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Buzz Report: Latest trends, part 2

Keeping clinicians up-to-date on clinical knowledge is one of the main goals of the Wild on Wounds (WOW) conference held each September in Las Vegas. Every year, I present the opening session, called “The Buzz Report,” which focuses on the latest-breaking wound care news—what’s new, what’s now, and what’s coming up. I discuss new products, practice guidelines, resources, and tools from the last 12 months in skin, wound, and ostomy management.

In the January issue, I discussed some of the updates from my 2015 Buzz Report. Now I’d like to share a few more, along with some of my favorite resources.

Product buzz

Wound dressings with silicone are designed to reduce pain and trauma during dressing changes and to protect the wound. Coloplast’s new Biatain® Silicone Lite does just that, combining an absorbent polyurethane foam dressing with a semipermeable, water- and bacteriaproof top film and a soft silicone woundcontact layer. The thin foam provides a closer fit at skin level, resulting in increased mobility and product comfort.

Anasept® Antimicrobial Wound Irrigation Solution provides a new dimension in antimicrobial wound care and negative-pressure wound therapy (NPWT). This FDA-cleared solution is a clear isotonic liquid that delivers 0.057% broad-spectrum antimicrobial sodium hypochlorite via a NPWT device. Kill studies for Anasept® are fascinating: a 30-second kill time for infections with Clostridium difficile, methicillin-resistant Staphylococcus aureus, vanc o mycinresistant enterococci, Pseudo monas, and many more. Anasept comes with an easyto- use spikable container with an integrated hanger that can be quickly attached to an I.V. pole or NPWT device. It can be used with most NPWT systems that have instillation or infusion capability.

Cutimed® Sorbact® Hydroactive B from BSN Medical provides infection control and fluid management for up to 4 days in a single wound dressing. It helps fight and prevent infection without chemical agents or antibiotics. The bacteria-binding, absorbent gel dressing with an adhesive border absorbs and locks wound exudate and bacteria in a hydropolymer gel core; with each dressing change, bound bacteria are removed. The hydrogel matrix helps maintain a moist wound environment.

No scissors? No problem! Hy-Tape International, maker of the Original Pink Tape®, has come to the rescue with Hy- Tape® Pre-cut Strips and Patches. These latex free, waterproof, zinc–oxide-based adhesive tape products are perfect for extended wear, soothing to delicate skin, and adherent to wet, oily, or hairy skin. The single-use strips measure 1.25″ x 6″ and come in packs of four. They can quickly be used to secure devices or to “picture-frame” wounds or ostomy barriers. The patches are designed to cover a large area. Available in 4″ and 5″ squares, they’re perfect for making hydrocolloid dressings completely occlusive.

The American Diabetes Association’s report “Comprehensive Foot Examination and Risk Assessment” states that all individuals with diabetes should get an annual foot exam to assess peripheral neuropathy and protective sensation, including a test for vibration perception. Typically, the clinician uses a tuning fork to test for vibration sensation, but this can be difficult for those unfamiliar with the feel; also, the results are totally subjective. The new portable, handheld noninvasive Dynamic Neuroscreening Device (DND) from Prosenex provides objective and consistent quantitative testing for vibration sensation. It offers five grades of vibration and temperature discrimination to screen for large- and small-fiber neuropathy. FDA approved and made in the United States, DND was named the 2014 New Hampshire High Tech Product of the Year.

Zinc oxide ointment is a “go-to” product for incontinence-associated dermatitis. But its consistency makes it difficult and messy to spread evenly over the skin. Mission Pharmacal Co. has created a new solution for this—Dr. Smith’s Adult Barrier Spray. This 10% zinc oxide solution comes as an easy, touch-free, spray application, offering accurate, uniform coverage with no rubbing necessary.

Incidence data reveal that the heel is the most common site of facility-acquired pressure ulcers. Once a heel pressure ulcer develops, complete elimination of heel

pressure using a pressure-relief device is critical. The new TruVue™ Heel Protector from EHOB positions a pillow under the Achilles tendon to elevate the heel. Constructed

with an anti-shear pad that serves as a barrier to shearing forces, the device has a deep, V-cut heel well that fully off – loads the heel without product interaction and relieves product-to-heel engagement with foot flexion.

