Wound Care Resources

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.

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.

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).

With the plethora of wound contact dressings available and the demand for their use in clinical practice, clinicians need to keep abreast of what is new on the market to ensure that they provide their patients with the best treatment options, while also considering the costs involved. Preventing pain to the patient, trauma to the wound or periwound skin, and infection, are key considerations for clinicians at dressing changes (Hollinworth, 2001). With advances in wound care technology, patients should not experience pain due to adherent products causing trauma to the wound and/or ‘skin stripping’. The use of silicone dressings can help to prevent such occurrences from happening and thus promote patient wellbeing and quality of life (Upton, 2011; Yarwood-Ross, 2013). This article looks at the role of primary wound contact layers in wound management, and introduces a new silicone dressing with case reports demonstrating its positive effects in clinical practice.