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7TH
EPUAP OPEN MEETING, TAMPERE, FINLAND
Pressure Ulcer Prevention and Management, Poster Abstracts, September
2003
(continued from Volume 5, Issue 3, 2003)
THE EFFICACY
OF COLLAGENASE IN THE MANAGEMENT OF WOUNDS OF PATIENTS IN A HOSPITAL SETTING
C. Triller, MD, Z. Parac MD, Assist. Prof. D. Smrke, MD, PhD,
Department of General Surgery, University Clinical Centre, Ljubljana,
Slovenia
Introduction:
Wound Bed preparation (WBP) is aimed at promoting closure by preparing
the wound bed. Debridement is an important part of WBP. The purpose of
this study was to evaluate clinical efficacy of collagenase* and its handling
properties in the management of various wounds, treated in a clinical
setting. Enzymatic debridement with collagenase is shown to be easy, selective,
without causing bleeding, pain and damaging healthy skin.
Methods:
Dressing changes took place once per day, depending on the amount of exudate
and condition of the wound a secondary dressing was chosen according to
the discretion of the clinician. Data was collected by means of a questionnaire,
looking at among others, clinical efficacy of collagenase e.g. time to
complete debridement, aetiology –, size/depth of the wound, evolution
of the condition of the wound bed, exudate production, pain, dressing
comfort, handling of the dressing regime. The trial continued until complete
debridement was achieved, the wound had closed, the patient was withdrawn,
or an adverse incident was reported.
Results:
N = 30 wounds were included in the evaluation. Upon initial the total
mean wound size was 12 x 8 cm, mean wound depth was 0.8 cm. At the end
of the study the total mean wound size was 8 x 5 cm, mean wound depth
was 0.1 cm. Upon initial the total percentage of black necrotic tissue
present was 70%, the percentage of sloughy tissue present was 20%. At
the end of the study the amount of black necrotic tissue present was reduced
to 20% and the amount of sloughy tissue present was 5%. The average time
to complete debridement for the evaluated wounds was seven days, with
a range of ±3 days. Collagenase was easy to apply and to remove
and the patients reported no – or little pain upon dressing application,
wearing the dressing and dressing removal.
Conclusion:
Collagenase was demonstrated to support the removal of non viable tissue
in patients with wounds treated in a clinical setting, the product was
well tolerated by the patients and easy to handle for the clinicians.
* Iruxol is a product of Smith & Nephew Medical Ltd
CUSHIONING
EFFECTS OF WOUND DRESSINGS: NEW FINDINGS
S M Adams, FIMLS, B Griffiths, BSc, MSc, PhD, MRSC, LTi, S
M Bishop, BSc, C.Biol, M.I.Biol
Wound Healing Research Institute, ConvaTec Global Development Centre,
Deeside, UK
Pressure ulcers/sores
on the body are caused by consistent pressure application by opposing
surfaces over the skin covering bony prominences, resulting in reduced
blood flow, soft tissue necrosis and consequent ulcer development. These
wounds are known to particularly affect certain patient groups, such as
elderly, immobile or diabetic patients.
In order to better assess the cushioning effects of wound dressings, a
laboratory-based pressure monitoring model has been developed and employed
to study the cushioning-effect applied by hydrated dressings in vitro.
This test has been designed to closely mimic the clinical situation.
Whilst much previous research has focussed on pressure relieving devices
and mattresses, relatively little work has been presented on the effect
of wound dressings on interface pressure. The presented pressure mapping
data demonstrates differences in cushioning effectiveness between wound
dressing types. The data also demonstrates how cushioning effectiveness
can be altered by increased exudate absorption over a dressing’s
wear time. Previous thinking on the cushioning effects of foam dressings
is reviewed.
Reference:
Gray, D., Treatment of a heel pressure sore; a case study, Nursing
and Residential Care, Vol 2 (12), November 2000.
