CHRONIC WOUNDS Providing Efficient and Effective Treatment Barbara Acello, MS, RN CHRONIC WOUNDS Providing Efficient and Effective Treatment Barbara Acello, MS, RN Chronic Wounds: Providing Efficient and Effective Treatment is published by HCPro, Inc. Copyright © Barbara Acello, MS, RN All rights reserved. Printed in the United States of America. 5 4 3 2 1 Download the additional materials of this book XJUIUIFQVSDIBTFPGUIJTQSPEVDU ISBN: 978-1-60146-940-3 No part of this publication may be reproduced, in any form or by any means, without prior written consent of HCPro, Inc., or the Copyright Clearance Center (978-750-8400). Please notify us immediately if you have received an unauthorized copy. HCPro, Inc., provides information resources for the healthcare industry. HCPro, Inc., is not affiliated in any way with The Joint Commission, which owns the JCAHO and Joint Commission trademarks. Barbara Acello, MS, RN, Author Casey Pickering, Editor Adrienne Trivers, Product Manager Erin Callahan, Senior Director, Content Mike Mirabello, Production Specialist Matt Sharpe, Senior Manager of Production Shane Katz, Art Director Jean St. Pierre, Vice President, Operations and Customer Relations Advice given is general. Readers should consult professional counsel for specific legal, ethical, or clinical questions. Arrangements can be made for quantity discounts. For more information, contact: HCPro, Inc. 75 Sylvan Street, Suite A-101 Danvers, MA 01923 Telephone: 800-650-6787 or 781-639-1872 Fax: 800-639-8511 Email: [email protected] Visit HCPro online at: www.hcpro.com and www.hcmarketplace.com 10/2013 22052 Table of Contents Introduction ............................................................................................................................... vii Chapter 1: Overview of Wounds ..................................................................................................1 Acute Wounds ................................................................................................................................................................1 Chronic Wounds .............................................................................................................................................................1 Pressure Ulcers ..............................................................................................................................................................3 NPUAP Stages and Definitions .........................................................................................................................................3 Reverse Staging (Backstaging) .........................................................................................................................................8 The Kennedy Terminal Ulcer ............................................................................................................................................8 Lower-Extremity Ulcers ...................................................................................................................................................9 Wound Healing ............................................................................................................................................................. 10 Wound Infection ............................................................................................................................................................ 11 Chapter 2: Wound Infection, Colonization, Classification of Pathogens .................................. 15 Wound Colonization ...................................................................................................................................................... 15 NERDS .........................................................................................................................................................................20 Wound Infection ............................................................................................................................................................20 Wound Pain Related to Infection .....................................................................................................................................26 Nonhealing Wounds ......................................................................................................................................................29 Ostetomyelitis ...............................................................................................................................................................29 Carbapenem-Resistant Enterobacteriaceae (CRE) ...........................................................................................................31 Chronic Wounds: Providing Efficient and Effective Treatment iii Table of conTenTs Wound Culture ..............................................................................................................................................................32 Wound Bed Preparation .................................................................................................................................................35 Risk of Tetanus in Pressure Ulcers, Skin Tears, and Chronic Wounds ................................................................................38 Chapter 3: Introduction to Biofilms ...........................................................................................43 What Are Biofilms? .......................................................................................................................................................43 Biofilm Identification......................................................................................................................................................52 Wound Cultures ............................................................................................................................................................53 Biofilm Testing ..............................................................................................................................................................54 Biofilm Treatment ..........................................................................................................................................................55 Biocides .......................................................................................................................................................................60 Less Common Treatments .............................................................................................................................................61 Selecting a Treatment ...................................................................................................................................................63 Chapter 4: Using Topical Wound Care Products .......................................................................69 Why Use Topical Wound Care Products? ........................................................................................................................69 Topical Treatment .........................................................................................................................................................70 Definitions .................................................................................................................................................................... 74 Reasons for Using Topical Antimicrobial Products on Wounds ..........................................................................................75 Cleansing and Rinsing Wounds ......................................................................................................................................75 Cleansing Solutions .......................................................................................................................................................76 Selection of Gauze ........................................................................................................................................................80 Topical Wound Care Products ........................................................................................................................................80 Advantages and Disadvantages .....................................................................................................................................80 Selecting a Treatment ...................................................................................................................................................83 Dressings .....................................................................................................................................................................88 Hyperbaric Oxygen Therapy (HBOT) ...............................................................................................................................89 Ongoing Monitoring.......................................................................................................................................................90 Documentation .............................................................................................................................................................90 iv Chronic Wounds: Providing Efficient and Effective Treatment Table of conTenTs Chapter 5: The Clinical Use of Honey ........................................................................................95 History of Medicinal