PATIENT CARE4fen±uraA4

Innovative dressings improve

wound care management
New treatment modes
bring enhanced healing
for patients
W ound and skin care prod-
ucts have progressed dra-
marically in the last couple
of decades. The concept of moist wound
healing is ingrained and the trend of using
BIOBURDEN AND WOUND BED PREPA-
RATION. Wound bed preparation, includ-
ing debridement and biohurden control
are mainstays for effective wound heal-
ing. Silver dressings continue to be the
dressings that remain in and on the wound No. 1 advanced wound care product
for longer periods has proven to be het- choice available.
ter for patients in addi- These innovative dressings continue to
BY CYNTHIA A. FLECK, R.N. tion to saving money. gain widespread use, not just for the worst
Thankfully, the days wounds and sites but for safe, hroad spec-
of "plug and conceal' trum prophylaxis of infection and
are gone because ulcers increased healing outcomes across the
and skin conditions can spectrum of wound care.
now be managed at the Perhaps one of the safest and easiest
cellular level, orchestrat- ways for clinicians to comhat bioburden
ing the healing process every step of the (the total population of bacteria, fungus
way. As with each aspect of health care, and viruses) within a wound is ro use ion-
it is necessary for providers and clinicians ic silver. Ionic silver often can provide the
to keep up with changes in technology 'kick start' that a stalled, chronic ulcer
and maintain an awareness and under- needs to begin healing.

N ew wound care technology is

paving the way for a different
kind of patient care. No longer are
standing of what's new, how it works and
what's available. This article will provide
information on the latest wound and skin
Look for dressings that deliver sus-
tained-release ionic silver over a period
of time (three to seven days or longer).
wounds to be 'plugged and con- products, thereby bringing solutions to Because silver has tittle chance of devel-
cealed" but instead managed on a decision makers and offering better out- oping clinically significant resistance (Jour-
cellular level. By improving the overall comes, less pain, increased skin integrity, nal of Hospital Infections, 2005), has very
healing process, clinicions save time, odor control, decreased biohurdcn and limited sensitivity and is available over
organizations cut costs and the pain overall, more effective care. Incorporat- the counter, it makes a wonderful dress-
associated with wounds is mitigated ing these tools can help conserve capital ing choice.
for patients. "Smart' dressings treat a and resources while saving clinicians' time, Preventing a wound from entering into
variety of different waunds and pro- facility costs and patients, ache and critical colonization with silver dressings
mate the growth of healthy tissue; and anguish. Also, using such key staff as a allows complications, costs and discomfort
more cost-effective dermal reploce- certified wound specialist and/or certified associated with infection to be avoided.
ments are just a few ways wound care wound care nurse is recommended when It also allows for potentially less frequent
is odvancing. making decisions about wound care. dressing changes and reduced nursing

