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BACKGROUND: Exudate pooling is the collection of wound fluid in the wound bed. Wounds with irregular depth, pockets, or cavities can create a dead space between the dressing and the wound bed where exudate can accumulate. Exudate pooling could lead to increased risk of infection or biofilm formation, maceration of the periwound skin, and delayed wound healing. PURPOSE: This article aims to offer a simplified yet practical summary for the prevention and management of exudate pooling by using advanced wound dressings. METHODS: Following a review of published literature, consensus statements, and best practice guidelines, the authors put their learnings into practice by translating the findings into a practical guide for the prevention and management of exudate pooling. RESULTS: Nearly half (49.6%) of all wounds have depth beyond the epidermis (0.22 cm), a characteristic that increases the risk of exudate pooling. In addition, approximately 12% of chronic wounds are undermined by tunneling or cavities underneath the skin where exudate could pool. Appropriate dressing selection can help manage exudate and prevent exudate pooling. In particular, dressings that provide a moist environment, manage the dead space, and maintain close contact with the wound bed may help reduce the risks associated with exudate pooling. A practical guide is presented that could be used by nurses at all levels to help select appropriate dressings. CONCLUSION: This practical guide could help prevent and manage exudate pooling and associated risk factors.

Background The HIV epidemic in South Africa is among the largest in the world with a prevalence of 20% among adults. The South African National Strategic Plan recognizes the need to address social and structural barriers to HIV prevention, as well as sociocultural and behavioral drivers, including alcohol abuse. Alcohol venues (AVs) are important social venues, yet few studies have explored structural factors contributing to HIV risk. We sought to evaluate the relationship between structural characteristics of AVs and HIV status of patrons. Methods The study was conducted in rural Msinga, South Africa where, as part of a community-based approach, education, counseling and HIV testing was offered at a convenience sample of AVs. Nested within this study, staff completed a structural characteristic checklist of the AVs where testing occurred. Categorical analyses evaluated the association between structural characteristics and positive HIV results. Results Of the 488 individuals tested at 46 AVs, 43 (8.8%) were seropositive. The majority of AVs were rural (71.7%), along a gravel road (43.5%), un-registered (56.5%), informal (73.9%), lacked a liquor license (58.7%), were well-maintained (78.3%), single rooms (84.1%) with lighting (97.8%), make-shift seating (62.2%), and adjacent to outdoor space (65.8%). Sound systems (41%) and bathrooms (37%) were less common. Preventative health signage for under-age drinking (26%), smoking cessation (8.7%) and HIV prevention (2.2%) were rare. Several AVs employed women to work behind the bar; security guards and DJs were less common. Higher HIV prevalence was significantly associated with AVs that were well-maintained (p=0.008), in town (p=0.006) compared to remote, had an indoor toilet (p=0.004), discrete gender bathrooms compared to a single bathroom (p=0.003), and a security guard present (p=0.047). Conclusion Higher HIV prevalence was associated with certain structural characteristics of AVs. Further research is needed to understand social dynamics within AVs and how these structural characteristics facilitate risk behaviors to inform community-based interventions that can address HIV risk. Disclosures Sheela Shenoi, MD MPH, Merck: My spouse worked for Merck 1997-2007 and retains stock in his retirement account. There is no conflict with the work presented in the abstract.