In the community setting, leg ulcer management involves both care of the wound itself and the skin of the lower limb. Cleansing is vital to enure that infection does not develop in the wound itself and that the integrity of the periwound skin is maintained. Maintaining the skin’s barrier function is also vital, as, without this, fluid loss, inflammation, dryness and infection can develop. Wound exudate can also act as an irritant to healthy skin, particularly when permitted to accumulate under wound dressings. Keeping the skin clean and free of debris, alongside more frequent dressing changes can help in the treatment of irritated skin. This article highlights the use of an innovative cleansing product (UCS; medi UK), which is designed as a premoistened cloth that safely and effciently cleanses the wound of slough and debris, while rehydrating periwound skin.
Wound fluid, or exudate, is a normal consequence of healing but physiological circumstances within the individual or their wound can arise, which lead to excessive wound fluid production. There is a risk of maceration and excoriation of surrounding skin, which can cause distress and impact on quality of life. Therefore robust assessment and nursing intervention can successfully manage exudate and facilitate improved wound healing.
Meningococcal disease is a contagious bacterial condition that can result in life-threatening sepsis as well as the development of extensive blistering and lesions. This article presents the topical management regimen for one young patient’s wound care in conjunction with the community and outpatient paediatric teams. Practical tips on how to manage complex wounds in children will be outlined to demonstrate that such cases can be managed effectively by nursing teams in a relaxed home environment and outpatient setting, preventing readmission and supporting the emotional recovery of the child and parents. The success of this case study and the reintegration of the child back into daily life and school was attributed to the joint working and collaboration between parents and child, and tissue viability, paediatric and community nursing teams.
There are a number of mechanisms at play that can delay wound healing. Wounds can become stuck in a prolonged inflammatory stage resulting in high volumes of wound exudate, which contains agents that contribute to delayed healing. Exudate plays an essential role in wound healing but at excessive volumes it can also facilitate biofilm formation, which can further delay healing. Maintaining optimum levels of exudate is vital for healthy wound healing, as is the prevention or disruption of biofilm formation in the wound bed. This article also looks at Sorbion Sachet S® (BSN medical), a triedandtested uperabsorbent dressing, which is now back on the Drug Tariff, but at a lower price. This article discusses the mechanisms used in the reintroduced superabsorbent dressing and how it provides a cost-effective solution to the problem of treating highly exuding chronic wounds where clinical efficacy and budgetary concerns are both top priorities.
Moisture-associated skin damage (MASD) results from an extended period of exposure to various types of moisture, commonly urine or faeces, sweat, and wound exudate1. It can result in extensive skin breakdown through erythema, maceration and eventually moisture lesions, with the most common presentations being incontinenceassociated dermatitis (IAD), intertriginous dermatitis, periwound moisture-associated dermatitis, and peristomal moisture-associated dermatitis1. MASD is not caused by moisture alone — other factors including friction, hygiene products, or microorganisms are usually involved1. MASD can be painful and effect the patient’s quality of life2, potentially resulting in moisture lesions if not properly managed.
Venous leg ulcers make up a considerable part of the community nurse’s workload and the gold standard treatment is multilayered compression bandaging applied to cleansed and debrided lower limbs. The author of this piece looks at the background to leg ulcer development; as well as how to assess patients and the principles of prevention. This article also examines the KTwo® bandaging system (Urgo Medical), which has a built-in pressure indicator to ensure that application is both consistent and effective. The make-up of the twolayer system makes it as effective as four-layer systems without the associated bulk, which means that patients find it easier to wear.
An optimal wound environment for promoting healing is dependent on maintaining moisture balance (i.e. an environment that is neither too wet, nor too dry). Practitioners need to understand what is normal and what is problematic exudate for wound healing, as well as the impact that wound fluid might be having on the patient’s quality of life. For example, if dressings chosen are unable to contain the volume being produced, this can lead to embarrassment and social isolation, as well as discomfort to the patient from wearing bulky dressings. Assessing and understanding the cause of excess exudate will help practitioners to develop goals with the patient and target treatments to achieve the best outcomes overall. This article examines what is meant by a moist wound healing environment and looks at one dressing range, Eclypse®, that has been found to contribute to moist wound healing and promote patient quality of life (Rafter et al, 2015).
Depending on the patient’s presenting factors, managing complex or ‘hard-to-heal’ wounds can be a significant challenge for the community nurse. Increased longevity, while a positive also means that people are surviving medical and surgical procedures which were life-threatening in the past, with a 20% reduction in avoidable deaths. The delivery of complex community wound care is not a new concept, however, it is dependent on a number of factors such as the expectations of commissioners, providers, and health and social care policymakers, as well as the patient and the skill of the clinicians performing the care. Financial cutbacks in the NHS have also had a negative impact on the delivery of some community healthcare services. This article investigates whether all of these factors have impacted on the amount of complex wounds now being managed in the community setting.
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.
Excessive exudate production interferes with wound healing and has a detrimental effect on patients’ quality of life. Exudate management is crucial as wounds need an optimum level of moisture so that they can heal. Superabsorbent dressings can handle extreme levels of exudate, prevent leakage and reduce the frequency of dressing changes, allowing people to live a more normal life unhindered by saturated dressings that constantly need to be changed. Community nurses will often need to treat chronic wounds and may consider using superabsorbent dressings. The article takes a look at Zetuvit® Plus (HARTMANN), a superabsorbent dressing that is used for superficial, heavily exuding acute or chronic wounds with the author examining its potential role as a wound care option in the community.
