Bestof theBest 2015 - Wound Care Advisor - Practical … do the Los Angeles Lakers, Green Bay...

September/October 2015 • Volume 4 • Number 5

www.WoundCareAdvisor.com

A Publication

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Practical issues in wound, skin, and ostomy management

Bestof theBest 2015

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2 www.WoundCareAdvisor.com September/October 2015 • Volume 4, Number 5 • Wound Care Advisor

staff

Group PublisherGregory P. Osborne

PublisherTyra LondonEditor-in-Chief

Donna Sardina, RN, MHA, WCC, CWCMS, DWC, OMSEditorial Director

Cynthia Saver, RN, MSEditor

Kathy E. GoldbergCopy Editor

Karen C. ComerfordArt Director

David BeverageProduction ManagerRachel BargeronAccount Managers

Susan Schmidt Renee ArtusoJohn Travaline

PuBlished By

HealthCom Media259 Veterans Lane, Doylestown, PA 18901

Telephone: 215/489-7000Facsimile: 215/230-6931Chief Executive OfficerGregory P. Osborne

Executive Vice President, SalesBill Mulderry

Digital Program ManagerMichael FerrariFinance Director

MaryAnn FosbennerBusiness Manager Nancy J. Dengler

Wound Care Advisor (ISSN 2168-4421) is published byHealthCom Media, 259 Veterans Lane, Doylestown, PA18901. Printed in the USA. Copyright © 2015 by Health-Com Media. All rights reserved. No part of this publica-tion may be reproduced, stored, or transmitted in anyform or by any means, electronic or mechanical, includ-ing photocopy, recording, or any information storageand retrieval system, without permission in writing fromthe copyright holder. Send communication to Health-Com Media, 259 Veterans Lane, Doyles town, PA 18901.

The opinions expressed in the editorial and advertis-ing material in this issue are those of the authorsand advertisers and do not necessarily reflect theopinions or recommendations of the National Al-liance of Wound Care and Ostomy®; the EditorialAdvisory Board members; or the Publisher, Editors,and the staff of Wound Care Advisor.

Editorial Mission: Wound Care Advisor providesmultidisciplinary wound care professionals withpractical, evidence-based information on theclinical management of wounds. As the officialjournal of the National Alliance of Wound Careand Ostomy®, we are dedicated to deliveringsuccinct insights and information that our read-ers can immediately apply in practice and useto advance their professional growth.

Wound Care Advisor is written by skin and woundcare experts and presented in a reader-friendly elec-tronic format. Clinical content is peer reviewed.

The publication attempts to select authors who are knowl-edgeable in their fields; however, it does not warrant theexpertise of any author, nor is it responsible for any state-ments made by any author. Certain statements about theuse, dosage, efficacy, and characteristic of some drugsmentioned here reflect the opinions or investigational ex-perience of the author. Any procedures, medications, orother courses of diagnosis or treatment discussed or sug-gested by authors should not be used by clinicians with-out evaluations of their patients’ conditions and possiblecontraindications or danger in use, review of any applica-ble manufacturer’s prescribing information, and compari-son with the recommendations of other authorities.

editor-in-chief

Donna Sardina, RN, MHA, WCC, CWCMS, DWC, OMSCo-Founder, Wound Care Education Institute

Lake Geneva, WI

editorial advisory Board

Nenette L. Brown, RN, PHN,MSN/FNP, WCC

Wound Care Program CoordinatorSheriff’s Medical Services Division

San Diego, CA

Debra Clair, PhD, APN, RN, WOCN,WCC, DWC

Wound Care ProviderAlliance Community Hospital

Alliance, OH

Kulbir Dhillon, NP, WCCWound Care SpecialistSkilled Wound Care

Sacramento, CA

Fred BergVice President, Marketing/Business

DevelopmentNational Alliance of Wound Care and

OstomySt. Joseph, MI

Cindy Broadus, RN, BSHA, LNHA,CLNC, CLNI, CHCRM, WCC,

DWC, OMSExecutive Director

National Alliance of Wound Care and Ostomy

St. Joseph, MI

Gail Hebert, MS, RN, CWCN, WCC,DWC, OMS

Clinical instructorWound Care Education Institute

Plainfield, IL

Joy Hooper, BSN, RN, CWOCN,OMS, WCC

Owner and manager of MedicalCraft, LLCTifton, GA

Catherine Jackson, RN, MSN, WCCClinical Nurse Manager

Inpatient and Outpatient Wound CareMacNeal Hospital

Berwyn, IL

Jeffrey Jensen, DPM, FACFASDean and Professor of Podiatric

Medicine & SurgeryBarry University School of Podiatric

MedicineMiami Shores, FL

Rosalyn S. Jordan, RN, BSN, MSc,CWOCN, WCC

Director of Clinical EducationRecoverCare, LLC

Louisville, KY

Jeff Kingery, RNVice President of Professional

DevelopmentRestorixHealthTarrytown, NY

Jeri Lundgren, RN, BSN, PHN, CWS,CWCN

Vice President of Clinical ConsultingJoerns

Charlotte, NC

Courtney Lyder, ND, GNP, FAAN Dean and Professor

UCLA School of NursingLos Angeles

Nancy Morgan, RN, BSN, MBA,WOC, WCC, DWC, OMS

Co-Founder, Wound Care EducationInstitute

Plainfield, IL

Steve Norton, CDT, CLT-LANACo-founder, Lymphedema & Wound Care

Education, LLCPresident, Lymphedema Products, LLC

Matawan, NJ

Bill Richlen, PT, WCC, CWS, DWCOwner

Infinitus, LLCChippewa Falls, WI

Lu Ann Reed, RN, MSN, CRRN,RNC, LNHA, WCC

Adjunct Clinical InstructorUniversity of Cincinnati

Cincinnati, OH

Stanley A. Rynkiewicz III, RN, MSN,WCC, DWC, CCS

AdministratorDeer Meadows Home Health and

Support Services, LLCBHP Services

Philadelphia, PA

Cheryl Robillard, PT, WCC, CLTClinical SpecialistAegis TherapiesMilwaukee WI

Donald A. Wollheim, MD, WCC,DWC, FAPWCA

Owner and Clinician, IMPLEXUS WoundCare Service, LLC Watertown, WI

Instructor, Wound Care EducationInstitute

Plainfield, IL

Wear Your Certifi cationWear Your Certifi cationWear Your Certifi cationWith Pride.Check out the new

NAWCO® Online Clothing Store!Choose from a great collection of high quality clothing for work or home. Select from comfortable shirts, blouses, jackets and embroidered scrubs or lab coats. Embroidery is now always free. Order now and receive a free gift with each order. All proceeds go to a candidate scholarship fund.

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CONTENTS


FEATURES 12 Providing evidence-based care for patients with lower-extremity cellulitis By Darlene Hanson, PhD, RN; Diane Langemo, PhD, RN, FAAN; Patricia Thompson, MS, RN; Julie Anderson, PhD, RN; and Keith Swanson, MD Find out how to identify and intervene for this potentially dangerous bacterial skin infection.

37 Palliative wound care By Gail Rogers Hebert, MS, RN, CWCN, WCC, DWC, OMS, LNHA This approach brings patient-centered care to life.

44 Helping patients overcome ostomy challenges By Beth Hoffmire Heideman, MSN, RN Physiologic, psychological, and psychosocial issues demand careful planning, monitoring, and creativity.

DEPARTMENTS 6 From the Editor “Best of the Best” three-peat

9 Clinical Notes

Apple Bites

20 How to assess wound exudate

Medical gauze 101

24 Best Practices Evolution of a deep tissue injury or a declining pressure ulcer? • Get the ‘SKINNI’ on reducing pressure ulcers

41 Business Consult Creating effective education programs on a shoestring budget

49 Clinician Resources

50 NAWCO News

55 2015 WilD ON WOUNDS ExhiBiTORS GUiDE

September/October 2015 • Vol. 4, No. 5www.WoundCareAdvisor.com

page 37

page 12

page 44

31 Prove the Value Program Demonstrating the clinical and financial outcomes of advanced surface technologies. Content provided by Hill Rom.

What do the Los Angeles Lakers,Green Bay Packers, MontrealCanadiens, and New York Yan-

kees have in common? All three have“three-peated”, meaning they have wonthree consecutive championships. Thisyear, we at Wound Care Advisor, the offi-cial journal of the National Alliance ofWound Care and Ostomy (NAWCO), markour own three-peat—our third annual“Best of the Best” issue.

This may be the first time you have held Wound Care Advisor in your handsbecause normally we come to you via theInternet. Using a digital format for thispeer-reviewed journal allows us to bringyou practical information that you canaccess anytime, anywhere and gives youthe ability to access videos and other linksto valuable resources for you and yourpatients. However, it’s still nice sometimesto hold a print version of a journal, soonce a year, we bring you a compendiumof our most popular articles to create aresource you can turn to again and again.

If you’re new to Wound Care Advisor,this print edition is an opportunity for youto experience what you’ve been missing. If you’re a regular reader, this edition givesyou the opportunity to revisit some of ourbest articles.

Within these pages you’ll find featurearticles, best practices, step-by-step how-to’s, clinical resources, and news. Alongwith wound-related topics such as pallia-tive wound care, you’ll find a variety ofother topics, ranging from helping patientsovercome ostomy challenges to caring for

patients with lower-extremity cellulitis.You’ll also hone your skills by reading arti-cles on how to assess wound exudate anduse of medical gauze. We haven’t forgottenyour nonclinical related needs—check outthe article on creating effective educationprograms on a shoestring budget.

Also included as part of this special edi-tion, is an exclusive directory of the 2015Wild on Wounds Exhibitors Guide. Wild on Wounds (WOW) is an annual, multi -disciplinary national wound conferencepresented by the Wound Care EducationInstitute. The exhibitor guide featuresnames, products, and contact informationfor many different manufacturers and com-panies that can offer solutions to assist incaring for your patients.

In keeping with our digital format, this compendium will also be availableelectronically at our website, www.wound-careadvisor.com, where you’ll be able todownload resources and access links tovideos, clinical resources, and much more.

Thanks to our readers, Wound CareAdvisor is a champion. We appreciate yoursupport and look forward to bringing youmany more articles designed to help youachieve excellence in your clinicalpractice. Look for our four-peat in 2016!

Donna Sardina, RN, MHA, WCC, CWCMS,DWC, OMS

Editor-in-ChiefWound Care Advisor


From theEDiTOR

“Best of the Best” three-peat

http://woundcareadvisor.com

http://woundcareadvisor.com

Clears the way for healthy tissue

Collagenase SANTYL® Ointment 250 units/g is the only FDA-approved enzymatic debrider that

selectively removes necrotic tissue without harming granulation tissue

©2014 Smith & Nephew, Inc. SANTYL is a registered trademark of Smith & Nephew, Inc. 1-800-441-8227 www.santyl.com TM1614-0314

Collagenase SANTYL® Ointment is indicated for debriding chronic dermal ulcers and severely burned areas.

Occasional slight transient erythema has been noted in surrounding tissue when applied outside the wound. One case of systemic hypersensitivity has been reported after 1 year of treatment with collagenase and cortisone. Use of Collagenase SANTYL® Ointment should be terminated when debridement is complete and granulation tissue is well established.

Please see complete prescribing information on adjacent page.

For more information, please visit www.santyl.com.

DESCRIPTION: Collagenase SANTYL® Ointment is a sterile enzymatic debriding ointment which contains 250 collagenase units per gram of white petrolatum USP. The enzyme collagenase is derived from the fermentation by Clostridium histolyti-cum. It possesses the unique ability to digest collagen in necrotic tissue.

CLINICAL PHARMACOLOGY: Since collagen accounts for 75% of the dry weight of skin tissue, the ability of collagenase to digest collagen in the physiological pH and temperature range makes it particularly effective in the removal of detritus.1

Collagenase thus contributes towards the formation of granulation tissue and subsequent epithelization of dermal ulcers and severely burned areas. 2, 3, 4, 5, 6

Collagen in healthy tissue or in newly formed granulation tissue is not attacked. 2, 3,

4, 5, 6, 7, 8 There is no information available on collagenase absorption through skin or its concentration in body fluids associated with therapeutic and/or toxic effects, degree of binding to plasma proteins, degree of uptake by a particular organ or in the fetus, and passage across the blood brain barrier.

INDICATIONS AND USAGE: Collagenase SANTYL® Ointment is indicated for debriding chronic dermal ulcers 2, 3, 4, 5, 6, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18 and severely burned areas. 3, 4, 5, 7, 16, 19, 20, 21

CONTRAINDICATIONS: Collagenase SANTYL® Ointment is contraindicated in patients who have shown local or systemic hypersensitivity to collagenase.

PRECAUTIONS: The optimal pH range of collagenase is 6 to 8. Higher or lower pH conditions will decrease the enzyme’s activity and appropriate precautions should be taken. The enzymatic activity is also adversely affected by certain detergents, and heavy metal ions such as mercury and silver which are used in some antiseptics. When it is suspected such materials have been used, the site should be carefully cleansed by repeated washings with normal saline before Collagenase SANTYL®

Ointment is applied. Soaks containing metal ions or acidic solutions should be avoided because of the metal ion and low pH. Cleansing materials such as Dakin’s solution and normal saline are compatible with Collagenase SANTYL® Ointment.

Debilitated patients should be closely monitored for systemic bacterial infections because of the theoretical possibility that debriding enzymes may increase the risk of bacteremia.

A slight transient erythema has been noted occasionally in the surrounding tissue, particularly when Collagenase SANTYL® Ointment was not confined to the wound. Therefore, the ointment should be applied carefully within the area of the wound. Safety and effectiveness in pediatric patients have not been established.

ADVERSE REACTIONS: No allergic sensitivity or toxic reactions have been noted in clinical use when used as directed. However, one case of systemic manifestations of hypersensitivity to collagenase in a patient treated for more than one year with a combination of collagenase and cortisone has been reported.

OVERDOSAGE: No systemic or local reaction attributed to overdose has been observed in clinical investigations and clinical use. If deemed necessary the enzyme may be inactivated by washing the area with povidone iodine.

DOSAGE AND ADMINISTRATION: Collagenase SANTYL® Ointment should be applied once daily (or more frequently if the dressing becomes soiled, as from incontinence). When clinically indicated, crosshatching thick eschar with a #10 blade allows Collagenase SANTYL® Ointment more surface contact with necrotic debris. It is also desirable to remove, with forceps and scissors, as much loosened detritus as can be done readily. Use Collagenase SANTYL® Ointment in the following manner:

Rx only

1 – Prior to application the wound should be cleansed of debris and digested material by gently rubbing with a gauze pad saturated with normal saline solution, or with the desired cleansing agent compatible with Collagenase SANTYL® Ointment (See PRECAUTIONS), followed by a normal saline solution rinse.2 – Whenever infection is present, it is desirable to use an appropriate topical antibiotic powder. The antibiotic should be applied to the wound prior to the application of Collagenase SANTYL® Ointment. Should the infection not respond, therapy with Collagenase SANTYL® Ointment should be discontinued until remission of the infection.3 – Collagenase SANTYL® Ointment may be applied directly to the wound or to a sterile gauze pad which is then applied to the wound and properly secured.4 – Use of Collagenase SANTYL® Ointment should be terminated when debride-ment of necrotic tissue is complete and granulation tissue is well established.

HOW SUPPLIED: Collagenase SANTYL® Ointment contains 250 units of collagenase enzyme per gram of white petrolatum USP.

Do not store above 25˚C (77˚F). Sterility guaranteed until tube is opened.

Collagenase SANTYL® Ointment is available in 15 gram, 30 gram, and 90 gram tubes.

REFERENCES: 1. Mandl, I., Adv Enzymol. 23:163, 1961. 2. Boxer, A.M., Gottesman, N., Bernstein, H., & Mandl, I., Geriatrics. 24:75, 1969. 3. Mazurek, I., Med. Welt. 22:150, 1971. 4. Zimmermann, WE., in “Collagenase,” Mandl, I., ed., Gordon & Breach, Science Publishers, New York, 1971, p. 131, p. 185. 5. Vetra, H., & Whittaker, D., Geriatrics. 30:53, 1975. 6. Rao, D.B., Sane, P.G., & Georgiev, E.L., J. Am. Geriatrics Soc. 23:22, 1975. 7. Vrabec, R., Moserova, J., Konickova, Z., Behounkova, E., & Blaha, J., J. Hyg. Epidemiol. Microbiol. Immunol. 18:496, 1974. 8. Lippmann, H.I., Arch. Phys. Med. Rehabil. 54:588, 1973. 9. German, F. M., in “Collagenase,” Mandl, I., ed., Gordon & Breach, Science Publishers, New York, 1971, p. 165. 10. Haimovici, H. & Strauch, B., in “Collagenase,” Mandl, I., ed., Gordon & Breach, Science Publishers, New York, 1971, p. 177. 11. Lee, L.K., & Ambrus, J. L., Geriatrics. 30:91, 1975. 12. Locke, R.K., & Heifitz, N.M., J. Am. Pod. Assoc. 65:242, 1975. 13. Varma, A.O., Bugatch, E., & German, F.M., Surg. Gynecol. Obstet. 136:281, 1973. 14. Barrett, D., Jr., & Klibanski, A., Am. J. Nurs. 73:849, 1973. 15. Bardfeld, L.A., J. Pod. Ed. 1:41, 1970. 16. Blum, G., Schweiz, Rundschau Med Praxis. 62:820, 1973. Abstr. in Dermatology Digest, Feb. 1974, p. 36. 17. Zaruba, F., Lettl, A., Brozkova, L., Skrdlantova, H., & Krs, V., J. Hyg. Epidemiol. Microbiol. Immunol. 18:499, 1974. 18. Altman, M.I., Goldstein, L., & Horwitz, S., J. Am. Pod. Assoc. 68:11, 1978. 19. Rehn, V.J., Med. Klin. 58:799, 1963. 20. Krauss, H., Koslowski, L., & Zimmermann, W.E., Langenbecks Arch. Klin. Chir. 303:23, 1963. 21. Gruenagel, H.H., Med. Klin. 58:442, 1963.

Manufactured by: Smith & Nephew, Inc.Fort Worth, Texas 76107US Gov’t License #2004

Marketed by:

1-800-441-8227Smith & Nephew, Inc.Fort Worth, Texas 76107

Reorder Nos.0064-5010-15 (15 g tube)0064-5010-30 (30 g tube)0064-5010-90 (90 g tube)

© 2014 Smith & Nephew, Inc.SANTYL is a registered trademark of Smith & Nephew, Inc.140385-0814

Mild compression diabetic sockssafe and effective for lowerextremity edema

Diabetic socks with mild compression canreduce lower extremity edema in patientswith diabetes without adversely affectingarterial circulation, according to a random-ized control trial presented at the Ameri-can Diabetes Association 75th ScientificSessions Conference.