RANDOMIZED
CLINICAL TRIAL COMPARING THE EFFECT OF A SILVER CHARCOAL DRESSING (Actisorb
+ 25)1 IN THE MANAGE-MENT OF BACTERIAL LOAD IN PRESSURE ULCERS WITHOUT
SIGNS OF CLINICAL INFECTION, VERSUS CLEANSING AND DEBRIDEMENT RECOMMENDATIONS
OF THE AMERICAN AGENCY FOR HEALTH CARE POLICY RESEARCH CLINICAL PRACTICE
GUIDELINE ABOUT THE TREATEMENT OF PRESSURE ULCERS.
Joan-Enric Torra i Bou, Javier Soldevilla Agreda, Justo Rueda López,
Fernando Martínez Cuervo, José Verdú Soriano and
María Antonia Morera i Pomarede.
Unitat Interdisciplinària de Ferides Cròniques, Consorci
Sanitari de Terrassa and Grupo Nacional para el Estudio y Asesoramiento
en Ulceras por Presion y Heridas Crónicas (Spanish Pressure Ulcers
and Chronic Wounds Advisory Panel). Joan-Enric Torra i Bou. Unitat Interdisciplinària
de Ferides Cròniques, Consorci Sanitari de Terrassa. Hospital de
Terrassa, Ctra Torrebonica s/n, 08227 Terrassa, Barcelona, Spain. jtorra@readysoft.es
and jtorra@csdt.es
Introduction:
According with the recommendations of the American Agency for Health Care
Policy Research Clinical Practice Guideline about the Treatment of Pressure
Ulcers (1994), adequate cleansing and debridement prevents bacterial colonisation
from proceeding to the point of clinical infection. Current knowledge
and available resources have changed since 1994, as the role of bacterial
load instead besides local infection has been correlated with wound healing
delay; another fact is the development of silver dressings with the capacity
of managing bacterial load
Patients and methods:
We designed a randomized clinical trial in which we included stage III
and IV pressure ulcers without clinical signs of infection which were
randomly assigned to two arms of treatment:
- Cleansing and debridement
+ moist environment dressings (hydrogel and/or polymeric foam) in a
period of two weeks
- Cleansing and
debridement + a charcoal dressing (Actisorb+ 25) + moist environment
dressings (hydrogel and/or polymeric foam) in a period of two weeks.
Simultaneous swab
and aspiration cultures were done at day 0 and day 14. In a subgroup of
patients we did another culture at day 28, in this case ulcers from group
case or control were treated this two weeks only with adequate cleansing
and debridement .
Actisorb is an antimicrobial carchoal dressing containing silver firmly
bound to carbon fibres. Clinical signs of infection were established according
with a tool developed by the Gerontogical Nursing Intervention Center
of the University of Iowa College of Nursing.2 We considered a positive
bacterial load managing when bacterial levels were equal or less than
base readings.
Results:
We have included 99 pressure ulcers, 46 in the Actisorb group and 53 in
the control group. A subgroup of eighteen pressure ulcers (six in the
intervention group and twelve in the control one) were sampled at week
4.
Results in all the pressure ulcers included in the survey:
| |
Group Actisorb |
Group Control |
|
Positive Bacterial
load
managing at 2 weeks |
36
(78.3%) |
32
(60.4%) |
P:
0.056 |
Positive Bacterial
load
managing at 4 weeks |
5
(83.3%) |
2
(16.7%) |
P:
0.06 |
Twenty pressure ulcers
included in our survey were infected according to quantitative bacterial
data) although they did not present signs of clinical infection when included
in the survey. A subgroup of six infected pressure ulcers (two in the
intervention group and four in the control one) were sampled at week 4.
Results in the pressure ulcers with infection included in the survey:
| |
Group Actisorb |
Group Control |
|
Positive Bacterial
load
managing at 2 weeks |
8
(88.9%) |
2
(22.2%) |
P:
0.002 |
Positive Bacterial
load
managing at 4 weeks |
2
(100%) |
0 |
|
Discussion:
The systematic use of Actisorb in a period of two weeks of cleansing and
debridement is much effective than the recommendation of adequate cleansing
and debridement in order to manage bacterial load in pressure ulcers.
Two weeks after the intervention, pressure ulcers treated with Actisorb
remain with a better level of bacterial load management.
