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 noninvasive 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 equipment costs. 

Conclusion: The largest type of dressing products currently in use were nonadherent. 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

Chadwick P, Ahmad N, Dunn G, Elston D, Fisher N, Haycocks S, Kosnarova P, Morley R, Redfearn V, Smith M, Spruce P and Townsend R

Citation: Chadwick P, Ahmad N, Dunn G et al (2022) Local antibiotic delivery: early intervention in infection management strategy. The Diabetic Foot Journal 25(2): 44–52

Key words  - Foot infection  - Local delivery of antibiotics  - Targeted antimicrobial therapy

Authors

Prof Paul Chadwick is (Lead & Facilitator) Visiting Professor, Birmingham City University, UK; Noel Fisher is Consultant Orthopaedic Surgeon, Macclesfield Hospital, UK; Naseer Ahmad is Consultant Vascular Surgeon, Manchester Royal Infirmary, UK; George Dunn is Advanced Podiatric Specialist (High Risk), East Cheshire NHS Trust, UK; Prof Rob Townsend is Consultant Medical Microbiologist, Sheffield Teaching Hospitals NHS Foundation Trust, UK; Rob Morley is Consultant Podiatric Surgeon, UK; Debra Elston is Specialist Community Podiatrist, Heywood, Middleton and Rochdale, NHS Pennine Care, UK; Michelle Smith is High Risk Foot Team Podiatrist, Tameside and Glossop Integrated Care Foundation Trust, UK; Pavla Kosnarova is Consultant Diabetologist, Barnsley Hospital, UK; Victoria Redfearn is Wound Care Specialist Podiatrist, The Robert Hague Centre for Diabetes and Barnsley Hospital, UK; Samantha Haycocks is Consultant Podiatrist (High Risk), Salford Royal Foundation Trust, UK; Pamela Spruce is Clinical Director TVRE Consultant, UK

Article points

1. Systemic antibiotics are routinely prescribed for infected foot ulcers in individuals with diabetes but effective treatment can be disrupted by complications developing with their use

2. A method of delivering antibiotics directly to the site of infection, via antibiotic loaded beads, in addition to systemic use was debated by a multidisciplinary expert team of clinicians

3. These discussions resulted in the creation of a ‘tool kit’ of documents developed to support the safe and effective use of Stimulan by podiatrists in clinical practice

Systemic antibiotics are routinely prescribed for infected foot ulcers in individuals with diabetes. However, effective treatment can be disrupted by complications developing with their use, including allergic reactions, antibiotic-resistant organisms, the risk of clostridium difficile and possible organ toxicity. Poor vascular perfusion can also limit the availability of antimicrobial therapy to infected tissue. A method of delivering antibiotics directly to the site of infection, in addition to systemic use was debated by a multidisciplinary expert team of clinicians. Stimulan® (Biocomposites Ltd) is a system where antibiotics are mixed with calcium sulfate paste to form small beads. These can be placed in the foot wound following debridement, within a framework of standard best practice. The antibiotics are then released at therapeutic concentrations to the site of infection. As a result of these discussions, a ‘tool kit’ of documents was developed to support the safe and effective use of Stimulan by podiatrists in clinical practice. These could be adapted to meet the requirements of local protocols for care and, as a result, deliver additional antibiotic therapy to the infected wound.

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

David Wylie

Citation: Wylie D (2022) Foot screening in diabetes: What? — So what? — Now what? The Diabetic Foot Journal 25(2): 28–31

Contributors: Dr Paul Chadwick  Jill Cundell  Prof Mike Edmonds  Krishna Gohil  Duncan Stang  Stephanie Stanley  Rosalyn Thomas

Author

David Wylie is Is Associate Director NMAHP, NHS Education for Scotland, Glasgow, UK; Honorary Fellow, Glasgow Caledonian University, UK; Director of Professional Education, Royal College of Physicians & Surgeons, Glasgow, UK