“Control of lower extremity edema in pa-tients with diabetes: Double-blind RCT as-sessing the efficacy of mild compression dia-betic socksA” reports that the skinperfusion pressure of the medial calf in-creased in those using the socks, whichthe researchers say indicates that mi-crovascular circulation in the region mayhave improved with mild compression.

A total of 80 patients were randomizedinto two treatment arms, and patientswere followed weekly for 4 weeks. Thestudy’s authors conclude that mild com-pression diabetic socks “may be effective-ly and safely used” in patients with dia-betes and lower extremity edema.

Telemedicine may have limitedvalue for monitoring diabetic foot ulcers

“A randomized controlled trial comparingtelemedical and standard outpatient monitoring

of diabetic foot ulcersB” reports no differencein the incidence of amputation between thetwo groups, but notes that telemedical mon-itored patients had higher mortality.

A total of 401 patients participated inthe study, with similar demographics forthe two groups. The study end pointswere complete ulcer healing, amputation,or death.

The authors of the study in DiabetesCare write the higher mortality “throws in-to question the role of telemedicine inmonitoring diabetic foot ulcers” and callfor more research.

Vitamin D may help in treatingCrohn’s disease

A small study of 27 patients published inthe United European Gastroenterology Jour-nal found that those randomized to take2,000 U of vitamin D daily had significantlyhigher concentrations of serum 25-hydroxy -vitamin D and maintenance of intestinalpermeability at 3 months, compared tothose who took placebo.

Wound Care Advisor • September/October 2015 • Volume 4, Number 5 www.WoundCareAdvisor.com 9

ClinicalNOTES

http://www.abstractsonline.com/pp8/#!/3699/presentation/8736




http://care.diabetesjournals.org/content/early/2015/06/25/dc15-0332.abstract



Patients with serum 25-hydroxyvitaminD equal to or higher than 75 nmol/L hadsignificantly lower C-reactive protein andhigher quality of life, as well as non-sig-nificantly lower Crohn’s Disease ActivityIndex than those with a serum 25-hydrox-yvitamin D less than 75 nmol/L.

“Effects of vitamin D supplementation onintestinal permeability, cathelicidin and dis-ease markers in Crohn’s disease: Resultsfrom a randomised double-blind placebo-con-trolled studyC” also reports that those whodidn’t receive vitamin D had higher intes-tinal permeability.

Update on honey dressingreimbursement

The January 22 policy article, from theDurable Medical Equipment (DME)Medicare Administrative Contractor (MAC),which introduced a new coverage standardD

and was the basis of the MEDIHONEY®

products’ coding change from covered tononcovered codes, has been rescinded.An amended policy article, adopted by allfour DME MACs and effective October 1,2015, specifically confirms that coverageof multicomponent dressings that containmedicinal honey will be based on the un-derlying covered components.

Neutrophil response may impairwound healing in patients withdiabetes

“Diabetes primes neutrophils to undergo NE-

Tosis, which impairs wound healingE,” pub-lished in Nature Medicine, reports that inmice, disrupting the ability for neutrophilsto form neutrophil extracelluar traps(NETs), which trap and kill bacteria, im-proves wound healing.

Researchers disrupted the formation ofNETs by eliminating or controlling expres-sion of the PAD4 enzyme, but they notethat pharmacologic interventionF of PAD4activity needs to be tested to see if itachieves the same benefits.

Education and one-stepincontinence product helpsreduce pressure ulcers

Educating clinicians and implementing in-continence care procedures with a 1-stepproduct helps significantly reduce hospi-tal-acquired pressure ulcers, according to“A prospective, descriptive, quality improve-ment study to decrease incontinence-associ-ated dermatitis and hospital-acquired pres-sure ulcersG.”

The study, published in Ostomy WoundManagement and conducted in two acute-care neurology units, added that the rate


http://ueg.sagepub.com/content/early/2015/02/06/2050640615572176.full.pdf+html





https://www.dmepdac.com/resources/articles/2015/01_27_15.html

http://www.nature.com/nm/journal/v21/n7/full/nm.3887.html

http://www.nature.com/nm/journal/v21/n7/full/nm.3887.html

http://news.psu.edu/story/360684/2015/06/15/research/disabling-infection-fighting-immune-response-speeds-wound-healing

http://www.o-wm.com/article/prospective-descriptive-quality-improvement-study-decrease-incontinence-associated




of incontinence-associated dermatitisstayed the same.

Options for treatment afterradical hysterectomy studied

Certain patients with cervical cancer canbenefit from adjuvant chemotherapy afterradical hysterectomy with fewer long-termcomplications, such as lymphedema, anda therapeutic effect that is not significantlydifferent from adjuvant radiotherapy orconcurrent chemoradiation therapy, ac-cording to a study in PLOS One.

The 267 patients studied in “Clinical roleof adjuvant chemotherapy after radical hyste -rectomy for FIGO Stage IB-IIA Cervical Cancer:Comparison with adjuvant RT/CCRT using in-verse-probability-of-treatment weightingH” werefollowed for a median of 46.8 months. n

Online ResourcesA. http://www.abstractsonline.com/pp8/#!/3699/presentation/8736

B. http://care.diabetesjournals.org/content/early/2015/06/25/dc15-0332.abstract

C. http://ueg.sagepub.com/content/early/2015/02/06/2050640615572176.full.pdf+html

D. https://www.dmepdac.com/resources/articles/2015/01_27_15.html

E. http://www.nature.com/nm/journal/v21/n7/full/nm.3887.html

F. http://news.psu.edu/story/360684/2015/06/15/research/disabling-infection-fighting-immune-response-speeds-wound-healing

G. http://www.o-wm.com/article/prospective-descriptive-quality-improvement-study-decrease-incontinence-associated

H. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0132298


http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0132298






Cellulitis is an acute, painful, andpotentially serious spreadingbacterial skin infection that af-fects mainly the subcutaneous

and dermal layers. Usually of an acute on-set, it’s marked by redness, warmth,swelling, and tenderness. Borders of theaffected skin are characteristically irregu-lar. Although cellulitis may occur in manybody areas, this article discusses the mostcommon location—the lower limb.

In cellulitis, bacteria enter through an

opening in the skin caused by a bite, anulcer, a body piercing, or other disconti-nuity. The most common bacteria areStreptococcus pyogenes and Staphylococcusaureus, which are indigenous to the skin.

The body reacts to these microbes as for-eign, leading to presenting signs andsymptoms. On assessment, clinicians maynotice a recent insect bite, surgical inci-sion, or trauma to the leg.

Cellulitis and cutaneous abscesses com-bined cause nearly 600,000 hospital ad-missions annually in the United States—anincrease of 65% since 1999. Cellulitis andother soft-tissue infections account for upto 10% of hospital admissions. Incidenceof cellulitis ranges from 0.2 in 1,000 per-son-years to 24.6 in 1,000 person-years indifferent populations.

In 2006, about 14.5 million cases of cel-lulitis occurred, incurring costs of approxi-mately $3.7 billion overall. Costs may risewhen the condition is misdiagnosed orwhen antibiotics are used inappropriately,as this may prolong treatment or predis-pose patients to complications.

What the literature shows In 2012, Lipsky and colleagues completeda prospective multicenter study of pa-tients with soft-tissue infections to explorethe epidemiology, clinical presentation,treatment, and clinical outcomes. Of the1,033 subjects, 26.9% had cellulitis andthe same percentage had diabetic foot in-fections. In contrast, surgical-site infec-tions affected 16.7% and deep soft-tissue

Providing evidence- based care for patients with lower-extremity cellulitis Find out how to identify and intervene for this potentially dangerous bacterial skin infection. By Darlene Hanson, PhD, RN; Diane Langemo, PhD, RN, FAAN; Patricia Thompson, MS, RN; Julie Anderson, PhD, RN; and Keith Swanson, MD

Not all wound therapy is the same

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WOW Conference: Visit us at booth 311*KCI data on file.

NOTE: Specific indications, contraindications, warnings, precautions and safety information exist for KCI products and therapies. Please consult a physician and product instructions for use prior to application. Rx only.

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abscesses affected 13.6%. The lower legwas the most common cellulitis site(49.6%). Pain was rated as moderate tosevere in 73% (n = 203) of patients. Over-all, patients with cellulitis had more se-vere erythema and local warmth thanthose with other soft-tissue infections.However, abscess, induration, tenderness,and pain were more common and moresevere in patients with deep soft-tissueabscess. Leg warmth was absent in only10 of the 278 cellulitis patients.

Comorbidities most often accompanyingcellulitis included diabetes, peripheral vas-cular disease, chronic lung disease, andrenal insufficiency. Treatment included ini-tial I.V. vancomycin in 60% of patients,followed by penicillins, beta-lactamase in-hibitors, and cephalosporins. For patientshospitalized with cellulitis, the mean staywas 7.1 days (range, 5.8 to 8.1 days).

A 2010 study by Kilburn and colleaguesfound 25 randomized controlled trials re-lated to cellulitis. The review noted thatmacrolides reportedly were more effectivethan penicillins in treating cellulitis andoral antibiotics were more effective thanI.V. antibiotics. But due to lack of re-search-supported findings, reviewerscouldn’t give specific recommendationsfor cellulitis treatment; further study isneeded to determine the best treatment.

A retrospective epidemiologic and out-comes study by Zervos and colleagues (in2012) assessed the origin of complicatedand soft-tissue infections and the appro-

priateness of initial antibiotic therapy inhospital patients. In the sample of 1,096patients, the most common soft-tissue in-fections were cellulitis and abscess, usual-ly community acquired. S. aureus was themost common culture-positive skin infec-tion; 74% of these infections were methi-cillin-resistant. More work needs to bedone to examine the impact of skin infec-tions and use of appropriate initial thera-py for such infections.

Risk factors Cellulitis is common in patients with circu-latory problems of the legs, particularlythose with venous disease. Anyone whosustains leg trauma, an insect bite, or asurgical wound is at risk. People who areoverweight or have leg ulcers or lym-phedema are at higher risk. Lymphedemaespecially increases cellulitis risk becausethe lymphatic pathways transport immunecells to fight infection; if these pathwaysare blocked, cellulitis can readily occur.

Cellulitis isn’t contagious because it’s aninfection of the dermis and subcutaneoustissues, which act as a protective layerover the infected tissues. Rarely, it canlead to a deeper, more serious skin infec-tion, such as necrotizing fasciitis.

Diagnosis, staging, andclassification Clinical Resource Efficiency Support Team(CREST) guidelines aid diagnosis. Cellulitisranges from class I to class IV, with IV be-ing the most severe.• Class I: Patients lack systemic signs or

symptoms.• Class II: Patients have comorbid condi-

tions that affect recovery. • Class III: Patients have accompanying

limb-threatening conditions or confu-sion, tachycardia, or other unstable con-ditions.

• Class IV: Patients have severe, life-threatening infections or septicemia.(See Classifying cellulitis.)

Cellulitis is common

in patients with

circulatory problems

of the legs.


Differentiating cellulitis from similarconditionsCellulitis is diagnosed definitively basedon classic symptoms, which include a uni-lateral hot, erythematous, nonblanchingredness that persists with limb elevation.Skin may be dry and flaking. Commonly,subcutaneous tissue is tender; in severecellulitis, crepitations may occur.

Differentiating cellulitis from other con-ditions may prove challenging. One studywith a sample of 635 patients who’d beendiagnosed with cellulitis found only 425(67%) actually had the condition. Disordersthat can mimic cellulitis include eczema,tinea pedis, and other chronic conditionssuch as erysipelas. Lipodermatosclerosis al-so may be mistaken for cellulitis.

Unlike cellulitis, venous eczema cancause a range of manifestations, such asbilateral symptoms, itching, hemosiderindeposits, and edema. Suspect venouseczema, not cellulitis, in a patient withreddened leg skin, chronic venous diseaseor an ulcer, and a history of appropriateantibiotics with no improvement.

Dependent rubor from peripheral vas-cular disease also may resemble cellulitis.But in this condition, further assessmentreveals short-distance claudication or“rest” pain, lack of hair growth on thelower limb, and redness that completelydisappears on elevation.

Assessing for indurationIf you suspect cellulitis, assess for indura-tion—a hardened mass or formation withdefined edges, with slight swelling andfirmness at the edges or border betweennormal skin and skin affected by celluli-tis. The Bates-Jensen Wound AssessmentTool recommends assessing induration bygently attempting to pinch the affectedarea; with induration, you won’t be ableto pinch the tissue. Use a measuring toolto document how far induration extends.Wound care clinicians typically outlinethe indurated area from visit to visit to

This chart describes characteristics of the fourclasses of cellulitis.

CLASSIFICATION CHARACTERISTICS

Class I • No signs or symptoms of systemic toxicity • No uncontrolled comorbidities

Class II • Systemic illness or • Systemic wellness with comorbid conditions—for instance, peripheral vascular disease, chronic venous insufficiency, or morbid obesity, which may impede resolution of infection

Class III • Significant systemic signs and symptoms, such as acute confusion, tachycardia, tachypnea, or hypotension • Unstable comorbidities that may interfere with response to therapy • Limb-threatening infection caused by vascular compromise

Class IV • Sepsis syndrome. • Severe life-threatening infection, such as necrotizing fasciitis

Based on Clinical Research Efficiency Support Team (CREST). Guide -lines on the Management of Cellulitis in Adults. June 2005.www.acutemed.co.uk/docs/Cellulitis%20guidelines,%20CREST,%2005.pdf

Classifying cellulitis

Treatment of cellulitis depends on its classification.

• Class I: oral antibiotics in an outpatient setting• Class II: oral or I.V. antibiotics in an outpatient

setting• Class III: hospitalization for I.V. antibiotic therapy• Class IV: urgent hospitalization for intensive mul-

tiple therapy and specialist consult

Cellulitis treatment


determine if induration has increased ordecreased.

Treatment Guidelines for cellulitis treatment hinge onseverity. A triple approach using I.V. an-tibiotics, I.V. fluids, and pain managementis recommended. Light compression issuggested if the ankle-brachial index (ABI)is adequate, but use caution during anacute cellulitis episode. Consider limb ele-vation and analgesics for comfort.

Treatment should be prompt to help pre-vent complications. Using the HAMMMERacronym can help you remember the essen-

tial elements of treatment. (See Cellulitistreatment and HAMMMER interventions.)

AntibioticsClinicians typically prescribe a 14-daycourse of antibiotics (unless contraindicat-ed) if they’re unsure whether inflamma-tion stems from infection. Advise patientsto contact their primary care practitioner ifthey don’t notice a response to therapywithin 3 days. Antibiotics are effective inabout 90% of cases. If the affected area isquite small and cellulitis isn’t severe, itmay clear without antibiotics; if exudate ismore than minimal, the patient usuallyneeds antibiotics.

Empirical treatment with semisyntheticpenicillin, first-or second-generationcephalosporins, macrolides, or clin-damycin is advised, primarily because ofthe increasing incidence of methicillin-re-sistant S. aureus (MRSA) or erythromycin-resistant S. pyogenes. When cellulitis sur-rounds an abscess formation with MRSA,about half of the infections resist clin-damycin. Of the S. pyogenes cases resist-ant to macrolides, about 99.5% are sus-ceptible to clindamycin and 100% topenicillin. If the condition doesn’t im-prove, symptoms are extensive, or the pa-tient has a high temperature, hospitaliza-tion and I.V. antibiotics may bewarranted.I.V. fluids and hydrationAs with any systemic infection, I.V. fluidsare indicated, as the infection can signifi-cantly increase insensible water loss, inturn causing dehydration and possiblymultisystemic failure.

CompressionIn the past, studies recommended againstusing compression, assuming it couldspread bacteremia. Current best practiceincludes light compression therapy usedcautiously. (Acute infections that lead toswelling can cause higher tissue pressuresthan normal and compression could fur-

To help you remember interventions for patientswith cellulitis, think HAMMMER.

H for Hydrate: Urge patients to drink plenty of flu-ids—about 68 oz per day if possible.

A for Analgesia: Provide pain relief on a regular ba-sis.

M for Monitor pyrexia: Is the patient’s temperaturestill rising?

M for Mark off the area: Is the redness spreading?M for Measure limb circumference: Is leg size in-

creasing?E for Elevate the limb: Reduce swelling, if possible.R for Record assessment findings: Ensure accurate

documentation.

Based on Beasley A. Management of patients with cellulitis of thelower limb. Nurs Stand. 2011;(26)11:50-5.

HAMMMER interventions

Recurrent cellulitis can

damage the lymphatic

drainage system of the

affected limb, causing

lymphangitis, chronic

lymphedema, or both.


ther compromise the limb.) Teach the pa-tient how to apply and care for the com-pression hose. Before considering com-pression in any form, perform a vascularassessment, including ABI measurement.(See Cellulitis: A case study.)

Pain management and skin comfortAssess the patient’s pain level and pro-vide pain management as needed. Nons-teroidal anti-inflammatory drugs hastenhealing when combined with antibiot-ics.Moisturizing the limb can reduce skindryness and flaking and ease discomfort.

Limb elevationElevating the affected leg above heart levelis a key intervention for cellulitis. Raise theankle higher than the knee, the knee high-er than the hip, and the entire leg higherthan heart level. Continue elevation for thefirst 24 to 48 hours while I.V. antibioticsare infusing.

Monitoring for complicationsMeasure the patient’s temperature on anongoing basis. Expect to obtain blood cul-tures as a standard of care. For complexpatients with peripheral arterial disease,

Henry Castillo*, a 68-year-oldmigrant farm worker, comes toyour clinic for diabetes manage-ment. On examination, you finda weeping open leg wound withlower-leg redness and swelling.You note early signs and symp-toms of chronic obstructive pul-monary disease, includingshortness of breath on exertionand bilateral inspiratorywheezes.

Mr. Castillo’s history includestype 2 diabetes with peripheralneuropathy and hypertension.He reports he smokes one packof cigarettes daily and drinkstwo or three beers a day.

Initial laboratory tests show aglycosylated hemoglobin(HbA1c) level of 9.7, white bloodcell count of 13,000, hemoglobinlevel of 11.7 g/dL, low-densitylipoprotein level of 187 mg/dL,high-density lipoprotein level of50 mg/dL, and total cholesterollevel of 252 mg/dL.

Further assessment is war-ranted. You observe indurationand dry, flaky skin on his lowerleg, but no obvious signs of pe-ripheral arterial disease. Youstage his cellulitis as class II anddocument absence of peripheral

arterial disease. Oral antibioticsand increased fluids are or-dered. Although Mr. Castillo istreated at home, he will requirehospitalization if his inflamma-tion spreads while on oral an-tibiotics, if he has a suspectedsystemic infection, or if heshows objective signs andsymptoms of infection, includ-ing an elevated temperature ora red streak spreading up to-ward the trunk.

Mr. Castillo is prescribed oralantibiotics with analgesics andmoisturizing lotions to increasehis comfort. He is referred to thewound care center for ankle-brachial index measurement,which reveals adequate circula-tion. The clinician marks the af-fected leg area to help deter-mine if induration is increasingor decreasing, cleans the woundwith normal saline solution, andcarefully applies an antimicro-bial absorbent dressing.