Resource buzz

Accessing the Internet for information using smartphones and tablets has quickly become a huge part of health care. Two major wound care companies have released mobile applications to help healthcare professionals and consumers use and order their products. Several new woundcare books were published in 2015 as well. (See What’s the buzz on books?)

The iOn Healing™ mobile app from Acelity offers a suite of tools to improve customer support. In addition to product guides, features include the ability to connect and consult directly with an Acelity representative, track outcomes to support  documentation of medical necessity, and order V.A.C.® Therapy and instantly transmit the signed prescription to Acelity. The HIPAA-compliant app offers high-security data protection. Designed for use by licensed clinicians in the United States, it’s free to download and available for iOS and Android.

The Johnson & Johnson Wound Care Resource app helps identify new wounds, provides recommendations on wound care treatment, and keeps track of the daily checklists that come with continued treatment. It’s available free for iOS at iTunes and for Android at GooglePlay.

A dream come true for wound care clinicians—an app that measures wounds! With the Mobile Wound Care app from Tissue Analytics, you can take a wound photo with a smartphone camera and stream it directly to your desktop, where you can measure, track, and manage your patients’ wounds on a secure web portal. It’s available for iOS at iTunes and for Android at Google Play.

The Agency for Healthcare Research & Quality (AHRQ) produces evidence that can be used to make health care safer, better, more accessible, more equitable, and more affordable. AHRQ websites offer a wealth of useful information for clinicians A few of my favorites are the Patient Safety Channel on YouTube, Innovations Exchange, Safety Program for Nursing Homes: On-Time Pressure Ulcer Prevention, and Service Delivery Innovation Profile, such as this one, which details various healthcare projects around the country.

Donna Sardina is editor-in-chief of Wound Care Advisor and cofounder of the Wound Care Education Institute in Plainfield, Illinois.

DISCLAIMER: All clinical recommendations are intended to assist with determining the appropriate wound therapy for the patient. Responsibility for final decisions and actions related to care of specific patients shall remain the obligation of the institution,its staff, and the patients’ attending physicians. Nothing in this information shall be deemed to constitute the providing of medical care or the diagnosis of any medical condition. Individuals should contact their healthcare providers for medical-related information.

 

Buzz Report: Latest trends, Part 1

We all lead busy lives, with demanding work schedules and home responsibilities that can thwart our best intentions. Although we know it’s our responsibility to stay abreast of changes in our field, we may feel overwhelmed when we try to make that happen.

Keeping clinicians up-to-date on clinical knowledge is one of the main goals of the Wild On Wounds (WOW) conference, held each September in Las Vegas. Each year, I present the opening session of this conference, called “The Buzz Report,” which focuses on the latest-breaking wound care news—what’s new, what’s now, what’s coming up. I discuss innovative new products, practice guidelines, resources, and tools from the last 12 months in skin, wound, and ostomy management. This article highlights the hottest topics from my 2015 Buzz Report.

Guidelines buzz

Although not new in 2015, “Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline” from the National Pressure

Ulcer Advisory Panel (NPUAP), European Pressure Ulcer Advisory Panel, and Pan Pacific Pressure Injury Alliance is still a buzzing topic. The guideline was released in September 2014, and many facilities and clinicians are still busy trying to incorporate it into their protocols. This can be an arduous task, given the more than 575 specific recommendations. However, the quick-pick system using “thumbs up” and “thumbs down” icons next to each recommendation helps users separate the should do’s from the don’t do’s.

The American College of Physicians released two pressure ulcer guidelines in March 2015. “Treatment of Pressure Ulcers: A Clinical Practice Guideline” and “Risk Assessment and Prevention of Pressure Ulcers” are based on a systematic evidence review and focus on specific aspects of care. Each guideline has just three recommendations.

Although not a guideline per say, the evidence-based consensus document “The Management of Diabetic Foot Ulcers (DFUs) Through Optimal Off-loading” published in the Journal of the American Podiatric Medical Association includes eight specific consensus statements. Here are two of the most notable:

• Consensus statement #4: Total contact casting is the preferred method for off-loading plantar DFUs, as it has most consistently demonstrated the best healing outcomes and is a cost-effective treatment.

• Consensus statement #5: There currently exists a gap between the evidence supporting the efficacy of DFU off-loading and what is performed in clinical practice.

Literature buzz

Thousands of wound and ostomy articles are published each year. Below are just a few of the articles that I believe will have a significant impact at the bedside.

