Device for negative pressure wound therapy in low-resource regions: open-source description and bench test evaluation

Background: Negative (vacuum) pressure therapy promotes wound healing. However, commercially available devices are unaffordable to most potential users in low- and middle-income countries (LMICs), limiting access to many patients who could benefit from this treatment. This study aimed to design and test a cheap and easy-to-build negative pressure device and provide its detailed open-source description, thereby enabling free replication. Methods: the negative pressure device was built using off-the-shelf materials available via e-commerce and was based on a small pump, a pressure transducer, and the simplest Arduino controller with a digital display (total retail cost ≤ 75 US$). The device allows the user to set any therapeutic range of intermittent negative pressure and has two independent safety mechanisms. The performance of the low-cost device was carefully tested on the bench using a phantom wound, producing a realistic exudate flow rate. Results: the device generates the pressure patterns set by the user (25-175 mmHg of vacuum pressure, 0-60 min periods) and can drain exudate flows within the clinical range (up to 1 L/h). Conclusions: a novel, low-cost, easy-to-build negative pressure device for wound healing displays excellent technical performance. The open-source hardware description provided here, which allows for free replication and use in LMICs, will facilitate the application and wider utilization of this therapy to patients

Simplified Negative Pressure Wound Therapy Device for Application in Low-Resource Settings

Negative pressure wound therapy (NPWT) provides proven wound healing benefits and is often a desirable wound treatment. Unfortunately, NPWT devices are not widely available in low-resource settings (LRSs). In order to overcome identified NPWT barriers, a simplified NPWT (sNPWT) system was designed and iteratively improved during field-based testing. The sNPWT technology, our device design iterations, and the design-based results of our field tests are described. The sNPWT system includes a bellows hand pump, an occlusive drape, and a tube with tube connectors, connecting the drape to the pump. The most critical property of a sNPWT system is that it must be airtight. The details of the design iterations needed to achieve an occlusive system are explained. During the design process, the sNPWT system was tested during the earthquake relief in Haiti. This testing found that a liquid sealant was necessary to seal the drape to the peri-wound skin. A study conducted in Rwanda verified that a liquid latex sealant was safe to use and that the tube connector must be connected to the drape with an airtight method during the manufacturing process. This work has shown that sNPWT is feasible in LRSs. Since the completion of the clinical testing, the design has been further evolved and the developers are working with contract manufactures to produce the final design and preparing for regulatory approval applications

Shared Learning in an Interconnected World: Innovations to Advance Global Health Equity

The notion of reverse innovation --that some insights from low-income countries might offer transferable lessons for wealthier contexts--is increasingly common in the global health and business strategy literature. Yet the perspectives of researchers and policymakers in settings where these innovations are developed have been largely absent from the discussion to date. In this Commentary, we present examples of programmatic, technological, and research-based innovations from Rwanda, and offer reflections on how the global health community might leverage innovative partnerships for shared learning and improved health outcomes in all countries

Putting medical devices in context: a systematic review of evidence on design targeting low-resource settings

Most medical devices are inaccessible to healthcare facilities in low-resource settings (LRSs), severely limiting medical care for a vast proportion of the world's population. This article characterises the process used for designing medical devices for LRSs and investigate how the context-of-use is integrated into the process. A systematic review of 64 papers was conducted to identify peer-reviewed studies of devices intended for LRSs. Using the biodesign process as an analytic framework, a qualitative meta-analysis was conducted. Findings show the studies predominantly describe the later stages of medical device design, whilst largely neglecting how knowledge of the context is considered. To support engineers and improve outcomes, it is imperative that an understanding of the context is integrated throughout the design and product development process. This article highlights this gap and hopes to stimulate research into how context can be better incorporated into the design process for medical devices targeting those populations most in need.This is the author accepted manuscript. The final version is available from Inderscience Publishers via http://dx.doi.org/10.1504/IJDE.2015.07637

