Best practice wound management. Liz Milner Wound Consultant

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1 Best practice wound management Liz Milner Wound Consultant

2 The goals of wound care: reducing risks that inhibit wound healing, enhancing the healing process, and lowering the incidence of wound infections.

3 Reduction in wound area as a predictor Reduction in wound week 2 and 4 is a good predictor of the ability to heal by week 12 Venous leg ulcers a 20-40% reduction in wound area within 2 to 4 weeks Diabetic foot ulcer a reduction of >50% by week 4 of healing

4 Wounds UK wounds-uk.com Clinical Psychosocial Poor tissue perfusion/hypoxia Effects if pain, e.g. sleep disturbances Necrotic tissue Effects of odour, e.g. social isolation High bacterial load/infection Reduced motivation with treatment Oedema Lack of education and support Copious exudate/maceration Inability to self care Skin problems, e.g. eczema, hypersensitivities Altered mood, e.g. apathy/depression Malnutrition/dehydration Systemic conditions Barriers to healing Educational Traditional knowledge/ritualistic practice Inappropriate training and support Lack of understanding of research process Poor quality research Lack of critical appraisal skills Negative attitudes to evidence-based practice Information overload Professional /organisational Lack of consensus; expert opinion Inconsistent research findings No standardisation of accepted practice Interprofessional rivalry Lack of effective clinical role models Instability of health services Lack of resources Lack of focus on wound management

5 PRINCIPLES OF WOUND MANAGEMENT Understand Cause Aetiology acute / chronic wound History, examination, investigations, referrals Diagnosis! Heal Prevent / Maintain Palliative ongoing care Focus on Person with wound Identify / Rx Factors effecting healing Assess - Identify Short / Long Term Goals, Expected Outcomes Plan Care, * Implement,* Evaluate Outcomes Product selection / interventions based on skin / wound needs W.White 05

6 Their Journey Aims of Care Expected Outcome Healing Maintenance Palliation Our role is crucial: Identifying needs addressing Person / wound / skin

7 So why does an acute wound lead to a chronic ulcer? Many factors e.g. impaired oxygenation, malnutrition, non-adherence to care partnership Infection, increase in protease activity; decreased growth factor activity.

8 So why don t wounds heal? Has it got something to do with excess protease activity! It is difficult to assess the level of proteases in wound beds Research show a consistent trend of low levels in acute wounds and high levels in stalled wounds

9 The use of a point-of-care diagnostic test Principles for protease activity Treat the underlying cause and any factors that may aggravate the wound e.g. compression, pressure relief, correct ischemia etc Optimise the wound bed and patient condition Modulate protease activity, e.g. Proteasemodulating dressings

10 Reducing excess protease activity Cleansing: regular wound cleansing Debridement: remove slough at each dressing change reducing bacterial load that may acts as an inflammatory stimuli Protease inactivators: to bind and inactivate MMPs and elastase Antiseptic dressings: ( Iodine or silver) a reduction in bacterial levels may reduce protease activity by reducing the host and bacterial protease production

11 Reducing excess protease activity Anti-inflammatories: oral or topical doxycycline is a potent anti-inflammatory and antimicrobial. Steroid therapy has an anti-inflammatory effect by up-regulating the anti-inflammatory proteins and down-regulating the pro-inflammatory proteins Dressings and devices: that absorb/remove wound exudate: absorbant dressings and materials may reduce protease activity by removing proteasecontaining wound fluid. An effect of Negative pressure wound therapy may reduce protease activity

12 Ideal best practice guidelines Patient-centred wound care, Reflects increasing awareness and interest among practitioners in the social impact of living with a chronic wound. Patients are now more knowledgeable about treatment options and are increasingly becoming involved as active members of the wound-management team. Practitioners need to keep themselves up to date on new technologies and techniques in wound healing.

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