WoundSource Practice Accelerator's blog

As a cost-effective alternative to topical antibiotics, silver is now widely available in wound dressings. However, what does silver really do within the wound bed? Silver uses a multifaceted approach to combating infection that attacks bacteria internally.

Silver has become one of the most commonly used alternatives to topical antibiotics in recent years because of the growing concern over antibiotic resistance. Silver offers a multifaceted antimicrobial approach that makes it less likely for resistance to develop. With its limited and uncommon cytotoxicity, silver can be used to treat infected wounds over time and prevent further complications.

Before the discovery of penicillin in 1928, silver was the primary antimicrobial agent available. Now, as antibiotic resistance plagues the health care field, silver has new value for wound care. Additionally, silver has demonstrated limited cytotoxicity when used topically, thus making it a suitable alternative to antibiotics.

Here’s a question for you: How long does it take for a pressure injury (PI) to form? Do you think it happens in 30 minutes? 2 hours? 8 hours? The answer is actually all of the above. The time it takes for a PI to develop depends on a number of different factors, which we will discuss here.

Erythema: A result of injury or irritation that causes dilation of blood capillaries and manifests as patchy reddening of the skin. Occurs after a patient/resident is exposed to unrelieved pressure for 2 hours. It can be identified as a deep, localized redness; can also be blue or purple.

Hyperemia: The condition of having excess blood in vessels that supply an organ or area of the body. Occurs after patient/resident is exposed to 30 minutes of unrelieved pressure. It can be identified as a localized, non-blanchable redness.

Perfusion: The passage of blood through arteries and capillaries into tissues or organs. When insufficient, there is an increased chance that the patient may have complications.

Do you remember that cartoon from the 1960s (and later reproduced in the 1980s), The Jetsons? It was about a futuristic family that had all kinds of amazing robot helpers and automatic appliances. Rosie the Robot was the wonderbot that would whisk about the house, frantically preforming housekeeping duties, monitoring the security of the home, and generally making sure that everything was online and functioning. Do you ever feel like this as a clinician?

In the last 2 years, hospitals and skilled nursing facilities have seen unprecedented surges in admissions attributed to the COVID-19 pandemic sweeping across the world. Just in the United States, we saw a high of 116,243 weekly hospital admissions in mid-January of 2021. This dropped to a low of 13, 424 in mid-June of 2021 and then bumped up again to 86,871 in August of 2021.¹ With this fluctuation of numbers, along with staffing shortages and burnout, wound care professionals have seen significant overcrowding in many hospitals and facilities.

A nurse recently shared some of her experiences as a charge nurse in a skilled facility during the COVID-19 pandemic. She worked evenings (3-11:30 pm) at a local facility and was overwhelmed by the high number of patients she was responsible for. She typically worked on a 26-bed floor with just one nurse assistant for the shift. She later transferred to the night shift, where she was the only person on a 16-bed unit for the 8 hours. When asked how she was able to reposition patients as frequently as was recommended, the nurse said that she did “the best I could.” She is, unfortunately, not alone.

Advanced therapeutic devices in wound care can be among your greatest tools for encouraging wound closure. However, it can be disappointing when you may have an advanced modality in mind, but it is denied by the patient’s insurance plan. Or it is simply too expensive to have the patient pay out of pocket. One type of healing device that has a tremendous positive impact on wound healing is negative pressure wound therapy (NPWT). If it is not reimbursed properly, however, the patient may be looking at a shocking expense of thousands of dollars. What’s a wound care clinician to do? Having a few knowledge tools in your pocket may help you to navigate some of the complexities of ordering an NPWT system.

When working with a person who has been living with a chronic wound, it can be frustrating to try to figure out why the wound isn’t closing as the wound healing model would predict. Not all patients follow the “traditional” timeline. The wound may not progress neatly through the four phases of wound healing as expected. There may be an underlying issue that is preventing the wound from healing. How, as clinicians, can we address this? Can we actually expect closure of this wound based on the specific patient’s condition, or should we consider a palliative approach?