Canadian Association for Enterostomal Therapy Evidence-Based Recommendations for Conservative Sharp Wound Debridement

Abstract

The Canadian Association for Enterostomal Therapy Conservative sharp wound debridement evidence-based recommendations are a result of the decision and commitment to advance clinical nursing practice to improve the provision of care to patients via development of an open source guide. The recommendations were developed by a volunteer group of ET nurses who work in clinical practice, policy development, consultation, and education in wound care. The document was developed over the course of 2 years (2009-2011); it is a distillation of existing literature, guidelines, and expert opinion. The development and dissemination of the recommendations were sponsored by the Canadian Association for Enterostomal Therapy. These recommendations should be considered in the context of the organization or care setting as well as available resources and supports. Resources and supports take the form of access to emergency care, physicians and allied health care professionals, education, administrative support, funding, supplies, equipment, and policy. The recommendations should also be applied with consideration of the evolving evidence that will further define practices in Conservative Sharp Wound Debridement. Refer to the supplemental digital content associated with this article at (supplemental digital content 1, http://links.lww.com/JWOCN/A16) for the complete document.

Conservative Sharp Wound Debridement

“…2 Canadian provincial nursing licensing bodies do not consistently address CSWD in guidelines, policy, or position statements. Skip logic was used to eliminate those who had no experience in CSWD (n = 57), resulting in an interdisciplinary sample of 487 professionals.…”

“…Key areas of concern include variability in baseline wound knowledge and skills development in CSWD, as well as reports of lack of institutional policy. 2,6 Insisting on institutional policy to set practice standards and ensuring access to appropriate supplies can easily rectify the gaps in practice. [9][10][11] It is considered unacceptable to be self-taught 9 other nurses CSWD appears to be the most common form of skill development.…”

“…2 In a retrospective costeffectiveness analysis that included 176 community care clients with diabetic foot ulcers, CSWD was employed by enterostomal therapy (ET) nurses and RNs with advanced wound care knowledge and skills. 1 It is defi ned as removal of loose, devascularized tissue, callous or hyperkeratotic tissue with the aid of a scalpel, scissors, or curette above the level of viable tissue.…”

Sharp wound debridement: patient selection and perspectives

“…This article was published in the following Dove Press journal: Chronic Wound Care Management and Research CSWD is defined by the Canadian Association for Enterostomal Therapy (now Nurses Specialized in Wound, Ostomy and Continence Canada [NSWOCC]) as the removal of loose, devascularized tissue, callous or hyperkeratotic tissue with the aid of a scalpel, scissors, or curette above the level of viable tissue. 3 This skill requires clear direction within organizations as to who can perform therapeutically, ethically, safely, and within the scope of practice for their health profession, as determined by law. 4 Alexander Pope coined the phrase "fools rush in where angels fear to tread" in his Essay on Criticism in 1711.…”

“…A number of components of assessment are necessary to determine whether CSWD is appropriate for the patients. 3,20 1. Assess the wound using a validated wound assessment tool such as the Bates-Jensen Wound Assessment tool 21,22 and document the need and readiness of the wound to receive CSWD.…”