The clinical relevance of treating chronic wounds with an enhanced near-physiological concentration of platelet-rich plasma gel.

OBJECTIVE: This study investigated clinical outcomes in chronic nonhealing wounds following the short-term use of an enhanced, near-physiological concentration of platelet-rich plasma (PRP) gel (AutoloGel System, Cytomedix, Inc, Gaithersburg, Maryland). DESIGN: Study design was a large, observational case series using a multicenter registry database (all wounds included), which compared different populations within the database. SETTING: Thirty-nine centers contributed to the registry, including long-term acute-care centers, outpatient clinics, a durable medical equipment company, a home health agency, and a long-term-care center. PATIENTS: The target population included 285 chronic wounds (patient n = 200). Wound etiologies included diabetic, pressure, or venous ulcer; dehisced, surgical, or traumatic wound; and wounds of other etiologies. INTERVENTION: Therapeutic, PRP gel is produced from patient blood utilizing autologous platelets and plasma that contribute growth factors, cytokines, and chemokines, in a fibrin matrix. MAIN MEASURES: Area and volume of the wound and the linear total of undermining and sinus tracts/tunneling were calculated. Clinical relevance was determined by analyzing outcomes in wounds that responded to treatment. MAIN RESULTS: A positive response occurred in 96.5% of wounds within 2.2 weeks with 2.8 treatments. In 86.3% of wounds, 47.5% area reduction occurred, and 90.5% of wounds had a 63.6% volume reduction. In 89.4% undermined and 85.7% of sinus tracts/tunneling wounds, 71.9% and 49.3% reductions in linear total were observed, respectively. CONCLUSION: In chronic wounds recalcitrant to other treatments, utilization of PRP gel can restart the healing process. Rapid treatment response was observed in 275 of 285 wounds, and the magnitude of response was consistently high, with statistically significant outcomes reported for various subgroups.

Reducing pressure ulcer prevalence rates in the long-term acute care setting.

Information about pressure ulcer prevalence, prevention, and optimal management strategies in the long-term acute care hospital (LTACH) setting is sparse. Although care processes in other patient care settings have been reported to affect pressure ulcer prevalence rates, the effect of such programs in the LTACH is unknown. To reduce perceived above-average pressure ulcer prevalence rates and improve care processes, a 108-bed LTACH used a failure mode and effects analysis to identify and address high-priority areas for improvement. Areas in need of improvement included a lack of 1) wound care professionals, 2) methods to consistently document prevention and wound data, and 3) an interdisciplinary wound care team approach, as well as a faulty electronic medical record. While prevalence data were collected, policies and procedures based on several published guidelines were developed and incorporated into the pressure ulcer plan of care by the newly established wound care team. Improved assessment and documentation methods, enhanced staff education, revised electronic records, wound care product reviews, and a facility-wide commitment to improved care resulted in a reduction of facility-acquired pressure ulcer prevalence from 41% at baseline to an average of 4.2% during the following 12 months as well as fewer missing electronic record data (<1% of charts had missing data). These study results suggest that staff education, better documentation, and a dedicated wound care team improves care practices and reduces pressure ulcer prevalence in the LTACH. Studies to increase knowledge about the LTACH patient population and their unique needs and risk profiles are needed.

The effect of an antimicrobial drain sponge dressing on specific bacterial isolates at tracheostomy sites.

Patients with tracheostomies frequently experience complications, including bacteremia, sepsis, pneumonia, and multi antibiotic-resistant bacterial infections. A prospective, descriptive, randomized, controlled, clinical case series involving seven men and three women was conducted on patients in the neuroscience unit of a long-term rehabilitation hospital during a period of 25 days to compare the use of an nonwoven drain sponge dressing containing an antimicrobial (polyhexamethylene biguanide) to a non-impregnated, nonwoven drain sponge dressing on tracheostomy sites. Specifically, the purpose of the study was to compare the presence of four bacterial pathogens (methicillin-resistant Staphylococcus aureus, Enterobacter cloacae, Pseudomonas aeruginosa, and Staphylococcus aureus) and resident normal skin flora (alpha-hemolytic Streptococci and Staphylococcus epidermidis) at the tracheostomy sites. Culture results for total days of growth showed an absence of pathogens and presence of normal skin flora for 11 study days in patients randomized to the antimicrobial dressing group and an absence of pathogens and presence of normal skin flora for six study days in patients randomized to the control group. The results of this descriptive case series suggest that an antimicrobial drain sponge dressing could be an important adjunct in the control of infections in patients with tracheostomies without compromising normal skin flora.