Specialist tissue viability services: a priority or a luxury?

During the 1980s, the number of tissue viability nurses (TVNs) rose steadily in the UK, in response to mismanagement of patients with wounds (Fletcher, 1995). Since this time, and in response to the quality agenda, the necessity of promoting a tissue viability service (TVS) that is able to meet the needs of a changing population, while being cost effective and offering interventions based on research and evidence, has grown. The drive to reduce avoidable harm in healthcare and to make efficiency savings is continuing, with TVS being one of the key areas to deliver these targets. However, across the UK we have a wide range of role descriptions and job titles, yet little clarification as to the qualifications and skills required to deliver a successful TVS. Infection control specialist nurses have a clear identity with concise role descriptions representing a range of pay bands. Arguably, this is because they are aligned with a medical specialty, whereas TV is not. The introduction of ‘Any Qualified Provider’ (Department of Health, 2011) has witnessed some services, including management of leg ulceration, being delivered by non-NHS providers at a reduced cost. So is TVS in danger of becoming more of a ‘nice thing’ rather than a priority

Preoperative skin antisepsis – it ain’t what you do but the way that you do it

In 2010, the New England Journal of Medicine published a randomized controlled trial (RCT) which reported the use of preoperative skin antisepsis using 2% chlorhexidine gluconate/70% isopropyl-alcohol (applied with a disposable, purpose-built, sponge applicator and a “scrubbing” technique), or an aqueous 10% povidone-iodine based preparation (applied as a paint), for prevention of surgical site infection (SSI)1. Thirty-nine of 409 patients in the 2% CHG/70% IPA study arm (9.5%) and 71 of 440 patients in the 10% PVP-I study arm (16.1%) developed an SSI after clean and clean-contaminated abdominal procedures (RR = 0.59; 95% CI: 0.41 – 0.85; P=0.004)

Using QFD As A Method To Develop Functional Medical Products For Children With Cancer.

Quality Function Deployment (QFD) is a recognised method of translating customer needs into appropriate technical requirements to inform ergonomic design development. This paper details how QFD has been used to develop a tactile advanced product for a medical application. The project has undertaken innovative experimental and industrial research which has led to the design of a child-focused “Wiggle Bag” which will be used to safely harness and reduce infection at the site of a venous catheter placed in the chest wall of long-term child cancer sufferers. Children with cancer regularly have long term central venous catheters inserted through their upper chest wall to deliver medication. They can result in medical issues, particularly infections or accidental removal, but also discomfort for the children, particularly when sleeping. The research uses an inductive approach, triangulating various research strategies including questionnaires, focus groups and interviews from parents, carers and medical personnel. QFD was used to bring together the key findings from the primary data analysis to establish design criteria and inform the product development. The outcome of the research was a functional product ergonomically designed for maximum comfort and safety, with the added unique selling point of having antibacterial properties

Improving everyday life experiences for young children with cancer

Children with cancer regularly have long term central line catheters inserted in the chest to deliver medication. Often termed ‘Hickman Lines’, they result in tubing protruding from the chest, which can result in medical issues including infections, but also discomfort for the child, particularly when sleeping. A team of researchers, led by Dr Jess Power, including Professor David Leaper and Joanne Marie Harris, has been investigating the design and development of a product to contain these external lines, providing greater comfort and safety for the child whilst also meeting the needs of the medical communit

Can the design of glove dispensing boxes influence glove contamination?

Background Few studies have explored the microbial contamination of glove boxes in clinical settings. The objective of this observational study was to investigate whether a new glove packaging system in which gloves are dispensed one by one vertically with the cuff-end first has lower levels of contamination on the gloves and on the surface around the box aperture compared to conventional horizontally dispensed glove boxes. Methods Seven participating sites were provided with vertical glove dispensing systems and conventional boxes. Before opening boxes, the surface around the aperture was sampled microbiologically to establish base-line levels of superficial contamination. Once the boxes were opened, the first pair of gloves in each box were sampled for viable bacteria. Thereafter, testing sites were visited on a weekly basis over a period of six weeks and the same microbiological assessments made. Results The surface surrounding the aperture of the modified dispenser boxes became significantly less contaminated than the conventional boxes (P < 0.001) with an average of 46.7% less contamination around the aperture. Overall, gloves from modified boxes showed significantly less colony-forming units contamination than gloves from conventional boxes (P < 0.001). Comparing all sites over the entire six-week period, modified dispensed gloves had 88.9% less bacterial contamination. Conclusion This simple improvement to glove box design reduces contamination of unused gloves. Such modifications could decrease the risk of microbial cross-transmission in settings that utilise gloves. However, such advantages do not substitute for strict hand-hygiene compliance and appropriate use of non-sterile, single-use gloves

Effect of processing variables and bulk composition on the surface composition of spray dried powders of a model food system

