Super Bugs vs Super Heroes: A Wound Care Perspective

Transcription

1 Super Bugs vs Super Heroes: A Wound Care Perspective IPAC GTA Annual Education Day October 3 rd 2017 Zaynab Sheraly RN, BScN, MHSC, IIWCC Nicholas Joachimides RN, BScN, CRN(c), IIWCC, MClSc, MSc

2 This document was produced by its author and/or organization. PHO did not produce this document and is not responsible for the information provided within this document.

3 Table work On your tables you have a wound care question, as a group please discuss your thoughts. We ll discuss the answers as a large group. 5 Minutes to discuss

4 Super Wound healing Is wound contraction a reliable parameter in wound healing?

5 Practice Pearl In wound healing, we observe that the contraction of the wound causes significant reduction in the size of the wound. On the basis of this, some researchers have suggested that the agent/drugs which causes faster/significant wound contraction are good wound healing agents. Chronic wounds are often recalcitrant to healing, and they may not follow the expected trajectory that estimates a wound should be 30% smaller (surface area) at week 4 to heal in 12 weeks. Ref: Wound Bed Preparation Dr. Sibbald et.al. 2011

6 Super on Infections What is wound contamination, colonization, critical colonization and systemic infection?

7 Super Definitions Term Contamination Definition Microbial Attachment with no proliferation of microorganisms Colonization Proliferation on the wound bed at a non- critical level with no clinical host reaction no inflammation. No intervention Critical Colonization Bacterial are dividing. Release of bacterial toxins invade wound surface. Increased variety of bacteria present. Biofilm may be present. Impairment to healing. Clinical signs of infection may not be obvious or are subtle. Systemic Infection Local or systemic host reaction, Impairment to healing, invasion of surrounding tissue. Usually obvious clinical signs of infection. May have systemic signs.

8 Super Bugs Question of the day What are superbugs and why are they becoming more prevalent?

9 Super Bugs Practice pearls Frequent use of Antibiotics & Genetic Mutation Do not treat contamination and colonization with antibiotics. ( Ref: Best practice centers of disease control) Reduce person to person contact Hand Hygiene Many people may carry MRSA, VRE (vancomycinresistant Enterococci) or an ESBL(extended spectrum beta lactamases) and not know Do not always make you sick but can spread to others who can get sick

10 SUPERHERO Swab Technique Can swab technique lead to misleading results?

11 Practice Points Yes swab technique can impact results of a wound swab. Common practice misconceptions: a) Swab the wound before cleaning it - Ask wound experts in your hospital how wounds are being cleaned (I always look for half-used single use saline bottles and 3mL respiratory bottles yikes!!!!) b) Found a hunk of yellow/greenish discharge and placed it in the specimen container c) I made sure to swab the entire wound, even the skin around it if its infected we ll know!

12 SUPERHERO Measurements Can inaccurate wound measurements be mistaken for wound infection?

13 Practice Points Inaccurate or inconsistent measurements can be misleading, and cause confusion Connect with your wound care expert/champion and discuss how wounds are measured (using a standardized approach) Inaccuracies in wound measurements over time can be perceived as failure to heal or progress Creating an accurate wound management record can go along way!

14 SUPERHERO Odour!!!! When and how do we assess for odour in a wound?

15 Practice Points Malodour is a classic sign of infection However odour should be assessed after we clean a wound (remember the cleaning technique) Do not smell the old dressing (how good did you want it smell?) Consider other factors like where the wound is located (for example foot wounds may also smell like sweaty feet, bums may well smell like bums!)

16 References Bates-Jensen BM, Ovington LG. Management of exudate and infection. In: Sussman C, Bates-Jensen B. Wound Care: A collaborative practice manual for health professionals. 3rd Ed. Baltimore, Williams & Wilkins, 2007: Bowler PG. The 105 bacterial growth guideline: reassessing its clinical relevance in wound healing. Ostomy/Wound Management. 1994;40(8): Robson MC. Wound infection: a failure of wound healing caused by an imbalance of bacteria. Surgical Clinics of North America. 1997;77(3): Sapico FL, Ginunas VJ, Thornhill-Hyones M, et al. Quantitative microbiology of pressure sores in different stages of healing. Diagn Biol Infect Dis. 1986;5: Bergstrom N, Bennett MA, Carlson CE, et al. Treatment of pressure ulcers. Clinical Practice Guideline No. 15. Agency for Health Care Research and Quality (AHRQ), formerly known as the Agency for Health Care Policy and Research (AHCPR) Publication No Rockville, MD: AHRQ, U.S. Public Health Service, U.S. Department of Health and Human Services (DHHS); December 1994: Rudensky B, Lipschits M., Isaacsohn M, Sonnenblick M. Infected pressure sores: comparison of methods for bacterial identification. Southern Medical Journal. 1992;85(9): Slater RA, Lazarovitch T, Boldur I et al. Swab cultures accurately identify bacterial pathogens in diabetic foot wounds not involving bone. Diabetic Medicine. 2004;21(7): Stotts NA. Determination of bacterial burden in wounds. Adv Wound Care. 1995;8: Harding K, Queen D (eds). Wound infection in clinical practice: an international consensus. International Wound Journal. 2008;5(3): Wood GL, Gutierrez Y. Diagnostic Pathology of Infectious Diseases. Philadelphia: Lea & Febiger, Dow G, Browne A, Sibbald RG. Infection in chronic wounds: controversies in diagnosis and treatment. Ostomy Wound Management. 1999;45: Saye DE. Recurring and antimicrobial resistant infections: considering the potential role of biofilms in clinical practice. Ostomy Wound Management. 2007;53(4): Gilman G, ed. Topical agents for open wounds: Antibacterials, antiseptics, antifungals. Reviewed by Rodeheaver G, Cooper JW, Nelson DR, Meehan M. Charleston, SC: Hill-Rom International, Barr JE. Principles of wound cleansing. Ostomy/Wound Management. 1995;41(Suppl 7A): McMullen D. Topical metronidazole, art II. Ostomy/Wound Management. 1992;38(3): Keast D and Lindholm C. Ensuring that the correct antimicrobial dressing is selected. Wounds International. 2012;3(3):22-28.