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JULIE EVANS (TVN) Abertawe Bro Morgannwg University Health Board, Rehab Engineering Unit, Morriston Hospital, Swansea, UK. julie.evans2@abm-tr.wales.nhs.uk
Introduction: Patients may succumb to infections from a variety of ÂopportunisticÊ bacteria as a result
Table 1 -Sequence of intervention and associated wound response
of concurrent co-morbidities. The Centers for Disease Control and Prevention (CDC) Atlanta, USA Wound status at beginning of week
Swab culture
dressing
Antibiotic
state that MRSA causes more than 50% of all health-care associated staphylococcal infections. Costs Exudate not controlled. Peri-wound maceration, breakdown with proud wound for UK „nosocomial‰ infections may be as high as £1 billion per year. This case study highlights the bed, fragile easily bleeding tissue. Size, approx. 3cm diameter management of a longstanding, highly exuding, MRSA infected foot ulcer and demonstrates how Exudate not controlled. Peri-wound maceration, breakdown. appropriate intervention can lead to effective management of the bacterial load.
Exudate not controlled. Peri-wound maceration, surrounding Ag Fibrous absorbent dressing Rifampicin and cipro oxin Patient details: 92 year old registered blind female, chronic heart failure and reduced mobility.
Exudate not controlled. Peri-wound maceration with surrounding cellulitis. Admitted to orthopaedic trauma ward following fracture to left hip and subsequent surgical repair. Ulcer appeared over L. hallux soon after admission, possibly as a result of trauma combined with tissue Exudate controlled - no maceration, healthy granulation tissue. ischaemia. The left surgical hip wound also produced high levels of exudate which was managed with topical negative pressure (TNP) treatment. Healthy granulation tissue, wound exudate reduced. Healthy granulation, wound exudate - negligible. Wound assessment: At week 5 when referred to TVN - circular wound approx 2.5cm in diameter
located over L. hallux, with fragile, deep red granulation tissue that bled easily. Extensive peri-wound erythema extending approx. 3 cm to mid-foot and the adjoining digit was swollen, hot to touch and Little/no progress was achieved with antimicrobials (Ag dressings/systemic antibiotics), (Table 1). This painful. A variety of wound dressings used over weeks 1-5 had failed to prevent maceration and gradual was particularly disappointing as topical and concurrent systemic antimicrobial therapy should have breakdown of the peri wound area from the caustic effects of high levels of exudate production. yielded a positive response. It was decided to focus on managing the wound environment using an absorbent dressing that possesses Hydration Response Technology (HRT). Key components of HRT include its powerful osmotic pull whilst maintaining a moist wound healing environment. HRT has the An overview of intervention and wound response is presented in Table 1. It can be seen that wound ability to draw wound fluid into the dressing matrix (where the aqueous component is bound) together progress was not only stalled but that deterioration was evident. An increase in wound exudate pro- with the accompanying free floating bacteria. Prompt management of the high exudate volume and duction in conjunction with stalled healing is regarded as a clinical indicator of wound infection. Positive the associated bacterial load swiftly returned the wound bed to an environment conducive to healing. wound cultures for MRSA in conjunction with the increase in wound exudate lead to the conclusion Effcient management of exudate and bacterial load are key components of Wound Bed Preparation. that the wound was infected with MRSA.
The initial management strategy of using active mechanisms (antimicrobials) together with moderate absorbent capacity dressings had failed to manage the bioburden or the exudate volume. Using sorbion sachet S with HRT allowed this highly absorbent, non traumatic dressing to bind the exudate, sequester bacteria andmodulate protease activity whilst maintaining a moist wound environment. Apart from woundresolution the additional benefits were reduced costs and a vastly improved quality of life for the patient.
While this is a single case study the question is posed as to the perceived need for widespread antimicrobial use. Further studies are welcomed.

Source: http://www.hrhealthcare.co.uk/downloads/sorbion/hrsc018.pdf

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