Diagnosis and treatment impacts on wound care efficiency drivers: real-world analysis

Enhanced antibacterial activity of starch-alginate beads by a synergistic effect between Cu2+ and Zn2+ ions with a potential wound dressing application

The synthesis and characterization of starch/alginate composite beads, crosslinked with Cu2+, Zn2+, and Cu:Zn mixtures were investigated, focusing on their potential application in exudative wound dressings. Hydrogel beads were prepared using the external gelation method and then dried via freeze-drying to create cryogels and air-drying to create xerogels. Microstructural characterization was performed using SEM and EDS, showing the typical porous structure with a homogeneous distribution of cations across the beads. Unimetallic beads exhibited higher equilibrium water uptake compared to Cu:Zn bimetallic beads (500 % vs. 300 %). After the swelling study, the total amount of Cu2+ released was significantly below the maximum allowed level as a safeguard against copper toxicity. All beads demonstrated excellent antimicrobial activity against E. coli, S. aureus, and P. aeruginosa. Bimetallic materials, particularly cryogels with equal or greater amount of zinc relative to copper, were particularly effective against P. aeruginosa. Hence, the synthesized bimetallic starch-alginate materials presented superior water absorption capacity and significantly enhanced antibacterial response compared to unimetallic beads, due to the synergistic effect between Cu2+ and Zn2+ ions, making then suitable for use in exudative wound dressings.

Performance of a silicone foam dressing in management of wounds in a community setting: a sub-analysis of the VIPES study

OBJECTIVE

Managing the gap between the dressing and the wound bed can facilitate the healing of exuding wounds. A silicone foam dressing (Biatain Silicone; Coloplast A/S, Denmark) was developed for application to exuding wounds. A sub-analysis of the real-world, prospective, observational VIPES (Observatoire en Ville des Plaies ExSudatives) study was conducted to investigate the use and performance of the silicone foam dressing in a community nursing setting in France.

METHOD

The sub-analysis included patients from the VIPES study who received the silicone foam dressing as a primary dressing for an acute or hard-to-heal (chronic) wound. Epidemiological and wound healing outcomes were reported via a smartphone application.

RESULTS

Overall, 64 patients were included in the sub-analysis. At baseline, most wounds (n=33/40; 82.5%) were in treatment failure (i.e., were stagnant, non-healing or had poor exudate management). At the last follow-up visit, a median of 22.5 (range: 3-151) days post baseline, 48.4% of wounds had healed and 25.0% were progressing towards healing. From baseline to the last follow-up visit, significant reductions in exudate level (p<0.0001) and exudate pooling (p<0.0001), and significant improvements in wound edges (p≤0.0001) and periwound skin (p<0.01) were observed. A total of 62.3% of patients had re-epithelialising wounds at the last follow-up visit. The majority of nurses (88.3%) and patients (85.0%) reported that the wound had improved and, at most dressing removals (93.5%), nurses reported that the dressing conformed closely to the wound bed.

CONCLUSION

Overall, the data suggest that use of the silicone foam dressing in community practice supported the healing of wounds, illustrating the importance of exudate and gap management.

Hydration response technology dressings for low to excessively exuding wounds: a systematic review

OBJECTIVE

The aim of this systematic review was to identify and qualify the current available evidence of the wound exudate handling capabilities and the cost-effectiveness of hydration response technology (HRT). HRT combines physically modified cellulose fibres and gelling agents resulting in wound dressings that absorb and retain larger quantities of wound exudate.

METHOD

A systematic search was conducted in MEDLINE (via PubMed and PubMed Central) according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search was conducted using an unlimited search period. Studies or reviews that evaluated effect on wound exudate and cost-effectiveness, as well as the impact on wound healing were considered. Records focusing on wound management using HRT devices were included.

RESULTS

The literature search identified four studies and one comparative analysis, ranging from low to moderate quality, that compared HRT dressings to other interventions (carboxymethyl cellulose dressing, other superabsorbent dressings, negative pressure wound therapy).

CONCLUSION

The analysed data supported the beneficial use of dressings with HRT for exuding wounds which was characterised by fewer dressing changes, improved periwound skin conditions and reduced costs.

