Regional Wounds Victoria

12/06/2023

07/10/2021

ANSWER TO LAST WEEK'S QUESTION:
***QUESTION***
Providing there are no other causes for increased exudate, wound exudate is generally at its highest during which wound healing phase:
A. Haemostasis
B. Inflammatory
C. Proliferation
D. Remodelling

***ANSWER***
B. Inflammatory

In general, exudate production is highest during the inflammatory phase and decreases as healing progresses.
The inflammatory process, triggered by the formation of a wound, releases a range of substances (mediators and enzymes), that among other effects increase interstitial fluid production
and encourage the formation of wound exudate.
Of note is the increase in capillary permeability induced during inflammation. The tight junctions
between the cells that form the capillary walls (the endothelial cells) and the porous carbohydrate-rich
lining of capillaries have important roles in regulating fluid, protein, and cell release, into the surrounding tissues. Inflammatory mediators break down the proteins that hold the endothelial cells tightly together and disrupt the lining, allowing fluid, proteins, and cells to escape more readily, leading to an increase in wound exudate.

REFERENCE:
World Union of Wound Healing Societies (WUWHS) Consensus Document. Wound exudate: effective
assessment and management Wounds International, 2019
https://www.wuwhs.org/wp-content/uploads/2020/09/exudate.pdf

Photo shared with permission

04/10/2021

THIS WEEK'S QUESTION IS MULTIPLE CHOICE:
Providing there are no other causes for increased exudate, wound exudate is generally at its highest during which wound healing phase:
A. Haemostasis
B. Inflammatory
C. Proliferation
D. Remodelling

Photo shared with permission

23/09/2021

ANSWER TO THIS WEEK'S QUESTION:
***Question***
What problems can occur with excessive wound exudate?
A. Leakage and soiling, Periwound skin damage and wound expansion
B. Malodour, Increased risk of infection and Pain
C. Psychological effects, Fluid and electrolyte imbalance and Increase in dressing frequency
D. All of the above

***Answer***
D. All of the above

Excessive exudate production can be associated with a wide range of problems. Leakage and soiling can be particularly distressing to people and their carers, and can be burdensome because of increased needs for washing of clothing and bed linen.

Leakage or strikethrough may result in odour (which is sometimes, but not always, a sign of increased wound bioburden or infection). Leakage/strikethrough may also increase the risk of infection by providing a route by which micro-organisms can enter the wound.

Frequent dressing changes may be required to ensure containment of the exudate or to monitor the wound. Frequent dressing changes may also be of benefit in preventing potential infection and biofilm formation. However, frequent dressing changes may be taxing and distressing to the patient, especially if associated with pain, and can cause wound bed or periwound skin damage . Consequently, further studies investigating the potential impact and benefits of increased dressing change frequency and positive clinical outcomes are required.

Other causes of discomfort and pain in patients with an excessively exuding wound include periwound skin damage and a ‘drawing’ pain sometimes produced by dressings with a high rate of absorbency, especially when used in wounds where levels of exudate is decreasing.

High levels of exudation may also result in significant protein loss and put the patient at risk of fluid/electrolyte imbalance.

Excessive exudate can have a serious psychosocial impact on patients and reduce quality of life. For example, patients’ work, social and home lives may be disrupted by dressing changes or by fear and embarrassment related to leakage or odour, which can prevent patients from leaving their homes.

Image used with permission.

Reference:
World Union of Wound Healing Societies (WUWHS) Consensus Document. Wound exudate: effective
assessment and management Wounds International, 2019

https://www.woundsinternational.com/resources/details/wuwhs-consensus-document-wound-exudate-effective-assessment-and-management

22/09/2021

Where were you when the earthquake hit Victoria this morning at about 9.15am? We hope everyone is OK. It must have been scary for many people, especially those near the epicentre close to Mansfield!
(chart shared from https://earthquakes.ga.gov.au/event/ga2021sqogij)

20/09/2021

THIS WEEK'S QUESTION IS MULTIPLE CHOICE:
What problems can occur with excessive wound exudate?
A. Leakage and soiling, Periwound skin damage and wound expansion
B. Malodour, Increased risk of infection and Pain
C. Psychological effects, Fluid and electrolyte imbalance and Increase in dressing frequency
D. All of the above

Image used with permission.

