Effect of three wound dressings on infection, healing comfort, and cost in patients with sternotomy wounds - a randomized trial

Study objective: To compare three dressing types in terms of their ability to protect against infection and promote healing, patient comfort, and cost-effectiveness.

Design: Prospective, randomized controlled trial.

Setting: Major metropolitan, academically affiliated, tertiary referral center.

Patients: Seven hundred thirty-seven patients were randomized to receive a dry absorbent dressing (n = 243) [Primapore; Smith & Nephew; Sydney, NSW, Australia], a hydrocolloid dressing (n = 267) [Duoderm Thin ConvaTec; Mulgrave, VIC, Australia], or a hydroactive dressing (n = 227) [Opsite; Smith & Nephew] in the operating theater on skin closure.

Results: There was no difference in the rate of wound infection or wound healing between treatment groups. The Primapore dressing was the most comfortable and cost-effective dressing option for the sternotomy wound. Duoderm Thin dressings were associated with increased wound exudate (p < 0.001), poor dressing integrity (p < 0.001), more frequent dressing changes (p < 0.001), more discomfort with removal (p < 0.05), and increased cost (p < 0.001).

Conclusions: In the context of no additional benefit for the prevention of wound infection or the rate of wound healing for any of the three dressing products examined, dry absorbent dressings are the most comfortable and cost-effective products for sternotomy wounds following cardiac surgery.

The cost-benefit of using soft silicone multilayered foam dressings to prevent sacral and heel pressure ulcers in trauma and critically ill patients: a within-trial analysis of the Border Trial.

Little is known about the cost-benefit of soft silicone foam dressings in pressure ulcer (PU) prevention among critically ill patients in the emergency department (ED) and intensive care unit (ICU). A randomised controlled trial to assess the efficacy of soft silicone foam dressings in preventing sacral and heel PUs was undertaken among 440 critically ill patients in an acute care hospital. Participants were randomly allocated either to an intervention group with prophylactic dressings applied to the sacrum and heels in the ED and changed every 3 days in the ICU or to a control group with standard PU prevention care provided during their ED and ICU stay. The results showed a significant reduction of PU incidence rates in the intervention group (P = 0·001). The intervention cost was estimated to be AU$36·61 per person based on an intention-to-treat analysis, but this was offset by lower downstream costs associated with PU treatment (AU$1103·52). Therefore, the average net cost of the intervention was lower than that of the control (AU$70·82 versus AU$144·56). We conclude that the use of soft silicone multilayered foam dressings to prevent sacral and heel PUs among critically ill patients results in cost savings in the acute care hospital.

A randomised controlled trial of the effectiveness of soft silicone multi-layered foam dressings in the prevention of sacral and heel pressure ulcers in trauma and critically ill patients: The border trial

The prevention of hospital acquired pressure ulcers in critically ill patients remains a significant clinical challenge. The aim of this trial was to investigate the effectiveness of multi-layered soft silicone foam dressings in preventing intensive care unit (ICU) pressure ulcers when applied in the emergency department to 440 trauma and critically ill patients. Intervention group patients (n = 219) had Mepilex^® Border Sacrum and Mepilex^® Heel dressings applied in the emergency department and maintained throughout their ICU stay. Results revealed that there were significantly fewer patients with pressure ulcers in the intervention group compared to the control group (5 versus 20, P = 0·001). This represented a 10% difference in incidence between the groups (3·1% versus 13·1%) and a number needed to treat of ten patients to prevent one pressure ulcer. Overall there were fewer sacral (2 versus 8, P = 0·05) and heel pressure ulcers (5 versus 19, P = 0·002) and pressure injuries overall (7 versus 27, P = 0·002) in interventions than in controls. The time to injury survival analysis indicated that intervention group patients had a hazard ratio of 0·19 (P = 0·002) compared to control group patients. We conclude that multi-layered soft silicone foam dressings are effective in preventing pressure ulcers in critically ill patients when applied in the emergency department prior to ICU transfer.

Electrospun nanofibre membranes as wound dressing materials

An effective wound dressing is not only able to protect the wound area from its surroundings to avoid infection and dehydration, but also to speed up the healing process by providing an optimum microenvironment for healing, removing any excess wound exudates, and allowing continuous tissue reconstruction. In this study, two biodegradable polymers, polycaprolactone (PCL) and polyvinyl alcohol (PVA), were used to electrospin nanofibre membranes. The wound dressing performances of these two membranes were compared with the wound dressing performances of protein coated membranes and conventional non-woven cotton wound dressings. In addition, fibre morphology, porous structural property, mechanical properties of the nanofibre membranes, and their drainage capacity and wound skin histology were examined.

Electrospun nanofibres

This research contributes new knowledge to fundamental understanding and applications of nanofibre materials made by the electrospinning technique. An innovative method was developed to visualise the fibre thinning, and the nanofibres with improved mechanical properties and controlled surface wettability were prepared. These nanofibres have shown significant potential in wound dressing application.