The clinician correctly appliescompression wraps, and teach-es Mr. Castillo how to protectthe compression wraps andwhat to do if they seem tootight. She instructs family mem-bers to make sure he keeps his

leg elevated properly to relievethe accompanying edema. Shealso advises him when to returnto the clinic and teaches himhow to do ankle exercises to in-crease blood flow. She instructsfamily members how to supportthe limb carefully when movingand turning him.

To ensure comprehensivecare, the clinician refers Mr.Castillo to a nutritionist for di-etary management of his lowhemoglobin value and high cho-lesterol and HbA1c levels. Thetreatment plan includes physicaltherapy, wound care, compres-sion therapy, foot exercises, androutine monitoring after his clin-ic visit.

When Mr. Castillo returns tothe clinic, the clinician notes im-provement. Induration and red-ness have decreased, no signsor symptoms of fever are pres-ent, and his wound has healed.She fits him for compressionstockings to decrease the risk ofcellulitis recurrence. For this pa-tient, comprehensive, holisticmanagement resulted in a posi-tive outcome.

*Fictitious name

Cellulitis: A case study


assess for complications, such as gangreneand poorly healing wounds.

If cellulitis doesn’t respond to ordinarytreatment, suspect complications, such assepticemia. This condition arises when bac-teria spread to the lymph system and blood-stream. Rarely, the infection may spread todeeper fascial tissues (resulting in necrotizingfasciitis) or to the bone (causing osteomyeli -tis). Signs and symptoms of systemic infec-tion include chills, sweating, fatigue, generalmalaise, muscle ache, and a sensation ofheat. These require prompt attention.

Recurrent cellulitis can damage the lym-phatic drainage system of the affectedlimb, causing lymphangitis, chronic lym-phedema, or both. Also, abscesses mayform if the infection becomes highly local-ized in a small area.

Innovations in therapyIn England, a nurse-led “Red Legs” servicehas been established to help meet theneeds of patients with conditions that canbe misconstrued as cellulitis. A team ofhealthcare professionals established inte-grated care pathways for cellulitis diagnosisand treatment. Results were promising andincluded a significant cost savings. Anothergroup of British researchers reported on theeffectiveness of training caregivers aboutcellulitis using simulation methods. In a2011 simulation study by Unsworth and col-leagues, nurses who participated in patientsimulation scenarios had a 45% increase inconfidence levels regarding diagnosing andmanaging cellulitis and recognizing patientdeterioration. Further research is needed sohealthcare professionals can provide cost-effective, evidence-based treatment for themany individuals affected by cellulitis. ■

Selected referencesBeasley A. Management of patients with cellulitis ofthe lower limb. Nurs Stand. 2011;26(11):50-5.

Clinical Resource Efficiency Support Team (CREST).Guidelines on the Management of Cellulitis inAdults. June 2005. www.acutemed.co.uk/docs/Cellulitis guidelines, CREST, 05.pdf

Dalal A, Eskin-Shwartz M, Mimouni D, et al. Interven-tions for the prevention of recurrent erysipelas and cel-lulitis. Cochrane Database Syst Rev. 2012:4:CD009758.

Elwell R. Developing a nurse-led integrated ‘redlegs’ service. Br J Community Nurs. 2014;19(1):12-9.

Harris C, Bates-Jensen B, Parslow N, et al. Bates-Jensen wound assessment tool: pictorial guide vali-dation project. J Wound Ostomy Continence Nurs.2010;37(3):253-9.

Jenkins TC, Knepper BC, Sabel AL, et al. Decreasedantibiotic utilization after implementation of aguideline for inpatient cellulitis and cutaneous ab-scess. Arch Intern Med. 2011;171(12):1072-9.

Kilburn SA, Featherstone P, Higgins B, Brindle R.Interventions for cellulitis and erysipelas. CochraneDatabase Syst Rev. 2010 June 16;(6):CD004299.

Levell NJ, Wingfield CG, Garioch JJ. Severe lowerlimb cellulitis is best diagnosed by dermatologistsand managed with shared care between primary andsecondary care. Br J Dermat. 2011;164(6):1326-8.

Lipsky BA, Moran GJ, Napolitano LM, et al. Aprospective, multicenter, observational study of com-plicated skin and soft tissue infections in hospital-ized patients: clinical characteristics, medical treat-ment, and outcomes. BMC Infect Dis. 2012;12:227.

Stevens DL, Bisno AL, Chambers HF, et al. Practiceguidelines for the diagnosis and management ofskin and soft tissue infections: 2014 update by theInfectious Disease Society of America. Clin InfectDis. 2014;59(2):147-59.

Unsworth J, Tuffnell C, Platt A. Safer care at home:use of simulation training to improve standards. BrJ Community Nurs. 2011;16(7):334-9.

Wingfield C. Diagnosing and managing lower limbcellulitis. Nurs Times. 2012;108(27):18-21.

Wound, Ostomy and Continence Nurses Society(WOCN). Guideline for management of wounds inpatients with lower-extremity venous disease. Mt.Laurel, NJ: Author; 2011.

Zervos MJ, Freeman K, Vo L, et al. Epidemiologyand outcomes of complicated skin and soft tissueinfections in hospitalized patients. J Clin Microbiol.2012;50(2):238-45.

Darlene Hanson is a clinical associate professorat the University of North Dakota (UND) Collegeof Nursing and Professional Disciplines inGrand Forks. Diane Langemo is a professoremeritus, Patricia Thompson is a clinical associ-ate professor, and Julie Anderson is professorand acting director of library sciences at UND.Keith Swanson is a physician specializing in in-ternal medicine and vascular medicine at theAltru Health System in Grand Forks.

We believe in skin.

Coloplast Corp. Minneapolis, MN 55411 / 1-800-533-0464www.webelieveinskin.com The Coloplast logo is a registered trademark of Coloplast A/S. © 2015 Coloplast Corp. All rights reserved.

* Wound Treatment Associate is a registered trademark of the WOCN Society.

At Coloplast, we combine the power to heal with the strength to defend. We’ve integrated skin and wound care to create an end-to-end solution that works across the care continuum. From prevention to intervention. We’re committed to protecting the body’s fi rst line of defense. Because skin is vital to health. To learn more visit webelieveinskin.com.

Wound care isn’t separate from skin care. It’s skin care in its most elevated form.

Megan Ruby, RDWound Treatment Associate*Advanced Wound and Skin CareLas Vegas, NV

http://www.coloplast.us/we-believe-in-skin

AppleBiTESBiTES

Dose from WCEI


How to assesswound exudate By Nancy Morgan, RN, BSN, MBA, WOC, WCC,DWC, OMS

Each issue, Apple Bites brings you a toolyou can apply in your daily practice.

Exudate (drainage), a liquid produced bythe body in response to tissue damage, ispresent in wounds as they heal. It con-sists of fluid that has leaked out of bloodvessels and closely resembles blood plas-ma. Exudate can result also from condi-tions that cause edema, such as inflam-mation, immobility, limb dependence,and venous and lymphatic insufficiency.

Accurate assessment of exudate is im-portant throughout the healing processbecause the color, consistency, odor, andamount change as a result of variousphysiologic processes and underlyingcomplications.

Consistent terminology is crucial to en-sure accurate communication among cli-nicians. Here are terms you should keep

in mind when observing the wound anddocumenting your findings.

Type • Serous—thin,

clear, wateryplasma, seenin partial-thicknesswounds andvenousulcera tion. A mod er ate to heavyamount may indicate heavy bio-burdenor chronicity from a subclinical infec-tion. Serous exudate in the acute in-flammatory stage is normal.

• Sangui -neous—bloody drain -age (freshbleeding)seen in deeppartial-thick-ness and full-thickness wounds duringangiogenesis. A small amount is normalin the acute inflammatory stage.

• Serosangui -neous—thin,watery, palered to pinkplasma withred bloodcells. Smallamounts may be seen in the acute in-flammatory or acute proliferative heal-ing phases.

• Purulent—thick, opaque drainage thatis tan, yellow, green, or brown. Puru-

Accurate

assessment of exudate isimportant.


lent exudateis never nor-mal and is of-ten associatedwith infectionor high bacte-ria levels.

Amount • None—Wound tissues are dry.• Scant—Wound tissues are moist, but

there is no measurable drainage. • Small/minimal—Wound tissues are very

moist or wet; the drainage covers lessthan 25% of the dressing.

• Moderate—Wound tissues are wet; thedrainage involves more than 25% to 75%of the dressing.

• Large or copious—Wound tissues arefilled with fluid that involves more than75% of the dressing.

Consistency • Low viscosity—thin, runny• High viscosity—thick or sticky; doesn’t

flow easily

Odor • No odor noted • Strong, foul, pungent, fecal, musty, or

sweet

Use the following terms to describe thecondition of primary and secondarywound dressings:• Dry—The primary dressing is unmarked

by exudate; the dressing may adhere tothe wound.

• Moist—Small amounts of exudate are vis-ible when the dressing is removed; theprimary dressing may be lightly marked.

• Saturated—The primary dressing is wetand strikethrough occurs.

• Leaking—The dressings are saturated, andexudate is leaking from primary and sec-ondary dressings onto the patient’s clothes.

A useful resource to help you withyour assessment is the Bates-Jensen WoundAssessment ToolA. n

Selected referencesBates-Jensen Wound Assessment Tool. http://www.geronet.med.ucla.edu/centers/borun/modules/Pressure_ulcer_prevention/puBWAT.pdf. AccessedMarch 3, 1214.

Romanelli M, Vowden K, Weir D. Exudate managementmade easy. Wounds International. 2010;1(2). http://www.woundsinternational.com/made-easys/exudate-management-made-easy. Accessed March 3, 2014.

World Union of Wound Healing Societies. Principlesof Best Practice: Wound Exudate and the Role ofDressings. London: MEP Ltd; 2007. http://www.woundsinternational.com/clinical-guidelines/wound-exudate-and-the-role-of-dressings-a-consensus-document/page-1. Accessed March 3, 2014.

Nancy Morgan, cofounder of the Wound CareEducation Institute, combines her expertise as aCertified Wound Care Nurse with an extensivebackground in wound care education and pro-gram development as a nurse entrepreneur.

Information in Apple Bites is courtesy of the WoundCare Education Institute (WCEI)B, copyright 2014.

Online ResourceA. http://www.geronet.med.ucla.edu/centers/borun/modules/Pressure_ulcer_prevention/puBWAT.pdf

B. http://www.wcei.net/

Use the terms dry,moist, saturated,

and leaking todescribe the condition

of primary andsecondary wound

dressings.

http://www.geronet.med.ucla.edu/centers/borun/modules/Pressure_ulcer_prevention/puBWAT.pdf

http://www.geronet.med.ucla.edu/centers/borun/modules/Pressure_ulcer_prevention/puBWAT.pdf

http://www.wcei.net/


Medical gauze101 By Nancy Morgan, RN, BSN, MBA, WOC, WCC,DWC, OMS

Each issue, Apple Bites brings you a toolyou can apply in your daily practice.

Medical gauze, a bleached whitecloth or fabric used in bandages,

dressings, and surgical sponges, is themost widely used wound care dressing.Commonly known as “4×4s,” gauze ismade from fibers of cotton, rayon, poly-ester, or a combination of these fibers.Surgical gauze must meet standards ofpurity, thread count, construction, andsterility according to the United States Phar-macopeiaA.

Gauze offers a variety of options—wo-ven or nonwoven, sterile or nonsterile,plain or impregnated, and fenestrated (per-forated or with slits)—and is available invarious sizes, shapes, and thicknesses.

Woven or nonwoven gauzeMatching the correct type of gauze dress-ing to the wound is essential to success-ful wound healing.

Woven gauze. Woven gauze has a loose,open weave, which allows fluids from thewound to be absorbed into the fibers,wicked away, or passed through into otherabsorb ent materials in the wound’s dressing. Most woven prod-ucts are a fine orcoarse cot-ton mesh,dependingon thethreadcount perinch. Fine-mesh cot-ton gauze is often used for packing, suchas in a normal saline wet-to-moist dressing,whereas coarse-mesh cotton gauze, such asa normal saline wet-to-dry dressing, is usedfor nonselective debriding. Woven gauzeshouldn’t be cut and placed in a woundbecause loose fibers (lint) may get lost inthe wound and delay healing.

Nonwoven gauze. Nonwoven gauze con-sists of fibers pressed together to resemblea weave, which provides improved wickingand greater absorbent capacity. Comparedto woven gauze, this type of gauze pro-duces less lint and has the benefit of leav-ing fewer fibers behind in a wound whenremoved. Most nonwoven gauze dressingsare made of polyester, rayon, or blends ofthese fibers and are stronger, bulkier, andsofter than woven pads.

Types of gauze dressings• Impregnated dressings—These gauze

dressings are coated or saturated with

By Saltanat ebli, licensed under CC0 via Wikimedia

Com

mons.


http://www.pharmacopeia.cn/v29240/usp29nf24s0_m34710.html

http://www.pharmacopeia.cn/v29240/usp29nf24s0_m34710.html

pharmaceutical materials, such as pe-troleum jelly, oil or water emulsion,hydrogel, iodine, or antimicrobials.

• Wrapping gauzes—Used for secure-ment, padding, and protection, thesedressings may include cotton, elastic,or a nylon and rubber mix, and have afluff dried with crinkle-weave pattern.

• Sponges—A sponge, often referred toas a gauze pad, is a piece of gauzefolded into a square. Common sizesare 2×2 and 4×4.

Appropriate use of gauzeGauze can be used for cleansing, pack-ing, scrubbing, covering, and securing ina variety of wounds.

Closely woven gauze is best for extrastrength or greater protection, while openor loose weave is better for absorbency ordrainage.

When it comes to packing for a wound,use a single gauze strip or roll to fill deepulcers as opposed to multiple single gauzedressings (2×2s or 4×4s) because retainedgauze in the ulcer bed can serve as asource of infection.

For many years, woven gauze was usedin the wet-to-dry wound treatment. Thistreatment consisted of applying moistenedsaline gauze to the wound bed and, whenthe gauze was dry and embedded into thewound tissue, ripping it out to debridenecrotic tissue from the wound. Many stud-iesB and clinical practice guidelinesC now dis-courage—and even condemn—the use ofwet-to-dry gauze for treatment of wounds.When other forms of moisture-retentivedressings aren’t available, continually moistgauze (wet to moist) is preferable to thewet-to-dry treatment.

Click hereD to access examples of brandsand types of gauze dressings. ■

Selected referencesHess CT. Skin and wound care products. In: HessCT. Clinical Guide To Skin And Wound Care. 7thed. Philadelphia, PA: Wolters Kluwer Health/Lippin-cott Williams & Wilkins: 2013.

National Pressure Ulcer Advisory Panel, EuropeanPressure Ulcer Advisory Panel and Pan Pacific Pres-sure Injury Alliance. Prevention and Treatment ofPressure Ulcers: Quick Reference Guide. EmilyHaesler, ed. Osborne Park, Western Australia: Cam-bridge Media; 2014.

Rolstad BS, Bryant RA, Nix DP. Topical manage-ment. In: Bryant RA, Nix DP, eds. Acute and Chron-ic Wounds: Current Management Concepts. 4th ed.St. Louis, MO: Elsevier Mosby; 2012:289-306.

Nancy Morgan, cofounder of the Wound CareEducation Institute, combines her expertise as aCertified Wound Care Nurse with an extensivebackground in wound care education and pro-gram development as a nurse entrepreneur.

Information in Apple Bites is courtesy of the WoundCare Education Institute (WCEI)E, copyright 2015.

Online ResourcesA. http://www.pharmacopeia.cn/v29240/usp29nf24s0_m34710.html

B. http://deconsolidatenow.org/Documents/10_Ovington_Article.pdf

C. http://www.npuap.org/wp-content/uploads/2014/08/Updated-10-16-14-Quick-Reference-Guide-DIGITAL-NPUAP-EPUAP-PPPIA-16Oct2014.pdf

D. http://www.woundsource.com/product-category/dressings/gauzes-non-wovens

E. http://www.wcei.net/


Matching the correcttype of gauze dressing to the woundis essential tosuccessful woundhealing.

http://deconsolidatenow.org/Documents/10_Ovington_Article.pdf

http://deconsolidatenow.org/Documents/10_Ovington_Article.pdf

http://www.npuap.org/wp-content/uploads/2014/08/Updated-10-16-14-Quick-Reference-Guide-DIGITAL-NPUAP-EPUAP-PPPIA-16Oct2014.pdf

http://www.woundsource.com/product-category/dressings/gauzes-non-wovens



Evolution of adeep tissue injuryor a decliningpressure ulcer? By Jeri Lundgren, BSN, RN, PHN, CWS, CWCN

A declining pressure ulcer decreasesthe quality of life for patients and

places providers at risk for regulatory cita-tions and litigation. But it’s important forclinicians to determine whether the firstappearance of skin injury is truly a stage Ior II pressure ulcer or if it’s a deep tissueinjury (DTI), a unique staging category for a pressure ulcer. Otherwise, a clinicianmight think a pressure ulcer is gettingworse instead of the change being thenormal progression of a pressure ulcerthat is presenting as a DTI.

DTI and pressure ulcer comparisons An increasing body of evidence demon-strates that the epidermis and dermis aremore resilient to the effects of pressurethan muscle tissue, so many pressure ul-cers start in the muscle tissue. Pressure ul-cers can present within 24 hours of insult

or can take as long as 5 days to appear.Therefore, if a patient has experienceddamage to the muscle tissue, it may takedays before there is any indication on thesurface of the skin that a pressure ulcerhas developed. Once the deep tissue dam-age presents itself, it’s important that theclinician accurately stages it as a DTI.

Understanding the characteristics of aDTI helps clinicians determine if the pres-sure ulcer is a DTI or a superficial pressureulcer. Initially, a DTI presents as a localizedarea of intact skin with dark discoloration,such as purple, maroon, or a bruiselike ap-pearance, or a blood-filled blister. The tis-sue in the DTI area may be preceded bytissue that’s painful, firm, mushy, boggy, orwarmer or cooler than adjacent tissue.

On the other hand, a stage I pressureulcer will have light discoloration, such aslight pink or light red, of intact skin. Ifthe pressure ulcer initially presents with afluid-filled blister versus a blood-filledblister, it would be considered a stage IIpressure ulcer.

Evolution of a DTI As a DTI evolves, clinicians may see a thinblister over a dark wound bed on the skin.The skin may open up superficially, whichcauses many clinicians to erroneously stagethe DTI as a stage II pressure ulcer. Clini-cians should continue to stage the wound

BestPRACTiCES

Deep tissue injury

Epidermis and dermis

are more resilient tothe effects of pressure

than muscle tissue.


as a DTI, but should describe the character-istics of how the skin is blistering or hassuperficial open areas. The DTI may furtherevolve and become covered by thin eschar,and further evolution may be rapid, expos-ing additional layers of tissue, even withoptimal treatment. Once the DTI has fullyopened, exposing the level of tissue dam-age, it can then be accurately staged as IIIor IV pressure ulcer.