26/08/2021

ANSWER TO LAST WEEK'S QUESTION:
***Question***
You're caring for a person at high risk of pressure injury who cannot reposition themselves. When you walk into their room, you notice their heels have not been offloaded as planned and are resting directly on the bed. When you check the skin on their heels you find the L) heel is reddened where it was contacting the bed.
You would document this as a Stage 1 pressure injury if the erythema:
A. blanches when light pressure is applied with your finger.
B. hasn’t faded within 30 minutes.
C. has a maroon/ purple tone.
D. doesn’t blanche when light pressure is applied with your finger.

***Answer***
D. doesn’t blanche when light pressure is applied with your finger

The definition of a Stage 1 pressure injury is:
"Non-blanchable erythema.
Intact skin with non-blanchable redness of a localised area usually over a bony prominence. Darkly pigmented skin may not have visible blanching; its colour may differ from the surrounding area. The area may be painful, firm, soft, warmer or cooler as compared to adjacent tissue. Stage I may be difficult to detect in individuals with dark skin tones"

****Why A, B and C are incorrect***
* A is INCORRECT because a Stage 1 pressure injury does NOT blanche when light pressure is applied with your finger.
* B is INCORRECT because according to the definition, there is no need to wait 30 minutes to see if the area fades or becomes blanchable to qualify as a stage 1 pressure injury.
* C is INCORRECT because a purple or maroon tone would indicate a suspected deep tissue injury rather than a stage 1.

REFERENCES
https://www.regionalwoundsvictoria.com/rwv-poster-pressure-injury-definitions

https://pppia.org/resources/

European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers/Injuries:
Clinical Practice Guideline. The International Guideline. Emily Haesler (Ed.). EPUAP/NPIAP/PPPIA; 2019.

https://guidelinesales.com/page/PPPIA

Photo purchased from NPIAP with permission of the copyright holder, Gordian Medical, Inc. dba American Medical Technologies. Do not copy without permission. Photo may be purchased from https://npiap.com/page/Photos

23/08/2021

THIS WEEK'S QUESTION IS MULTIPLE CHOICE:
You're caring for a person at high risk of pressure injury who cannot reposition themselves. When you walk into their room, you notice their heels have not been offloaded as planned and are resting directly on the bed. When you check the skin on their heels you find the L) heel is reddened where it was contacting the bed.

You would document this as a Stage 1 pressure injury if the erythema:
A. blanches when light pressure is applied with your finger.
B. hasn’t faded within 30 minutes.
C. has a maroon/ purple tone.
D. doesn’t blanche when light pressure is applied with your finger.

Watch out for the answer on Thursday evening!

Photo purchased from NPIAP with permission of the copyright holder, Gordian Medical, Inc. dba American Medical Technologies. Do not copy without permission. Photo may be purchased from https://npiap.com/page/Photos

12/08/2021

ANSWER TO THIS WEEK'S QUESTION:
According to the Journal of Wound Care International Consensus Document. Defying hard-to-heal wounds with an early anti-biofilm intervention strategy: wound hygiene, what are the four stages of wound hygiene?

***QUESTION***
A. 1. Select a dressing
2. Clean the wound (only if debris is present)
3. Dress the wound
4. Explain aftercare to the patient

B. 1. Cleanse the wound and peri-wound skin
2. Debride
3. Refashion the wound edges
4. Dress the wound

C. 1. Explain the procedure to the patient
2. Clean the wound with normal saline
3. Debride if required
4. Dress the wound

***ANSWER***
B.

1. Cleanse the wound and peri-wound skin.
(Cleanse the wound bed to remove devitalised tissue, debris, and biofilm. Cleanse the peri-wound skin to remove dead skin scales and callus, and to decontaminate it).
2. Debride.
Remove necrotic tissue, slough, debris and biofilm at every dressing change.
3. Refashion the wound edges.
Remove necrotic, crusty and/or overhanging wound edges that may be harbouring biofilm. Ensure the skin edges align with the wound bed to facilitate epithelial advancement and wound contraction.
4. Dress the wound.
Address residual biofilm while printing or delaying regrowth of biofilm by using dressings containing anti-biofilm and/or antimicrobial agents.

The core principle of wound hygiene is to remove or minimise all unwanted materials, including biofilm, devitalised tissue and foreign debris from the wound, address any residual biofilm, and prevent its re-formation.

Like all forms of hygiene, the hallmark of wound hygiene is repetition: the wound must be cleansed, derided and its edges refashioned at every assessment and dressing change.

