The human and economic burden of chronic wounds is increasing (Sen et al, 2009). In the United Kingdom alone, it is estimated that over 2.2 million wounds were treated by the National Health Service in 2012/13, at a cost of between £4.5 and £5.1 billion (Guest et al, 2015). Choice of wound dressing is therefore an important factor, not only in terms of comfort for the patient, but also in optimising clinical efficiency and thereby minimising treatment time and cost.
Wound debridement and wound cleansing are considered an important part of wound management (Strohal et al, 2013). Selection of the correct cleansing or debridement method should be following comprehensive wound assessment to guide decision-making regarding appropriate cost-effective treatment. This second part in our clinical skills series discusses wound cleansing and debridement methods commonly available in primary care and their importance in wound bed preparation.
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.
Chronic oedema is a major clinical problem worldwide (Moffatt et al, 2019a). The condition has many important secondary consequences for health, activity and participation (Moffatt et al, 2017). Its prevalence also has a significant association with the presence of a wound (Moffatt et al, 2019b). There are many challenges to managing patients in this group, which can lead to ineffective and inappropriate care and have a significant impact on patient quality of life (Green and Meskell, 2016). This article discusses some of these challenges and the impact which they may have on patients and healthcare professionals caring for them.
Surgical site infections (SSIs) are the most common type of nosocomial infection, accounting for up to 20% of all hospitalacquired infections in Europe (European Centre for Disease Prevention and Control [ECDPC], 2013). There are varying SSI rates reported across the UK. In 2016, Public Health Wales reported an overall 14-day SSI rate for women undergoing caesarean section of 4.35% — 83% of which were superficial infections and 92.5% were detected after discharge (PHW, 2016). From 2015–2016, Aneurin Bevan University Health Board (ABUHB) services experienced an increase in the SSI rate for women birthing by caesarean section from 3.07% to 5.86% respectively. Therefore, a multifaceted approach to quality improvement (ABUHB organisational method) was adopted throughout the duration of 2017, with a view to implement by 2018. The aim was to reduce SSIs for women birthing by caesarean section in ABUHB. Interventions included the use of evidence-based practice and guidelines, education and engagement among clinicians, patients and staff, and the gradual implementation of Leukomed® Sorbact® (Essity) post-operative dressings.
The recent pandemic has highlighted the impact of social isolation on health. District and community nurses are in daily contact with vulnerable, elderly clients for whom the norm is a world with little social contact. This compounds the health inequalities affecting this population. District and community nurses require support to meet the psychological and social needs of these clients. In order to improve the health of older people with long-term conditions, joint action between agencies, voluntary groups and charities is imperative. Inclusive and creative evidence-based interventions could be the public health solution to the emerging crisis in the psychological health of elderly clients with chronic conditions.
There are a number of eye diseases that increase in prevalence in older age, all of which affect vision to varying degrees. Impaired vision can impact significantly on an older person’s quality of life and ability to live independently. This article addresses the most common eye diseases seen in older adults. It discusses risk factors, signs, symptoms as well as treatment and management, with the aim of providing an overview for nurses, thus increasing knowledge, understanding and confidence in this area.
