Risk Assessment and Prevention

Emily Greenstein's picture

By: Emily Greenstein, APRN, CNP, CWON, FACCWS

Being a wound care professional is often a lot like being a detective. You have to decide what caused the wound, what is contributing to its not healing and how you are going to get it to heal. I have decided to start a series of “cases” that are commonly overlooked or seen in the chronic wound care setting. The cases will focus on real-life scenarios—moisture-associated skin damage versus pressure injury, red leg syndrome versus venous stasis ulcer, how to identify pyoderma, and the importance of a moist wound healing environment. This series will also provide practical strategies for overcoming healing obstacles for slow, non-healing, and challenging wounds.

WoundSource Practice Accelerator's picture

Pressure injuries are among the most significant health and patient safety issues that health care facilities face daily. Aside from the strong impact on patients’ quality of life, they also have high costs of treatment, not just to the patient, but also to the health care industry. The Agency for Healthcare Research and Quality reported $20,900 to $151,700 per individual patient and pressure injury in health care costs. The prevalence of present-on-admission (POA) pressure injuries is 26.2% among those admitted to the hospital from a nursing home and 4.8% among those admitted from another living setting. Hospital-acquired pressure injuries (HAPIs) cost the US health care system $9.1 to $11.6 billion a year.

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The coronavirus disease 2019 (COVID-19) pandemic has forced health care professionals to take a closer look at the most effective and appropriate measures for pressure injury prevention. In 17% of all COVID-19 cases pneumonia secondary to acute respiratory distress syndrome is the most common complication; therefore, prone positioning is used as an adjuvant therapy. The prone position allows for dorsal lung region recruitment, end-expiratory lung volume increase, and alveolar shunt decrease. To be most effective, this position should be maintained for 10 to 12 hours, thereby increasing prolonged pressure on certain areas of the body. However, prone positioning should be supervised and monitored regularly by nursing staff experienced with this positioning technique.

Ivy Razmus's picture
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By Ivy Razmus, RN, PhD, CWOCN

The coronavirus disease 2019 (COVID-19) pandemic has left many people with free time on their hands as other activities are cut to avoid exposure to the virus. What if we used this time during the pandemic to strengthen screening for cancers? When later-stage cancers are discovered, patients often undergo surgery with open wounds, new stomas, and other risk factors for infection. These wounds may require wound vacuum devices, complex dressing changes, increased nursing time, and in some cases an increased length of hospital stay. After discharge, these patients often require care in a skilled nursing facility to help them transition to home care. Can we prevent ostomies and wounds by making screening more accessible? Further, the diagnosis of cancer can lead to hospitalization and an increased need for adjuvant therapy such as chemotherapy or radiation, which weakens the immune system.

Cathy Wogamon's picture

By Cathy Wogamon, DPN, MSN, FNP-BC, CWON

Communication issues have arisen in the wound care world while providing care during the coronavirus disease 2019 (COVID-19) pandemic. Many of our older adult patients may already have hearing issues and rely on reading lips, which is impossible with the recent advent of masking and face shields. In addition to the masks, it is often difficult for patients to differentiate who is who when we are all in full protective gear. How can we make communicating with our patients less difficult during these trying times? Here are a few suggestions:

WoundSource Practice Accelerator's picture
bioburden management

Surgical site infections (SSIs) are a risk for the more than 10 million patients who undergo inpatient surgical procedures every year in the United States. Between 300,000 and 500,000 Americans develop SSIs annually. SSIs are defined as infections related to an operative procedure that occur at or near the surgical incision within 30 days of the procedure, or within 90 days if prosthetic material is implanted.

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Preventing Cross-Contamination

Surgical site infections (SSIs) are wound infections that occur after invasive surgical procedures. Depending on the location of the wound and the level of post-operative care that the patient receives, the risk of developing an SSI can be as high as 20%,1 although across all patients undergoing inpatient procedures in the United States, the rate of SSI occurrence is between 2% and 4%.2

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Preventing Post-Operative Complications

Surgical complications impact many patients every year, and when post-operative complications occur, they can disrupt the normal healing cycle and introduce new challenges in patient care. It is estimated that between 3% and 27% of surgical patients have unforeseen complications related to their surgical event.1

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By the WoundSource Editors

Lower extremity wounds such as diabetic foot ulcers (DFUs), venous ulcers, and arterial ulcers have been linked to poor patient outcomes, such as patient mortality and recurrence of the wound. Although precise recurrence rates can be difficult to determine and can vary across different patient populations, we do know that the recurrence rates of lower extremity wounds are quite high.