The prevention of medical-device related pressure ulcers in a Critical Care Unit

This article explores medical-device related pressure ulcers (MDRPU) in an intensive care unit (ICU) at the Royal United Hospitals Bath NHS Foundation Trust (RUH). The data presented outlines a reduction in PU of 66% over a 6-year period and a reduction in MDRPU of 50% over the same period. MDRPU were particularly challenging to prevent in ICU during the COVID-19 pandemic, where there were additional numbers of patients in the ICU with medical devices in place. Additionally, during the COVID-19 pandemic, an increased number of patients in the ICU were nursed prone (face down), adding additional pressure on the facial structure, a range of measures were put in place to avoid those avoidable MDRPU in the ICU at the RUH. Measures focused on skin checking, offloading and rotation of devices, including endotracheal tubes, non-invasive ventilation, nasogastric (NG) and nasojejunal (NJ) tubes and catheters. A specific comfort and pressure care record was developed for ICU to record the assessments of these at risk areas.

KEY WORDS  Pressure ulcer  Device-related  pressure ulcer  DRPU  Medical-device related pressure ulcers

NICOLA HEYWOOD Tissue Viability Nurse Specialist, Royal United Hospitals Bath NHS Foundation Trust.

STEPHANIE WORTHINGTON Tissue Viability Nurse and Critical Care Sister, Royal United Hospitals Bath NHS Foundation Trust.

MICHAELA ARROWSMITH Lead Tissue Viability Nurse, Royal United Hospitals Bath NHS Foundation Trust.

MARGI JENKINS Matron, Critical Care Services, Royal United Hospitals Bath NHS Foundation Trust.

LAURA HERRING Tissue Viability Nursing Assistant, Royal United Hospitals NHS Foundation

Australian guideline on wound healing interventions to enhance healing of foot ulcers: part of the 2021 Australian evidence-based guidelines for diabetesrelated foot disease

Pamela Chen1,2,3* , Keryln Carville4 , Terry Swanson5 , Peter A. Lazzarini6,7, James Charles8 , Jane Cheney9, Jenny Prentice10 and on behalf of the Australian Diabetes-related Foot Disease Guidelines & Pathways Project11,12

Abstract

Background: Diabetes-related foot ulceration (DFU) has a substantial burden on both individuals and healthcare systems both globally and in Australia. There is a pressing need for updated guidelines on wound healing interventions to improve outcomes for people living with DFU. A national expert panel was convened to develop new Australian evidence-based guidelines on wound healing interventions for people with DFU by adapting suitable international guidelines to the Australian context.

Methods: The panel followed National Health and Medical Research Council (NHMRC) procedures to adapt suitable international guidelines by the International Working Group of the Diabetic Foot (IWGDF) to the Australian context. The panel systematically screened, assessed and judged all IWGDF wound healing recommendations using ADAPTE and GRADE frameworks for adapting guidelines to decide which recommendations should be adopted, adapted or excluded in the Australian context. Each recommendation had their wording, quality of evidence, and strength of recommendation re-evaluated, plus rationale, justifications and implementation considerations provided for the Australian context. This guideline underwent public consultation, further revision and approval by ten national peak bodies.

* Correspondence: pamelachen@iinet.net.au 3 Joondalup Health Campus, Ramsay Healthcare Australia, Perth, Australia Full list of author information is available at the end of the article

© Diabetes Feet Australia 2022 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Results: Thirteen IWGDF wound healing recommendations were evaluated in this process. After screening, nine recommendations were adopted and four were adapted after full assessment. Two recommendations had their strength of recommendations downgraded, one intervention was not currently approved for use in Australia, one intervention specified the need to obtain informed consent to be acceptable in Australia, and another was reworded to clarify best standard of care. Overall, five wound healing interventions have been recommended as having the evidence-based potential to improve wound healing in specific types of DFU when used in conjunction with other best standards of DFU care, including sucrose-octasulfate impregnated dressing, systemic hyperbaric oxygen therapy, negative pressure wound therapy, placental-derived products, and the autologous combined leucocyte, platelet and fibrin dressing. The six new guidelines and the full protocol can be found at: https:// diabetesfeetaustralia.org/new-guidelines/

Conclusions: The IWGDF guideline for wound healing interventions has been adapted to suit the Australian context, and in particular for geographically remote and Aboriginal and Torres Strait Islander people. This new national wound healing guideline, endorsed by ten national peak bodies, also highlights important considerations for implementation, monitoring, and future research priorities in Australia.

Keywords: Diabetes-related foot ulcer, Diabetic foot, Foot ulcer, guideline, Recommendations, Treatment, Wound healing, Wound treatment.

Parafricta bootees compared with standard care to prevent heel pressure ulcers: a multicentre pragmatic randomised controlled trial

Background: Parafricta bootees are made of low friction material intended to prevent heel pressure ulcers (PU).

Aims: To compare, in hospitalised patients, whether the bootees, added to standard care (SC), prevent heel PU compared with SC alone.

Methods: Patients with Waterlow score ≥20 and no heel PUs at baseline were randomly allocated to either bootees plus SC, or SC alone. Target sample size was 450 patients. Patients’ heels were clinically assessed for heel PUs at day 3 and day 14. 

Results: Slow recruitment stopped the study early. In 31 recruited patients there were zero incident heel PUs (intervention group, 0%) versus 1 (SC group, 6%) at day 3 and no new heel pressure ulcers at Day 14.

Conclusion: This study failed to reach sufficient statistical power to assess the efficacy of the bootees in preventing heel PUs. No adverse events were related to the bootees. Only 1 patient in the SC group developed a heel PU.

