The value of slough in wounds for the diagnosis of microbiology cultivation

Slough is not currently a recommended microbiology culture specimen. The aim of our work is to analyse the concordance of results between slough and swab samples for cultures. A single-centre, retrospective, cross-sectional study involving patients (n = 131) with hard to heal wounds was conducted from October 2022 to October 2023. Pairs of slough and swab samples were collected for microbiological analysis and subdivided depending on whether a relatively clean wound bed was obtained. Swab samples were collected using the Levine and deep pus methods, Cohen's κ coefficients calculated to evaluate concordance, and microbiological agreement analysed. Gram-stain results did not differ significantly between slough and swab samples (𝜒2 = 329.287, p = 0.688; concordance, κ = 0.879, p < 0.001); microbiological agreement was 90.1%. Samples from 87 patients with relatively clean wound beds generated excellent concordance between slough and Levine technique (κ = 0.867, p < 0.001; microbiological agreement, 89.7%). In 44 patients with slough and deep pus swab where a relatively clean wound bed could not be obtained, Gram-stain also demonstrated excellent concordance (κ = 0.898, p < 0.001; microbiology agreement, 90.9%). Our data provide evidence that slough is a reliable wound specimen from hard to heal wounds for microbiology culture.

The Chronic Wound-Related Pain Model: Holistic Assessment and Person-Centered Treatment

Chronic wound-related pain is a complex biopsychosocial experience that is experienced spontaneously at rest and exacerbated during activities. Tissue debridement, trauma at dressing change, increased bioburden or infection, exposure of periwound skin to moisture, and related treatment can modulate chronic wound-related pain. Clinicians should consider multimodal and multidisciplinary management approach that take into account the biology, emotions, cognitive thinking, social environment, and other personal determinants of pain. Unresolved pain can have a significant impact on wound healing, patients' adherence to treatment, and individual's quality of life.

SELF-ASSESSMENT OF PRIMARY CARE NURSES ABOUT CARE FOR PEOPLE WITH VENOUS ULCERS: A CROSS-CUTTING STUDY

Objective: To identify the self-knowledge of primary care nurses about care for people with venous ulcers. Method: This is a cross-sectional study with 40 nurses working in health units. Two data collection instruments were used: characterization, developed by the author, and self-assessment on venous ulcers. Results: All questions of the self-assessment instrument reached medians classified as little level of knowledge, except questions related to the application of elastic compression therapy, with the median = 3 (moderate), and the evaluation of lower limbs to investigate arterial involvement, with 3.50, between little and moderate. The item cleaning the lesion stood out, which obtained median = 4 (little) and the highest average found in the responses, 4.03 (little). Conclusion:The nurse’s self-assessment reached moderate and low scores of clinical practice in terms of knowing (theoretical knowledge) and doing (practical knowledge) in the care of people with venous ulcers. Venous ulcer is a complex wound and requires knowledge from nurses about the pathophysiology and appropriate treatment, interfering with the improvement of the person’s quality of life. It is believed that this study can encourage the reflection of this professional and education actions in the services.

AUTOAVALIAÇÃO DE ENFERMEIROS DA ATENÇÃO PRIMÁRIA SOBRE ASSISTÊNCIA À PESSOA COM ÚLCERAS VENOSAS: UM ESTUDO DE CORTE TRANSVERSA

Objetivo:Identificar o autoconhecimento de enfermeiros da atenção primária sobre assistência à pessoa com úlceras venosas. Método: Trata-se de um estudo de corte transversal com 40 enfermeiros lotados em unidades de saúde. Utilizaram-se dois instrumentos de coleta de dados: caracterização, elaborada pelo autor, e autoavaliação sobre úlcera venosa. Resultados: Todas as questões do instrumento autoavaliativo alcançaram medianas classificadas como nível de conhecimento pouco, à exceção das questões relativas à aplicação de terapia compressiva elástica com mediana = 3 (moderado) e à avaliação de membros inferiores para investigar comprometimento arterial, 3,50, entre pouco e moderado. Destacou-se o item limpeza da lesão, o qual obteve a mediana = 4 (pouco) e a maior média encontrada das respostas, 4,03 (pouco). Conclusão: A autoavaliação do enfermeiro atingiu os escores moderado e pouco da prática clínica no que tange ao saber (conhecimento teórico) e ao fazer (conhecimento prático) no cuidado à pessoa com úlcera venosa. A úlcera venosa é uma ferida complexa e exige do enfermeiro conhecimento sobre a fisiopatologia e o tratamento adequado, interferindo na melhora da qualidade de vida dessa pessoa. Acredita-se que este estudo possa fomentar a reflexão desse profissional e ações de educação nos serviços.