What is the healing time of Stage II pressure ulcers? Findings from a secondary analysis,” in Advances in Skin & Wound Care Journal, describes data collected from a multicenter randomized clinical trial. The authors conclude that achieving complete re-epithelialization in stage 2 pressure ulcers takes approximately 23 days and that on average, small ulcers heal 12 days faster than those with a surface of 3.1 cm2 or greater.

NPUAP released two key papers in 2015.

• “Hand check method: Is it an effective method to monitor for bottoming out?” reviewed the science behind the clinical practice of hand checks for bottoming out on a support surface. NPUAP’s position statement supports use of hand checks with air mattress overlays and chair cushions only. NPUAP stated more research is needed to develop acceptable ways to evaluate the performance of mattress replacements and integrated bed systems; until such time, clinicians should follow the manufacturer’s recommendation and not perform hand checks.

• The white paper “Do lift slings significantly change the efficacy of therapeutic support surfaces?” is designed to increase clinicians’ critical thinking when using lift slings in combination with therapeutic support surfaces. NPUAP recommends clinicians choose a combination of support surface and sling that meets the patient’s needs while focusing on the risks and benefits of leaving a sling beneath a patient.

A 2015 review and analysis of literature on friction and pressure ulcers in the Journal of Wound Ostomy Continence Nursing explained that friction alone doesn’t directly cause pressure ulcers, and cautioned against categorizing friction wounds as pressure ulcers. “Friction-induced skin injuries—are they pressure ulcers? An updated NPUAP white paper” explains that friction can result in shear forces that may lead to a pressure ulcer; however, without shear, friction alone doesn’t lead to pressure ulcers.

Ulcers from sickle cell disease

About 1% to 3% of the U.S. population lives with sickle cell disease (SCD). From 25% to 75% of these people also experience leg ulcers. “Sickle cell disease & wound care: Lower extremity ulcers in ‘crisis,’” published in Today’s Wound Clinic, identified key diagnostic characteristics and treatment protocols to consider. The underlying cause of SCD ulcers remains unknown. Most begin spontaneously or from trauma as small scabbed areas over the medial or lateral malleoli. Scabs progress to round, punched-out lesions with raised margins, deep bases, and necrotic slough, with surrounding brown hyperpigmentation and scaling. Patients typically complain of extreme tenderness or pain at the ulcer site.

Treatment aims to manage SCD and associated anemia and control pain. Local wound care involves moist wound healing, bacteria control, protection from trauma, loose-fitting clothing around the ankles to avoid friction, and pressure dressings, such as an Unna’s boot. In many cases, sharp debridement can’t be done because of intolerable pain. A good alternative is biological debridement.

Infrared skin thermometry

All objects at temperatures above absolute zero release infrared radiation. Heat from wound inflammation, fever, and infection is a form of infrared radiation. By using a noncontact infrared thermometer to monitor wounds and surrounding tissue, clinicians can identify signs of deep inflammation, infection, or trauma that may be invisible on the surface. “Infrared skin thermometry: An underutilized cost-effective tool for routine wound care practice and patient high-risk diabetic foot self-monitoring,” published in Advances in Wound Care, found wounds with an elevated temperature measured with infrared thermometry were eight times more likely to be diagnosed with deep infection. A temperature elevation over the same spot on the other foot in a patient with diabetes without a foot ulcer may indicate an acute Charcot foot. In addition, limb ischemia results in lower regional, local, and side-to-side variability in temperatures. Using an infrared thermometer, clinicians can identify unequal vascular supply by measuring temperatures proximal and distal to the wound. Commercially available, inexpensive, noncontact infrared thermometers can detect localized increases in skin surface temperature comparable to scientific grade instruments.

Noncontact infrared thermometry also can be used to assess the skin for pressure ulcers, such as deep-tissue injury, dark skin tones, and circulatory status around the wound. I believe all wound care practitioners should have a noncontact infrared skin thermometer on their tool belt. For examples of these thermometers, visit http://goo.gl/6wN5eJ.

Product buzz

Debrisoft® is a ground-breaking active debridement system from Loh­mann & Rauscher that mechanically debrides and cleans wounds by rapidly removing debris, necrotic material, slough, exudate, and hyperkeratotic tissue. The dressing is made of soft, angled polyester fibers that loosen debris while protecting intact granulation tissue and epithelial cells. To use, moisten with tap water or saline solution. Then, using light pressure and a circular motion, gently rub the wound or skin with the soft, fleecy side of the dressing. You can use Debrisoft each time you change the wound dressing.