The biological and physiological impact of the performance of wound dressings

Chronic wounds affect millions globally and are a huge financial burden. Whilst there are many wound dressings commercially available to manage these wounds, the complexity of the repair process makes it difficult to select the right dressing for the right wound at the right time. Thus, in this narrative review, we have examined reasons why wounds fail to heal, summarised the pathophysiology of the chronic wound environment and provided an evidence-based, clinically-relevant compilation of the published literature relevant to dressing design and evaluation. This has highlighted the need for a deeper understanding of wound exudates, how exudates change throughout the healing process, and how they are impacted by different dressing materials. Studies assessing biochemical and biophysical changes in exudates throughout the healing process are extremely valuable in this regard, enhancing both our understanding of the wound healing process and the ability to assess dressing performance. In addition, this knowledge allows us to replicate various wound conditions in the laboratory, and develop clinically-relevant models for testing current and new dressings, therefore providing a more comprehensive understanding of how and when they should be used. This approach makes the use of dressings more effective, thereby improving outcomes, and reducing the economic burden of chronic wounds.

Evaluation of a five-layer hydrocellular polyurethane foam dressing across wound care settings in southern Europe

OBJECTIVE

The burden of chronic wounds did not disappear during the Covid-19 pandemic, so new ways to address healthcare practitioner (HCP) education had to evolve. The Teach, Try, and Talk (T3) programme was conceived in 2021 with HCPs in southern Europe (Italy, Spain and Portugal).

METHOD

Virtual education sessions with experienced HCP guest speakers were held and a five-layer hydrocellular polyurethane foam dressing (HPFD) was introduced as a way of reducing dressing change frequencies and improving clinician satisfaction. HCPs recorded their experience of the HPFD using an online form and participated in a further virtual session with experienced HCPs to discuss the results.

RESULTS

There were a total of 190 responses. A significant dressing change reduction from 3.6 changes per week to 1.8 with the HPFD (p<0.001) was observed in Italy, Spain and Portugal and within different care settings (hospital, wound clinic/health centre and the patient's home). Nearly one-third of participants stated one more day of dressing wear time was achieved by the ability of the HPFD to lock in and manage exudate, with nearly a quarter of responses stating it was due to fewer than three dressing lobes being full. The majority (97.8%) of HCPs stated they would recommend the HPFD to colleagues and patients.

CONCLUSION

The T3 programme is a highly successful method of training delivery and practice improvement across a variety of healthcare settings in southern Europe, helping support HCP engagement and ongoing development in challenging times during the Covid-19 pandemic. The programme can be adapted considering the needs of different HCPs and payor and/or healthcare systems.

Study on the timing of first dressing change with alginate dressing application in PICC placement among tumor patients

Objective

To explore how the timing of the initial dressing change influences bacterial growth when alginate dressings were used after peripherally inserted central catheter (PICC) line insertion in tumor patients.

Methods

In total, 186 tumor patients who had an alginate dressing after PICC insertion were randomly divided into a control group, observation group one (OG1), and observation group two (OG2). The control group had their first dressing change 48 h after PICC insertion, while OG1 was after 72 h and OG2 was after 96 h after. Samples were taken at the dressing change from the insertion site and surrounding skin. The results of the bacterial culture were compared to investigate how the timing of the first dressing change affected catheter infection.

Results

Of the 186 patients, 29 had a positive bacterial culture. Of these, 10 were in the control group, 9 were in OG1, and 10 were in OG2. IBM SPSS Statistics 21.0 was adopted to analyze the correlation between the timing of the first dressing change and insertion site infection. No statistical significance between the timing of the first dressing change and insertion site infections was found (P > 0.05).

Conclusions

The condition of each tumor patient should be comprehensively evaluated after PICC placement to determine when the first dressing change should occur, but it can likely be extended to 96 h after insertion to promote wound healing, reduce clinical workload, and lower patient economic burden.

Tuning the properties of porous chitosan: Aerogels and cryogels

Highly porous chitosan-based materials were prepared via dissolution, non-solvent induced phase separation and drying using different methods. The goal was to tune the morphology and properties of chitosan porous materials by varying process parameters. Chitosan concentration, concentration of sodium hydroxide in the coagulation bath and aging time were varied. Drying was performed via freeze-drying leading to "cryogels" or via drying with supercritical CO₂ leading to "aerogels". Cryogels were of lower density than aerogels (0.03-0.12 g/cm³vs 0.07-0.26 g/cm³, respectively) and had a lower specific surface area (50-70 vs 200-270 m²/g, respectively). The absorption of simulated wound exudate by chitosan aerogels and cryogels was studied in view of their potential applications as wound dressing. Higher absorption was obtained for cryogels (530-1500%) as compared to aerogels (200-610%).