REFERENCE:
Murphy C, Atkin L, Swanson T, Tachi M, Tan YK, Vega de Ceniga M, Weir D, Wolcott
R. International consensus document. Defying hard-to-heal wounds with an early antibiofilm intervention strategy: wound
hygiene. J Wound Care 2020; 29(Suppl 3b):S1–28

https://www.magonlinelibrary.com/pb-assets/JOWC/JWC_Consensus_Wound_Hygiene.pdf

09/08/2021

THIS WEEK'S QUESTION IS MULTIPLE CHOICE:
According to the Journal of Wound Care International Consensus Document. Defying hard-to-heal wounds with an early anti-biofilm intervention strategy: wound hygiene, what are the four stages of wound hygiene?

A. 1. Select a dressing
2. Clean the wound (only if debris is present)
3. Dress the wound
4. Explain aftercare to the patient

B. 1. Cleanse the wound and peri-wound skin
2. Debride
3. Refashion the wound edges
4. Dress the wound

C. 1. Explain the procedure to the patient
2. Clean the wound with normal saline
3. Debride if required
4. Dress the wound

22/07/2021

ANSWER TO LAST WEEK'S QUESTION:
***Question***
Ann is a 75yo lady admitted to your service for the management of recurrent cellulitis and bilateral lymphoedema. She attends the appointment with her husband who is very caring and involved in Ann's health care. During the admission assessment, Ann asks if lymphoedema could be caused by the 'worms and bugs' that live under her skin. Ann points to numerous scabs and small wounds on her thighs and chest stating that these are caused by the bugs burrowing. Ann becomes quite fixated and continues, saying that she has observed worm-like creatures from her eyes and nose. She also produces a piece of gauze with what she thinks is one of these bugs and has numerous photos on her phone of the worms and bugs that she has 'caught as proof'. On close examination, they are photos of dried blood or other body fluids. Ann would not accept any other explanation than these were parasites and commented her GP didn't believe her either even though tests indicated Ann felt she required on-going antibiotics to treat the infestation and washed her skin with harsh topical products. During the appointment, her husband is noncommittal when Ann asks him for confirmation that he has seen the bugs. Over the coming weeks as Ann's legs improve with correct compression her fixation on the parasites reduces and only occasionally picks at her skin.
Anne may be experiencing:
A. Kyrle Disease
B. Trichotillomania
C. Delusions of parasitosis
D. Onychophagia
E. Scabies
F. Maggot infestation

***ANSWER***
C. Delusions of parasitosis
Delusions of parasitosis is a delusion disorder characterised by an unshaken belief of having been infested by parasites when one is not. The person believes the infestation may be the result of macroparasites like helminths or smaller like viruses or bacteria. Those with delusional parasitosis may injure themselves trying to extract the parasites and may perceive the parasites as crawling or burrowing in the skin. 'Matchbox sign' is also prevalent where the person brings dust, fibres, scab, or debris from the skin as evidence of the infestation in a container, like a matchbox. Treatment is notoriously difficult as most will refuse to believe that there is a noninfectious reason for their illness.

Image from DermNet.org. https://creativecommons.org/licenses/by-nc-nd/3.0/nz/legalcode

19/07/2021

THIS WEEK'S QUESTION IS MULTIPLE CHOICE:
Ann is a 75yo lady admitted to your service for the management of recurrent cellulitis and bilateral lymphoedema. She attends the appointment with her husband who is very caring and involved in Ann's health care. During the admission assessment, Ann asks if lymphoedema could be caused by the 'worms and bugs' that live under her skin. Ann points to numerous scabs and small wounds on her thighs and chest stating that these are caused by the bugs burrowing. Ann becomes quite fixated and continues, saying that she has observed worm-like creatures from her eyes and nose. She also produces a piece of gauze with what she thinks is one of these bugs and has numerous photos on her phone of the worms and bugs that she has 'caught as proof'. On close examination, they are photos of dried blood or other body fluids. Ann would not accept any other explanation than these were parasites and commented her GP didn't believe her either even though tests indicated Ann felt she required on-going antibiotics to treat the infestation and washed her skin with harsh topical products. During the appointment, her husband is noncommittal when Ann asks him for confirmation that he has seen the bugs. Over the coming weeks as Ann's legs improve with correct compression her fixation on the parasites reduces and only occasionally picks at her skin.

Anne may be experiencing:
A. Kyrle Disease
B. Trichotillomania
C. Delusions of parasitosis
D. Onychophagia
E. Scabies
F. Maggot infestation

Image from DermNet.org. https://creativecommons.org/licenses/by-nc-nd/3.0/nz/legalcode