Use staging only for pressure ulcers The staging classification system shouldbe used for pressure ulcers only to de-scribe the level and type of tissue in-volvement. Accuracy of the stage is im-portant not only to assess the progress ofthe wound but also to determine appro-priate interventions. For more informationabout staging pressure ulcers, review theNational Pressure Ulcer Advisory Panel PressureUlcer Stages/Categories.

Keep in mind that by accurately stag-ing a pressure ulcer you can help yourpatients receive appropriate treatment sothey can achieve the best possible out-comes. ■

Selected referencesNational Pressure Ulcer Advisory Panel, EuropeanPressure Ulcer Advisory Panel and Pan Pacific Pres-sure Injury Alliance. Prevention and Treatment ofPressure Ulcers: Clinical Practice Guideline. OsbornePark, Western Australia: Cambridge Media; 2014.

Wound, Ostomy and Continence Nurses Society.Guideline for Prevention and Management of Pres-sure Ulcers. Mount Laurel, NJ: Wound, Ostomy andContinence Nurses Society; 2010.

Jeri Lundgren is vice president of clinical con-sulting at Joerns in Charlotte, North Carolina.She has been specializing in wound preventionand management since 1990.

Online ResourceA. http://www.npuap.org/resources/educational-and-clinical-resources/npuap-pressure-ulcer-stagescategories/


http://www.npuap.org/resources/educational-and-clinical-resources/npuap-pressure-ulcer-stagescategories/

http://www.npuap.org/resources/educational-and-clinical-resources/npuap-pressure-ulcer-stagescategories/

http://www.elastogel.com

Get the ‘SKINNI’on reducingpressure ulcers By Cindy Barefield, BSN, RN-BC, CWOCN

Like many hospitals, HoustonMethodist San Jacinto Hospital uses

national benchmarks such as the NationalDatabase of Nursing Quality Indicators(NDNQI®) to measure quality outcomes.Based on benchmark reports that showedan increased trend of pressure ulcers incritically ill patients in our hospital, theclinical nurses in our Critical Care SharedGovernance Unit-Based Council (CCS-GUBC) identified an improvement op -portunity.

As a certified wound, ostomy, and con-tinence nurse (CWOCN), I serve as a re-

source for the critical care units, so Iworked with the council on the initiative.We used the Prosci ADKAR® change mod-el to guide the project. This model incor-porates five steps to ensure a smoothchange process: Awareness, Desire,Knowledge, Ability, and Reinforcement.

Step1: Awareness The first step for the CCSGUBC was toraise awareness of the need for change.During a meeting, we reviewed occur-rences of hospital-acquired pressure ulcersso members would know the problem.

Step2: Desire Awareness prompted council members toembrace the need for change to improvepatient outcomes. Their desire for changefueled a discussion of opportunities forimprovement.


(continued on page 28)

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Step3: Knowledge Knowledge was the next step in thechange process. Clinical nurses identifiedthe need for additional resource nurses foreach shift to help with pressure ulcer stag-ing and skin care. This led to the develop-ment of “skin care champions,” who act

as resource nurses for the clinical area.Clinical nurses interested in the projectvolunteered for the new role. Currently,there are seven skin care champions.

The skin care champions participated inan interprofessional education program ledby the CWOCN, a physical therapy/clinicalwound specialist, and a clinical dietitian.Topics included wounds, pressure ulcers,nutrition and wound healing, incontinence-associated dermatitis, and an overview ondocumentation of pressure ulcers. A reviewof current literature on best practices withskin care bundles also was included.

To provide additional educational sup-port, all critical care nurses were given ac-cess to free NDNQI Pressure Ulcer Train-

ing modules via the hospital intranet. The skin care champions embraced the

challenge of creating a skin care bundle.As nurses with critical care experience,they were familiar with bundles forcatheter-associated urinary tract infectionand ventilator-associated pneumonia. Theyhad implemented these best practices toimprove patient outcomes and were eagerto do the same for pressure ulcer preven-tion. They were confident that the successof the skin care bundle depended on syn-ergy of all components as a whole ratherthan on a single component.

During an interactive session, the skincare champions developed the compo-nents of the skin care bundle based on aliterature review for topics of importanceto their patient population. They chosethe following topics: Support surface,Keep repositioning, Incontinence manage-ment, Needs/risks, and Improve docu-mentation, which form the acronym SKIN-NI. “What’s the SKINNI?” has become acommon question at our organization. Theenergy and enthusiasm for this nurse-ledinitiative have been widespread.

One challenge the skin care championsfaced was adding documentation for thenew skin care bundle to the electronicmedical record (EMR). The clinical dieti-tian on the project team and a technologi-cally savvy skin care champion collaborat-ed to create a process that clinical nursescould use when documenting.

Step4: Ability Ability was the next step in the changeprocess. At this stage, the skin care bundlewas integrated into nursing practice. Theteam has developed many innovative waysto keep the focus on the new process:


(continued on page 30)

(continued from page 26)

Advancing wound care one solution at a time

*The skin protection claim does not apply to the Foaming Body Cleanser and the Antifungal Body Powder.

Unless otherwise noted, the product claims, information and recommendations in this document were obtained from the manufacturer and have not been independently verified by McKesson Medical-Surgical. The properties of a product may change or be inaccurate following the posting or printing of the product information in this document, either in the print or online version. Caution should be exercised when using or purchasing any products from McKesson’s online or print document by closely examining the product packaging and the labeling prior to use. Be advised that information contained herein is intended to serve as a useful reference for informational purposes only and is not complete clinical information. This information is intended for use only by competent healthcare professional exercising judgment in providing care. This promotion is not open to the general public and may be terminated by McKesson Medical-Surgical at any time. Due to regulatory restrictions related to gifts and gratuities, this promotion cannot be offered to healthcare providers licensed in Vermont or to federal government employees.

© 2015 McKesson Medical-Surgical Inc. All trademarks and registered trademarks are the property of their respective owners.

Your residents deserve the best care available. Now, with McKesson Medical-Surgical’s full suite of advanced wound care solutions, it’s easier to give them just that. Whether you’re seeking clinical or business support, proven skin care solutions or quality advanced wound care products, we can help you provide the best care, and save money doing it.

Visit mckessonwoundcare.com to request a complimentary sample of our new Silicone Foam Adhesive Dressing.

Clinical and business support:

Access to our Clinical Resource Team Customized webinars Assistance as you create product formularies In-servicing Access to the F314 Wound Care QuickPath McKesson SpendManagerSM

Advanced skin and wound care:

Eight THERA™ Advanced Skin Care products that help cleanse, moisturize, protect* and treat the skin

Our comprehensive wound care products include Wound Cleansers and Guides, Wound Dressings, Cover and Absorptive Dressings and Multi-Layer Compression Bandages

Request a complimentary sample today!

Your residents deserve the best care available. Now, with McKesson Medical-Surgical’s full suite of

NEW!

• The skin care champions and the nurseleader of the project wear a large but-ton that reads “What’s the SKINNI?” toraise awareness about the skin carebundle throughout the organization.The stick figure used with the messagehas become a symbol for the project.

• Small cardboard signs taped at eachcomputer have the same “What’s theSKINNI?” message to remind nurses todocument the skin care bundle.

• The leader of the CCSGUBC and I sendfrequent e-mails with reminders and re-inforcement messages.

Step5: Reinforcement As with any change, reinforcement andsustainability of this new practice arenecessary to achieve quality outcomes.We’re using several reinforcement strate-gies, including: • The skin care champions and I provide

peer-to-peer feedback informally and

face-to-face using criteria specific to theskin care bundle.

• A Life Saver® candy with a card thatsays “You are a Life Saver® for your pa-tient today” is given to clinical nurseswho correctly document the skin carebundle in the EMR. This provides rein-forcement for the change in practice.Life Saver® cards are distributed asneeded at the discretion of the skincare champions.

• The skin care champions conductmonthly pressure ulcer surveys to eval-uate outcomes and share the resultswith the nursing team.

Success story Skin care champions and members of theCCSGUBC presented the project for thehospital-system Shared Governance Con-ference. It was a great opportunity toshare best practices with nurse colleagues.Over the past year, we have also beenpleased to validate a significant decreasein the rate of pressure ulcers in criticallyill patients. ■

Selected referencesCooper KL. Evidence-based prevention of pressureulcers in the intensive care unit. Crit Care Nurse.2013;33(6):57-67.

Gray-Siracusa K, Schrier L. Use of an interventionbundle to eliminate pressure ulcers in critical care. J Nurs Care Qual. 2011;26(3):216-25.

Hiatt, Jeffrey. ADKAR®:A model for change in busi-ness, government and our community. Loveland,Col.: Prosci Learning Center Publications; 2006.

Institute for Healthcare Improvement. How to guide:Prevent pressure ulcers. Cambridge, MA: Institutefor Healthcare Improvement; 2011. www.ihi.org/resources/Pages/Tools/HowtoGuidePreventPres-sureUlcers.aspx

Cindy Barefield, RN is a certified wound, osto-my, and continence nurse at Houston MethodistSan Jacinto Hospital in Texas.


(continued from page 28)

The skin care

champions and the

nurse leader of the

project wear a large

button that reads

“What’s theSKiNNi” to raise

awareness.

Prove the Value ProgramA program to objectively demonstrate the clinical and financial outcomes of advanced surface technologies for pressure ulcer patients.

©2014 Hill-Rom Services, Inc. ALL RIGHTS RESERVED. ORDER NUMBER 186787 rev 2 09-JUN-2014 ENG – US


Content and funding provided by Hill-Rom

Clinitron® Rite-Hite® System Hill-Rom® P500 Surface

What is Prove the Value program?The Hill-Rom® Prove the Value program is based upon collecting and analyzing information on individuals who have recently used or are currently using a Clinitron® bed or P500 wound surface. The program will help demonstrate the value of advanced wound care solutions through local assessments within your facility.

After the data is collected and analyzed, Hill-Rom will partner with you to summarize key findings in a short case study.

Improve Overall Wound Care

• The program provides an opportunity for a methodicalassessment of advanced wound surfaces that canpotentially lead to improved clinical results andenhanced resident satisfaction.

• The program provides an opportunity to review overallwound care performance, treatment protocols andusage of proper wound support surfaces within yourfacility.

Assist with Marketing Efforts

• The case study can be used to share clinicalresults with current and potential referral sourcesregarding residents who used advanced wound caretechnologies in your facility.

• The case study can be used to promote your facility’sexpertise to treat individuals with complex wounds.

How will my facility benefit from participating in the program?

Pressure Ulcer Healing Rate

Percent Wound Healing Volume (LxWxD)

54.0

Week 1

54.0

Week 2

46.1

Week 3

26.2

Week 4

22.4

Week 5

24.6

Week 6

24.6

Week 7

54% overall reduction in pressure ulcer volumefrom week 1 to week 7



FacilityGolden LivingCenter Skilled Nursing Facility - Murrysville, PA

OverviewAn 89 year old male, with a Stage IV pressure ulcer on his sacrum, experienced an overall reduction in wound volume by 54% while on Hill-Rom’s Clinitron® Rite-Hite® system. The reduction occurred over a 7 week period.

BackgroundThe graph below represents a positive wound healing outcome of a male resident in his late eighties. The resident developed a Stage IV pressure ulcer related to multiple health comorbidities, which included a Urinary Tract Infection, Anemia, COPD, and Diabetes Type II.

In an effort to treat the wound and prevent further skin breakdown, the resident was placed on a Group 2 Low Air Loss with Alternating Pressure support surface. Concurrently, the resident experienced decreased nutritional intake and refused fecal incontinence management – all of which could have impacted pressure ulcer healing. After five days on the Group 2 surface and still showing no observable signs of wound improvement, the Clinitron® Rite-Hite® system was considered for the resident.

The resident had a Braden Risk Assessment score of 15 and a sacral wound volume of 54 cm3 at the time of the Clinitron® Rite-Hite® system placement. While on the Clinitron® Rite-Hite® system, the initial wound dressing used was an alginate twice a day. This was changed on week 4 to Santyl dressing once a day.

Pressure Ulcer Overview• Anatomic Location: Sacrum

• Side of Body: Left

• Pressure Ulcer Stage: Stage IV

• Tunneling/Undermining: Yes

Wound Healing Overview/Clinical ResultsOver a 7 week period the patient realized an overall reduction in pressure ulcer volume by 54%. While on the Clinitron® Rite-Hite® system, the greatest wound healing occurred in week 4 when overall volume decreased 43% week-over-week. Importantly, there were no hospital admissions while the patient was on the Clinitron® bed.

Prove the Value ProgramOutcomes and key findings

Pressure Ulcer Healing Rate

Percent Wound Healing Volume (LxWxD)

54.0

Week 1

54.0

Week 2

46.1

Week 3

26.2

Week 4

22.4

Week 5

24.6

Week 6

24.6

Week 7

54% overall reduction in pressure ulcer volumefrom week 1 to week 7



Hill-Rom reserves the right to make changes without notice in design, specifications and models. The only warranty Hill-Rom makes is the express written warranty extended on the sale or rental of its products.


For further information about this product or a service, please contact your local Hill-Rom representative or visit our webpage:

USA 800-445-3730 Canada 800-267-2337

www.hill-rom.com

Financial ConsiderationsThere are a variety of factors that influence costs associated with healing complex pressure ulcers. These factors include the age and physical condition of the resident, type and number of comorbidities, treatments and dressings, and medical options such as Group 2* support surfaces, Group 3* Air Fluidized Therapy, and Negative Pressure Wound Treatment devices. Labor costs associated with wound treatments also need to be considered.

While every situation is unique, favorable results have been achieved when advanced wound care products have been used to treat pressure wounds. Research indicates these products have helped facilitate faster healing rates, can have a favorable impact on nursing care, and can promote increased resident satisfaction – all have a direct or indirect impact on costs.

Hill-Rom is pleased to be partnering with facilities like Golden LivingCenter Skilled Nursing Facility in Murrysville to better evaluate and understand outcomes and costs associated with effective wound care management.

*According to the Healthcare Common Procedure Coding System (HCPCS), Group 2 support surfaces include powered air flotation beds, powered pressure reducing air mattresses, and non-powered advanced pressure reducing mattresses. Group 3 support surfaces are complete bed systems called air-fluidized beds. This product category uses circulation of filtered air through silicone beads, creating the characteristic of fluid.4

1. Ochs R. et al. Comparison of Air-Fluidized Therapy with Other Support Surfaces Used to Treat Pressure Ulcers in Nursing Home Residents. Ostomy/Wound Management 2005;51(2) 28-46.

2. VanGilder C., Lachenbruch CA. Air-Fluidized Therapy - Physical Properties and Clinical Uses. Annals of Plastic Surgery 2010; 65(3):366-368.

3. Black J. et al. Pressure Ulcer Incidence and Progression in Critically Ill Subjects - Influence of Low Air Loss Mattress versus a Powered Air Pressure Redistribution Mattress. J Wound Ostomy Continence Nurs. 2012;39(3):1-7.

4. Centers for Medicare & Medicaid Services. “Medicare Policy Regarding Pressure Reducing Support Surfaces – JA1014.” Guided Pathways to Medicare Resources (n.d.): n. pag. CMS.gov. Centers for Medicare & Medicaid Services, 24 Aug. 2012. Web. <http://www.cms.gov/Medicare/Medicare-Contracting/ContractorLearningResources/downloads/JA1014.pdf>.

Nursing home residents who had a Stage III/IV pressure ulcer, and were treated with a Group 3 surface, healed 4.4 times faster and had 2.6 fewer hospitalizations or ER visits compared to residents on Group 2 surfaces1.

Bedside procedures such as washing and changing wound dressings are easier while residents are on a Group 3 product2.

Residents who have been placed on the Clinitron® bed often acknowledge they are comfortable and experience less pain caused by pressure ulcers2.

No high risk patients developed a pressure ulcer while on the P500 surface compared to 19% of individuals who developed an ulcer while on another powered air surface3.



OverviewAn 83 year old female resident with a hard-to-heal sacral pressure ulcer experienced complete wound healing within a month while on the Hill-Rom Clinitron® Air Fluidized Therapy system.

BackgroundThe graph below represents a positive wound healing outcome of a female resident suffering from a sacral pressure ulcer initially recognized as unstageable. The resident had a high Braden risk score of 11 and medical diagnosis that included Diabetes Type II and Dementia – all of which were contributing factors to wound development.

The resident was placed on a Low Air Loss Mattress Replacement System in order to prevent further skin breakdown and treat the wound. Additionally, the resident’s nutritional intake was closely managed so that she was receiving adequate levels of nourishment essential for wound healing. However, the pressure ulcer proved to be difficult to heal. Over several months, the resident was treated by a visiting wound care physician 28 times and the wound was debrided seven times. Multiple wound dressing selections were used and consisted of REPARA® Calcium Alginate Wound Dressing, Mepilex® Border Absorbent Foam Dressing, AQUACEL® Ag Hydrofiber® Wound Dressing with Silver Ribbon, and MEDIHONEY® Calcium Alginate Dressing.

Despite standard wound therapy and treatment efforts, the pressure ulcer was not healing in an adequate or timely manner. Costs to treat were high and the resident’s quality of life was affected as she experienced discomfort and pain from the wound. The Director of Nursing was eager to close the wound, so the Clinitron® Air-Fluidized Therapy system was ordered and placed for the resident on October 28, 2013.

Wound Healing Overview/Clinical ResultsWhile on the Clinitron® Air Fluidized Therapy system, the most significant healing occurred between October 29 and November 7, when the overall wound size decreased 70% week-over-week. Furthermore, the resident’s wound completely healed within one month of using the Clinitron® Air Fluidized Therapy system. The resident continued to use the Clinitron® Air Fluidized Therapy system until December 9, 2013, when she was stepped down to a facility-owned Low Air Loss Alternating Pressure surface. The wound has remained closed.

Prove the Value Program Case StudyA clinical assessment on the outcomes and key findings of complete pressure ulcer healing while on the Clinitron® Air-Fluidized Therapy system

1/2/13 2/11/13 3/11/13 4/8/13 5/7/13 7/3/13 8/6/13 9/3/13 10/1/13

0.03 0.18 0.40 0.18 0.14 0.10 0.27 0.560.00

Low Air Loss Mattress Replacement SystemClinitron® Air Fluidized Therapy SystemLow Air Loss Alternating Pressure Surface

Wound Healing Volume in cm3 (LxWxD)

Monthly Healing Progression

10/29/13 11/7/13 11/12/13 11/20/13 12/12/13 1/16/14

0.40 0.12 0.08 0.00 0.00 0.00

Weekly Healing Progression

FacilityCourtyard Gardens Nursing and Rehabilitation Center – Middletown, PA

Pressure Ulcer Healing RateComplete wound healing was achieved while on the Clinitron® Air Fluidized Therapy system in one month.