A Complete Guide to Maggot Therapy

Since the revival of maggot therapy in Western wound care approximately thirty years ago, there has been no comprehensive synthesis of what is known about its clinical practice, supply chain management, and social dimensions. This edited volume fills the information vacuum and, importantly, makes the current state of knowledge freely accessible. It is the first to provide sound, evidence-based information and guidance covering the entire supply chain from production to treatment. The chapters are arranged in five parts presenting the latest on clinical practice, the principles of therapeutic action, medicinal maggot production, distribution logistics, and the ethical dimensions of maggot therapy. The contributors have paid particular attention to the challenges encountered in compromised, low-resource healthcare settings such as disasters, conflict, and poverty. There are still many barriers to the widespread uptake of maggot therapy in healthcare settings. This book will be essential reading for a global audience of doctors, nurses, allied healthcare providers, students, and entrepreneurs with an interest in maggot-assisted wound care. It will be the go-to reference for those who plan, regulate, and coordinate healthcare, and want to establish a maggot therapy program, particularly in low- and middle-income and other compromised healthcare settings where maggot therapy can provide much-needed, affordable, and efficacious wound care

A Complete Guide to Maggot Therapy

Since the revival of maggot therapy in Western wound care approximately thirty years ago, there has been no comprehensive synthesis of what is known about its clinical practice, supply chain management, and social dimensions. This edited volume fills the information vacuum and, importantly, makes the current state of knowledge freely accessible. It is the first to provide sound, evidence-based information and guidance covering the entire supply chain from production to treatment. The chapters are arranged in five parts presenting the latest on clinical practice, the principles of therapeutic action, medicinal maggot production, distribution logistics, and the ethical dimensions of maggot therapy. The contributors have paid particular attention to the challenges encountered in compromised, low-resource healthcare settings such as disasters, conflict, and poverty. There are still many barriers to the widespread uptake of maggot therapy in healthcare settings. This book will be essential reading for a global audience of doctors, nurses, allied healthcare providers, students, and entrepreneurs with an interest in maggot-assisted wound care. It will be the go-to reference for those who plan, regulate, and coordinate healthcare, and want to establish a maggot therapy program, particularly in low- and middle-income and other compromised healthcare settings where maggot therapy can provide much-needed, affordable, and efficacious wound care

ACTING ON THE NEED OF A CLIENT, CAREGIVER, AND PRACTITIONER SEATING AND MOBILITY GUIDE

There is a significant need for individuals with a disability and specific mobility limitations to require a wheeled mobility device. Wheeled mobility devices allow individuals to gain and/or maintain independence and engagement in occupations. The evaluation, prescription, and fitment of wheeled mobility devices are complex, requiring clients and caregivers to use and maintain these devices in specific ways. Barriers caregivers face can include not positioning the client properly in the wheeled mobility device, damaged or missing wheelchair parts, or improper positioning of the straps and belts, affecting posture, which could lead to secondary complications

The value of intermittent point-prevalence surveys of healthcare-associated infections for evaluating infection control interventions at Angkor Hospital for Children, Siem Reap, Cambodia.

BACKGROUND: There are limited data on the epidemiology of paediatric healthcare-associated infection (HCAI) and infection control in low-income countries. We describe the value of intermittent point-prevalence surveys for monitoring HCAI and evaluating infection control interventions in a Cambodian paediatric hospital. METHODS: Hospital-wide, point-prevalence surveys were performed monthly in 2011. Infection control interventions introduced during this period included a hand hygiene programme and a ventilator-associated pneumonia (VAP) care bundle. RESULTS: Overall HCAI prevalence was 13.8/100 patients at-risk, with a significant decline over time. The highest HCAI rates (50%) were observed in critical care; the majority of HCAIs were respiratory (61%). Klebsiella pneumoniae was most commonly isolated and antimicrobial resistance was widespread. Hand hygiene compliance doubled to 51.6%, and total VAP cases/1000 patient-ventilator days fell from 30 to 10. CONCLUSION: Rates of HCAI were substantial in our institution, and antimicrobial resistance a major concern. Point-prevalence surveys are effective for HCAI surveillance, and in monitoring trends in response to infection control interventions

