JULIE EVANS (TVN) Abertawe Bro Morgannwg University Health Board, Rehab Engineering Unit, Morriston Hospital, Swansea, UK. [email protected] Introduction: Patients may succumb to infections from a variety of ÂopportunisticÊ bacteria as a result Table 1 -Sequence of intervention and associated wound response
of concurrent co-morbidities. The Centers for Disease Control and Prevention (CDC) Atlanta, USA
Wound status at beginning of week Swab culture dressing Antibiotic
state that MRSA causes more than 50% of all health-care associated staphylococcal infections. Costs
Exudate not controlled. Peri-wound maceration, breakdown with proud wound
for UK „nosocomial‰ infections may be as high as £1 billion per year. This case study highlights the
bed, fragile easily bleeding tissue. Size, approx. 3cm diameter
management of a longstanding, highly exuding, MRSA infected foot ulcer and demonstrates how
Exudate not controlled. Peri-wound maceration, breakdown.
appropriate intervention can lead to effective management of the bacterial load.
Exudate not controlled. Peri-wound maceration, surrounding
Ag Fibrous absorbent dressing Rifampicin and cipro oxin
Patient details: 92 year old registered blind female, chronic heart failure and reduced mobility.
Exudate not controlled. Peri-wound maceration with surrounding cellulitis.
Admitted to orthopaedic trauma ward following fracture to left hip and subsequent surgical repair.
Ulcer appeared over L. hallux soon after admission, possibly as a result of trauma combined with tissue
Exudate controlled - no maceration, healthy granulation tissue.
ischaemia. The left surgical hip wound also produced high levels of exudate which was managed with
topical negative pressure (TNP) treatment.
Healthy granulation tissue, wound exudate reduced.
Healthy granulation, wound exudate - negligible.
Wound assessment: At week 5 when referred to TVN - circular wound approx 2.5cm in diameter
located over L. hallux, with fragile, deep red granulation tissue that bled easily. Extensive peri-wound erythema extending approx. 3 cm to mid-foot and the adjoining digit was swollen, hot to touch and
Little/no progress was achieved with antimicrobials (Ag dressings/systemic antibiotics), (Table 1). This
painful. A variety of wound dressings used over weeks 1-5 had failed to prevent maceration and gradual
was particularly disappointing as topical and concurrent systemic antimicrobial therapy should have
breakdown of the peri wound area from the caustic effects of high levels of exudate production.
yielded a positive response. It was decided to focus on managing the wound environment using an absorbent dressing that possesses Hydration Response Technology (HRT). Key components of HRT include its powerful osmotic pull whilst maintaining a moist wound healing environment. HRT has the
An overview of intervention and wound response is presented in Table 1. It can be seen that wound
ability to draw wound fluid into the dressing matrix (where the aqueous component is bound) together
progress was not only stalled but that deterioration was evident. An increase in wound exudate pro-
with the accompanying free floating bacteria. Prompt management of the high exudate volume and
duction in conjunction with stalled healing is regarded as a clinical indicator of wound infection. Positive
the associated bacterial load swiftly returned the wound bed to an environment conducive to healing.
wound cultures for MRSA in conjunction with the increase in wound exudate lead to the conclusion
Effcient management of exudate and bacterial load are key components of Wound Bed Preparation.
that the wound was infected with MRSA.
The initial management strategy of using active mechanisms (antimicrobials) together with moderate absorbent capacity dressings had failed to manage the bioburden or the exudate volume. Using sorbion sachet S with HRT allowed this highly absorbent, non traumatic dressing to bind the exudate, sequester bacteria and modulate protease activity whilst maintaining a moist wound environment. Apart from wound resolution the additional benefits were reduced costs and a vastly improved quality of life for the patient. While this is a single case study the question is posed as to the perceived need for widespread
antimicrobial use. Further studies are welcomed.
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