2 4 MATERIALS MANAGEMENT IN HEALTH CARE february 2007 | matmanmog.com

intervention and time, one of the most It allows a clinician to control the ODOR CONTROL. New innovations in
expensive line items on the income state- amplitude (and thus, the level of pain wound odor control using cyclodextrin
ment. These advanced silver dressings experienced by a patient), thereby increas- technology are taking the dressing mar-
afford more savings because they stay in ing the level of precision while having an ket by storm. Most odors are llpophilic
place and work effectively over the course antimicrobial effect subdermally; and it {oil loving).
of several days. also will change the way bedside debride- New dressings that use cyclodextrins
The most versatile silver dressings are ment is performed. (same technology as used in Febreze) use
recommended since they are applicable These newly available devices offer a bucket-shaped conformation of the
to a variety of wounds and the changing rapid results safely and efficiently while bydrated cyclodextrin molecule to irre-
needs of those wounds. providing exceptional granulation with versibly capture lipopliilic odor molecules,
Dressings rhat perform double or triple minima! or no bleeding. Tbe technology is which then neutralizes the odor (see
duty are particularly popular, offering used within inpatient and outpatient clin- Fig.2,p.26).
nuiltiples uses. Some worthy products are ics throughout the country. Cyclodextrins occur naturally and are
included in Fig. 1. This relatively gentle wound bed prepa- proven safe to use in modern wound care.
ration tool offers hope to patients whose But how do tbe latest odor-elimination
ULTRASONIC DEBRIDEMENT. A virtu- wounds have stalled out. This new equip- dressings compare with the older technol-
ally pain^lree way to prcpiire a vvnund ment introduces novel options for necrot- ogy of charcoal-based dressings?
bed is ultrasonic dehridcmciit. ic wounds. 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
rif<. I Versatile silver dressings on the market exudates stabilize the 'bucket' shape
• Calcium alginate/carboxymethylcel- ings to give them ontimicrobial power of the cyclodextrin molecule, allowing
luiose silver combinations, which offer (CastellonoJJ, Mannari RJ, PoyneWG, Rob- odor to be captured and neutralized more
superior absorption of wound fluid while son MC. Comparison Evaluation of Silver effectively.
providing good wet strength and one-piece Contoining Antimicrobial Devices and Drugs, Charcoal activity, on the other hand,
removal in addition to sustained release of poster presented at the 20th Annual John decreases in the presence of wound exu-
safe, ionic silver (Chakravorthy D, Fleck CA, A. Boswick Burn Conference, Maui, Hawaii, dates because serum proteins in tbe exu-
Evaluation of two polyscccha ride-si I ver-bosed 2006). Think of them as " 2 i s t Century dates deactivate in the presence of wound
high absorbency wound dressings, poster wound core in a tube," cost-effective and exudates. Additionally, cyclodextrins
presented at the Symposium on Advances easy to use and remove from any wound intrinsically have a longer active time of
in Skin and Wound Core, Son Antonio, TX, bed. odor-absorbing function by nature of their
April 2006). material.
• Ionic silver powder (sprinkled in diffi- Hydrocolloids, known to be the smelli-
• Silver site dressings that provide pro- cult-to-reach spats or anywhere you want est generic dressing category as well as
tection from catheter-related blood stream absorption and antimicrobial protection) is the most prevalently used advanced
infections as well as those infections aris- olso a good choice since you can literally wound management product, by nature
ing from other percutaneous tubes and make any dressing a "silver" dressing. Also of their composition develop odor under
openings such as chest tubes. Unlike makes o wonderful addition to negative the occlusive seal they form.
chlorhexadine site dressings, silver is safer pressure treatment such as the V.A.C.(r) Newly available bydrocolloids incor-
and more gentle, causing fewer skin sensi- (K.C.I., San Antonio, Texas or the Versatile porate tbe cyclodextrin technology to dra-
tivities and can be used in children under 1(tm) (Blue Sky Medical Group, Carlsbad, matically reduce odor, making dressing
the age af 16, as well as having a broader CA) since it decreases pain, ador and poten- changes more comfortable for a patient
spectrum, covering Pseudomonas aerigi- tially days of theropy. and caregiver.
nosa, unlike chlorhexadine.
• Silver foams can easily be used as o PAIN CONTROL. The number of pain-
• Silver amorphous hydrogels, literally primary or secondary (for extra absorption) reducing dressings on the market that
meoning, "without form" or semi-liquid ge dressing that provides a bit of cushioning combine silicones for gentle no-stick dress-
silver. They're great for dry wounds, to fill while pocking a broad-spectrum antimicro- ing changes, as well as superabsorbent
open spaces and to spread on other dress- bial 'punch' that soaks up exudates. foam materials for greater fluid handling,

matmanmog.com I /t^/^rwary 2007 MATERIALS MANAGEMENT IN HEALTH CARE 2 5

PATIENT
will continue to increase because quality home care at the patient's discharge. These products not only can improve
of life is integral to wound care practice. Another plus is that this system is the skin's appearance and texture., but can
And, don't overlook other pain free prod- only dressing that does not require wound help build collagen and develop skin's
ucts such as alcohol-free, nonstinging prep cleansing, further reducing costs of saline resistance to damage. Sucb ingredients as
wipes to protect the fragile periwound or wound cleansers. In addition, polyacry- good quality silicones in advanced skin
skin from maceration and adhesive late moist wound therapy debrides just care products provide protection through
stripping. These easy-to-apply copolymers as well as collagenase, according to an the use of dimethicone, zinc oxide,
provide protection for the vulnerable epi- article in the July 2005 issue of the Jour- calamine and surfactant-free pbospho-
dermis, without the pain and stinging sen- nal of Wound Care. It provides constant lipid cleansers that clean with derivatives
sation that alcohol based ones historical- cleansing of the wound bed by removing of vegetable oil instead of h;irmful, dry-
ly have created. devitalized material and biofilm., and ing detergents or soaps.

