Topical Wound Therapy Products With Ionic Silver: A Technologic Analysis.

PURPOSE: The purpose of this technologic analysis was to review use of ionic silver as a component of topical wound therapy products. APPROACH: Published literature from a variety of fields related to ionic silver and its use in topical wound therapy products was reviewed and a summary of common commercially available wound care products containing ionic silver was generated, along with general recommendations for use. Safety information from both manufacturer guidelines and the Manufacturer and User Facility Device Experience (MAUDE) database is summarized. CONCLUSIONS: Various formulations of ionic silver products are used for topical treatment of wounds. Antimicrobial activity varies according to the specific silver formulation and type of microorganisms in the wound bed. In vitro evidence suggests that some bacterial strains may be developing resistance to ionic silver. Improved knowledge of the benefits and safety precautions associated with topical silver preparations can guide its application to topical therapy for wound healing.

Intra-Abdominal Pressure Measurement Devices: A Technologic Analysis.

PURPOSE: The purpose of this Technologic Analysis is to review devices designed to measure intra-abdominal pressure (IAP); these devices are used to detect intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). APPROACH: Published literature focusing on devices designed to measure IAP was reviewed, comparing the options available and outlining recommendations for appropriate use. Safety information regarding IAP measurement devices was derived from the Manufacturer and User Facility Device Experience (MAUDE) database. CONCLUSIONS: Intra-abdominal hypertension is prevalent among critically ill patients of all ages and is linked to adverse consequences, such as abdominal compartment syndrome. The condition is often unrecognized due to the lack of overt clinical symptoms, supporting the need for devices to accurately measure IAP. Commercially available devices measure IAP indirectly, typically via the bladder or stomach. Additional research is needed to demonstrate the benefits of routine screening, further define risk factors for IAH/ACS development, and evaluate the impact of measures to reduce IAP in an effort to improve patient outcomes.

Abdominal Negative Pressure Wound Therapy Devices for Management of the Open Abdomen: A Technologic Analysis.

PURPOSE: The purpose of this technologic analysis was to analyze technologic features of abdominal negative pressure wound therapy (NPWT). APPROACH: Published literature regarding abdominal negative pressure wound therapy (aNPWT) devices was reviewed. A summary of management approaches for the open abdomen provides a foundation for understanding the benefits of aNPWT. Safety information regarding aNPWT was derived from the Manufacturer and User Facility Device Experience (MAUDE) Database. CONCLUSIONS: The open abdomen approach with temporary abdominal closure may be employed for patients with a variety of conditions. Specialized abdominal NPWT devices, either singly or in combination with other approaches, may contribute to improved outcomes in this high-risk patient population. Manufacturer recommendations and clinical guidelines should be followed to minimize patient risk.

Single-Use Negative Pressure Wound Therapy Devices: A Technologic Analysis.

PURPOSE: The purpose of this technologic analysis was to evaluate single-use negative pressure wound therapy (sNPWT) devices. APPROACH: Published literature regarding negative pressure wound therapy, particularly focusing on single-use or disposal devices, was reviewed. Varied features of devices currently available in the United States were drawn from use instructions published by individual manufacturers. Safety information regarding sNPWT was derived from the Manufacturer and User Facility Device Experience (MAUDE) Database. CONCLUSIONS: Single-use or disposable negative pressure wound therapy devices provide a safe and effective alternative to traditional negative pressure wound therapy. These devices promote healing of select open wounds and reduce complication rates in closed surgical incisions, when used in accordance with manufacturer guidelines. They may be used in any setting, but they are designed for use in home care and may be applied as a primary treatment option or following a course of traditional negative pressure wound therapy.

Negative Pressure Wound Therapy Devices With Instillation/Irrigation: A Technologic Analysis.

PURPOSE: The purpose of this technologic analysis was to critique technologic features of devices designed to deliver negative pressure wound therapy with instillation or irrigation (iNPWT). APPROACH: Published literature regarding negative pressure wound therapy (NPWT) devices with the added feature of instillation or irrigation was reviewed to provide an overview of iNPWT. Varied features of devices currently available in the United States were described based on instructions published by individual manufacturers. Safety information regarding iNPWT was derived from the Manufacturer and User Facility Device Experience (MAUDE) Database. CONCLUSIONS: The additional option of instillation or irrigation available with some NPWT devices may provide clinical benefits in carefully selected patients. Advantages may be related to facilitated removal of thick exudate and necrotic tissue. Devices with instillation options are indicated for inpatient settings, with ongoing monitoring of health care professionals. A simpler device with an intermittent irrigation option may be used in the home setting, with proper supervision. More research is needed to demonstrate the clinical effectiveness and cost of the therapy.

Prevalence of Fecal Incontinence in the Acute Care Setting.

PURPOSE: The aim of this study was to determine the prevalence of fecal incontinence (FI) and its associated risk factors in acutely ill adult hospitalized patients. METHODS: A cross-sectional design was used to collect data at 2 time points in 7 hospitals in the Midwestern United States. An investigator-developed tool was used by trained data collectors to identify pertinent patient characteristics, the presence of FI, and potential associated factors. RESULTS: The prevalence of FI in the 1083 patients assessed was 20% (n = 221). Prevalence rates from the 7 individual hospitals ranged from 16% to 30%. Medications were the most common associated factor (49%; n = 109), followed by neurologic diseases (40%; n = 89), and bowel motility disorders (30%; n = 67). The majority of patients with FI had stool consistency described as "loose unformed" (59%; n = 130) or "liquid" (25%; n = 55). Many patients had multiple potential risk factors for FI; 48% (n = 107) had 1 associated factor, 37% (n = 82) had 2 associated factors, and 8% (n = 18) had 3 or more associated factors. Age was associated with an increased likelihood of FI; the chances for FI increase 1.7% with each year of age. Unit type was also a significant associated with FI; patients managed in the intensive care unit were 78% more likely to have FI as compared to patients care for in a medical-rehabilitation unit. CONCLUSIONS: Fecal incontinence is a common problem in hospitalized adult patients. Previously identified risk factors were also found in our sample.