Choosing the correct dressing is often key to moving a wound along the healing trajectory, with its ability to deal with problems such as pain, excess exudate production and inflammation being crucial to the healing outcome. Infection is also a serious problem in many wounds and this article looks at the basics of wound infection as well as some of the main treatments, such as topical antimicrobials. However, clinicians are faced with a huge range of wound care products, many of which have antimicrobial properties. This article considers the use of one gelling fibrous silver dressing (Durafiber® Ag; Smith and Nephew), which is specifically designed to deal with many of the problems mentioned above, particularly excess exudate production and infection. The authors also presents the results of a small, prospective multicentre case series that was carried out to assess the efficacy of Durafiber Ag in a variety of wounds.
Community nurses require a wide skill set to deal with the variety of clinical presentations they meet in any given day. This includes wound care, which can present nurses with a range of management challenges, i.e. how to combat infection, which kind of dressings to use to control exudate volume and how to ensure that dressings provide patient comfort and do not further damage the wound or skin on removal. It is important, therefore, that community nurses have access to a range of versatile products that can be used in a variety of clinical situations and which are also cost-effective. This article examines some of the common wound care issues that community nurses can face, as well as looking at how a versatile wound dressing (Durafiber® Ag; Smith & Nephew) — which has a variety of applications in primary care — can help with some of these issues.
Many community nurses will have encountered atopic eczema, a widespread skin condition resulting in itchy, red, dry and cracked skin and which has a serious effect on patients’ quality of life. When atopic eczema becomes infected with Staphylococcus aureus, however, these symptoms can intensify, resulting in outbreaks of folliculitis and widespread infected eczematous lesions. These can be painful and distressing and community nurses need to be aware of the symptoms and treatments in order to deal with the problem themselves or refer on. This article looks at the background to infected atopic eczema as well as the main treatments, including oral antibiotics, antiseptics, combination topical therapies and good hygiene.
The government's policy of moving care closer to home means that not only will community nurses continue to see patients with chronic wounds such as leg ulcers, pressure ulcers and diabetic foot ulcers, they may also start to see an increase in the numbers of patients who have been discharged from hospital with surgical wounds, who might previously have stayed in secondary care for a longer period. It is imperative that community nurses tasked with visiting a range of patients in their own homes have an understanding of the fundamentals of wound development and management to provide basic evidence-based wound care. This article looks at some of those fundamentals, including debridement, dressing application and removal, wound cleansing, infection, and the effects of comorbidities on the wound.
Maureen Benbow discusses the complex problem of dealing with MRSA in the community.
Erica Denton discusses the importance of good oral hygiene care and palliative care of patients.
Lynfa Edwards gives a brief overview of the use of silver and iodine to reduce bacteria in wounds.
Lynfa M. Edwards, MSc, RGN, NDN, Cert Ed, is a Senior Lecturer/Practitioner, Centre for Research and Implementation of Clinical Practice, Wolfson Institute of Health Sciences, Thames Valley University, London.
Article accepted for publication February 2001.
Kate Carter overviews the management and treatment of pilonidal sinus disease. Kate Carter BSc Hons, RGN, Trainee Nurse Practitioner, Tooting NHS Walk-In Centre, London. Article accepted for publication: May 2003
Dr Kate Springett discusses the reasons why all practitioners have a responsibility for caring for the 'at risk' foot - and gives a few pointers on how this should be done.
Dr Kate Springett, Senior Lecturer, MSc Podiatry Course Leader, School of Health Professions, University of Brighton. Article accepted for publication: September 2003
Carl Hanson discusses the importance of good oral hygiene care and palliative care of patients. Carl Hanson is a Head and Neck Macmillan Nurse at Queen Elizabeth Hospital, Birmingham Article accepted for publication: January 2004