Development of an international risk-stratified pressure injury prevention bundle for intensive care

Background Intensive care patients are particularly vulnerable to hospital-acquired pressure injury, which is associated with significant patient harm. Pressure injury prevention begins with a risk assessment, often using a risk assessment scale; then, preventative interventions should be implemented relative to assessed risk. However, few scales are designed for intensive care and interventions are often not adequately implemented. The COMHON Index is one intensive care-specific pressure injury risk assessment scale which categorises patients as being at low, moderate or high risk, presenting an opportunity for interventions to be mandated relative to risk level in a ‘minimum preventative intervention set’. This would ensure that, at a minimum, intensive care patients have a set of preventative interventions implemented relative to their pressure injury risk level, potentially overcoming inadequate intervention application while improving resource allocation. Aim The aim of this program of research was to develop a minimum set of pressure injury preventative interventions relative to pressure injury risk level, as determined by the COMHON Index, for international use within intensive care units. Methods A three-phase program of research was undertaken to address the overall aim. Phase One: To identify which preventative interventions are effective in preventing pressure injury in adults admitted to acute and intensive care settings, a systematic review and meta-analysis of randomised controlled trials was undertaken across five databases. Included studies were grouped by intervention type. Studies were synthesised narratively, and random-effects meta-analysis was undertaken for homogenous interventions and data. Phase Two: To develop international consensus about which preventative interventions should be applied relative to each COMHON Index pressure injury risk level in a minimum preventative intervention set, a modified Delphi study was conducted. Singular interventions which demonstrated effectiveness to prevent pressure injury in Phase One were considered by an expert panel (experienced intensive care nurses with expert pressure injury prevention knowledge) for inclusion in the intervention set. Consensus was developed across three rounds. Phase Three: In preparation for future international testing of the minimum intervention set, the COMHON Index was formally translated into a very commonly used language (Chinese Mandarin) using a four-step approach (forward-translation, back-translation, comparison of forward/back-translations, pilot testing). Pilot testing was undertaken in a Chinese intensive care unit with 20 nurses to assess instrument ease-of-use and understanding. A concurrent validity analysis was then undertaken using retrospective data comprising 80 paired COMHON Index and Braden scale patient assessments from the same intensive care unit. Results Phase One: Overall, 69 studies were included; 45 in an acute synthesis, and 26 in an intensive care synthesis (two in both). Intention-to-treat meta-analysis indicated that only one intervention had a significant effect to reduce pressure injury in acute (Australian medical sheepskin) and intensive care settings (prophylactic dressings: sacral and heel). However, several interventions (as listed in Phase Two results) individually demonstrated intervention effectiveness. Phase Two: Twelve pressure injury preventative interventions were considered for inclusion by 67 panel members. Consensus indicated that all patients should receive: risk assessment within two hours of admission; eight-hourly reassessment of risk; and disposable incontinence pad use. Moderate- and high-risk patients should also receive: a reactive mattress support surface and a heel off-loading device. Additionally, high-risk patients should receive: oral nutritional supplements; preventative dressings (sacral, heel, trochanteric); an active mattress support surface; and a pressure-redistributing seating cushion. Repositioning is required ≥ four-hourly for low-risk, and ≥ two-hourly for moderate- and high-risk patients. Two interventions were discarded: medical grade sheepskin overlays and a urinary catheter care intervention. Phase Three: Five iterations of the translation approach and two sets of original instrument amendments were required to achieve translation. Pilot testing demonstrated that the scale was easy-to-use and understand. Concurrent validity testing indicated that the sum scores of the COMHON Index and Braden scale were strongly correlated but not all subscales were correlated. Conclusion A minimum pressure injury preventative intervention set, which is a significant contribution to intensive care practice internationally, has been developed. Furthermore, this research has resulted in the COMHON Index being available in the three of the most commonly spoken languages worldwide. The instrument and matching preventative intervention set have promising global clinical applicability, and the potential to assist with overcoming poor preventative care. However, the minimum intervention set requires testing on an international scale