KEY WORDS:  Pressure ulcer   Bootees   Friction   Medical device-related pressure ulcers   Shear

ANDREW CLEVES, Researcher, Cedar, Cardiff and Vale University Health Board, Cardiff Medicentre , University Hospital of Wales, Cardiff

NICOLA IVINS, Clinical Research Director, Welsh Wound Innovation Centre, Rhodfa Marics, Ynysmaerdy, Pontyclun

MICHAEL CLARK, Commercial Director, Welsh Wound Innovation Centre, Rhodfa Marics, Ynysmaerdy, Pontyclun

GRACE CAROLAN-REES, Cedar Director (Retired), Cedar, Cardiff and Vale University Health Board, Cardiff Medicentre, University Hospital of Wales, Cardiff

NIA JONES, Advanced Clinical Podiatrist, seconded to the Welsh Would Innovation Centre, Rhodfa Marics, Ynysmaerdy, Pontyclun.

JUDITH WHITE, Researcher, Cedar, Cardiff and Vale University Health Board, Cardiff Medicentre, University Hospital of Wales, Cardiff.

RHYS MORRIS,Cedar Director, Cedar, Cardiff and Vale University Health Board, Cardiff Medicentre, University Hospital of Wales, Cardiff

Attitudes of UK based wound specialists towards the use of mobile applications in wound care delivery: a cross-sectional survey. Part 1: quantitative findings

Introduction: This survey of wound care specialists in the UK aims to be the first study to establish the prevalence of mobile wound app use and the perceived barriers to their implementation in wound care. This article presents the quantitative findings of the study.

Method: A cross-sectional survey of UK-based wound clinicians was undertaken to explore the current use of mobile applications in the field of wound care. A 40 question SurveyMonkey survey was used and distributed via closed Facebook groups for clinicians working in UK-based wound care services. Data analysis included calculation of Cronbach’s alpha coefficient for attitude scales, summary statistics and thematic analysis of free text responses. Not reported in this paper The STROBE checklist was considered within the methodology of the study.

Results: Overall, n=250 survey responses were received. Complete survey responses were received from n=153 wound clinicians. This included responses from 121 nurses and 29 podiatrists and from clinicians from all four devolved nations of the UK. Only 21–24% of clinicians reported using mobile applications for wound care at the time of this survey. Almost all (99.5%) of clinicians responding to the survey have access to a smartphone with most (58.7%) having both a personal and work smartphone

Conclusions: It is evident that UK-based clinicians currently use mobile smartphones regularly, including within their clinical work, but do not currently use wound care focussed mobile applications. Barriers affecting the implementation of mobile applications in wound care services include a lack of interoperability between mobile applications and other IT infrastructure, poor Wi-Fi signal, negative attitudes towards technology, a lack of workforce diversity and bureaucratic obstructions.

Implications for practice: Clinical leaders in wound care should consider the factors identified within this study when developing implementation strategies for new mobile application technologies into wound care services.

KEY WORDS  Digital  Attitudes  Barriers  Enablers  Wound healing

MATTHEW WYNN Lecturer in Adult Nursing, University of Salford Correspondence: Room 3.42 Mary Seacole Building, University of Salford, Salford, M5 4BR, m. o.wynn@salford.ac.uk

MICHAEL CLARK Professor, Commercial Director, Welsh Wound Innovation Centre, Rhodfa Marics, Ynysmaerdy, Pontyclun

Is there a place for surgical site assessment using new imaging modalities during routine clinical care? A review of dressing use and changes from an online survey

Abstract: The care and management of surgical incisional wounds continues to attract both interest and concern, due to continued high rates of surgical site infection (SSI) and morbidity. Novel approaches to objective wound assessment using non invasive imaging modalities show promise in providing independent, objective wound assessment but only with the proviso that the wound is visible and can be ‘seen’ by the imaging detector.

Methods: An online semi-structured questionnaire was distributed via Survey Monkey to tissue viability nurses. Data was summarised descriptively, with responses relating to participant demographics and use of wound dressings tabulated. Key variables were also cross tabulated to investigate possible associations between variables. An economic analysis was conducted to estimate average weekly costs associated with changing and applying dressings, including both staff and equipmen costs. 

Conclusion: The largest type of dressing products currently in use were non adherent. Dressing changes took place approximately twice per week: more frequently if wounds were assessed/diagnosed as infected. The majority of wound assessment and dressing changes were undertaken by band 5, 6 or 7 nurses. There is a potential role for non-invasive infrared thermography to stratify risk of later SSI based upon the temperature distribution across wound site and adjacent skin territories. Early and objective interventions for early wound infection can reduce hospital inpatient stay, community visits, antimicrobial usage, patient morbidity and healthcare costs related to wound infection.

KEY WORDS   Imaging  Infrared  Dressing change  Dressings, treatment  Pay grade  Regime  Sonography  Surgical wound

PASANG TAMANG Postgraduate Researcher School of Human and Health Sciences, University of Huddersfield, UK.

CHARMAINE CHILDS PhD, Professor of Clinical Science, College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, UK JOHN STEPHENSON, PhD, Senior Lecturer in Biomedical Statistics, Institute of Skin Integrity and Infection Prevention, School of Human and Health Sciences, University of Huddersfield KAREN OUSEY, PhD, Professor of Skin Integrity, Director for the Institute of Skin Integrity and Infection Prevention - University of Huddersfield Department of Nursing

Frailty Syndromes: should wounds be considered an additional syndrome?

SAMANTHA HOLLOWAY Academic Editor, Wounds UK; Reader, Programme Director, Cardiff University School of Medicine, Cardiff