Implementing a pressure ulcer prevention program and enhancing the role of the CWOCN: impact on outcomes.
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Hospitals in the US are increasingly concerned with the rising number of hospital-acquired pressure ulcers. To reduce its 2002-2003 average hospital-acquired pressure ulcer prevalence rate of 9.2%, a regional medical center in southeastern US initiated a process improvement and education program. Quarterly pressure ulcer prevalence studies were conducted and the Medical Intensive Care Unit was found to have the highest number of hospital-acquired pressure ulcers among the five units participating in the study. As part of a new Pressure Ulcer Strategic Plan, significant changes were made to the organizational infrastructure and processes, which included implementing the Braden Risk Scale Assessment Tool in place of the Norton Risk Scale, developing a pressure ulcer prevention protocol, creating Pressure Ulcer/Skin Tear Physician orders for nurses, establishing a Skin Resource Team, and providing additional education, training, and other relevant resources. Better appreciation for and enhanced utilization of Certified Wound Ostomy Continence Nurses were encouraged. New support surfaces were purchased. Implementing these changes resulted in a decrease in the quarterly hospital-acquired pressure ulcer prevalence in participating units, including the Medical Intensive Care Unit where rates dropped from a high of 29% to near 0%. Clinicians now approach pressure ulcers as preventable rather than inevitable and view Certified Wound Ostomy Continence Nurses as resources and clinical experts for prevention and treatment. Overall quality of care and financial resource utilization also have substantially improved. (+info)
Umbilical cord care: a pilot study comparing topical human milk, povidone-iodine, and dry care.
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OBJECTIVE: To compare the incidence of omphalitis among three groups, each using a different type of newborn cord care: povidone-iodine, dry care, and topical human milk. DESIGN: Case control. SETTING: A large urban university hospital in Turkey and participant homes after discharge. PARTICIPANTS: 150 healthy, full-term newborns and their mothers. INTERVENTIONS: Umbilical cord care consisted of one of three methods: topical application of povidone-iodine twice daily, topical application of mother's milk twice daily, or dry care (keeping the cord dry and clean). MAIN OUTCOME MEASURE: Outcome was measured in terms of the presence or absence of omphalitis and the number of days elapsed before cord separation. An ongoing questionnaire was administered by telephone every other day after the participants left the hospital. In addition to demographic information, the cord separation day and any signs of omphalitis were recorded in the questionnaire. RESULTS: There were no significant differences between the three groups in terms of omphalitis occurrence. Two cases of omphalitis were observed (one in the human milk group, one in the povidone-iodine group). Interestingly, babies in the dry care or topical human milk group had shorter cord separation times than those in the povidone-iodine group. CONCLUSION: The cultural practice of applying human milk to the umbilical cord stump appears to have no adverse effects and is associated with shorter cord separation times than are seen with the use of antiseptics. (+info)
Safety of neonatal skin cleansing in rural Nepal.
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OBJECTIVE: A high proportion of deaths during the neonatal period are attributed to infections. Neonatal skin plays an important role in protecting the newborn from invasive pathogens. In preparation for a study of newborn skin cleansing with chlorhexidine in Nepal, we evaluated the feasibility, acceptability, and safety of the newborn cleansing procedure. STUDY DESIGN/SETTING: Observational pilot study of full-body cleansing of newborns in rural Nepal. METHODS: Thirty two newborn infants were wiped with commercially available non-antiseptic baby wipes. Pre and post-procedure axillary temperatures were recorded to estimate the impact of cleansing on body temperature. Skin aggravation, residual moisture, removal of vernix, and maternal satisfaction were assessed qualitatively. RESULTS: Body temperature of newborns decreased an average of 0.40 C (95% CI: 0.31 to 0.49 C, p < 0.0001) during the procedure. There was no evidence of skin aggravation, injury or removal of vernix, and mothers expressed satisfaction with the procedure. The procedure was simple and project workers were easily trained. CONCLUSION: Care must be taken to promptly wrap infants after skin cleansing procedures as slight temperature decrease was noted after the procedure. These pilot data indicate, however, that gentle cleansing of newborn skin poses minimal risk to infants. This procedure is safe and appropriate precautions can be taken to deliver safe skin antisepsis with chlorhexidine to infants in the community. (+info)
Phenolic constituents of Malus doumeri var. formosana in the field of skin care.
