Infection Resources

Pressure ulcers are often preventable and highlight the broader challenges of maintaining high standards of care, especially in vulnerable patient populations, such as those with psychiatric conditions. This article highlights the difficulties pressure ulcers pose for healthcare organisations, healthcare professionals and patients, while also exploring strategies to address these challenges in clinical practice.

Over 124,000 people in the UK have long-term indwelling catheters (Gage et, al, 2017; Nazarko, 2017). Indwelling urinary catheters increase the risks of infection and ill health (Feneley et al, 2015; Public Health England [PHE], 2016). They can leak, block and management can be burdensome for the person with the catheter, caregivers and health service (Cottenden et al, 2013). This article updates readers on how to reduce the risks of infection, leakage and catheter blockage, and how to manage these problems when they occur.

Selection of the most appropriate wound dressing is vital for promoting effective wound healing. With the vast number of options of wound dressings currently available, healthcare professionals may find it confusing to select the most appropriate dressing (World Union of Wound Healing Societies [WUWHS], 2020a). This article discusses the importance of wound assessment, focusing on identifying goals of treatment and the selection of an appropriate dressing to manage any identified barriers to healing. In turn, this will help community nurses provide person-centred care that promotes healing and improves overall patient wellbeing.

Wound healing is complex and there are many factors that can interfere with the normal healing process, which can result in an acute wound becoming a chronic, non-healing one. Cigarette smoking is frequently listed as one of the factors which can interfere with wound healing. However, it is one of the potentially modifiable lifestyle behaviours that can reduce the risk of developing a nonhealing wound (Ellis, 2018). Although the precise mechanisms as to how smoking delays healing are currently not clear (Sorensen et al, 2010a, b; Sorensen, 2012), this paper explores the literature on how smoking interferes with the wound healing process at a pathophysiological level, together with how it may be responsible for increased infection rates and delayed healing. In addition, it also discusses how smoking can contribute to infection and wound dehiscence in surgical wounds and delay healing in chronic wounds, resulting in a prolonged recovery time for the patient.

Active diabetic foot disease relates to problems associated with peripheral arterial disease (PAD), infection and/or neuropathy. Diabetes still remains one of the main causes of non-traumatic limb amputation and premature death, both of which may be preventable (Prompers et al, 2007; National Institute for Health and Care Excellence [NICE], 2019). The purpose of this article is to discuss three of the clinical emergencies seen in the diabetic foot, namely PAD, infection and Charcot neuro-osteoarthropathy (Charcot foot). The aim is to provide a refresher of diabetes and the associated complications and to enhance knowledge and clinical skills in the management of diabetic foot disease. A case report is used to provide narrative to the potential complexity seen within the process.

Dehisced surgical wounds are a common occurrence and are seen both in primary and secondary care. The impact of a dehisced wound is far reaching. For the National Health Service, there are increased in-patient costs and additional resources in terms of an extended healing time, such as staffing and dressing materials and therapies. For the patient, a dehisced wound can impact significantly on their wellbeing and quality of life and for patients of working age, the economic impact of not being able to work can be enormous. This article discusses the incidence of wound dehiscence, outlines the types of wounds which are most likely to dehisce, and the most common reason for this, wound infection. Strategies for managing wound infection, including the use of antiseptic and antimicrobial products, together with a frequently used therapy, topical negative pressure therapy (TNPT), are also discussed.

The National Catheter Education Programme is a Health Education England-funded initiative to improve the care of patients with catheters. Part of this initiative is the Secret Life of Catheters programme. This article highlights the need for improvement in catheter care and explains the development of this project, which aims to drive improvements across primary and secondary settings through the large-scale delivery of a multiprofessional educational programme in catheter care. The programme explores key dilemmas that district nurses, community nurses, healthcare assistants and doctors can encounter with catheters, and provides approaches to address them. By standardising the teaching of clinical concepts and practice strategies, it is hoped that variations in practice and pockets of misunderstanding can be eliminated.

The specialty of wound care is one that has expanded exponentially in modern times with a plethora of theories and technologies, including wound bed preparation, the role of proteases, negative pressure wound therapy (NPWT), and an almost bewildering array of dressing formulations, from antimicrobials to larval-based products. However, for the clinician on the ground who may not have time to appraise all the theory — or indeed afford all of the new technologies — there is still a high premium placed on having a range of wound care dressings that can be used on a variety of wounds, are simple to use, patientfriendly, and, increasingly important in this day and age, cost-effective (Chandan et al, 2009). In a follow-up to a previous article (Morgan, 2015), this piece looks at one particular dressing (Actilite Protect®; Advancis Medical) and reviews the latest in a series of case studies that show how it can be effective in a range of wounds, in particular infected wounds, due to its innovative use of honey.

Pilonidal sinus is a benign disease that involves a sinus in the natal cleft. This condition mostly affects the young and the resulting wounds can be extremely painful and debilitating. For symptomatic pilonidal disease, treatment may involve surgical intervention such as incision and drainage. The management of pilonidal wounds can be challenging, but with a systematic approach to wound care that involves patients in their own care to help prevent infection and recurrence of this painful disorder, positive results can be achieved. Treatment should not prevent patients from returning to the normal activities of daily living (both social and work-related), and nurses should aim to achieve this as quickly as possible. Psychological care is just as essential as nursing care when managing this disease. This article provides an overview of pilonidal sinuses for community nurses as well as focusing on one dressing which is designed to cope with them, in particular, the excess exudate that can be produced (Exufiber®; Mölnlycke Health Care).