GROWTH FAaOR DELIVERY NEGATIVE PRESSURE THERA-

Fig. 2 Bucket-shaped cyclodextrin (starch)
SYSTEMS AND SKIN SUBSTI- PY. Negative pressure or suction
malecule captures odar molecules, which
TUTES. Look forward to seeing is applied with a tube and scaled
neutralize odor.
more bioengineered 'smart' with an occlusive dressing. This
dressings (such as bioengineered technology 'stretches' cells
MOLECULAR STRUCTURE:
cellulose) that provide more tban involved in the healing process,
0 ring composed of glucose
one function, offering care for units releasing biochemical mediators
a variety of wound needs and of cell proliferation and pulls
growth factor delivery systems tbem together, healing tbe
and skin substitutes. These bio- Hydrophilic
wound. The vacuum effect evac-
(water-loving)
engineered in vitro cultured skin Lipophilic
exterior uates wound fluid, reduces ede-
(oil-loving)
cells begin as harvested neona- Interior ma and helps form new blood
tal foreskins and are grown in vessels and granulation tissue.
3-D SHAPE: The lipophilic
the lab. Negative pressure wound ther-
covity attracts and traps
Biiayered products are com- odor-causing molecules. apy is useful for large deficits
prised of a dermal equivalent Serum protein binding to and recalcitrant wounds.
and Type 1 bovine collagen that the outside wall stabilizes
Although not considered new,
the cyclodextrin bucket.
contains human dermal fibro- this equipment provides answers
blasts and an overlying corni- Source: Medline Advanced Skin ond Wound Care, 2006
for difficult-to-close wounds.
fied epidermal layer of ker-
atinocytes. Single-layer, living dermal debriding wounds at a mean rate of 38.11
COVERING THE FUTURE. Matrix metal-
replacement made of mesh Vicryl and percent per week, according to an article
loproteases (MMPs) Lire structurally relat-
human neonatal foreskin-derived fibrob-
in Ostomy Wound Management., 2003, ed, protein-degrading enzymes (proteas-
lasts and tbeir products work to produce
and an article in the October 2005 issue es) that alter the extra cellular matrix
an immediate cover and viable delivery
of the Journal of Wound Care. during tbe wound healing puxess. MMPs
system for key healing growth factors.
control platelet Liggregatlon, macrophage
ADVANCED SKIN CARE PRODUCTS, just and neutrophil function, cell migration
NOVEL DEBRIDING SYSTEMS. Polyacry as we require good nutrition to survive, and proliferation, neoangiogenesis and
late debriding systems provide quick, sim- our skin can be nourished from the out- collagen secretion and deposition. They
ple, safe and pain-free debridement in a side-in with advanced nutritional goods. 'turn on' or 'turn off matrix proteins,
trouble-free, user-friendly dressing that Skin care products containing specific, cytokines, growth factors and adhesion
provides 24-hour simultaneous rinsing specially treated amino acids, antioxi- molecules. Crucial for the inflammatory
and debriding (see Fig. 3, p. 28). dants, MSM (methylsulfonylmethane), a phase of wound healing are the same mol-
The dressing is activated by Ringer's naturally occurring anti-inflammatory ecules that, when produced in surplus,
solution, the most perfect physiologic flu- agent, and vitamin co-factors can nour- hinder healing in chronic wounds. Chron-
id. It is changed only once per day, mak- ish and strengthen skin, providing an ic wounds generally have high protease
ing it an ideal choice in acute care; and insurance policy against breakdown and levels (MMPs) and low protease inhibitor
changing it can be taught to a family for trauma, such as skin tears and wounds. levels compared with acute wounds. TTiere

