Wound digest Wound digest
This digest summarises recent key papers published in the areas of pressure ulcers, skin integrity, venous leg ulcers and diabetic foot ulcers.
SELECTED PAPERS OF INTEREST 1. Prevention of tracheostomy-related pressure ulcers in children 2. Skin tear prevention and management among patients in the acute aged care and rehabilitation units in the Australian Capital Territory: a best practice implementation project
3. Randomized controlled trial comparing treatment outcome of two compression bandaging systems and standard care without compression in patients with venous leg ulcers
To compile the digest, a Medline search was performed for the three months ending in April 2012 using the search terms ‘pressure ulcers’, ‘skin integrity,’ ‘leg ulcers’ and ‘diabetic foot ulcers’. Papers have been chosen on the basis of their potential interest to practitioners involved in day-to-day wound care. The papers were rated according to readability, applicability to daily practice and novelty factor.
Pressure ulcers 1
Prevention of tracheostomy-related pressure ulcers in children
Readability Relevance to daily practice Novelty factor
n In this study, the intervention model used a rapid-cycle, Plan-Do-Study-Act (PDSA) framework for improvement research. All tracheostomy-dependent patients admitted to the 18-bed ventilator unit from July 2008 to December 2010 were included.
n Pressure ulcers are commonly acquired in paediatric institutions and they are a key indicator of the standard and effectiveness of care. The authors recognised a high rate of tracheostomy-related pressure ulcers (TRPUs) in their ventilator unit and instituted a quality improvement programme to develop and test potential interventions for TRPU prevention, condensed them into a clinical bundle, and then implemented the bundle into their standard practice.
n TRPU stage and description, the number of days each TRPU persisted, and bundle compliance were recorded in real time. All TRPUs were staged by a wound-care expert within 24 hours.
n The interventions incorporated into the TRPU- prevention bundle included frequent skin and device assessments, moisture-reducing device interface, and pressure-free device interface.
n There was a significant decrease in the rate of patients who developed a TRPU from 8.1% during
the preintervention period, to 2.6% during bundle development, to 0.3% after bundle implementation.
n There was a marked difference between standard and extended tracheostomy tubes in TRPU occurrence (3.4% vs 0%; P = .007) and days affected by a TRPU (5.2% vs 0.1%; P < .0001).
n Education and ongoing assessment of skin integrity and the use of devices that minimise pressure at the tracheostomy-skin interface effectively reduce TRPU even among a population of children at high risk. These interventions can be integrated into daily workflow and result in sustained effect.
Boesch RP, Myers C, Garrett T, Nie A, Thomas N, Chima A, McPhail GL, Ednick M, Rutter MJ, Dressman K. Prevention of tracheostomy-related pressure ulcers in
children.Pediatrics 2012; 129(3): 792–97.
Skin tears 2
Skin tear prevention and management in acute aged care and rehabilitation units
Readability Relevance to daily practice Novelty factor
n This project utilised a pre- and post-implementation audit design using the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice programmes. The project was conducted from June to November 2010 with the audits conducted in the acute aged care and rehabilitation units of two public hospitals in the
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