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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.

Holly Hovan's picture
neuropathy testing for sensory perception (Braden Scale)

By Holly M. Hovan, MSN, GERO-BC, APRN, CWOCN-AP

As wound care professionals, the Braden Scale for Predicting Pressure Sore Risk® is near and dear to our hearts. With that in mind, our evidence-based tool needs to be used correctly to yield accurate results. Working with long-term care and geriatric populations opens up a world of multiple pre-existing comorbidities and risk factors that aren’t always explicitly written into the Braden Scale categories. Additionally, the frequency of Braden Scale use may contribute to a multitude of different scores. The resident behaves differently on different shifts, for example, being asleep on the night shift but up and about on days. What is the correct way to score these patients? I believe that a less frequent Braden Scale assessment yields more accurate results. However, we should still complete a Braden Scale on admission, during transfer, when receiving, and most importantly, with any change in condition.

WoundSource Practice Accelerator's picture

Prevention and management of biofilm and infection in wounds can be supported by using antimicrobial and antibiofilm dressings. Internationally, there has been a rising prevalence of antibiotic-resistant organisms; this has resulted in increased incorporation of antimicrobial dressings in wound management. These dressings offer many advantages because they are easy to use, are readily available, have a decreased risk of resistance, and deliver sustained release of antimicrobial agents to the wound bed. This mode of action allows for a lower concentration of the agent and thereby lowers the possibility of toxicity to host cells.

WoundSource Practice Accelerator's picture

Bioburden: Bioburden is the number of microorganisms in a wound, and a high bioburden can cause delayed wound healing.

Biofilm: Biofilms are usually composed of mixed strains of bacteria, fungi, yeasts, algae, microbes, and other cellular debris that adhere to the wound surface.

Epibole: Epibole refers to rolled or curled-under closed wound edges. These rolled edges are thickened epidermis that may be callused, dry, scaly, and/or hyperkeratotic. When epibole is present in a wound, it signals to the body that the wound has healed, even though the wound remains open. Epibole must be resolved to allow the wound to close.

WoundSource Practice Accelerator's picture

Delayed wound healing occurs in various wound types and in patients with significant comorbidities. Hard-to-heal wounds have proven to be a challenging and worldwide crisis resulting in high financial burdens.

WoundSource Practice Accelerator's picture

Biofilms are found in the majority of chronic wounds and pose a critical health threat, causing nearly 80% of refractory nosocomial infections. They also have a damaging virulence mechanism, which induces resistance to antimicrobials and evasion from the host’s immune system. Over 90% of chronic wounds contain bacteria and fungi living within a biofilm construct. Biofilms have been reported as major contributing factors to a multitude of chronic inflammatory diseases. Given the resistance of the bacteria, biofilms increase the risk of infection and cost the health care system millions of dollars annually. Clinicians should have practical knowledge of the role and impact that biofilms play in impeding chronic wounds, thus leading to risks of complications such as infection.

WoundSource Practice Accelerator's picture

Wound debridement is a critical strategy in treating hard-to-heal wounds. It is a process that expedites healing by removing necrotic tissue, non-viable tissue, and foreign material. It can also be used to manage biofilm to prevent infection. Debriding a wound exposes the healthy underlying tissue to promote healing. There are several methods of debridement. Determining the best option will depend on the health care setting as well as the characteristics of the wound being treated.

Diane Krasner's picture
wound care documentation

By Diane L. Krasner, PhD, RN, FAAN

Scope of Practice and Standards of Practice guide nurses and other members of the interprofessional wound care team in caring for patients with wounds. Documentation in the medical record is a key aspect of the standard of practice and serves to record the care delivered to the patient or resident. Your documentation should follow your facility guideline for documentation. Accurate documentation helps to improve patient safety, outcomes, and quality of care.

This WoundSource Trending Topic blog considers general wound documentation dos and don'ts and presents 10 tips for success. Good, better, and best documentation examples are included for each tip.

Temple University School of Podiatric Medicine's picture
Keywords: 

By Temple University School of Podiatric Medicine Journal Review Club

One of the most severe complications of the diabetic foot is diabetic osteomyelitis. The diagnosis of diabetic foot osteomyelitis requires clinical suspicion of infection, and an associated soft tissue infection only increases the likelihood of confirming diabetic foot osteomyelitis. That said, there are still challenges in the diagnosis of osteomyelitis, such as a bone infection without the clinical manifestations of infection. This occurs in approximately half of all hard-to-heal osteomyelitis cases. Currently, the tests used to confirm a diagnosis of diabetic foot osteomyelitis include a probe-to-bone test, radiography, magnetic resonance imaging (MRI), and bone biopsy. Laboratory tests are also used to confirm the diagnosis of diabetic foot osteomyelitis, with the most important biomarker being erythrocyte sedimentation rate (ESR).