A similar product, DebriMitt™ from Crawford Healthcare, is designed as a single-use mitt with a finger pouch. It gently removes nonviable tissue, hyper­keratotic skin, and debris and can disrupt biofilms in the wound base.

A natural approach to wound debridement can be achieved with the new BioMonde BioBag®, which contains disinfected larvae of Lucilia sericata (maggots) in a sealed sterile polyester net bag. The bag is placed directly onto the wound bed; larvae remain sealed within the dressing for the full 4-day treatment. The BioBag allows larvae to pass secretions through the pores of the polyester containment net, dissolving and physically removing devitalized tissue and bacteria from the wound without removing healthy and viable tissue. All wound-cleaning benefits of larval therapy remain in the BioBag without fear of larvae wandering from the treatment area.

Helix3 CM™ and Helix3 CP™ are new collagen wound dressings from Amerx. Helix3 CM is a bioactive collagen matrix dressing composed of 100% type 1 bovine native collagen formulated in a highly absorptive porous collagen sheet. Helix3 CP is 100% type 1 bovine nonhydrolyzed collagen powder. Because these products aren’t hydrolyzed, they contain 10 times more nondenatured, native triple-helix structured collagen than similar products.

For the latest bedding fabrics that reduce shear and friction, see New bedding fabrics.

Note: Watch for part 2 of the Buzz Report in the March-April issue.

Selected references

Brienza D, Antokal S, Herbe L, et al. Friction-induced skin injuries: Are they pressure ulcers? An updated NPUAP white paper. J Wound Ostomy Continence Nurs. 2015;42(1):62-4

Brienza D, Deppisch M, Gillespie C. Do lift slings significantly change the efficacy of therapeutic support surfaces? A National Pressure Ulcer Advisory Panel White Paper. March 2015. http://goo.gl/nocsIj

Call E, Deppisch M, Jordan R, et al. Hand check method: Is it an effective method to monitor for bottoming out? A National Pressure Ulcer Advisory Panel Position Statement. June 2015. http://goo.gl/k0U4OL

National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel, and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers: Quick Reference Guide. Emily Haesler, ed. Perth, Australia: Cambridge Media; 2014. http://goo.gl/5IkUVG

Palese A, Luisa S, Ilenia P, et al; PARI-ETLD Group. What is the healing time of Stage II pressure ulcers? Findings from a secondary analysis. Adv Skin Wound Care. 2015;28(2):69-75.

Penne JR, Goodman BM, Chen IA. Sickle cell disease & wound care: lower extremity ulcers in “crisis.” Today’s Wound Clinic. 2015;9(3). http://goo.gl/nfEk68

Qaseem A, Humphrey LL, Forciea MA, et al; Clinical Guidelines Committee of the American College of Physicians. Treatment of pressure ulcers: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2015;162(5):370-9.

Qaseem A, Mir TP, Starkey M, et al; Clinical Guidelines Committee of the American College of Physicians. Risk assessment and prevention of pressure ulcers: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2015;162(5):359-69.

Sibbald RG, Mufti A, Armstrong DG. Infrared skin thermometry: an underutilized cost-effective tool for routine wound care practice and patient high-risk diabetic foot self-monitoring. Adv Skin Wound Care. 2015;28(1):37-44.

Snyder RJ, Frykberg RG, Rogers LC, et al. The management of diabetic foot ulcers through optimal off-loading: building consensus guidelines and practical recommendations to improve outcomes. J Am Podiatr Med Assoc. 2014;104(6):555-67.

Online Resources

O. therapeuticbedding.com/more_woundcare

Donna Sardina is editor-in-chief of Wound Care Advisor and cofounder of the Wound Care Education Institute in Plainfield, Illinois.

DISCLAIMER: All clinical recommendations are intended to assist with determining the appropriate wound therapy for the patient. Responsibility for final decisions and actions related to care of specific patients shall remain the obligation of the institution, its staff, and the patients’ attending physicians. Nothing in this information shall be deemed to constitute the providing of medical care or the diagnosis of any medical condition. Individuals should contact their healthcare providers for medical-related information.