Practice Accelerator

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Antimicrobial Resistance: The process that occurs when bacteria, fungi, and parasites (microorganisms) change over time and no longer respond to antimicrobial medications. This resistance makes it more difficult to treat infections and increases the risk of spreading diseases that result in severe illness and death.

Antibiotic Resistant: Organisms that have the ability to alter themselves genetically so that antibiotics do not have an inhibitory or lethal effect on them, thus allowing continued proliferation.

Antiseptic: Any chemical agent preventing or inhibiting microorganism growth.

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The incorporation of silver into wound dressings has been a breakthrough to combat the effects of antibiotic resistance, despite silver safety concerns. Regardless of its recent popularity, silver is not a new tool in health care.

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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.

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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.

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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.

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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.

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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.

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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?

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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.

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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.

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