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Plant phenolic compounds isolated from a 70% aqueous acetone extract of the leaves of Malus doumeri A. CHEV. var. formosana (KAWAK. & KOIDZ.) S. S. YING, a type of Taiwanese indigenous plant, were evaluated for potential application in the field of skin care. A phytochemical investigation of the active fractions resulted in the isolation of seven compounds of which the structures were identified by spectroscopic characterization. In the present study, the isolated phenolic compounds were evaluated for their free radical-scavenging activities against 1,1-diphenyl-2-picrylhydrazyl (DPPH) and the superoxide radicals, anti-elastase, and for their anti-matrix metalloproteinase-1 (MMP-1) activity in human skin fibroblast cells. Of these compounds, 3-hydroxyphloridzin (2), 3-hydroxyphloretin (6), and quercetin (7) exhibited the strongest DPPH and superoxide radical-scavenging activities. The IC50 values of these compounds were 9.2, 7.7, and 15.4 microM, respectively, for the DPPH radical, and 25.0, 19.6, and 42.6 microM, respectively, for the superoxide radical. 3-Hydroxyphloridzin (2) and 3-hydroxyphloretin (6) also showed xanthine oxidase inhibitory activity, with IC(50) values of 52.1 and 22.4 muM, respectively. In the test for elastase inhibitory activity, phloretin (5) and 3-hydroxyphloretin (6) were the most potent compounds. Phloretin (5), 3-hydroxyphloretin (6), and quercetin (7) showed better inhibition of MMP-1 production in fibroblast cells. To the best of our knowledge, this is the first time that the active phenolic compounds from M. doumeri var. formosana have been isolated, reported, and described. The above results suggest that the extract of M. doumeri var. formosana containing phenolic compounds could be suitable naturally occurring active constituents for use in anti-aging or cosmetic products. (+info)
Colocutaneous fistula management in a dehisced wound: a case study.
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A fistula is an abnormal opening between two or more organs or structures. Wound drainage containment is a key component of nonsurgical fistula management and may include pouches, skin barriers, transparent dressings, troughing procedures, saddle bagging, bridging, and condom and suction catheters used in combination with complex or routine pouching. Following extensive abdominal surgery, the wound of a 50-year-old woman dehisced and a colocutaneous fistula formed inside the wound. The wound containing the fistula, which was draining liquid stool, was too large for existing commercial pouching systems. When initial management efforts, including negative pressure wound therapy, failed to achieve containment goals, clinicians adapted the negative pressure wound therapy dressing to surround the fistula, which helped facilitate therapy while providing a platform for an ostomy appliance to contain the fistula drainage. The system was changed every 2 days until discharge. The wound and fistula management combination improved patient comfort and mobility, facilitated healing, and reduced patient dietary restrictions. (+info)
Using horsechestnut seed extract in the treatment of venous leg ulcers: a cost-benefit analysis.
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Venous leg ulcers affect approximately 0.6% of the western population, consuming millions of healthcare dollars every year. To determine whether an alternative venous ulcer treatment using horsechestnut seed extract-- Aesculus hippocastanum-- and conventional therapy involving dressings and compression was more cost-effective than using conventional therapy alone, a 12-week cost-benefit analysis of horsechestnut seed extract therapy was conducted. The study, using data from a 12-week prospective, randomized, placebo-controlled trial conducted in South Australia in 2002-2004, involved 54 patients with venous ulceration who received treatment through a large South Australian district nursing service. Taking into account the cost of horsechestnut seed extract, dressing materials, travel, staff salaries, and infrastructure for each patient, horsechestnut seed extract therapy combined with conventional therapy was found to be more cost-effective than conventional therapy alone with an average savings of AUD 95 in organizational costs and AUD 10 in dressing materials per patient. This study confirms that dressing change frequency has a significant impact on the total cost of wound care and suggests that district nursing service operation efficiency may be enhanced through the use of horsechestnut seed extract as a result of less frequent nursing visits. Further study of this treatment modality is warranted. (+info)
Managing ichthyosis: a case study.
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Ichthyoses-- rare, genetic, incurable dermatologic diseases characterized by dry, thickened, scaling skin-- affect more than 1 million Americans and can cause devastating disfigurement with numerous physical, social, and emotional consequences. Topical treatments typically focus on symptom management. A 44-year-old man presented with severe X-linked type ichthyosis. When his condition did not improve with the use of a variety of topical and systemic treatments, a once-a-day, over-the-counter skin care regimen consisting of a surfactant-free cleanser followed by the application of moisturizer containing amino acids, vitamins, antioxidants, and methylsulfonylmethane was prescribed. After 4 weeks of using this management regimen on a test area on his left arm, the skin was clear and discomfort and itching had subsided. Subsequent application of the skin care products on other affected areas also did not cause any adverse reactions and his skin continued to improve. Symptom resolution and patient satisfaction indicate the product line may be a viable consideration for use in patients with similarly compromised skin. (+info)
Managing a traumatic wound in a geriatric patient.
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Clinical management of a wound in a geriatric patient requires an understanding of age-related changes in the skin and the knowledge to make appropriate treatment choices. This case study describes clinical assessment and management of a traumatic hip wound in a 75-year-old patient. In addition to addressing his nutritional status by providing supplements, topical wound care preparations, including papain-urea and castor oil/balsam of Peru/trypsin, were used as a conservative approach to address debridement and periwound skin concerns. Extra vigilance is required to assess wounds in geriatric patients to determine proper wound treatment and achieve optimum results. Additional studies to evaluate optimal treatment strategies in the clinical management of traumatic wounds in the geriatric population are needed. (+info)