Wound, skin and support surface technology continue to grow and gain strength, bringing solutions to home health providers and offering better outcomes, less pain, increased skin integrity, odor control, decreased bioburden and overall more effective care. Keeping up with the latest trends is as easy as reading this article. Incorporating these novel tools can help build your business and set you apart from your competition, providing value and answering your customer?s toughest issues and needs.
The most versatile silver dressings are recommended since they are able to handle a variety of wounds and changing needs.
Silver dressings will continue to grow and gain strength, not just for the worst wounds and sites, but for safe, broad spectrum prophylaxis of infection and increased healing outcomes across the spectrum of wound care. Perhaps one of the safest and easiest ways for clinicians to combat bioburden (the total population of bacteria, fungus and viruses) within a wound is to utilize ionic silver. Look for dressings that deliver sustained release ionic silver over a period of time (three to seven days or longer). Since silver has little chance of developing clinically significant resistance, very limited sensitivity and is available over-the-counter (OTC), it makes a wonderful dressing for home care. It also allows for potentially less frequent home visits due to its ability to stay put and work effectively over several days. The most versatile silver dressings are recommended since they are able to handle a variety of wounds and changing needs. Dressings that perform double or triple duty are particularly popular with the home care clinician. Some worthy products include:
- Calcium Alginate/Carboxymethylcellulose Silver Combinations: Offer superior absorption of wound fluid while providing good wet strength and one piece removal in addition to sustained release of safe, ionic silver
- Silver Site Dressings: Provide protection from catheter related blood stream infections as well as those infections arising from other percutaneous tubes and openings such as chest tubes
- Silver Amorphous (literally “without form”) or Semi-Liquid Gel Silver: Great for dry wounds, to fill open spaces and to spread on other dressings for antimicrobial power
- Ionic Silver Powder: Sprinkled in difficult to reach spots or anywhere you want absorption and antimicrobial protection; a good choice to literally make any dressing a “silver” dressing
- Ultrasonic Debridement: A novel, virtually pain-free way to prepare the wound bed allowing the clinician to control the amplitude (and thus the level of pain experienced by the patient), therefore increasing the level of precision and having an antimicrobial effect sub-dermally to change the way bedside debridement is performed. This newly available device offers rapid results, safely and effectively, while providing exceptional granulation with minimal or no bleeding.
New innovations in wound odor control using cyclodextrin technology are taking the dressing market by storm. Most odors are lipophilic (oil loving). New dressings with cyclodextrins (same technology as in Febreze® by Proctor and Gamble) use a bucket-shaped conformation of the hydrated cyclodextrin molecule to irreversibly capture lipophilic odor molecules, which then neutralize the odor (see Figure 2). Cyclodextrins occur naturally and are proved safe to use in modern wound care. How do the latest odor elimination dressings compare to the older technology of charcoal-based dressings? Cyclodextrins work optimally in the presence of wound exudate and need the wound moisture to work effectively. Both moisture and serum proteins in the wound exudates stabilize the “bucket” shape of the cyclodextrin molecule, allowing more effective odor capture and neutralization. Charcoal activity decreases in the presence of wound exudates because serum proteins in the exudates deactivate in the presence of wound exudates. Additionally, cyclodextrins intrinsically have a longer active time of odor-absorbing function by nature of their material.
Palliative and pain reducing dressings that combine silicones for gentle, no-stick, pain-free dressing changes, as well as superabsorbent foam materials for greater fluid handling will continue to prosper in the market since quality of life is integral to wound care practice. And don?t forget about alcohol-free, non-stinging prep wipes to protect the fragile periwound skin from maceration and adhesive stripping.
Look forward to seeing more bioengineered “smart” dressings (such as bioengineered cellulose) that provide more than one function, offering care for a variety of wound needs.
Novel debriding systems: Polyacrylate debriding systems provide quick, simple, safe and pain-free debridment in a trouble-free, user-friendly dressing that provides 24-hour simultaneous rinsing and debriding. The dressing is activated by Ringer?s solution, the most perfect physiologic fluid, and is only changed once per day making it an ideal home care dressing, tended by clinical staff or taught to the family. Another plus is that this system is the only dressing that does not require wound cleansing. It provides constant cleansing of the wound bed, removing devitalized material and biofilm and debrides wounds at a mean rate of 38.11 percent per week — much faster than any enzymatic debriding ointment.
Just as we need good nutrition to survive, our skin can now be nourished from the outside in thanks to advanced skin care products. Skin care products containing specific, specially treated amino acids, antioxidants, MSM (methylsulfonylmethane), and vitamin co-factors can nourish and strengthen the skin, providing an insurance policy against skin breakdown and wounds. These products can not only improve the skin?s appearance and texture, but also help build collagen and develop the skin?s resistance to damage. These products additionally provide high-tech protection due to ingredients such as quality silicones, like dimethicone, zinc oxide, calamine and surfactant-free phospholipids cleansers that clean with derivatives of vegetable oil instead of harmful, drying detergents.
Support surfaces remain a pivotal piece of the wound care puzzle. Off-loading of high-pressure, bony prominences as well as the management of friction, shear, moisture and heat are basic to preventing and healing pressure ulcers as well as offering comfort and prevention of pulmonary issues. Versatility is the name of the game in specialty support surfaces. Products that are easy to incorporate in your practice setting, such as mattress overlays and mattress replacements; don?t require the bed frame to be moved; and offer low air loss and alternating pressure features provide the client with a variety of therapies to address all the intrinsic risk factors: pressure, shear, friction, heat and moisture. Some of these products also offer a bariatric or “no weight limit” alternative. Most wounds are best handled by a group 2 support surface that offers therapy such as low air loss. Prevention of pressure ulcers can be easily addressed by one of the cost-effective group 1 products, non-powered overlays or high-density foam mattress replacements.
Percival SL, Bowler PG, Russell D. Bacterial resistance to silver in wound care. Journal of Hospital Infections (2005) 60, 1-7.
Chakravarthy D, Fleck CA. Evaluation of two polysaccharide-silver based high absorbency wound dressings, poster presented at the Symposium on Advances in Skin and Wound Care, San Antonio, Texas, April 2006.
Castellano JJ, Mannari RJ, Payne WG, Robson MC. Comparison Evaluation of Silver Containing Antimicrobial Devices and Drugs, poster presented at the 20th Annual John A. Boswick Burn Conference, Maui, Hawaii, 2006.
Fleck CA. Beyond Band-Aids, Advance for Providers of Post-Acute Care, March/April 2006.
Fleck CA. Identifying and Fighting Odor in Wounds, Advances in Skin and Wound Care, June 2006.
Paustian C. Debridement rates with activated polyacrylate dressings. Ostomy Wound Management 2003; 49(Suppl 1):2.
Fleck CA and McCord D. The Dawn of Advanced Skin Care. Extended Care Product News;95 (5): 32, 34-39, September 2004.