Overview of guidelines for the prevention and treatment of venous leg ulcers: a US perspective

E Foy White-Chu,1 Teresa A Conner-Kerr2 1Oregon Health and Science University, Portland VA Medical Center, Portland, OR, 2Winston-Salem State University, Department of Physical Therapy, Winston Salem, NC, USA Abstract: Comprehensive care of chronic venous insufficiency and associated ulcers requires a multipronged and interprofessional approach to care. A comprehensive treatment approach includes exercise, nutritional assessment, compression therapy, vascular reconstruction, and advanced treatment modalities. National guidelines, meta-analyses, and original research studies provide evidence for the inclusion of these approaches in the patient plan of care. The purpose of this paper is to review present guidelines for prevention and treatment of venous leg ulcers as followed in the US. The paper further explores evidence-based yet pragmatic tools for the interprofessional team to use in the management of this complex disorder. Keywords: venous insufficiency, varicose ulcer, wound, compression bandage

Evaluation of a hand-held far-ultraviolet radiation device for decontamination of Clostridium difficile and other healthcare-associated pathogens

<p>Abstract</p> <p>Background</p> <p>Environmental surfaces play an important role in transmission of healthcare-associated pathogens. There is a need for new disinfection methods that are effective against <it>Clostridium difficile</it> spores, but also safe and rapid. The Sterilray™ Disinfection Wand device is a hand-held room decontamination technology that utilizes far-ultraviolet radiation (185-230 nm) to kill pathogens.</p> <p>Methods</p> <p>We examined the efficacy of disinfection using the Sterilray device in the laboratory, in rooms of hospitalized patients, and on surfaces outside of patient rooms (i.e. keyboards and portable medical equipment). Cultures for <it>C. difficile</it>, methicillin-resistant <it>Staphylococcus aureus</it> (MRSA), and vancomycin-resistant <it>Enterococcus</it> (VRE) were collected from commonly-touched surfaces before and after use of the Sterilray device.</p> <p>Results</p> <p>On inoculated surfaces in the laboratory, application of the Sterilray device at a radiant dose of 100 mJ/cm² for ~ 5 seconds consistently reduced recovery of <it>C. difficile</it> spores by 4.4 CFU log₁₀, MRSA by 5.4 log₁₀CFU and of VRE by 6.9 log₁₀CFU. A >3 log₁₀ reduction of MRSA and VRE was achieved in ~2 seconds at a lower radiant dose, but killing of <it>C. difficile</it> spores was significantly reduced. On keyboards and portable medical equipment that were inoculated with <it>C. difficile</it> spores, application of the Sterilray device at a radiant dose of 100���mJ/cm² for ~ 5 seconds reduced contamination by 3.2 log₁₀CFU. However, the presence of organic material reduced the lethal effect of the far-UV radiation. In hospital rooms that were not pre-cleaned, disinfection with the Sterilray device significantly reduced the frequency of positive <it>C. difficile</it> and MRSA cultures (<it>P</it> =0.007).</p> <p>Conclusions</p> <p>The Sterilray™ Disinfection Wand is a novel environmental disinfection technology that rapidly kills <it>C. difficile</it> spores and other healthcare-associated pathogens on surfaces. However, the presence of organic matter reduces the efficacy of far-UV radiation, possibly explaining the more modest results observed on surfaces in hospital rooms that were not pre-cleaned.</p