©2015 Hill-Rom Services, Inc. ALL RIGHTS RESERVED. 188205 rev 1 20-APR-2015 ENG – US

notice in design, s e extended on the sale or rental of its products.

©


Hill-Rom reserves the right to make changes without notice in design, specifications and models. The only warranty Hill-Rom makes is the express written warranty extended on the sale or rental of its products.

©2015 Hill-Rom Services, Inc. ALL RIGHTS RESERVED. 188205 rev 1 20-APR-2015 ENG – US

For further information about this product or a service, please contact your local Hill-Rom representative or visit our webpage:

USA 800-445-3730 Canada 800-267-2337

www.hill-rom.com

Wound Healing MeasurementsDate Length (cm) Width (cm) Depth (cm)

1/2/13 0.6 0.4 0

2/11/13 1 0.3 0.1

3/11/13 1.8 0.5 0.2

4/8/13 2 0.5 0.4

5/7/13 1.5 0.4 0.3

7/3/13 1.4 0.5 0.2

8/6/13 1.3 0.4 0.2

9/3/13 1.7 0.8 0.2

10/1/13 2.1 0.9 0.3

10/29/13 1.9 0.7 0.3

11/7/13 1.5 0.4 0.2

11/12/13 1.6 0.5 0.1

11/20/13 0 0 0

12/12/13 0 0 0

1/16/14 0 0 0

Financial ConsiderationsThere are a variety of factors that influence costs associated with healing complex pressure ulcers. These factors include the age and physical condition of the resident, type and number of comorbidities, treatments and dressings, and medical options such as Group 2* support surfaces, Group 3* Air Fluidized Therapy, and Negative Pressure Wound Treatment devices. Labor costs associated with wound treatments also need to be considered.

While every situation is unique, favorable results have been achieved when advanced wound care products have been used to treat pressure wounds. Research indicates these products have helped facilitate faster healing rates, can have a favorable impact on nursing care, and can promote increased resident satisfaction – all have a direct or indirect impact on costs.

Hill-Rom is pleased to partner with facilities like Courtyard Gardens Nursing and Rehabilitation Center in Middletown to better evaluate and understand outcomes and costs associated with effective wound care management.

*According to the Healthcare Common Procedure Coding System (HCPCS), Group 2 support surfaces include powered air flotation beds, powered pressure reducing air mattresses, and non-powered advanced pressure reducing mattresses. Group 3 support surfaces are complete bed systems called air-fluidized beds. This product category uses circulation of filtered air through silicone beads, creating the characteristic of fluid.3

1. Jackson, et al. Pressure Ulcer Prevention in High-Risk Postoperative Cardiovascular Patients. Critical Care Nurse 2011;31:44

2. Ochs R. et al. Comparison of Air-Fluidized Therapy with Other Support Surfaces Used to Treat Pressure Ulcers in Nursing Home Residents. Ostomy/Wound Management 2005;51(2) 28-46.

3. VanGilder C., Lachenbruch CA. Air-Fluidized Therapy - Physical Properties and Clinical Uses. Annals of Plastic Surgery 2010; 65(3):366-368.

Clinitron® Air Fluidized Therapy system reduced pressure ulcer incidence in extremely high risk patients, which resulted in an estimated 88% reduction in cost to treat.1

Nursing home residents who had a Stage III/IV pressure ulcer, and were treated with a Group 3 surface, healed 4.4 times faster and had 2.6 fewer hospitalizations or ER visits compared to residents on Group 2 surfaces.2

Residents who have been placed on the Clinitron® Air Fluidized Therapy system often acknowledge they are comfortable and experience less pain caused by pressure ulcers.3



notice in design, s e extended on the sale or rental of its products.

©


By preventing and relieving suf-fering, palliative care improvesthe quality of life for patientsfacing problems associated with

life-threatening illness. This care ap-proach emphasizes early identification,impeccable assessment, and treatment ofpain and other issues—physical, psy-chosocial, and spiritual.

When relieving distressing symptomstakes higher priority than healing thewound, the patient may choose palliativewound care after consulting with themedical team. Addressing such issues aspain, odor, exudate, bleeding, infection,and cosmetic appearance, this treatmentapproach couples the elements of tradi-tional wound care with symptom man-agement. When delivered correctly, itbrings patient-centered care to life.

Addressing pain

Many wound care patients have ongoingpain. Dressing removal can be the mostpainful part of wound management. Ifpain intensifies with each dressingchange, the palliative-care approach maycall for use of nonadherent long-wear-time dressings to reduce dressing-changefrequency. Minimizing unneeded stimulito the wound also is important; topical lidocaine preparations help by numbing

the area locally during dressing changes. Try to schedule dressing changes for a

time when patients feel their best, if pos-sible. Before you start, offer pain medica-tion; wait until it reaches maximal effec-tiveness before assessing whether thepatient is ready to begin the procedure.Also consider using music, relaxation,position changes, meditation, guided imagery, and transcutaneous electricalnerve stimulation. If the patient has dis-comfort during the dressing change, callfrequent time-outs: Stop the procedureand ask if the patient would like a break.If so, don’t resume activity until the pa-tient consents.

Palliative wound care This approach brings patient-centered care to life. By Gail Rogers Hebert, MS, RN, CWCN, WCC, DWC, OMS, LNHA


Reducing odor

When unpleasant wound odor reducesquality of life, odor management be-comes a palliative-care goal. Wound odorcan embarrass the patient, causing de-pression and self-imposed isolation. Fam-ily members may feel guilty if they can’tapproach the bedside owing to overpow-ering wound odors. Wound odor alsomay decrease the patient’s appetite,which impedes the palliative-care goal ofproviding adequate nutrition.

Because odor commonly results frombacteria in necrotic tissue, considerwound debridement if it’s consistent withthe patient’s overall plan of care. Autolyt-

ic methods commonly are used becausethey’re gentle and easy to implementwith moisture-retentive dressing prod-ucts. Other aids to managing odors in-clude systemic and topical antibiotics, sil-ver dressings, charcoal dressings, topicalhoney dressings, cadexomer iodine–im-

pregnated dressings, and properly dilutedantiseptic solutions.

If wound odor permeates the patient’sroom, consider placing essential oils, kit-ty litter, or coffee beans nearby. Alsoconsider using scented candles and hav-ing visitors place methylated preparationsunder their noses to mask the smell.These strategies help enable the patientto socialize with others.

Decreasing wound exudate High exudate levelscan pose challengesfor both palliativewound care patientsand clinicians. Con-sider using ab-sorbent dressingproducts, such asfoams, alginates, andspecialty dressings.The goal is to man-age exudate to keepexcess moisture off surrounding skin,where it could cause further breakdown.

If exudate volume is high enough tonecessitate frequent dressing changes or if odor control is needed, considerpouching the wound. Negative-pressurewound therapy (NPWT) helps containthe drainage if all other wound factorsare consistent with use of this therapy.Pouching and NPWT help manage odorbecause these closed systems don’t allowexudate to contact room air, except dur-ing equipment or dressing changes.

Unlike traditional wound care treat-ment, a palliative-care approach mayavoid moist wound healing for dry andscabbed areas. Although moist woundhealing is widely accepted to expeditehealing, when the patient’s prognosis is limited and the wound can be managedwithout further complications, healingtakes lower priority, and scabbed areascan be left open to air with no dressing.

A palliative-careapproach may avoid

moist wound healing for

dry and scabbed areas.


Managing bleeding

In malignant wounds, bleeding may re-sult from the effects of cancer cells onblood vessels. Tissue becomes friableand more susceptible to local trauma.Bleeding also may result from overallhealth conditions, including abnormalplatelet function.

For minor bleeding, calcium alginatedressings (typically used to absorb exu-date) can help trigger the coagulationcascade. Also consider such products asabsorbable gelatin powders, collagens,and vasoconstrictors. Chemical cauteriza-tion with silver nitrate may be required,as well as suturing of involved vesselsand laser therapy.

Preventing and managinginfection

Preventing wound infection is an impor-tant goal for all wound care patients. Usebasic infection-prevention measures—good nutrition, wound cleaning, exudatemanagement, and timely dressingchanges—if these can be done in align-ment with the patient’s wishes. If healing

is a palliative-care goal for a patient witha wound infection, traditional treatmentapproaches (including culturing) are ap-propriate. Be sure to weigh the benefits oftreating the infection against the burdenthe treatments could place on the patient.

If wound healing isn’t a goal for yourpatient, formal diagnosis and treatmentof a wound infection isn’t necessarilywarranted. If treating it won’t yield bene-fits and the patient can be maintainedcomfortably, the infection may not re-quire active treatment.

However, in many cases, bacteria inthe wound cause pain, odor, and highlevels of exudate, which are problematicand reduce quality of life. In this case, tomeet palliative-care goals you may needto take steps to reduce the bioburden.Try such traditional methods as debride-ment, antiseptics, antibiotics, and variousantimicrobial dressings and therapies.

Improving cosmetic wound appearance

Most patients don’t want others to seetheir wounds. If the wound is on thehead, neck, or other highly visible area,this poses a challenge. Patients may beembarrassed and not want to frighten others by their appearance. A major chal-lenge in palliative care is to dress thewound in an inconspicuous way that pro-tects patients’ dignity and supports theirdesire for socialization. One way to dothis is to avoid bulky dressings in favor oflower-profile, more streamlined dressings.

Creating symmetry with dressings isimportant, too. Dressing just one side ofthe body immediately draws the observ-

er’s eye to that side because of the asym-metry. So when feasible, use dressings tobuild up both sides of the body to re-store symmetry and make the wound lessnoticeable. Also, dressings come in vari-ous skin tones to blend better against theskin; choose the most appropriate tonefor your patient. And try to use clothingcreatively to cover the wound.

Palliative wound care embodies thebest of patient-centered care by focusingon what’s best for the patient—even ifthat’s not what’s best for the wound. Ag-gressively managing the most distressingsymptoms of chronic wounds helps max-imize patients’ quality of life. ■

Editor’s note: Learn more about palliativecare at http://woundcareadvisor.com/pallia-tive-wound-care-part-vol4-no1/.

Selected referencesLetizia M, Uebelhor J, Paddack E. Providing pallia-tive care to seriously ill patients with nonhealing

wounds. J Wound Ostomy Continence Nurs.2010;37(3):277-82.

Temel JS, Greer JA, Muzikansky A, et al. Early pallia-tive care for patients with metastatic non–small-celllung cancer. N Engl J Med. 2010;363(8):733-42.

Tippett A. Palliative Wound Care: Merging SymptomManagement into Advanced Wound Care Practice.Posted April 27, 2011. www.woundsource.com/blog/palliative-wound-care-merging-symptom-management-advanced-wound-care-practice

Tippett A. What is Palliative Wound Care? PostedMay 6, 2012. www.woundsource.com/blog/whatpalliative-wound-care.

Tippett A, Sherman R, Woo KY, Swezey L, PosthauerME. Perspectives on Palliative Wound Care: Interpro-fessional Strategies for the Management of PalliativeWounds. December 2012. www.woundsource.com/whitepaper/perspectivespalliative-wound-care-interprofessional-strategiesmanagement-palliative-wou.

Woo KY, Sibbald RG. Local wound care for malig-nant and palliative wounds. Adv Skin Wound Care.2010;23(9):417-28.

Gail Rogers Hebert is a clinical instructor withthe Wound Care Education Institute in Plain-field, Illinois.

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Creating effectiveeducationprograms on ashoestringbudget Following a few tips willleave clinicians wantingmore. By Jennifer Oakley, BS, RN, WCC, DWC, OMS

It’s time again for annual staff education,and you, the certified wound clinician,

need to teach the staff at your organiza-tion. You dream of staff entering a state-of-the-art classroom with computers ateach station, mannequins, wound anato-my models, and enough products for eachstudent to do hands-on demonstrations.But when you open your eyes, you’re sit-ting in a room with ordinary tables andchairs, your laptop, a screen, a brain fullof knowledge, and a very tight budget.

It can be challenging year after year tokeep staff interested enough to attendthese mandatory education sessions. Let’sbe honest: Staff are busy people. The lastthing they want to do is leave all thework they need to do to come to a train-ing session they don’t think they need.They may feel they aren’t learning any-thing new because year after year it’s thesame boring content being taught to themin the same boring way. To avoid thatproblem, you need to regularly reevaluatehow you’re teaching and to whom youare teaching, and think of creative ways topresent the material.

How we learnThe first thing to consider when teachingstaff is how to reach the adult learner.Adults learn in different ways. Some learnby listening (auditory), others by looking(visual), and some through a hands-on(tactile or kinesthetic approach). Each ed-ucational session you teach should giveyour attendees something to listen to,something to look at, and something todo with their hands, or some type of“hands-on” demonstration, to keep every-one involved. (See Matching techniques tolearning style.)

In addition, consider the backgroundand scope of practice of your audience.For example, your presentation on pres-sure ulcers might focus on preventionwhen you’re speaking to nursing assis-tants, but focus on staging, care plan de-velopment, and treatment when your au-dience is a group of nurses.

Tools of the tradeIt’s important to ask yourself, What do Iphysically need in the classroom to teachthe staff? Be careful, as this is where your“wants” often overtake the actual “needs.”You may not have the funds in your budgetto buy that mannequin with 14 woundsand 2 stomas nor the 12 laptops for yourclassroom. But I bet your budget allowsyou to afford some fun; after all, fun isfree!

Laughter has been shown to promptdopamine release and stimulate the frontallobe to enhance thinking. This “feel good”


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H

feeling lasts for hours, so the smile youcreate in the classroom carries back ontothe unit and ultimately to the patient’sbedside. Incorporating humor and fun in-to your education programs will not onlykeep staff coming back year after year butalso build a stronger team.

You don’t need the best high-end com-puter programs, wound models, or man-nequins to teach wound or stoma assess-ment. You can use other budget-friendlymethods to provide fun, effective educa-tion without breaking the piggy bank.

Start by jumping online. Search for freedownloads that allow you to create Mi-crosoft PowerPoint®-based games fromtemplates in JeopardyA or other formats, oreven make crossword puzzles. Downloadfree pictures and clip art to capture the at-tention of visual learners and enhance thelearning experience. Give handouts forthose tactile learners to take notes on, un-derline, and follow along with your talk.

Enlist sales representatives for help. Fre-quently, they will provide free educationabout a product or topic and includehands-on demonstrations. Those lower-ex-tremity wraps or negative pressure modal-ities are great topics for hosting a lunch-and-learn session with a sales rep. Be surethe rep understands the need to focus oneducation, not make a sales pitch.

You can also get creative and solveyour own budget crisis by making yourown training tools. (See DIY training toolson a budget.)

Set the stage Next, take a look at the environmentyou’re teaching in. Do you have enoughroom? Is there enough seating? How is thelighting? Will everyone be able to see andhear you?

Before your presentation, practice, prac-tice, practice; try to have one practice ses-sion in the room where you will bespeaking. Time your presentation so youknow you haven’t tried to pack in toomuch information. A way to avoid thisproblem is to establish one or two overallgoals for the typical 60-minute presenta-tion and build in time for questions. Thinkof questions that might arise so you’reready with answers. If a question comesup that you don’t know the answer to,simply say, “I don’t know the answer. I’llfind out and get back to you.”

Stay on task During the presentation, keep focused onyour agenda. If a person raises a questionthat’s off topic, you can say that you’ll talkwith him or her at the break.

Remain fair and unbiased during thepresentation and cite your sources for in-formation. Always be approachable. Re-member, you’re the staff’s source for in-


You can incorporate various techniques intoyour presentation to ensure you’re reaching allthree types of learners.

Type of Sample teaching learner techniques

Auditory: Prefer Lecture, discussiondiscussion of concepts groups, question andthey have heard answer sessions

Visual: Learn by Pictures, clip art, seeing posters

Tactile (or Hands-on kinesthetic): Learn demonstrationsby touching, like to perform tasks

For more information on learning styles, access this videoB. Although the setting is a college, the principles still apply.

Matching techniques to learning style

http://www.edtechnetwork.com/powerpoint.html

http://www.youtube.com/watch?v=oNxCporOofo

formation and if they don’t feel you’reapproachable, they won’t ask questionsor request clarification when they’re un-clear.

You also need a way to check if partici-pants have learned the main points of thepresentation. A brief verbal or written quizin the format of a question-and-answersession will help you assess this and pro-vides an additional opportunity for rein-forcing important information.

Finally, end on time to show you re-spect the staff’s time.

Passion for the professionWe always want staff to feel valued. Helpingthem stay current in their knowledge willhelp them keep the same passion for theirprofession they had when starting out intheir careers. If, as the educator, you do yourjob well, it’s likely that staff will do their jobthat way, too. Pay it forward with a smile. n

Jennifer Oakley is a clinical instructor forWound Care Education Institute.

Online ResourcesA. http://www.edtechnetwork.com/powerpoint.htmlB. http://www.youtube.com/watch?v=oNxCporOofo


Here are examples of do-it-yourself training tools you can create for little cost. Once you openyour imagination, the possibilities are endless.

DIY training tools on a budget

1 Create your own gamedice. Attach foam to eachside of a six-sidedStyrofoam cube. Thenattach photos of all sixstages of pressure ulcers.As students roll the dice,ask questions regarding

stage, tissue type, treatment, and other facts.

2 Use inexpensiveCrayola® Air-Dry-Clay(about $6 for a 2.5 lbbucket) to createwound and stomamodels. (The author

made a stoma model and a 14-cm × 14-cmwound model, and had clay left over.) Allowthe models to dry for a day or two; then useacrylic paint and sponges to give color andtexture (see progression). You’re now readyto assess staff’s knowledge. You can evengive them scenarios on the wound or stomaand have them select appropriate treatment.

3 Stoma model createdwith clay

4 Finished stomamodel. Participants canmeasure the heightand size of the stomaand assess:

• color of the stoma• lumen location• mucocutaneous junction• peristomal skin.

This model can also be used forlearning how to properly fit and applyskin barriers.

5 Wound modelcreated with clay

6 Finished woundmodel. Participantscan measure thelength, width, anddepth; practicepacking a wound;

examine different tissue types; andassess:• undermining• tunneling• epibole.

Participants then document theirassessment.


No one wants an ostomy, butsometimes it’s required to savea patient’s life. As ostomy spe-cialists, our role is to assess

and intervene for patients with a stomaor an ostomy to enhance their quality oflife. We play an active role in helping pa-tients perform self-care for their ostomyand adjust to it psychologically, startingeven before surgery.

Preoperative considerations Preparation for the ostomy is the mostcritical aspect of a healthy adjustment.When the ostomy is planned, the patientand family members are more likely to

process the life changes it will entail.They can learn about anticipated postsur-gical changes in the patient’s diet, cloth-ing, and sexuality, and family memberscan become more sensitive to the changein their loved one.

