GENERAL PURPOSE:To provide information on risk factors for surgical site infections (SSIs) and actions to mitigate that risk.
TARGET AUDIENCE:This continuing education activity is intended for ...surgeons, surgical teams, physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.
LEARNING OBJECTIVES/OUTCOMES:After participating in this educational activity, the participant should be better able to:1. Identify modifiable risk factors associated with the development of SSIs.2. Select steps to mitigate the risks for and morbidity from SSIs.
ABSTRACTGiven the current reimbursement structure, the avoidance of a surgical site infection (SSI) is crucial. Although many risk factors are associated with the formation of an SSI, a proactive and interprofessional approach can help modify some factors. Postoperative strategies also can be applied to help prevent an SSI. If an SSI becomes a chronic wound, there are recommended guidelines and strategies that can foster healing.
ABSTRACTPressure injuries/ulcers are a global health issue, and there is a need for clinicians from many countries and continents to express their opinions on the terminology change (pressure ulcer ...to injury) and revised staging definitions. A convenience, opinion survey sample of clinicians from the Western Asia Gulf Region enrolled in a yearlong wound care course participated by expressing their opinion about these changes. Results reveal support for the pressure injury terminology and the revised staging definitions.
OBJECTIVE:To determine the opinions of healthcare clinicians in the Philippines regarding the 2016 National Pressure Ulcer Advisory Panel (NPUAP) terminology changes and revised staging definitions.
...DESIGN AND SETTING:A survey methodology was used in Manila, Philippines. Convenience samples of healthcare clinicians of varying disciplines and employment settings were invited to participate in this research.
INTERVENTIONS:A survey was administered at key intervals regarding the revised NPUAP terminology changes and revised staging definitions. The survey was administered before and after an interactive, basic 2-day wound course was conducted.
MAIN RESULTS:Results revealed strong support for the 2016 NPUAP terminology change from pressure ulcer to pressure injury and the revised staging definitions.
CONCLUSIONS:Since the NPUAP changed its terminology and revised the staging definitions, the wound care community has been responding to those changes. Because pressure injuries are a global health concern, the opinions of clinicians outside the United States are equally valuable. The healthcare clinicians in the Philippines surveyed appear to embrace the new terminology changes and revised staging definitions put forth by the NPUAP.
Objective
Hospital-acquired pressure injuries harm over 2.5 million patients at a U.S. cost of $26.8 billion. Sub-epidermal moisture scanning technology supports clinicians to anatomically identify ...locations at-risk of developing hospital-acquired pressure injuries. Our objective was to evaluate the cost-effectiveness of adopting sub-epidermal moisture scanners in comparison to existing hospital-acquired pressure injury prevention guidelines structured around subjective risk assessments.
Methods
A Markov cohort model was developed to analyze the cost-effectiveness of sub-epidermal moisture scanners in comparison to existing prevention guidelines, based on current clinical trial data from the U.S. health care sector perspective in the acute, acute rehabilitation and skilled nursing facility settings. A hypothetical cohort was simulated over a time horizon of one year. An incremental cost-effectiveness ratio was measured using U.S. dollars per quality-adjusted life year at a willingness-to-pay threshold of $100,000/quality-adjusted life year, and uncertainty was tested using probabilistic sensitivity analysis.
Results
Integration of sub-epidermal moisture scanners yielded cost-savings of $4054 and 0.35 quality-adjusted life years gained per acute care admission, suggesting that sub-epidermal moisture scanners are a dominant strategy compared to standard care and producing a net monetary benefit of $39,335. For every 1000 admissions in high-risk acute care, sub-epidermal moisture scanners could avert around seven hospital-acquired pressure injury-related deaths and decrease hospital-acquired pressure injury-related re-hospitalization by approximately 206 bed-days.
Conclusions
Acute care, acute rehabilitation and skilled nursing settings that adopt sub-epidermal moisture technology could achieve a return on investment in less than one year. Providers may want to consider these types of technology that aid clinical judgment with objective measures of risk in quality improvement bundles.
Ask a WCET nurse!: Wound dressing selection Barbara Delmore; Barbara Suggs
World Council of Enterostomal Therapists journal,
10/2012, Letnik:
32, Številka:
4
Journal Article
Ask a WCET Nurse Barbara Delmore; Barbara Suggs
World Council of Enterostomal Therapists journal,
04/2011, Letnik:
31, Številka:
2
Journal Article
Recenzirano
I am a nurse in the home care setting. I recently admitted a new patient to my caseload who has adenocarcinoma of unknown primary with invasion into the pelvic bone. She has been treated with ...chemotherapy. As I was doing my assessment, the husband of the patient showed me the patient's left groin that has a raised, smooth, hard nodule with a purplish red discolouration; there is also yellow slough in the wound (Figure 1). The wound measures 4 cm (l) x 6 cm (w). The surrounding tissue was intact and did not show any signs of infection. Her left leg appears oedematous as compared to her right leg. She has severe pain, but it is hard to discern if it is more 'bone' pain rather than from her left groin. The husband also showed me an old gauze dressing that he had just removed before I came, which had a moderate amount of serosanguinous drainage with a mild odour. The area itself appears to be intact except for an opening at 9 o'clock within this area that has a small amount of yellow slough. Upon further questioning, the patient's husband said that this was an old biopsy site that he thought was infected based on his observation of the drainage and odour. However, this area seems to me to be an evolving wound. Have you seen anything like this? If so, how would you address treating and healing this wound?
Pressure ulcer prevention program: a journey Delmore, Barbara; Lebovits, Sarah; Baldock, Philip ...
Journal of wound, ostomy, and continence nursing,
2011 Sep-Oct, Letnik:
38, Številka:
5
Journal Article
Recenzirano
The Centers for Medicare & Medicaid Services' regulations regarding nonpayment for hospital-acquired conditions such as pressure ulcers have prompted a marked increase in focus on preventive care. ...Our hospital also used this change in payment policy as an opportunity to strengthen our pressure ulcer prevention practices. We used an 8-spoke prevention wheel to develop and implement practice changes that reduced pressure ulcer incidence from 7.3% to 1.3% in 3 years. Because it is about the journey, we will describe the mechanisms we designed and implemented, and identify strategies that worked or did not work as we promulgated a quality improvement process for pressure ulcer prevention in our large urban hospital center.
Ask a WCET Nurse! Faecal Incontinence Barbara Delmore; Barbara Suggs
World Council of Enterostomal Therapists journal,
01/2011, Letnik:
31, Številka:
1
Journal Article
Recenzirano
Answers to several questions related to faecal incontinence are answered by a WCET nurse. One of the questions asked involves what signs and symptoms should one look for that can lead to pressure ...ulcer formation and how to successfully manage these ulcers.
