Planning for Success

Clarissa Young

Abstract
In 1996 Launceston General Hospital (LGH) established a pressure ulcer resource group (PURG) using a small project framework based on Thomsett’s 1 small project model. By adopting a systematic and planned framework, the PURG was able to articulate the hospital’s, staff’s and patients’ needs in relation to pressure ulcer assessment, management and prevention. With planning and networking within the organisation, project objectives were successfully achieved. Using a project framework, proposals for the allocation of resources to the value of $165,000, to manage pressure ulcers and wounds, were put to the hospital executive.

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An Overview of Necrotizing Fasciitis

Gary Bain

Abstract
Necrotizing fasciitis, a serious infective process, causes extensive tissue damage, resulting in critical illness and potential disfigurement. This article presents a brief review of the pathology, clinical manifestations and treatment of this wound management challenge.

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Moulded Footwear: A Case Report

Laurence Foley

Summary
Many methods of reducing pressure on the insensate foot, to prevent or heal plantar wounds, have been described. This article briefly examines some of these methods and outlines a modified version of one method applied to heal a chronic foot wound.

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Risk Factors for Pressure Ulcers – Can They Withstand the Pressure?

Michael Woodward

Abstract
Evidence for risk factors for pressure ulceration was graded as follows:
A: supported by two or more prospective studies;
B: supported by prospective or retrospective studies;
C: anecdotal evidence, case reports or studies which do not all support the risk factor but consensus expert opinion provides support, or
D: conflicting evidence not supported by consensus expert opinions.
Among the Pressure Ulcer Interest Subcommittee of the Australian Wound Management Association (AWMA), expert consensus was reached: no risk factors were supported by evidence graded A; reduced mobility and activity, shear and friction and older age were supported by evidence graded B; moisture (especially faecal incontinence), nutritional factors, vitamin C status, oxygen delivery, diabetes, dry skin and previous pressure ulceration were supported by evidence rated C, and a rating of D given evidence supporting zinc status, male gender, race, temperature (skin and core), cancer and other chronic illnesses, recent hospital transfer, use of antipsychotic medications and psycho-social factors. Evidence-based preventive approaches will be most cost-effective but more data must be gathered to determine whether evidence for risk factors not currently well-supported can be strengthened.

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Larva Therapy in Modern Wound Care: A Review

JCT Church

Summary
This is a review of the reintroduction of larva therapy (LT) into modern wound care. Subjects addressed include the relevant larval biology, laboratory requirements for production for clinical use, patient selection, dressing techniques, clinical results and prospects for the future.

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Product evaluation – Polyacrylate Strands: A Cavity Wound Dressing

Gary Bain and Natalie Potts

Summary
The wound management department (WMD) of the Sydney Adventist Hospital undertook a 3-month evaluation of a new cavity wound dressing – AcryDerm Strands ™. When utilised on a variety of wounds, including dehiscence, pressure ulceration and fungating tumours, the product was found to provide clinical, as well as patient comfort and cost-saving, advantages.

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Pressure Point Offloading in the Diabetic Foot

Laurence Foley

Summary
The formation of diabetic wounds has been discussed, with an emphasis on the effects of force on the plantar tissues and the theoretical response of those tissues. As pressure reduction is an integral part of the healing process for diabetic wounds, many types of offloading strategies in the medical literature have been examined. All report success – to varying degrees – but not all comparisons have been applied in a similar way and few have controlled for similar variables. This article presents for discussion a range of off-loading methods that wound care practitioners can employ, depending on the site and severity of the presenting wound.

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Assessment and Management of the Burn Wound

Stuart P Pegg

Summary
Burn injuries still carry a high risk of morbidity and mortality. Central to this is control of sepsis by the use of good antimicrobial agents and the treatment of large burns in specialised burn centres, where the skills and expertise of the team enable early excision and skin grafting of such injuries. The introduction of new skin substitutes – which enable the dead tissue, a great culture medium for bacteria, to be removed and the raw areas to be covered – has helped considerably. Such procedures have been made possible by a team approach to the treatment of burn patients, particularly with respect to the control of sepsis.

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Applying Health Promotion Strategies to Wound Management –
A Community-based Pilot Project

Susie Prest

Summary
A needs assessment survey of community health nurses in the Waverley and Darlinghurst Community Health Centres in 1995 identified that community health nurses, within their scope of practice, manage a significant number of chronic wounds, including leg ulcers. Restricted access to medical and allied health specialists, newer products and updates on current trends in research were identified by the community health nurses as hindering their holistic management of those with chronic wounds.
This paper discusses how health promotion strategies were used during a wound care pilot project to design, develop and mobilise wound management resources for community health nurses at Waverley and Darlinghurst Community Health Centres. These resources included a resource folder, education sessions and an initial assessment form. Two self-help educational pamphlets – ‘Leg ulcer management’ and‘Nutrition and wound healing’ – were produced for clients. Surveys were sent to surgical supply companies in the geographical areas of Waverley and Darlinghurst Community Health Centres (the inner-city and eastern suburbs of Sydney, New South Wales) and the information gathered incorporated into a wholesalers’ folder that community health nurses could access.

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Latex Allergies

Darryl Kelly

Abstract
With the increase in the demand for latex products, latex allergy has emerged as a challenge for both health-care workers and the general population. It is important to identify the existence of this problem and, where skin changes occur in relation to the use of a latex product, the diagnosis of latex allergy needs to be considered.

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Learning About Wound Management: The Clinical Effectiveness Model

W Madsen

Summary
Over the last century, nurses’ involvement in wound management has ranged from that of following strict dressing regimes to autonomous practice 1. In the past, nurse education tended to reinforce the expectations of the time. An adherence to apprenticeship-style training, whereby nurses often had little understanding of the effects of the dressing they were applying to a wound, contributed significantly to a theory-practice gap in wound management. Nurses were not actively involved in the decision-making process. This paper reviews the means by which nurses have learned wound management skills in the past. It also illustrates the use of the clinical effectiveness model in the education of advanced wound management practitioners. The benefits of using this model as a basis of teaching include encouragement of evidence-based practices in the workplace, a breaking down of research barriers and a sharing of the skills and knowledge of experienced clinicians intimately involved in the care of clients with wounds 2.

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Use of Antiseptics in Managing Difficult Wounds

Joan Faoagali

Abstract
Wound care regimes have changed dramatically over the past 35 years. The principles of most types of wound healing have been investigated in detail and implemented with effect, as part of evidence-based wound healing practice compatible with the science of wound healing physiology. Occlusive dressings are important adjuncts to the armamentarium of the practitioner in charge of open wounds. Topical antibioticis and antiseptics are of limited use and toxic to healing tissue. There is a wide range of literature on the use of antiseptics and other products on chronic wounds. Of the commonly used products (hypochlorites, phenol derivatives, povidone iodine, quaternary ammonium compounds, chlorhexidine, silver compounds), only in the case of cadexomer povidone iodine does a comprehensive literature base support its use in decreasing the tissue load of bacteria and increasing the healing rates of wounds.

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