Assessment On initial assessment, evaluate your pa-tient’s body configuration, stoma place-ment, skin integrity, physical limitations,psychological needs, and home caregiv-ing system. Then develop a plan of careto mitigate problems that could impedethe patient’s ability to maintain and man-age the ostomy system.

The human body comes in many con-figurations and sizes. Because each per-son’s body is unique, clinicians may needto get creative to adapt the ostomy sys-tem to a patient’s body. Options foradapting it to your patient’s physicalcharacteristics include using: • a one-piece vs. a two-piece system• a flexible flange, clear drape flange, or

moldable flange.

Factors affecting decisions about an os-tomy include its location, skin integrity,and physical ability. (See Decision guidefor ostomy products.)

LocationThe stoma may be located near an inci-sion, under a peniculum, or in an ab-

Helping patients overcome ostomy challenges Physiologic, psychological, and psychosocial issues demand careful planning, monitoring, and creativity. By Beth Hoffmire Heideman, MSN, RN


Decision guide for ostomy products

The chart below suggests appropriate products to use based on your patient’s physical condition orostomy characteristics. It applies to patients with ileostomies, urostomies, or colostomies. Refer pa-tients with special challenges to a certified wound clinician.

OSTOMY SYSTEM BASICS

Description What to use

Retracted stoma (below abdominal plane) • Convex flange • Convex ring • Strip paste

Protruded stoma (above abdominal plane) • Flat flange • Flat ring

Acidic effluence (ileostomy or urostomy) • Extended-wear flange • Extended-wear skin protector • Convex adaptor ring

Basic (neutral) effluence (colostomy) • Standard-wear flange • Standard skin protector • Stoma paste, adaptor rings • Adhesive strips

PERIWOUND SKIN

Eroded or denuded • Stoma powder • Use crusting method: Apply powder, dust off, apply skin prep; repeat three times.

Fungal rash • Antifungal powder and skin protectant • Skin protectant product • Use crusting method: Apply powder, dust off, apply skin prep; repeat three times.

Infection or ulcer • Calcium alginate silver powder • Hydrofera blue • Silver hydrofiber • Calcium alginate silver sheet

SPECIAL SITUATIONS

Stoma located in abdominal fold or • One-piece systemabnormal position • Extended-wear products • Convex adaptor rings • Silicone tape • Pectin ring

Stoma located on a flat surface • One- or two-piece system(regardless of body position) • Standard ostomy system

Difficult adherence • Consider using ostomy belt, medical adhesive spray, or latex bonding cement.

Stoma near incision line • Offset flange opening to right or left.

Hernia • Ostomy hernia belt (requires physician order and prescription specifying ostomy hernia belt)

High-output stoma • Adaptor valves connected to night drainage bag (for urostomy or ileostomy); acquire through patient’s ostomy supply vendor.

Additional recommendations If your patient’s ostomy problems aren’t resolving:• Assess for patterns.• Determine what occurred and identify related issues.• Evaluate for changes in the patient’s psychosocial status.• Carefully observe the stoma as the patient passes effluent.


dominal fold. Ostomies in these areascan be hard to manage because ofwound dressings, staples, adhesive strips,and body shape.

If the ostomy system is located next toan incision, you may want to adapt it byusing stoma paste strips, moving theflange opening to the right or left, or us-ing a pectin-ring stoma system without aflange. When the stoma is placed undera peniculum, pressure from the weightslows effluence (drainage) flow. To de-crease pressure on the stoma and pro-mote flow, an abdominal support bindercan be used. (See Case study 1: Stoma lo-cation challenge.)

If the stoma is located in an abdomi-nal fold, you can use a one-piece flexibleostomy system to increase adherence.When needed, add stoma paste stripsand either medical adhesive spray or abonding cement.

Skin integrityAlways consider skin integrity whenchoosing an ostomy system. Take into ac-count the patient’s fragility from such fac-tors as age, medications, an irregular ab-dominal plane from previous surgeries orscarring, moisture or oily skin that limitsflange adherence, and comorbidities(such as psoriasis, fungal infections, andulcers). Options for maintaining skin andostomy-system integrity include use ofcrusting, silicone flanges, stoma pastestrips, or topical medication covered withhydrocolloid or extended-wear products.

Physical abilitiesBe aware that a patient with limited mus-cle function may have limited gross andfine motor skills, which makes self-care achallenge. Expect patients with such con-ditions as multiple sclerosis and musculardystrophy to have limited strength. Thosewith amyotrophic lateral sclerosis, Parkin-son’s disease, or stroke are likely to havelimited muscle control. In each case, re-

When the patient declines to participate in the planof care, solving a stoma location problem can bedifficult, as this case study illustrates.

HistoryMary, a 25-year-old moribund, obese, bedbound pa-tient, had a colostomy to assist with healing a stageIV pressure ulcer adjacent to her anus. The stomawas placed under the pannus, and Mary’s familywas responsible for ostomy care.

AssessmentOn assessment, Mary weighed 365 lb. Her diet washigh in fat and salt. The pannus hung below herknees, restricting effluence flow and stretching thestoma. Four assistants and mobility devices wererequired to move her.

Plan• Reduce weight of the pannus to lessen pressure

on the stoma.• Promote weight loss.• Instruct the family in ostomy management.

ActionsTo address Mary’s problems, the healthcare team:• taught the family how to stop the pannus from

applying pressure on the stoma by using a sup-port binder

• educated the family on how to assess the effec-tiveness of pressure-reduction techniques formaintaining stoma function

• promoted weight loss by referring Mary to a reg-istered dietitian

• referred Mary to a social worker for emotionalcounseling related to weight loss

• remeasured the stoma with each wafer change.

OutcomeAlthough the family responded well to teaching,Mary declined to follow through with the plan ofcare (which included weight reduction) and contin-ued to gain weight. As a result, the stoma continuedto stretch and flatten until it became level with theabdominal plane. As it kept enlarging, she chose touse an incontinence pad to collect effluence.

The stoma, 2.5 cm inheight when first placed,became nearly level withthe abdominal plane.

Case study 1: Stoma location challenge


habilitation support and physical or occu-pational therapy can help the patientlearn how to adapt to the stoma.

Psychological adjustment Hidden issues can make it hard for pa-tients to adjust to the ostomy system. Thepatient who undergoes an unplanned os-tomy has to relearn life skills while griev-ing the change in self-image and dealingwith a sense of having an imperfectbody, loss of control, or feeling like aninfant. To this patient, the ostomy systemmay become the enemy, so to speak.The patient may refuse to learn aboutself-care and ignore ostomy complica-tions. To help patients regain a sense ofcontrol, clinicians must address body im-age with them and provide education.

The following interventions can helpthe patient focus on the positive: • Suggest that the patient keep a diary of

daily activities.• Listen actively as the patient expresses

thoughts and feelings.• Confront false ideations, such as “I’m a

baby now,” “No one will ever touchme again,” or “I smell” with such posi-tive statements as “I’m still an adult,”“My wife loves me,” or “I can use de-odorizers to make sure the ostomydoesn’t smell.”

• Recommend ostomy support groups orspiritual or psychological counseling.

Mental illnessMental illness also can cause ostomy man-agement problems. Mentally ill patientsmay respond differently to an ostomy thanother patients, leading to lack of properostomy self-care. If mental illness goes un-recognized and unaddressed, the stoma orperistomal skin may become damaged.

As a wound care clinician, be sure tocarefully review reports of unresolving os-tomy malfunction issues, note their fre-quency, and observe malfunction patterns.When these malfunctions occur consistent-

As this case study shows, psychosocial and physio-logic problems may converge to cause stoma retrac-tion and other ostomy challenges.

HistoryJim, a 70-year-old man with a history of high anxietyand schizophrenia, had been managing his ostomyindependently in his own home. Five weeks aftermoving to a senior apartment complex, his ostomysystem began to constantly release (pull away) fromhis abdomen and the peristomal skin became denud-ed. Jim’s family decided to sever contact with himbecause of his multiple calls to them for help withthe ostomy. At that point, the patient’s physicianwrote a referral for home care.

AssessmentJim’s stoma height had been 2.5 cm. On assessment,the home care nurse found a rosy red stoma andfound that hyperperistalsis caused it to retractdeeply into the abdomen when the patient experi-enced anxiety or stress, most notably at night. Psy-chological assessment revealed Jim was lonely andfelt rejected by his family.

Plan• Monitor the stoma for physical changes.• Assess the flange-release pattern.• Observe the patient’s behavior.• Provide emotional support to the patient. • Consult a social worker to identify another care-

giving option.

ActionsTo address Jim’s problems, the nurse:• used a convex flange to manage leakage of efflu-

ence under the flange, which occurred with stomaretraction

• used the crusting method (stoma powder and skinprotectant) to promote healing and protect peris-tomal skin

• obtained an order for dicyclomine to reduce hy-perperistalsis, which had caused the stoma to re-tract into the abdomen

• advised the patient to listen to music on the radioat low volume at night to decrease his sense ofloneliness and anxiety.

OutcomeThe social worker was able to connect Jim with anadult day-care program and activities taking placenear where he lived. Over a 2-month period, heachieved an intact ostomy system and continuedwith community outreach supports.

Note that the stoma has retracted into the abdomen.

Case study 2: Effect of psychological distress on ostomy care


ly, assess the patient for mental illnessand provide a referral to appropriate sup-port services. (See Case study 2: Effect ofpsychological distress on ostomy care.)

Depressed patients may avoid thestoma or ostomy system. They may fail toapply the system or, conversely, leave iton for extended periods to avoid thinkingabout the body-image change it repre-sents. On the other hand, highly anxiouspatients may be hypervigilant and removethe ostomy system frequently to check onthe stoma. In patients with either depres-sion or high anxiety, the stoma and peris-tomal skin may break down.

Bipolar patients may have difficultylearning about self-care because of theirhigh or low affect. They should receivecare from a mental health specialist,along with appropriate medications, tosupport their ability to learn and adjust tothe ostomy.

Unmedicated schizophrenic patientsmay have trouble processing the pres-ence of a stoma. They may perceive thestoma or ostomy system as alien and at-tack it, injuring themselves or damagingthe stoma or peristomal skin. This re-sponse demands careful mental healthobservation and medication monitoringto prevent further bodily harm.

Home caregivers’ behaviorThe patient’s home caregivers also maybe a hidden cause of ostomy systemproblems. They may be unable to acceptthe change in their loved one, and theirnegative reactions may result in the pa-tient’s failure to perform self-care. Thislack of self-care reflects the patient’s dis-tress. Observe carefully for disharmonyamong caregivers and address any issues.Through active listening or referral to asupport group or counseling, you canhelp ease negative behaviors.

Financial constraintsIf because of complications, your patient

needs additional ostomy supplies beyondwhat the insurance company allows: • Ask the physician to write a letter of

medical necessity to the insurancecompany and vendor that explains thereason for product overage.

• Contact the ostomy supply vendor torequest free samples.

• Contact ostomy support group members,who may be able to provide samples.

Overcoming adversityA patient with a malfunctioning ostomysystem or a maladaptive response to it canpose a challenge for the ostomy manage-ment specialist or the wound, ostomy, andcontinence nurse. But with careful plan-ning, monitoring, and creativity, such chal-lenges can be overcome so the patient canhave the highest possible quality of life. ■

Selected referencesBaranoski S, Ayello EA. Wound Care Essentials:Practice Principles. 3rd ed. Philadelphia, PA: Lippin-cott Williams & Wilkins; 2011.

Johnson RJ. Finding Health: A Search for Wellnessand Longevity. CreateSpace Independent PublishingPlatform; 2011.

Shulman L. Brooks/Cole Empowerment Series: TheSkills of Helping Individuals, Families, Groups, andCommunities. 7th ed. Brooks/Cole Cengage Learn-ing; 2009.

Taylor SG, Renpenning K. Self-Care Science, Nurs-ing Theory and Evidence-Based Practice. SpringerPublishing; 2011.

Townsend MC. Psychiatric Mental Health Nursing:Concepts of Care in Evidence-Based Practice. 8th ed.Philadelphia, PA: F.A. Davis; 2105.

Wound, Ostomy and Continence Nurses Society(WOCN). Colostomy and Ileostomy Products andTips: Best Practice for Clinicians. Mt. Laurel, NJ:WOCN; 2013.

Wound, Ostomy and Continence Nurses Society(WOCN). Peristomal Skin Complications: Best Prac-tice for Clinicians. Mt Laurel, NJ: WOCN; 2007.

Wound, Ostomy and Continence Nurses Society(WOCN). Stoma Complications: Best Practice for Cli-nicians. Mt. Laurel, NJ: WOCN; 2014.

Beth Hoffmire Heideman is a wound care nurseat McAuley Seton Home Care in Cheektowaga,New York.

The resources below will help you addressissues in your practice.

NPUAP position statement onhand check for bottoming out

Use of the hand check to determine “bot-toming out” of support systems should belimited to static air overlay mattresses, ac-cording to a position statement from theNational Pressure Ulcer Advisory Panel(NPUAP).

“Hand check method: Is it an effectivemethod to monitor for bottoming outA” addsthat the hand check method is “inappro-priate” for replacement mattresses and in-tegrated bed systems and calls for addi-tional research for a bedside method todetermine when a support surface hasbottomed out.

Summary of pressure ulcer treat-ment guidelines from ACP

The National Guideline Clearinghouse,part of the Agency for Healthcare Re-search and Quality, has published a sum-mary of “Treatment of pressure ulcers: aclinical practice guideline from the AmericanCollege of PhysiciansB” (ACP).

The full guidelinesC can be found in theMarch 3 issue of the Annals of InternalMedicine.

NIOSH education on nurses’ work hours

The National Institute for OccupationalSafety and Health (NIOSH) has published“NIOSH training program for nurses on shiftwork and long work hoursD.” Part 1 of theprogram discusses the risks associated withthese work hours related to fatigue, andPart 2 is designed to increase knowledgeabout personal behaviors and workplacesystems to reduce the risks.

Continuing education credit is availablefor the course.

Implementing guidelines in an organization

Struggling to implement practice guidelineswhere you work? Check out “Implementingguidelines in your organization: What ques-tions should you be askingE?” an expert com-mentary in the National Guideline Clearing-house, part of the Agency for HealthcareResearch and Quality. n

Online ResourcesA. http://www.npuap.org/wp-content/uploads/2012/01/Hand-Check-Position-Statement-June-2015.pdf

B. http://www.guideline.gov/content.aspx?f=rss&id=49051&osrc=12

C. http://annals.org/article.aspx?articleid=2173506

D. http://www.cdc.gov/niosh/docs/2015-115/

E. http://www.guideline.gov/expert/expert-commentary.aspx?f=rss&id=49423


ClinicianRESOURCES

http://www.npuap.org/wp-content/uploads/2012/01/Hand-Check-Position-Statement-June-2015.pdf

http://www.npuap.org/wp-content/uploads/2012/01/Hand-Check-Position-Statement-June-2015.pdf

http://www.guideline.gov/content.aspx?f=rss&id=49051&osrc=12



http://annals.org/article.aspx?articleid=2173506

http://www.cdc.gov/niosh/docs/2015-115/

http://www.cdc.gov/niosh/docs/2015-115/

http://www.guideline.gov/expert/expert-commentary.aspx?f=rss&id=49423



Note from Executive Director

By Cindy Broadus, RN, BSHA, LNHA,CLNC, CLNI, CHCRM, WCC, DWC, OMS

The theme for this issue of WoundCare Advisor is “the best of the best,”so it seemed appropriate for this note

to be about the “best of the best” from theNAWCO viewpoint.

What does “best of the best” mean? Merri-am Webster defines the word best as “thegreatest degree of good or excellence.” Inaddition, Merriam Webster defines the wordexcellence as, “extremely high quality.”

One high-quality conference full of excel-lence is the Wound Care Education Insti-tute’s Wild on Wounds (WOW) Conference.Since its inception in 2004, this conferencehas provided bedside clinicians with the op-portunity to come together to learn, net-work, and have fun! After 12 years, WOWcontinues to be the go-to conference of theyear for many clinicians. With a loyal groupof dedicated clinicians, continued growth,and a focus on what is best for the atten-dees, the WOW conference makes it on my“best of the best” list.

As WOW has grown, so has the numberof Wound Care Certified clinicians. Withmore than 18,000 certified clinicians, NAW-CO continues to be the largest certificationbody in the United States. I think about allof these clinicians with a great sense ofpride for each and every one of them andwhat they have accomplished. Enhancingtheir knowledge and increasing their pres-ence was an individual decision made byeach person. Why? Because they wanted tobe the “best of the best.”

I’d like to take that one step further. What

constitutes the “best of the best” in this groupof talented, intelligent, compassionate clini-cians? It’s clinicians who consistently goabove and beyond to make it better for pa-tients who are often overlooked. Others per-ceive these clinicians as “going the extramile” and “giving 150%.”

As WOW and the certified number of cli-nicians grew, we knew there needed to be away to acknowledge these excellent practi-tioners. Who better to choose these deserv-ing clinicians than the people they workwith on a daily basis? That’s why in 2007NAWCO established the Awards Committeeand decided on the criteria for four awardsto be given that year: Outstanding WCC ofthe Year, Outstanding Work in DiabeticWounds, Outstanding Research in WoundCare, and a WCC Scholarship to an Out-standing Clinician working in the field.

Every year, the clinicians who are chosenreceive their 15 minutes of fame. But whathappens when the curtain goes down, thelights go out, and everybody goes backhome? We may think that these individualsare forgotten, but I believe that among theirpeers, patients, and families they remain fa-mous. With that said, I wanted to give themall another 15 minutes of fame by recogniz-ing them again. I am certain that today theyplay as vital a role in the care of wound pa-tients as they did the year they were chosen.

Outstanding WCC of the Year 2007 – LuAnn Reed RN, WCC, DWC2008 – Rachel Pacheco RN, WCC


NAWCONEWS


2009 – Shane Pilkington OT, BS, WCC2010 – Sharon Perry RN,NP-BC,WCC2011 – Beny Tadina-Himes RN, WCC2012 – Monessa Wadford RN, BSN, WCC2013 – Ava Chavaz RN, WCC2014 – Chelsey Hawthorne RN-BC, WCC,

BSN

Outstanding Work in Diabetic Wounds2007 – Michelle Goncalves, LPN, WCC2008 – Stanley Rynkiewicz RN, BSN, WCC,

DWC2009 – Catherine Jackson RN, WCC2010 – Kulbir Dhillon NP,WCC2011 – Nenette Brown MSP, NP, WCC2012 – Sandra Leamer-Newhouse RN, WCC2013 – Jessica Kuznia PT, WCC, DWC2014 – Anna Ruelle DPM, WCC

Outstanding Research in Wound Care2007 – LuAnn Reed RN, WCC, DWC2008 – Amy Narciso RN2009 – Anne Blevins RN, BSN, WCC2010 – Christine Fanelli MS, NP-BC, CWS,

WCC2011 – Connie Johnson RN, MSN, WCC,

DWC, LLE, OMS2012 – Julie Lientz BSN, RN, WCC, CWON2013 – Connie Johnson RN, MSN, WCC,DWC, LLE, OMS2014 – Michael Katzman BSN, RN, ONC,

WCC

WCC Scholarship2007 – Janet Jones, RN2008 – Christina Albright RN, WCC2009 – Rebecca Thompson RN2010 – Maren Zinski RN, BSN, WCC2011 – Marlene Bilello RN, WCC2012 – Melinda Kofmehl, RN2013 – Angela Rumery LPN 2014 – Craig Johnson RN, BSN

I would like to extend my personal thankyou to all the winners for the job that youdo, the care you provide, and the compas-sion you display. We are honored that youchose the WCC credential to enhance yourprofessional careers. Your commitment tolearning, along with your expertise, makesa difference in the lives of wound care pa-tients you encounter across the UnitedStates.