Abstract The surface compositions of food powders created from spray drying solutions containing various ratios of sodium caseinate, maltodextrin and soya oil have been analysed by Electron Spectroscopy for Chemical Analysis. The results show significant enrichment of oil at the surface of particles compared to the bulk phase and, when the non-oil components only are considered, a significant surface enrichment of sodium caseinate also. The degree of surface enrichment of both oil and sodium caseinate was found to increase with decreasing bulk levels of the respective components. Surface enrichment of oil was also affected by processing conditions (emulsion drop size and drying temperature), but surface enrichment of sodium caseinate was relatively insensitive to these. The presence of "pock marks" on the particle surfaces strongly suggests that the surface oil was caused by rupturing of emulsion droplets at the surface as the surrounding matrix contracts and hardens

Surgical site infection: poor compliance with guidelines and care bundles

Surgical site infections (SSIs) are probably the most preventable of the health care- associated infections. Despite the widespread international introduction of level I evidence-based guidelines for the prevention of SSIs, such as that of the National Institute for Clinical Excellence (NICE) in the UK and the surgical care improvement project (SCIP) of the USA, SSI rates have not measurably fallen. The care bundle approach is an accepted method of packaging best, evidence-based measures into routine care for all patients and, common to many guidelines for the prevention of SSI, includes methods for preoperative removal of hair (where appropriate), rational antibiotic prophylaxis, avoidance of perioperative hypothermia, management of perioperative blood glucose and effective skin preparation. Reasons for poor compliance with care bundles are not clear and have not matched the wide uptake and perceived benefit of the WHO ‘Safe Surgery Saves Lives’ checklist. Recommendations include the need for further research and continuous updating of guidelines; comprehensive surveillance, using validated definitions that facilitate benchmarking of anonymised surgeon-specific SSI rates; assurance that incorporation of checklists and care bundles has taken place; the development of effective communication strategies for all health care providers and those who commission services and comprehensive information for patients

Wound infection in clinical practice : principles of best practice

The International Wound Infection Institute (IWII) is an organisation of volunteer interdisciplinary health professionals dedicated to advancing and improving practice relating to prevention and control of wound infection. This includes acute wounds (surgical, traumatic and burns) and chronic wounds of all types, although principally chronic wounds of venous, arterial, diabetic and pressure aetiologies. Wound infection is a common complication of wounds. It leads to delays in wound healing and increases the risk of loss of limb and life. Implementation of effective strategies to prevent, diagnose and manage, is important in reducing mortality and morbidity rates associated with wound infection. This second edition of Wound Infection in Clinical Practice is an update of the first edition published in 2008 by the World Union of Wound Healing Societies (WUWHS). The original document was authored by leading experts in wound management and endorsed by the WUWHS. The intent of this edition is to provide a practical, updated resource that is easy-to-use and understand. For this edition, the IWII collaborative team has undertaken a comprehensive review of contemporary literature, including systematic reviews and meta-analyses when available. In addition, the team conducted a formal Delphi process to reach consensus on wound infection issues for which scientific research is minimal or lacking. This rigorous process provides an update on the science and expert opinion regarding prevention, diagnosis and control of wound infection. This edition outlines new definitions relevant to wound infection, presents new paradigms and advancements in the management and diagnosis of a wound infection, and highlights controversial areas of discussion

Consensus guidelines for the identification and treatment of biofilms in chronic nonhealing wounds

Background: Despite a growing consensus that biofilms contribute to a delay in the healing of chronic wounds, conflicting evidence pertaining to their identification and management can lead to uncertainty regarding treatment. This, in part, has been driven by reliance on in vitro data or animal models, which may not directly correlate to clinical evidence on the importance of biofilms. Limited data presented in human studies have further contributed to the uncertainty. Guidelines for care of chronic wounds with a focus on biofilms are needed to help aid the identification and management of biofilms, providing a clinical focus to support clinicians in improving patient care through evidence-based medicine. Methods: A Global Wound Biofilm Expert Panel, comprising 10 clinicians and researchers with expertise in laboratory and clinical aspects of biofilms, was identified and convened. A modified Delphi process, based on published scientific data and expert opinion, was used to develop consensus statements that could help identify and treat biofilms as part of the management of chronic nonhealing wounds. Using an electronic survey, panel members rated their agreement with statements about biofilm identification and treatment, and the management of chronic nonhealing wounds. Final consensus statements were agreed on in a face-to-face meeting. Results: Participants reached consensus on 61 statements in the following topic areas: understanding biofilms and the problems they cause clinicians; current diagnostic options; clinical indicators of biofilms; future options for diagnostic tests; treatment strategies; mechanical debridement; topical antiseptics; screening antibiofilm agents; and levels of evidence when choosing antibiofilm treatments. Conclusion: This consensus document attempts to clarify misunderstandings about the role of biofilms in clinical practice, and provides a basis for clinicians to recognize biofilms in chronic nonhealing wounds and manage patients optimally. A new paradigm for wound care, based on a stepped-down treatment approach, was derived from the consensus statements