2 6 MATERIALS MANAGEMENT IN HEALTH CARE february 2007 \ matmanmog.com

PATIENT CARE[fpnt..rPi]
24^hour rinsing effect will be an increase in the use of collagen address the needs of the wound at a cellu-
dressings with advanced native collagen. lar level as well as growth in the area of
based on state-of-the-art biomaterial sci- pain and odor relief. MMHC
ence and technology, which gives it the
ftinger's Wound Microorganisms Necrotic potential to alter the wound environment CYNTHIA A. FLECK, R.N., \S A CERTIFIED
solution debris tissue
biochemically, including MMPs and elas- WOUND SPECIAtiST AND DERMATOL-
tase. There also will be more cost-effec- OGY ADVANCED PRACTICE NURSE,
tive dermal replacements, MMP modula- FLECK ALSO IS VICE PRESIDENT OF
tors, as well as other biologicals that tackle CLINICAL MARKETING AT MEDLINE
various issues in the wound bed and sur- INDUSTRIES INC.'S ADVANCED SKIN
rounding tissue and skin. AND WOUND CARE DIVISION,
The wound and skin care industry will MUNDELEIN, ILL. SHE CAN BE CON-
continue to respond with products that TACTED AT CFLECKgnMEDLINE.COM.

Resources for increosing wound care knowledge

Prior to application into the wound, the
Associations
polyacrylate debriding system is activat-
Association for the Advancement of Wound Care, www.aawcone.org
ed with Ringer's solution.
Wound, Ostomy ond Continence Nurses Society, www.wocn.org
American Professional Wound Care Association, www.apwca.org
Notional Pressure Ulcer Advisory Panel, www.npuap.org

Certifying orgonizations
American Acodemy of Wound Monagement-multidisclplinary board certification,
wmv.oatvm.org
Wound, Ostomy and Continence Nurses Society, www.wocn.org

Helpful wound care sites

Advancing the Proctice, www.advoncingtheproctice.org
Wound Science, www.woundscience.com
World Wide Wounds, www.worldwidewounds.com
Due to the polyacrylate's higher affinity
Medline Advanced Skin ond Wound Care, www.medline.com/woundcarB
for proteins than for solts, the obsorbent
core simultaneously takes up and binds Reference texts
wound debris, necrotic tissue and Chronic Waund Care: A Clinical Source Book for Healthcare Professionals, 4th Edition. 2007.
microorganisms in exchange far ovailable this spring at www.hmpcommunications.com
Ringer's solution. Wound Care Essentials, 2004, available ot www.iww.com
Wound Care Practice. 2nd Edition, ovoilable later in 2007 at www.6esfpufc.com
Acute and Chronic Wounds. 3rd Edition. 2006, ovailoble at www.mosby.com

Conferences
Americon Professional Wound Core Association's Annual Conference: April 19-22,
Philadelphio; www.opwco.org
Symposium on Advanced Waund Core: April 28-May 1, Tompo, Fla.; www.sawc.net
Wound, Ostomy and Continence Nurses Society Annual Conference: June 9-13, Salt Lake Gty;
www.wocn.org
Clinical Symposium on Advances in Skin and Wound Care: Oct. 11-14, Nashville;
www.symposiumonwoundcore. com
Wound Care Congress: Oct. 23-27, Dollas; www.waundcorecangress.com
The 24-hour rinsing action rapidly estob-
lishes a clean wound bed, allowing for Journals
active waund healing ta take place. There Advances in Skin and Wound Care, published by Lippincott Willioms ond Wilkins,
is tissue growth, ongiogenesis and cellu- wwwjww.com
lar migratian. Ostomy.^ound Monogement (O/WM), published by HMP Cammunications, www.o-wm.com
WOUNDS, published by HMP Communicotions, www.woundresearch.cam
Source: Wedime Advonced Skin and Wound Core, 2002 Journal of Wound. Ostomy ond Continence Nursing, published by Lippincott Willioms and Wilkins

2 8 MATERIALS MANAGEMENT IN HEALTH CARE fehruary 2007 \ motmanmag.com