PEG site infections: a novel use for Actisorb Silver 220

Gastrostomy site infections: dealing with a common problem

The most popular method of providing appropriate nutrition for large numbers of patients with swallowing difficulties is enteral feeding. However this treatment is not without complications, one of which is localized gastrostomy site infection. This is prevented initially by decolonisation of the oropharyngeal tract with antibiotic prophylaxis prior to insertion, and systemic antibiotics post insertion. Later complications include tracking infection, which is rare but can occur. Hypergranulation of the tissue can occur around the gastrostomy tube and this can become colonised or infected leading to further problems for the patient. A good gastrostomy site care pathway plan is required to maintain a healthy site and appropriate treatment required to minimize the infection risk.

A retrospective study evaluating silver-impregnated dressings on cesarean wound healing

OBJECTIVE

This retrospective study was designed to assess the effectiveness of silver-impregnated dressings in reducing postoperative wound care visits.

DESIGN

A retrospective chart review of 72 patients was conducted to compare the effectiveness of silver-impregnated dressings with traditional wound dressings in reducing additional postoperative visits associated with surgical site infections (SSIs) in patients undergoing cesarean delivery: Prior to October 1, 2009, incisions of 36 women were covered with gauze pads. Subsequent to that date, Silverlon dressings (Cura Surgical, Geneva, Illinois) were applied to the wounds of the remaining 36 women.

MAIN RESULTS

Two patients whose incisions were covered with a gauze pad and 2 patients who received the silver-impregnated dressings developed an SSI requiring additional wound care visits. Silver-impregnated dressings did not significantly reduce the rate of wound care-related postoperative visits, but the experimental group had a higher rate of comorbidities.

CONCLUSIONS

Although there was no observed difference in the number of women requiring additional wound care visits, the significantly greater number of comorbidities noted in the silver-impregnated dressing group should have theoretically placed them at increased risk for SSIs and additional postoperative wound care visits, suggesting that silver-impregnated dressings may have more of a protective effect than is appreciated in this study. A randomized prospective study is planned to further assess its usefulness in decreasing the incidence of wound infections along with its potential benefits regarding wound appearance.

Managing overgranulation tissue around gastrostomy sites

The development of overgranulation tissue around gastrostomy sites isa common problem. While there is little evidence to suggest that one treatment is more effective than another, a review of current practice suggests that there is an opportunity to improve clinical practice and patient outcomes in this area of care. The authors performed a simple practice-based audit to identify the extent of the problem within one geographical location. A care pathway approach was introduced,which reinforced the basic principles of care and encouraged the use of a 'double-foam' dressing on overgranulation tissue. A foam dressing impregnated with polyhexamethylene biguanide was used at the wound interface, providing a safe and effective alternative to managing overgranulation. Findings showed that a strategic approach to managing overgranulation tissue around gastrostomy devices can improve patient outcomes and clinical practice.

Constipation, treatment and biofeedback therapy

Constipation is commonly encountered by the community nurse, particularly in older people. A comprehensive assessment is required prior to treatment, to exclude potential pathologies such as a bowel cancer. There are many potential causes of constipation, such as poor diet or use of opioid analgesia. This can guide the nurse to a potential treatment, for example to include more fibre in the diet or to possibly change the analgesia used. However if these and/or other therapies fail, biofeedback therapy offers a non-surgical option. Biofeedback therapy includes patient education, retraining of the bowels and muscles, behavioural therapies and psychological support.

A review of the use of silver in wound care: facts and fallacies

This review traces the use of silver in wound care, discussing its merits as an antibacterial agent and constituent of many new dressings, which are increasingly tailored to the treatment of wounds ranging from acute surgical lesions to chronic and diabetic leg ulcers. Misconceptions regarding the biological properties of silver, its possible physiological value in the human body and wound bed, absorption through the skin, and safety factors are addressed. The article aims to present silver and the new range of sustained silver-release dressings as important features in the management of skin wounds, providing effective control of wound infections while ensuring patient comfort and quality of life.

Interventions to avoid maceration of the skin and wound bed

In the course of managing exuding wounds, particularly chronic wounds, failure to deal adequately with exudate can lead to exposure of the peri-wound skin to exudate and hence damage. This results in maceration of the skin and wound bed. Maceration is a largely under-recognized problem and one of the causes of delayed wound healing. Previous articles have focused on the nature and causes of maceration. This article describes a wide variety of wounds and skin conditions in which maceration might be present, or develop, during treatment, together with some strategies for avoiding maceration and the evidence base supporting them. It is only by becoming familiar with the various presentations of maceration, and with prophylactic treatment measures, that practitioners can avoid the increased costs and morbidity associated with it.