 % in the control and 0% in the intervention group (P = 0.01). Average length of stay was 4.5 days and 4.33 days in the control and intervention groups, respectively (P = 0.33). The significant differences between the control and intervention group in the rate of pressure ulcer development suggests that the type of linens used affect pressure ulcer risk and that this silk-like synthetic fabric technology may help reduce the incidence of pressure ulcers in high-risk patients. Controlled clinical studies in other patient populations are warranted.

Telemedicine in a rural community hospital for remote wound care consultations.

BACKGROUND: We found that the number of patients requiring wound care consultation was increasing but the distance from our rural campus to the main campus acted as a barrier for timely consultations. Therefore, we implanted a telemedicine program, based on technology manufactured by VISICU (Baltimore, MD) used by intensive care and step-down unit patients in our health system. PROCESS: A wound consultation was performed with one certified WOC nurse in the remote facility and another certified WOC nurse at the patient's bedside to establish method reliability. Following this assessment of feasibility, we initiated a formal program for remote wound care consultations in March 2009. Fifty remote wound consults have been completed, resulting in an estimated savings of $5000. CONCLUSIONS: Limited evidence supports telemedicine for remote wound consultations; most literature is based on use of digital camera images or Web cam/computer programs. Our program uses a unique, real-time technology for remote wound care consultations. The potential cost-savings related to decrease in complications of wounds and the positive effects on patient progression and length of stay have not yet been measured. However, our initial experiences suggest that remote consultations using real-time telemedicine reduce delay between request for consultations and its completion, diminish transportation and nonproductive staff time costs, and are comparable to traditional face-to-face consultations.

North Carolina wound nurses examine heel pressure ulcers.

PURPOSE: Heels are the second most common location for pressure ulcers, and their prevalence is increasing. The purpose of this multisite research project was to describe physical characteristics and medical history of patients experiencing heel pressure ulcers (PUs). SUBJECTS AND SETTING: The settings for this study were different healthcare settings (acute care, long-term care, and homecare) in North Carolina and Virginia, where member WOC nurses perform consultative services for patients with heel ulcers. Patients older than 18 years with a heel PU were included in the study. METHODS: A data collection tool was developed by the authors. Participating members of the NC WOC Nurses Group identified 84 participants. Descriptive statistics were used to summarize the data by using proportions, means, standard deviations, and ranges. RESULTS: Over half of the population had a palpable pedal pulse. Full-thickness PUs were found in 45% of the sample while 19% had suspected deep tissue loss. Subjects tended to be elderly and have low nutritional markers, high body mass index, multiple comorbid conditions such as diabetes mellitus, systemic infection, end-stage renal disease and peripheral arterial disease, as well as low Braden Scale scores. CONCLUSION: The study revealed important factors specific to heel PUs including advanced age, malnutrition, high body mass index, and multiple comorbid conditions. Further research is needed to further refine our knowledge of our factors associated with an increase likelihood of heel PUs. Our findings also point out the need for a tool specific for the evaluation of heel PU risk.