Wound healing progresses most rapidly in an environment that is clean, moist (but not wet), insulated, and protected from trauma and bacterial invasion. Selection of a dressing is based on specific wound characteristics: (1) the presence or absence of necrotic tissue, (2) bacterial load, (3) exudate volume, and (4) need for a bacterial barrier. Therefore, the optimal dressing should be able to control exudate without desiccating the wound surface; act as a bacterial barrier; allow atraumatic removal with no dressing left in the wound; and provide moisture vapor permeability sufficient to prevent overhydration of the wound and surrounding skin. There are a multitude of dressings on the market, and clinicians are frequently confused as to which type of dressing is the best for a particular wound. Effective dressing selection requires both accurate wound assessment and current knowledge of available dressings. The articles in the current supplement to the Journal of Wound, Ostomy and Continence Nursing review research about wound exudate management and the use of foam dressings.

Background: Surgical site infections (SSI) are a substantial concern for cesarean deliveries in which a surgical site complication is most unwelcome for a mother with a new infant. Steps taken pre-and post-operatively to reduce the number of complications may be of substantial benefit clinically, economically, and psychologically. Methods: A risk-based approach to incision management was developed and implemented for all cesarean deliveries at our institution. A number of incremental interventions for low-risk and high-risk patients including pre-operative skin preparations, standardized pre-and post-operative protocols, post-operative nanocrystalline silver antimicrobial barrier dressings, and incisional negative pressure wound therapy (NPWT) were implemented sequentially over a 5-y period. A systematic clinical chart review of 4,942 patients spanning all cesarean deliveries between 2007-2012 was performed to determine what effects the interventions had on the rate of SSI for cesarean deliveries. Results: The percentage of SSI was reduced from 2.13% (2007) to 0.10% (2012) (p < 0.0001). There were no substantial changes in the patient population risk factors over this time. As a result of the changes in incision management practice, a total of 92 cesarean post-operative SSIs were avoided: A total cost saving of nearly $5,000,000. Conclusion: Applying a clinical algorithm for assessing the risk of surgical site complication and making recommendations on pre-operative and post-operative incision management can result in a substantial and sustainable reduction in cesarean SSI.

Selecting the "ideal dressing" for a wound is based on considerations of specific factors, including presence of necrotic tissue, bacterial load, volume of exudate, and the need for a bacterial barrier. Many dressings are now available, including hydrocellular foam dressings, that possess multiple characteristics of the ideal dressing. This article reviews the performance of hydrocellular foam dressings in terms of pain control, epidermal stripping, leakage of wound fluid, ease of use, pressure reduction, and cost-effectiveness.

No abstract

ulcers and treatment negatively affect not only the physical, emotional and spiritual health of the patient, but also increase length of inpatient stay and costs. In compliance with the IHI Protecting 5 Million Lives campaign and the emphasis on wound care in 2008, BWMC tasked the Skin Care Committee to further improve prevention of pressure ulcers. The challenge was to decrease hospital acquired pressure ulcer development and to create user friendly screens and menus in the electronic record. Initially we explored ways to reduce the number of Stage I heel pressure ulcers by implementing a "Heels Up" Campaign. The next hurdle was to streamline the documentation. We explored a way to capture and take action in preventing ulcer development in patients at risk. Using a trigger Braden score of 18 or less, the CNS team developed an "APPLE" model that prompts the nursing team to implement preventative measures proactively. A red apple appears on the nursing task list when a Braden score of 18 or less is documented. This apple is a visual reminder to implement the nursing protocol for alteration in skin integrity. The campaign included a red apple pin to place on each name badge to further reinforce the reminder. Initial results and compliance with the improvements was demonstrated. The challenge is to assure that this improvement is sustained over time with the electronic screen changes and the visual prompts. By increasing the sensitivity of the Braden score from 16 to 18 as a trigger for action, we predict that the rate of hospital acquired pressure ulcers will decrease and remain low as we continue into our prevention efforts.STUDY AIM: The overall objective of this study is to determine the prevalence and nosocomial incidence of incontinence associated dermatitis (IAD) among long-term acute care (LTAC) patients. BACKGROUND AND SIGNIFICANCE: Recent literature suggests many reported Stage I and Stage II pressure ulcers actually may be attributable to IAD. In March 2005, a pilot prevalence study of IAD and perineal skin injury was performed in acute care facilities in the United States (Junkin, 2005; 2007). In this study, among patients with more than one perineal skin injury, IAD and pressure ulcers were the most frequent combination. To our knowledge, there are no published reports of IAD prevalence/incidence in the LTAC population. STUDY DESIGN: This was a cross sectional observational cohort study. Data was collected as a component of standard protocol skin inspections performed by the wound team at the LTAC. All data was collected within a 24-hour period from February 20-21, 2007. Data collection was observational and performed using a modified version of the data collection tool devel-oped by a company* that markets perineal skin care products. STUDY POPULATION: Ninety-six patients were present and eligible for data collection. Refusal to participate in the study or inability to gain consent for participation resulted in exclusion of 16 patients. Data was obtained from 80 participants. STUDY RESULTS: Data curren...