Our research suggest us several questions about the accuracy of clinical
signs and symptoms of localized infection in chronic wounds as we found
about 20% of pressure ulcers infected. Further research in this area is
essential for a deep understanding of this concepts in pressure ulcers.
Although the goal of our trial was not initially to test the effectivity
of the treatment of infection, our results suggest that the use of Actisorb
in the management of bacterial load in infected wounds is much better
than the recommendation of providing and adequate cleansing and debridement
before considering the use of topical antibiotics.
According to our results the use of Actisorb is better option for the
management of bacterial load as well for the treatment of infected pressure
ulcers than the traditional recommendation of cleansing and debriding
before the use of topical antibiotics. This fact is very important under
the point of view of cost/effectiveness of the treatment of pressure ulcers
as well as in the way for a rational use of antibiotics.
References:
1. Actisorb, Johnson & Johnson
2. Gradner SE, Frantz RA, Troia C, Esatman S, MacDonald M, Buresh K, Healy
D. A tool to assess clinical signs and symptoms of localized infection
in chronic wounds: Development and reliability. Ostomy W Manag 2001; 47(1):
40–47
This research has been done with an unrestricted research grant from
Johnson & Johnson, Spain.
RANDOMIZED
CLINICAL TRIAL ABOUT THE SYSTEMATIC USE OF MEPENTOL®, A TOPICAL PRODUCT
OF HYPEROXIGENATED FAT ACIDS AND HERBAL EXTRACTS, IN THE PREVENTION OF
PRESSURE ULCERS IN HEELS
Joan-Enric Torra i Bou, Joao Gouveira, Cristina Gouveira, Katia
Furtado, Teresa Segovia and Justo Rueda López
Joan-Enric Torra i Bou. Unitat Interdisciplinària de Ferides Cròniques,
Consorci Sanitari de Terrassa. Hospital de Terrassa, Ctra Torrebonica
s/n, 08227 Terrassa, Barcelona, Spain. jtorra@readysoft.es and jtorra@csdt.es
Introduction:
Pressure ulcers (PU) are the result of the effect in capillary circulation
of the compression made by a force that affect the tissues between the
skin and a body prominence. This compression forces may affect tissues
in three ways, damage in skin due to mechanical forces, damage in skin
tissues due to reperfusion injuries and damage in the skin due to necrotic
processes. Hyper-oxygenated fatty acids (HFA) are a topical product useful
in the prevention of PU and in the treatment of stage I PU as they have
effect in the improvement of local microcirculation as well as in barrier
properties of the skin.
Subject and method:
We have designed a randomized clinical trial in order to test the effectivity
of the systematic application of Mepentol®, an hyper-oxygenated fatty
acids solution with Equisetum arvense and Hypericum perforatum in the
prevention of pressure ulcers in patients at medium to high risk of pressure
ulcers in two nursing homes, Centro de Saude da Pampilhosa da Serra and
Santa Casa da Misericordia, Pampilhosa da Serra (Portugal). One-hundred
patients will be included in two arms of
intervention:
- Conventional measures
for preventing pressure ulcers defined in the protocol of two nursing
homes (control)
- The same measures
as control group plus the use of Mepentol applied in the heels twice
a day (case)
Patients will be treated
in a period of six weeks. Incidence of pressure ulcers according with
GNEAUPP, NPUAP and EPUAP guidelines will be used as main outcome measurement
in conjuntion with a range of heel skin characteristics.
Preliminary results:
We have now included 29 patients, 16 in the Mepentol group and 13 in the
control one. We hope to have the 50 + 50 patients included at the end
of June. The incidence of pressure ulcers in the Mepentol group is zero
while the incidence in the case group is 23.1 % (P = 0,042)
Preliminary discussion:
Our preliminary results are in accordance with the experimental and clinical
evidences about the effectivity of Mepentol in the prevention of pressure
ulcers and the treatment of Stage I pressure ulcers. Mepentol is an easy
to use and cost/effective measure for the prevention of pressure ulcers
in patients at risk of developing pressure ulcers.
This research has been done with an unrestricted research
grant from Laboratorios Bama Geve.
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