Central venous dialysis : an Australian survey

Aim: To explore the current central venous dialysis catheter (CVDC) nursing care practices in Australia. Method: A survey of dialysis units in Australia. Results: 66% return rate (48/73) Internal jugular is the main insertion site (75%) and the majority are tunneled (85%). Insertion was performed most commonly by radiologists (34%) followed by intensivists (24%) with one center reporting insertion by nursing staff. CVDCs were most commonly inserted in radiology (54%), followed by theatre (33%). Dressings were attended weekly (55%) or on dialysis days (45%). Chlorhexidine was the antiseptic solution of choice (54%) followed by povidine-iodine (37%). In 21% of centres Mupirocin was routinely applied in addition to the antiseptic solution. Transparent dressings were overwhelmingly favoured however most centres recommended alternatives related to patient need. 21% of units reported enrolled nurses undertaking dressings. All units reported the use of sterile gloves and sterile dressing packs. 10% reported different routine care for tunneled and non-tunneled. 40% of the units collected data on infection rates per catheter days. General opinion (39%) was identified as the reason to base CVDC protocols while descriptive studies (25%), RCTs (23%) and guidelines (18%) were also reported. Conclusion: There are significant variations in the Australian nursing practice related to the care of CVDCs. Although there is still practice based on general opinion there is evidence that changes in practice in the past 8 years may be associated with knowledge derived from research.

Drug release rate and anti-microbial effect of controlled-diffusion biopolymer membranes

In this study, a series of fibrous membranes made from cellulose acetate (CA) and polyester urethane (PEU) by co-electrospining or blend-electrospining were evaluated for drug release kinetics, in vitro anti-microbial activity and in vivo would healing performance when used as wound dressings. To stop common clinical infections, an antibacterial agent, Polyhexamethylene Biguanide (PHMB) was incorporated into e-spun fibres. The presence of CA in the wound healing membrane was found to improve hydrophilicity and permeability to air and moisture. The in vivo tests indicated that the addition of PHMB and CA considerably improved the wound healing efficiency. CA fibres became slightly swollen upon contacting with the wound exudates. It can not only speed up the liquid evaporation but also create a moisture environment for wound recovery. The drug release dynamics of membranes was controlled by the structure of membranes and component rations within membranes. The lower ration of CA:PEU retained the sound mechanical properties of membranes, and also reduced the boost release effectively and slowed down diffusion of antibacterial agent during in vitro tests. The controlled-diffusion membranes exert long-term anti-infective effect.

Crosslinking neat ultrathin films and nanofibres of pH-responsive poly(acrylic acid) by UV radiation

Electrospun polyelectrolyte hydrogel nanofibres are being developed for many applications including artificial muscles, scaffolds for tissue engineering, wound dressings and controlled drug release. For electrospun polyelectrolytes, a post-spinning crosslinking process is necessary for producing a hydrogel. Typically, radiation or thermal crosslinking routines are employed that require multifunctional crosslinking molecules and crosslink reaction initiators (free radical producers). Here, ultraviolet subtype-C (UVC) radiation was employed to crosslink neat poly(acrylic acid) (PAA) nanofibres and films to different crosslink densities. Specific crosslink initiators or crosslinking molecules are not necessary in this fast and simple process providing an advantage for biological applications. Scanning probe microscopy was used for the first time to measure the dry and wet dimensions of hydrogel nanofibres. The diameters of the swollen fibres decrease monotonically with increasing UVC radiation time. The fibres could be reversibly swollen/contracted by treatment with solutions of varying pH, demonstrating their potential as artificial muscles. The surprising success of UVC radiation exposure to achieve chemical crosslinks without a specific initiator molecule exploits the ultrathin dimensions of the PAA samples and will not work with relatively thick samples.

Peripherally inserted central catheter cushioning: a pilot study comparing gauze with silicone foam

A pilot study was conducted to compare gauze with silicone foam that may be left in place for as long as seven days. Adult patients who were receiving treatment via peripherally inserted central catheters were recruited and alternately assigned to either the gauze or silicone foam group. Patient-reported itch and discomfort, nurse-reported ease of removal, and skin status were recorded for four weeks at each weekly dressing change.

Rigid removable cover for dorsal wound protection and tube fixation in pigs

Objective To report the design and benefits of a rigid polyethylenecover ‘shell’ for the protection of dorsal torso wounds andtube fixation in pigs.

Methods Open C-shaped polyethylene shells were designed toprotect wounds and dressings on the dorsum of pigs used inresearch into negative pressure dressing-assisted wound healing.The shells were designed to resist trauma and contamination, tobe comfortable and expansible, and to facilitate tube fixation andmanagement. Strap fixation was optimised during experimentation. Efficacy was assessed by direct observation of dressing andwound protection, tube integrity and by macroscopic and microscopicassessments of wound healing.

Results The shells effectively protected the wounds againstblunt and sharp trauma, were simple to remove and reapply, were well tolerated and allowed for growth of the pigs. Circumferentia lneck straps attached by lateral straps to the shells provedcritical. There was no wound infection or inflammation underlyingthe shells. Porting tubing via mid-dorsal holes in the shells andaffixing the tubing just cranial to these holes prevented tubedamage and traction, permitted tube management from outsidethe cages and allowed the pigs to move freely without becomingentangled.

Conclusion These shells effectively protected dorsal skinwounds and dressings, prevented tube damage and facilitatedtube management in pigs. Similar systems may be useful forother production animals for wound management and for tubemanagement with negative pressure wound healing, drain tubesor the delivery of nutrition, fluids or medications.