Abstract
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Abstract
Pressure injuries (PIs) are adverse events associated with health care that can cause significant patient harm and discomfort, and have been identified as a cause of death. Some governments have established penalty funding for the occurrence of Stage 3 or 4 hospital-acquired PI; indicating that quality health care should prevent their occurrence. Auditing the prevalence of PI using a standardised methodology is a wellestablished way of comparing quality of health care across facilities. This paper reports the results of 10 years of PI prevalence auditing at a tertiary facility in Brisbane, Australia, and the nurse-led initiatives which led to a reduction in hospital-acquired PI prevalence from 13.7% in 2002 to 4.0% in 2012. Ongoing education and a whole-team approach to PI prevention, led by the hospital’s Quality Effectiveness Support Team, have been key factors in achieving this reduction. Executive support, continuing education and staff awareness campaigns, and judicious purchase of effective PI prevention devices are also considered critical to success. Additionally, a program of nursing research was established with PI prevention as a strategic priority. In the 2013 ACHS Accreditation Survey, the hospital was awarded a ‘Met with Merit’ rating for NSQHC Standard 8 — Preventing and Managing Pressure Injury.

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Question
What is the best available evidence regarding the effectiveness of doxycycline for healing chronic wounds?

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Abstract
Abstract
The type of dressing used to manage split-thickness skin graft (SSG) donor sites is variable, with limited evidence on the most effective dressing to use. We conducted a prospective randomised controlled trial comparing the effectiveness of calcium alginate and retention dressing (calcium alginate+Fixomull®) to Fixomull alone for the management of these wounds. Outcome measures included the proportion of healed donor sites, participant reports of pain and number of dressing changes.
A total of 56 elective surgical patients with skin graft donor sites were randomised. By day 15, significantly more participants treated with Fixomull alone had achieved 100% epithelialisation compared with those treated with calcium alginate+Fixomull (82% v 56%, p=0.04). Differences in mean pain scores between treatment groups were not discernible at day five clinic assessments. By day 15, Fixomull dressings were associated with less pain during the day (p=0.02) and during dressing changes (p=0.04). Participants who received Fixomull alone required significantly fewer dressing changes (p=0.009).
Retention dressings provide a simple, comfortable dressing that achieves acceptable time to healing for SSG donor site wounds. The popularity of retention dressings for the management of these wounds appears to be supported by our findings in respect to time to healing and comfort.

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Question
What is the best available evidence regarding the effectiveness of tea tree oil preparations used for managing wounds?

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Abstract
The extracellular matrix (ECM) provides a framework for cells and gives skin its tensile strength and elasticity. Loss of its integrity necessitates the clearing of damaged components and the deposition of firstly a provisional matrix and later remodelling of the ECM to support a functionally intact tissue. Matrix metalloproteinases (MMPs) are an important family of enzymes that function in the breakdown of the ECM and modulate the function of many biologically active molecules housed in the ECM. Through their enzymatic actions MMPs play a role in fundamental processes such as immune cell infiltration and ECM remodelling during wound repair. Their tight control is necessary for timely wound healing and excessive MMP activity participates in the development and persistence of chronic wounds, while reduced activity contributes to fibrosis. A number of inhibitors have been designed to target this activity and improve wound healing with limited success. Novel strategies are currently being investigated to improve wound healing by targeting MMP modulating molecules.

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Abstract
Infected wounds remain one of the greatest challenges in medicine. In recent years there have been vast advances in the development of topical antiseptics for wound healing. This is largely due to the increase in the resistance to antibiotics. Modern antiseptics such as a solution and gel containing Betaine and PHMB (Prontosan®) can be used as an alternative to antibiotic treatment and as an adjunct to antibiotics for systemic infections.

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Introduction
The concept of wound bed preparation (WBP) has evolved considerably since its formal inception. Several tools have been developed which encourage the process of WBP and wound healing, including TIME which was first introduced in 2003. The acronym TIME (tissue, infection, moisture, edge) remains at the forefront of chronic wound management 10 years on. The tool identifies elements for optimal WBP in order to provide coordinated management of a chronic wound to achieve effective healing.

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Question
What is the best available evidence regarding the use of wet-to- dry saline moistened gauze for debridement of wounds?