This is our ninth year of recognizing in-dividuals who have been chosen by theirpeers as the “best of the best.” Be sure toattend Saturday’s Session 114 (Paying it For-ward) to meet the Award Winners for 2015.

In the next issue, I will continue our se-ries of Board member introductions, but Ienjoyed this break in the series to be ableto recognize the “best of the best” in thewound care field. Congratulations, onceagain, to all of the past award recipients.You are all truly the “best of the best.”

James AdamsLaila Alamgir

Judy BakkenMichelle Ball

Dana BarrWilliam BarrettBettina BatesKristin BattsStina BjurstromAutumn BlevinsBarry Bontempo

Catherine Boone Randolph

Jennifer BrenkerPeaches BrownJessica BrownLeeKoshia CampbellJo Cavalier

New certificants

Below are WCC, DWC, and OMS certifi-cants who were certified from June to July 2015.


Sonja ChaseChristina ChristiansonDonna CincoEugenio ClarkeConrado ClementeDelores CoatsMarcella CriderBerta DeandaCatherine DelBelloSirner DhaliwalLisa DiazJacinda DiplacidoKaren DirschelKathy DoJessica DominguezBrooke DonstonJulie DowHarmony EckSina El-KhouryMisty EmmertLauren EverettRenee FagoneRebecca FranklinSusan GiardinoMercy GoloKristy GossonDawn GrahamMelodie GraingerJeffrey GreenSandra GuzmanLinda HammonsPaige HarknessHoma Hasnain, MDCatherine HaugRebecca HaugaardCheryl HillDanielle HiltonZachariah HladKarin HohlTammy HopkinsKimberly IngeJoseph JackKalonji Jahi

Katlen Jean-LouisLilia KarlstadAmanpreet KaurLaura KellyMisty KeoughJudith KimatuSusan KingSuzanne KinsellaLaurie KnowlesMaria KoppEleni KordazakisKimberly KrullWanda KudajAmanda KvienCharleen LanceJoy LangleyGina LarochelleJennifer LarsonElizabeth LawingerAmanda LejeuneDawn LewisLinda LoughMaria Romina

Sancha MalvarYunaidys MarreroLarry MartindaleKatherine MarxMargaret MasonJacob MasseyCarolyne Mburu-

GerenaMaurice McCainLeann McCurdyLisa McGeeDebra MeyersStephanie MillerTravis MillerShelley MillerChristina MinteerLisa MoffaOscar MorenoAnita MukerjeeSandra Muller White

Emily NordbergJoan Ondrejka-ColeDava OwenCora PalmerBentley PannellChristine ParanalTiffany PearsonLacy PessagnoJean PetersonLindsey PetersonGina PiccioneShawnee PutnamAmy ReaganChristy ReckeWadella RichardsCarmella RichardsonJennifer RileyMaria RodriguezWanda RodriguezPelaghia RoscaSusan RothenbergerMargaret RuddySarah Rudolph WestElisa SalgadoDebra SaltsmanLaura ScalfJudy SealsRashda ShaheenDoreen SharpAlexandra ShortKristina ShrollSarah SkretkowiczNeika SmallAmy SmithDona SmithBrenda SteepletonJenny StoutEvan SwansonLauren SzilagyiGail TaylorYoseph TesfayeMonique ThomasTammara Travis

Stephanie UngerApril VandergriffLaurie VandermeerAngela VaughnGinger WadeKimberly WatersCrystal WatersNancy WatesTiffany WestBetsy WrightLily YanacekJulieann YerkesMilissa ZackCyan Zieske

Christen AdamMarilyn Al-TwalPamela AndersonElija ArmstrongLaura AvelarMaureen AveryEmma BascoChristine BellStacey BencicChristina BerryCarol BlankenbakerSue BrunoRebecca BuhidarJoanne BurbankTeresa CaldwellVivienne CampbellBrenda CarriereChrista Cavallo

Recertified certificants Below are WCC,DWC, and OMS certificants whowere recertifiedfrom June to July2015.


Gail Christopherson-Brown

Marion ClarkeToni ClarkeAudrey CokenourPaula CorrisSusan CrowleyEmma CzazastyNydia Del Toro

RiveraCarla DonahueMichele DoughtyDenise DrakeShirley DrakeMarilou Ermitano-

MartelBarbara FisherElizabeth FloresJennifer FosterCelia GarciaMegan GilmoreSandra GoodinConsuelo GrantDonna GreenfieldWuntanee GruzenLisa HarrisRebecca HecoxTina HoverMelanie HughesJacqueline John-MullAudrey JoyNatalia JungwirthGahan KaloostianAna KimBarbara Kimsza-

MendesDiana KircherStacy KrakowerTamara KuhnMichelle LadreytMichele LeahyDeborah

LeBourgeois

Anusa LepadatuKathleen LeveringLorraine MacFeetersElizabeth MaloneyEleanor MangsatAngela MaroonCarla MarshallMarilyn Martinez-

WoolLori MastersonLisa McCoyAmy McIntireMatthew McNuttSuh-Lian MeiRicardo MendozaCarmen Milagros

GarciaPatricia MitchellChristine

Montalbano-KroonHolly MontgomeryLakisher MorganJoni MyhreTami NaumannSandra NeaseSuzanne NelsonGina NguyenKevin NimmoCasie NoelJosephine NotterTrisha NovelloDola OelslagerBernadette O’KeefeKristianne OngOmobola OpawoyeJill OsbornMaribel PaleTeresa QuirkElizabeth RataJanice ReichNora RowseyLaura RussellMarcus Scharre

Kela SchramMary SchwartzJan SevieriSharon ShirleyDonna SkillettKathleen SmithJennifer Smith-JamesDiane StiegSheila SudSalimma ThomasMaureen VanHornDawn VerscheureKathy Jean WalterShannon WasmerJoan WhiteCrystal WilkesRegina Williams

Denise WilliamsMary WilliamsSharon ZaverlSandra Zsikla

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Advantage Surgical & Wound Care provides superiorprofessional surgical wound care within the nursinghome, SNF, or long term care facility.

We provide treatment to those patients that havedifficulty traveling to a separate facility for wound care.

Surgical treatment that once required lengthy clinicappointments, expensive emergency transfers, or lossof patients to hospitalizations can now be easilyperformed at bedside, with minimal disturbance to thepatient’s daily activities, or the facility’s nursing staff.

www.advantagewoundcare.orgor call: 310-524-1300.

Providing superior bedsidesurgical wound care for

patients in long term health care facilities.

http://www.nawccb.org

NATIONAL WOUND CONFERENCE

Rio Hotel, Las Vegas, NevadaSeptember 2–5

www.WoundSeminar.com

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EXHIBITORS GUIDE

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Dear Colleagues,

We’re thrilled to have you at thisyear’s WILD ON WOUNDS℠

(WOW) National Conference!Being wound care clinicians

ourselves, we understand the uniquechallenges that you face, especiallywhen reimbursement policies requireyou to provide quality care withfewer resources.

The WOW conference is designedto provide you with information oncurrent standards of care, new pre-vention and treatment ideas, andtools that you can use to spreadyour knowledge.

One component of beingcurrent with wound care is yourfamiliarity with new technologiesand devices that prevent woundsor heal wounds faster. Our indus-try experts are here to provideyou with hands-on training and edu-cation about their products so you can make ameasurable impact on wound outcomes.

Wound Care Advisor created this useful Exhibitors Guide for you to carrywith you during exhibit times. We also suggest that you keep it as a resourcetool for future reference.

We hope you enjoy this Exhibitors Guide, and we’ll see you at theExhibitors’ Showcase!

Nancy Morgan & Donna SardinaWound Care Education Institute


Wild on WoundsWElCOME

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Meet with exhibitors,participate in hands-on labs, and learnabout new woundproducts and enter to win a great prize!

Exhibits are located in the Exhibit Hall of the Rio Hotel.

Exhibit hours:Thursday, Sept. 311:30 am to 2:00 pm

Friday, Sept. 411:30 am to 2:00 pm

A Fashion Hayven.....Common Area

Advanced Tissue .................328Advantage Wound Care ......409Alliqua Biomedical ..............405Amerx Health Care

Corporation (Amerigel)...327Anacapa Technologies,

Inc. ..................................129Andover Healthcare ............326Argentum Medical, LLC

(Silverlon) ........................125B. Braun Medical, Inc. ........430Calmoseptine .......................302Central Solutions, Inc. .......225Coloplast ..............................424Cork Medical .......................429Crawford Healthcare ...........226DARCO International, Inc. 325Derma Sciences, Inc. .........111DermaRite Industries...........425DeRoyal Ind.ustries .............426DM SYSTEMS – Heelift ......114EHOB...................................307Ferris Mfg. Corp.

(Polymem) .......................126Genadyne

Biotechnologies...............207

Healogics .............................209Hill-Rom...............................115HOMELINK..........................324HYTAPE

INTERNATIONAL ............310Intellicure Inc. .....................110Joerns RecoverCare .............311JUZO ....................................229KCI, an Acelity Company....101Keneric Healthcare (formerly

GWM Products)...............512Kiss Healthcare....................213Lohmann & Rauscher,

Inc. ..................................312ManukaMed USA, LLC ........305McKesson.............................233Medela Inc. ..........................413medi USA/circaid ................412MiMedx ................................411Mission Pharmacal ..............308Monarch Labs ......................410MPM Medical Inc. ...............224Nurse Rosie Products..........122Nutricia.................................309Organogenesis .....................331Osiris ....................................431Precision Fabrics .................228

Prosenex, LLC......................306Puracyn Plus by

Innovacyn........................333Royal Innovations ...............407Santus, LLC ..........................406Skil-Care...............................335Smith & Nephew AWM.......121Southwest Technologies .....434Spectrum Healthcare Inc. ...329Supreme Medical.................300Tissue Analytics, Inc. .........408VATA Inc. .............................524Viniferamine (McCord

Research) .........................200United Ostomy Associations

of America, Inc................432National Alliance of Wound

Care and Ostomy ............201Winchester

Laboratories (Saljet) ........427Wolters Kluwer Health -

Lippincott Williams & Wilkins ...............Common Area

Wound Source .....................303Wound Zoom ......................301Wound Care Education

Institute ............................201


Wild on Wounds2015 ExhiBiTORS

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Exhibitor Booth Exhibitor Booth Exhibitor Booth


A Fashion Hayvin, Inc. AFH is a marketing companythat promotes jewelry in over50 conventions annually. Wecater to today’s modern, work-ing professional. www.conventionjewelry.com See us in the common area

Advanced Tissue7003 Valley Ranch DriveLittle Rock, AR 72223Advanced Tissue is a nationalcompany with a singular focusof helping carry out woundtreatment plans through thedelivery of wound care sup-plies in unit dose packaging topatient’s homes and residentsof long term care facilities.Learn more by visitingwww.AdvancedTissue.com orcalling 866-217-9900. See us at booth 328

Advantage Wound Care222 N. Sepulveda Blvd. Ste. 2175El Segundo, CA 90245Providing superior bedsidesurgical wound care for pa-tients in long term health carefacilities. Advantage Surgical &Wound Care provides superiorprofessional surgical woundcare within the nursing home,SNF, or long term care facility.We provide treatment to thosepatients that have difficultytraveling to a separate facilityfor wound care. Surgical treat-ment that once requiredlengthy clinic appointments,expensive emergency trans-fers, or loss of patients to hos-pitalizations can now be easi-ly performed at bedside, withminimal disturbance to thepatient’s daily activities, or thefacility’s nursing staff.

www.advantagewoundcare.orgor call: 310-524-1300.See us at booth 409

Alliqua Biomedical2150 Cabot Blvd. WestLanghorne, PA 19047http://alliqua.comSee us at booth 405

Amerx Health Care Corp.1300 S Highland Ave Clearwater, FL 33756Amerx Health Care is proud tointroduce HELIX3 BIOACTIVECOLLAGEN MATRIX (CM) andPARTICLE (CP) dressings con-taining 100% Type 1 nativebovine collagen for effectivewound management in allwound phases. The Amerxproduct line also includes toprated AMERIGEL® HYDROGELWOUND DRESSING withOakin® for sustained moisthealing of dry wounds. www.AMERXHC.com or call:800-448-9599.See us at booth 327

Anacapa Technologies, Inc.301 E. Arrow Hwy, Suite 106San Dimas, CA 91773Anacapa is a veteran-owned,federally-certified small busi-ness engaged in the devel-opment, manufacturing andmarketing of patentedbroad-spectrum topical an-timicrobials; Anasept® An-timicrobial Skin and WoundCleanser and Gel and Silver-Sept® Silver AntimicrobialSkin and Wound Gel. Visit: www.ancapa-tech.netor call: 909-394-7795.See us at booth 129

Andover Healthcare, Inc.9 Fanaras DriveSalisbury, MA 01952Andover Healthcare is a leadingmanufacturer of cohesive band-ages, committed to innovativetechnology. CoFlex TLC–2 LayerCompression is available in avariety of options; Standard, Lite,XL, Calamine or Zinc.www.andoverhealthcare.comor call: 800-432-6686.See us at booth 326

Argentum Medical, LLC(Silverlon)2571 Kaneville CourtGeneva, IL 60134www.silverlon.com or call:888-551-0188.See us at booth 125

B. Braun Medical Inc.824 12th AvenueBethlehem, PA 18017B. Braun is a leading manufac-turer of infusion therapy andchronic care products with anenvironmental & personal fo-cus. B. Braun’s Wound Careproducts are designed to becost effective, and easy to usefor clinicians and patients.http://www.bbraunusa.com/prontosanwoundcare.html orcall: 610-691-5400.See us at booth 430

Calmoseptine, Inc.16602 Burke LaneHuntington Beach, CA 92647www.calmoseptine.com orcall: 714-840-3405.See us at booth 302

Central Solutions, Inc.401 Funston RoadKansas City, KS 66115Central Solutions is an FDAand EPA registered formulatorof skin care & infection con-trol offerings, including theBoaVida line of wound pre-vention products.www.centralsolutions.com orcall: 913-621-6542.See us at booth 225

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Coloplast1601 West River RoadMinneapolis, MN 55411Coloplast develops products andservices that make life easier forpeople with very personal andprivate medical conditions. Ourbusiness includes ostomy care,urology, continence care, andwound & skin care.www.coloplast.us or call: 800-788-0293.See us at booth 424

Cork Medical6406 Castleway Ct., Suite 100Indianapolis, IN 46250www.corkmedical.com or call:866-551-2580.See us at booth 429

Crawford Healthcare2005 S. Easton Rd., Su.203 Doylestown, PA 18901Crawford Healthcare is a rapid-ly growing international com-pany dedicated to developinginnovative wound and skintreatments that advance clinicalpractice while being gentle on patients and budgets. www.crawfordhealthcare.com/us or call: 855-522-2211.See us at booth 226

Darco International, Inc.810 Memorial Blvd.Huntington, WV 25701Darco International, Inc is theworld leader in the manufac-ture and distribution of postoperative foot wear, offloadingfootwear, and other foot andankle products. Darco prod-ucts are available from distrib-utors nationwide.www.darcointernational.comor call: 800-999-8866.See us at booth 325

Derma Sciences, Inc.214 Carnegie Center, Ste. 300Princeton, NJ 08540Derma Sciences is a tissue re-generation company focusedon advanced wound and burncare. We are committed to thedevelopment of intelligentwound management productsthat address clinical needthroughout the continuum ofcare. Our full portfolio of prod-ucts include: MEDIHONEY®,XTRASORB®, BIOGUARD®, ALGICELL® Ag, TCC-EZ® andamniotic tissue products AMNIOEXCEL® Amniotic Allograft Membrane andAMNIO MATRIX® Amniotic Allograft Suspension. www.dermasciences.com orcall: 609-514-4744. See us at booth 111

DermaRite Industries 7777 West Side AvenueNorth Bergen, NJ 07047DermaRite is the trusted man-ufacturer of quality skin,wound and personal careproducts, offered at significantcost savings when comparedwith the other name brands. www.dermarite.com or call:800-337-6296.See us at booth 425

DeRoyal®200 DeBusk LanePowell, TN 37849DeRoyal’s Wound Care prod-uct line features proprietarywound care technologies thatcan help heal even the mostdifficult wounds. Our prod-ucts provide you with ad-vanced, easy-to-use, afford-able solutions for all phases ofacute, chronic, and burnwound care. www.deroyal.com or call: 800-DEROYAL.See us at booth 426

DM Systems Inc1316 Sherman Ave.Evanston, IL 60201Combining unmatched clinicalevidence with the comfort,convenience and variety thattodays’ healthcare marketplacedemands, Heelift offloadingboots prevent and treat heelpressure ulcers like no other.Joining the Heelift lineup thisyear is the new Heelift GlideUltra and Heelift AFO Ultra,which have a new Ultra-Gripinner lining that provides ourmost comfortable boot everwhile maintaining clinical supe-riority. Clinician Validated –Cost Performer. Visit our Re-source Center at http://www.heelift.com/heeliftresources.html for videos, sample proto-cols, clinical articles and moreshowing how Heelift Boots canlower your prevalence. www.heelift.com or call: 800-254-5438.See us at booth 114

EHOB250 N. Belmont Ave.Indianapolis, IN 46222www.ehob.com or call: 800-899-5553.See us at booth 307

Ferris Mfg. Corp.5133 Northeast ParkwayFort Worth, TX 76106PolyMem is an innovative,adaptable, drug-free woundcare dressing. PolyMem dressings have been shown to reduce swelling, bruising,and pain associated with bothopen and closed wounds. www.polymem.com or call:817-900-1301.See us at booth 126

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Genadyne Biotechnologies16 Midland Ave.Hicksville, NY 11801Genadyne Biotechnologies isa US based developer andmanufacturer of negativepressure wound therapy andprovides products and serv-ices in more than 20 countriesworldwide. Genadyne offerssome of the most advancedcost effective tools in thehealthcare community.www.genadyne.com or call:800-208-2025.See us at booth 207

Healogics, Inc.5220 Belfort Rd., Suite 300Jacksonville, FL 32256Operating through variouspartnership models, Healogicsprovides a comprehensivewound care solution by build-ing and leading integratedwound care communitiesspanning inpatient, outpatientand post-acute care venues.www.healogics.com or call:800-379-9774.See us at booth 209

Hill-RomHill-Rom Corporate Offices1069 State Route 46 East Batesville, IN 47006Hill-Rom is a leading world-wide manufacturer and pro -vider of medical technologiesand related services for thehealth care industry, includingpatient support systems, safemobility and handling solu-tions, non-invasive therapeu-tic products for a variety ofacute and chronic medicalconditions, medical equip-ment ren tals, surgical prod-ucts and information technol-ogy solutions.

Through our unique com-bination of people, processand technology, Hill-Romcan help you achieve posi-tive safe skin outcomes foryou and your patients in

hospitals, long-term care fa-cilities and in the home.www.hill-rom.com or call:(812) 934-7777.See us at the show – booth 115

HOMELINK1111 West San Marnan DriveWaterloo, IA 50701Homelink, a national ancillaryservice network, in partner-ship with Eo2 Concepts ismarketing the TransCu O2wound device. A low dose tissue oxygenation system for the treatment of difficult to heal wounds.www.vgmhomelink.com orcall: 800-482-1993.See us at booth 324

Hy-Tape InternationalP.O. Box 540Patterson, NY 12563-0540Hy-Tape International pro-duces waterproof, zinc ox-ide-based adhesive tape.Patches and strips. Hy-Tapedelivers its unique qualitiesand benefits in both criticalcare and everyday situations,when it counts most.http://hytape.com or call:800.248.0101.See us at booth 310

Intellicure, Inc.2700 Research ForestThe Woodlands, TX 77381Driven by clinical expertiseand a commitment to advanceWound Care and HyperbaricMedicine, Intellicure offers asuite of collaborative solutionsthat facilitate patient-centeredoutcome-based care, efficientclinic operations, revenue

cycle optimization, and thecollection of quality clinicaldata utilized for prospectiveand retrospective studies. www.Intellicure.com or call:800-603-7896.See us at booth 110

Joerns RecoverCare2430 Whitehall Park Dr, Suite 100Charlotte, NC 28273www.joerns.comwww.recovercare.comor call: 800-826-0270 or888-750-7828.See us at booth 311

JUZO3690 Zorn Dr.Wyahoga Falls, OH 44223www.juzousa.com or call: 800-222-4999.See us at booth 229

KCI, an Acelity Company 12930 IH 10 WestSan Antonio, TX 78249KCI is a leading global med-ical technology company de-voted to changing the practiceof medicine with solutionsthat speed healing, reducecomplications and improvepatient lives. KCI is headquar-tered in San Antonio, Texas.The V.A.C.Ulta™ TherapySystem is an integratedwound therapy system thatprovides NPWT with an in-stillation option. www.kci1.com or call:800.275.4524.See us at booth 101

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Keneric Healthcare 8925 Sterling Street, Ste. 100Irving, TX 75063Keneric Healthcare is the man-ufacturer and distributor of theRTD® Wound Care Dressing.This proprietary highly ab-sorbent antimicrobial foamdressing is the only productavailable with three active in-gredients integrated into thefoam matrix; Methylene Blue,Gentian Violet and Silver. www.kenerichc.com or call:855-872-2013.See us at booth 512

Kiss Healthcare13089 Peyton Drive #C212 Chino Hills, CA 91709www.kisshealthcare.com orcall: 909-632-1361.See us at booth 213

Lohmann & Rauscher6001 SW Sixth Av., Suite 101Topeka, KS 66615-1004Revolutionizing wound bedpreparation, Lohmann &Rauscher’s ground-breakingnew Debrisoft® provides aneasy, effective and virtuallypainless method of debride-ment. Visit www.lohmann-rauscher.us for more informa-tion on Debrisoft® and ourother AWC products. Call: 800-279-3863.See us at booth 312

ManukaMed, Ltd.9654 West Linebaugh Ave.Tampa, FL, 33626ManukaMed® was formed witha vision to benefit patientsaround the world by facilitat-ing the supply of medicalgrade Manuka honey in theform of well designed, qualityproducts appropriate for med-ical application.www.manukamed.com or call:800-881-3654.See us at booth 305

McKesson Medical-Surgical9954 Mayland Dr., Suite 4000Richmond, VA 23233McKesson Medical-Surgicalworks with extended careproviders, in-home patients,payers and others across thespectrum of care to buildhealthier organizations thatdeliver better care to patientsin every setting. McKessonMedical-Surgical helps its cus-tomers improve their financial,operational, and clinical per-formance with solutions thatinclude pharmaceutical andmedical-surgical supply man-agement, healthcare informa-tion technology, and businessand clinical services. McKessonMedical-Surgical Inc. is an af-filiate of the McKesson Corpo-ration. McKesson Corporation,currently ranked 11th on theFORTUNE 500, is a healthcareservices and information tech-nology company dedicated tomaking the business of health-care run better.mms.mckesson.com or call:877.611.0081.See us at booth 233

Medela, Inc.1101 Corporate DriveMcHenry, IL 60050Medela, the market leader inbreastfeeding, has innovatedand manufactured medicalvacuum solutions featuringSwiss Technology for over 50years. From this foundation,Medela expanded into chronicwound management with negative pressure wound therapy.www.medela.com or call: 877-735-1626.See us at booth 413

medi USA/circaid6481 Franz Warner ParkwayWhitsett, NC 27377medi…I feel better! medi iscommitted to helping peopleall around the world live amore independent, productiveand satisfying life while manag-ing circulatory issues. meditakes its position as globalleader in medical compressionseriously by investing in re-search, education and inno -vation providing the latest tech-nologies in compressiontherapy enabling our patients tonot only manage their diseasebut to enjoy life to its fullest.http://mediusa.com or call: 800-633-6334.See us at booth 412

MiMedx1775 West Oak CommonsCourt NEMarietta, GA 30062MiMedx® is an integrated de-veloper, manufacturer and mar-keter of patent protected re-generative biomaterial productsand bioimplants pro cessedfrom human amniotic mem-brane. Our amniotic tissue of-fering promotes bioactive heal-ing and has achieved veryeffective clinical outcomes. Epi-Fix® is a bioactive tissue matrixallograft composed of HumanAmnion/Chorion Membrane(dHACM) that preserves andcontains multiple extracellularmatrix proteins, growth factors,cytokines, and other specialtyproteins to help regenerate softtissue and enhance healing.www.mimedx.com or call:866-477-4219.See us at booth 411

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Dr. Smith’s Adult BarrierSpray/Mission Pharmacal 10999 11-1-10 West, 10th Flr.San Antonio, TX 78230Dr. Smith’s® Adult BarrierSpray provides a touch-freeway to treat and prevent in-continence Associated Der-matitis. The zinc oxide 10%spray provides a safe and dis-creet alternative to traditionalcreams and ointments. http://adultbarrierspray.com/or call: 210-696-8400.See us at booth 308

Monarch Labs17875 Sky Park Circle, Suite KIrvine, CA 92614Monarch Labs develops, pro-duces, and distributes “LivingMedicine”: maggots, leeches,fish, and other medicinal ani-mals. Clinical and technicalsupport available 24/7.www.MonarchLabs.com orcall: 949-679-3000.See us at booth 410

MPM Medical, Inc.2301 Crown Ct.Irving, TX 75038MPM Medical, Inc. has beenin the Advanced Skin andWound Care market for morethan 20 years. MPM is intro-ducing the DryMax Extra, asuper absorbent dressing.MPM has the ONLY 2% lido-caine hydrogel in the market,RegenecareHA. MPM alsosells SilverMed, a silver hy-drogel, and has a 100% colla-gen, Triple Helix, available inpowder, 2x2, and 12” rope.MPM provides products toclinicians and patients to helpfacilitate wound healing and

increase better outcomes.www.mpmmed.com or call: 800-232-5512.See us at booth 224

National Alliance ofWound Care and Ostomy®717 Ave. Joseph Drive Su. 297 St. Joseph, MI 49085NAWCO® is the largest woundcare and ostomy credentialingboard and member associa-tion in the United States. Weoffer four certification pro-grams. WCC®, Wound CareCertified, DWC®, DiabeticWound Certified, LLE®, Lym-phedema Lower ExtremityCertified, and OMS, OstomyManagement Specialist®.www.nawccb.org or call:877-922-6292.See us at booth 201

Nurse Rosie Products 7320 Central Ave Savannah, GA 31406Nurse Rosie Products is proudto introduce Rosie WoundCare Solutions. Our newwound care division will giveyou great service, more ad-vance wound care options, adedicated wound care team,and technical wound caresupport. Nurse Rosie has themost affordable, effective andinnovative advanced woundcare products on the market.We have NPWT Pumps,biofilm defense products, andmany types of wound caredressings (including the only

controlled released Iodinefoam in the world). www.nurserosie.com or call:800-841-1109. See us at booth 122

Nutricia9900 Belward Campus Drive,Suite 100Rockville, MD 20850Nutricia is a global healthcompany that leads the devel-opment & use of advancedmedical nutrition for special-ized care. Our SpecializedAdult Nutrition products in-clude Pro-Stat®, UTI-Stat®,Fiber-Stat®, Diff-Stat®, and Nutilis®. Visit www.SpecializedAdultNutrition.com for informa-tion. Or call: 800-221-0308.See us at booth 309

Organogenesis, Inc.150 Dan RoadCanton, MA 02021Having pioneered the field,Organogenesis Inc. is a com-mercial leader in regenerativemedicine, focused in the areasof bio-active wound healingand soft tissue regeneration.www.apligraf.comwww.dermagraft.com or call:888-HEAL-2DAY.See us at booth 331

Osiris Therapeutics, Inc.7015 Albert Einstein DriveColumbia, MD 21046Grafix® is a cryopreservedplacental membrane com-prised of an extracellular ma-trix (ECM) rich in collagen,growth factors, fibroblasts,mesenchymal stem cells(MSCs), and epithelial cellsnative to the tissue.www.Osiris.com or call:443.545.1800.See us at booth 431

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Precision Fabrics Group,Inc.301 N Elm St, Suite 600Greensboro, NC 27406PFG & partner Standard TextileCo, have developed the nextgeneration of healthcare linensthat improve patient comfort;prevent, reduce & promotehealing of skin damage; elimi-nate a source of potential air-borne contamination; & loweroverall healthcare costs.http://www.therapeuticbedding.com/ or call: 844-Derma44.See us at booth 228

Prosenex, LLC33 Constitution DriveHudson, NH 03051Prosenex is the maker of theDynamic Neuroscreening Device (DND), a hand held,portable, non-invasive deviceused to detect peripheral neu-ropathy in patients with dia-betes or at risk for diabeteswho have yet to experienceclinical symptoms. The DND isused to establish a patientbaseline for future screeningthrough use of objective tem-perature and vibration discrim-ination testing. Prosenex isnow in partnership with TreVia Digital Health to store,share and analyze screeningresults in order to prevent &treat diabetes holistically.www.prosenex.com or call:603-546-0457.See us at booth 306

Puracyn Plus by Innovacyn3546 N. Riverside Ave.Rialto, CA 92377Innovacyn offers Puracyn PlusProfessional Formula, thenext-generation wound irriga-tion and management solutiondesigned to improve the mostessential part of the woundtreatment process: preparationof the wound bed. www.puracyn.com or call:866.318.3116.See us at booth 333

The Blanket Bar by RoyalInnovations, LLCP.O. Box 190928 Boise, Idaho 83719The Blanket Bar is an adjustable blanket support system that works!• Supports bedding up and

off of legs and feet• Fits Twin, Full, Queen and

King Size Beds• Height adjusts up to 40

inches www.theblanketbar.com orcall: 208-866-3897.See us at booth 407

Santus, LLC5550 W. Executive Dr. Ste. 230Tampa, FL 33609Our total Skin Care Regimenincludes a full line of productsthat clean, moisturize, protectand treat skin problems, pre-venting wounds from becom-ing a liability. Lantiseptic.com or call:8447santus.See us at booth 406

Skil-Care Corp29 Wells Ave.Yonkers, NY 10701Innovative products for nurs-ing and therapy. Designedand man ufactured with a difference.www.skil-care.com or call:914-963-2040.See us at booth 335

Smith & Nephew3909 Hulen St. Fort Worth TX 76107Come see us at our booth! www.santyl.com or call: 800-441-8227.See us at booth 121

Southwest Technologies,Inc., Wound Care Products 1746 Levee Rd.North Kansas City, MO 64116Southwest Technologies, Inc.offers innovative technologies(glycerine-based gel sheets,highly absorbent fillers, sever-al forms of collagen productsand our newly added honeysheets) for simple woundmanagement solutions. www.elastogel.com or call:816-221-2442.See us at booth 434

Spectrum Healthcare Inc.1260 Valley Forge Rd, Ste. 111Phoenixville, PA 19460www.spectrumhealthcare.netor call: 888-210-5576.See us at booth 329

Supreme MedicalPO Box 850247Mobile, AL 36685Supreme Medical is proud tobe the exclusive distributor ofSupreme Ag—a brand newCalcium Alginate Dressingcomprised of 1.5% Metallic Silver. Infected wounds don’tstand a chance against thepower of Supreme Ag!www.suprememedical.comor call: 800-461-1277.See us at booth 300

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Tissue Analytics, Inc.8 Market Place, Suite 405Baltimore, MD 21202Standardized wound measure-ments are key to monitoringhealing and selecting appropri-ate dressings. Our HIPAA-com-pliant app automatically meas-ures wound length, width, andarea—eliminating the error of ruler measurements. VisitBooth #408 to see how!www.tissue-analytics.comor call: 443-491-8241.See us at booth 408

United Ostomy Associationsof America, Inc.PO Box 525Kennebunk, ME 04043United Ostomy Associations ofAmerica (UOAA) offers advo-cacy, education, and peer sup-port for people who have orwill have an intestinal or uri-nary diversion. Visit us to learnmore about receiving free ma-terials to support your patients.www.ostomy.org or call: 800-826-0826.See us at booth 432

VATA Inc.308 S. Sequoia ParkwayCanby, OR 97013VATA Inc. will be introducing“Freddie” Fistula™ for entero-cutaneous fistulas (ECF) care.Also displaying Otto Ostomy™,Seymour II™, Wilma WoundFoot™, Pat Pressure UlcerStaging Model™ and others.These are the most realisticmodels and are great tools touse for competency testingand the use of NPWT. www.vatainc.com or call: 503-651-5050.See us at booth 524

Viniferamine®2769 Heartland Dr., Suite 303Coralville, IA 52241Viniferamine® is a science-based company focused onproviding skin and woundcare products ranging fromearly intervention to advancedwound care and incorporating

small molecule technology validated by genetic research.viniferamine.com or call: 855-312- 8667.See us at booth 200

Winchester Laboratories, LLP1177 Blue Heron Blvd., Suite B-106Riviera Beach, FL 33404Saljet a 30ml, one time use,sterile saline, designed forwound care. It is easy to use,is sterile every use, saves nurs-ing time and helps to achievebetter outcomes. www.saljet.com or call: 630-377-7880.See us at booth 427

Wolters Kluwer Health -Lippincott Williams &Wilkins2 Commerce Sq.,2001 Market St.Philadelphia, PA 19103www.lww.com or call: 215-521-8300.See us in the common area

Wound SourcePO Box 189, 206 Commerce St.Hinesburg, VT 05461www.woundsource.com orcall: 800-787-1931.See us at booth 303

Wound Zoom2916 Borham Ave.Stevens Point, WI 54481Affordable wound measure-ment camera that measuresand documents in a minute.Saves you time and moneywith accurate, repeatable, non-contact measurement. We alsooffer software to manage &analyze your data, and facili-tate telemedicine.www.woundzoom.com or call: 888.237.0546.See us at booth 301

Wound Care EducationInstitute®25828 Pastoral DrivePlainfield, IL 60585WCEI provides comprehen-sive online and onsite cours-es in the fields of Skin,Wound, Diabetic and OstomyManagement. Health careprofessionals who meet theeligibility requirements maysit for the prestigious WCC®,DWC® and OMS nationalboard certification examina-tions through the NationalAlliance of Wound Care andOstomy® which is the largestgroup of multidisciplinarycertified wound care profes-sionals in the United States.www.wcei.net or call: 877-462-9234See us at booth 201

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VendorShowcaseExhibits

Meet with exhibitors,participate in hands-onlabs, and learn aboutnew industry products.Chance to win a greatprize!

thursdaySeptember 3, 201511:30 a.m. – 2:00 p.m.

fridaySeptember 4, 201511:30 a.m. – 2:00 p.m.

KILLSSUPERBUGS

Pathogenic Bacteria:Acinetobacter baumannii

Carbapenem Resistant E. coli (CRE) Clostridium difficile (including spores)

Escherichia coliMethicillin Resistant Staphylococcus aureus (MRSA)

Proteus mirabilisPseudomonas aeruginosa

Serratia marcescens

Anasept® Antimicrobial Skin & Wound Care Products• FDA-Cleared, broad-spectrum antimicrobial• Unique, Patented Formula• Safe, non-cytotoxic and tissue compatible• Clinically Tested* • 18 months to 2-year shelf life• Anasept Gel is Medicare reimbursed HCPCS # A6248Anasept is a registered trademark of Anacapa Technologies, Inc*J. Lindfors, Ostomy/Wound Management. 2004; 50 (8): 28-41.

® 800-489-2591www.anacapa-tech.net

WoundIrrigation

WoundGel

WoundCleanser

Staphylococcus aureusVancomycin Resistant Enterococcus faecalis (VRE)Pathogenic Fungi: Aspergillus nigerCandida albicansSpores:Clostridium difficilePathogenic Virus:HIV

®

Physicians at MedStar Georgetown University Hospital, Center for Wound Healing, assessed the effectiveness of V.A.C. VeraFlo™ Therapy

with instillation of Prontosan® Wound Irrigation Solution vs. NPWT with V.A.C.® Therapy and

noted the following potential benefits:*

Reduced OR VisitsReduced Length of StayReduced Time to Final Surgical Procedure

They noted:

V.A.C. VERAFLO™

THERAPY

*Powers KA, Kim PJ, Attinger CE, et al. Early Experience with Negative Pressure Wound Therapy with Instillation in Acutely Infected Wounds. Poster presented at the 2013 Symposium of Advanced Wound Care (SAWC) Spring Conference, May 1-5, 2013, Denver, CO.

Important Note: Specific indications, contraindications, warnings, precautions and safety information exist for KCI products and therapies. Please consult a physician and product instructions for use prior to application. Rx Only.

©2015 KCI Licensing, Inc. All rights reserved. Prontosan is a trademark of B.Braun Medical Inc. All other trademarks designated herein are proprietary to KCI Licensing, Inc., its affiliates and/or licensors. DSL#15-0454.US.WOW (Rev. 8/15)

For more information, visit www.vaculta.com. Educational resources from nurse educators coming soon at www.VeraFlo.com

Visit us at Booth #101

http://vaculta.com

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