AAWC Wound Care Pearls

Are you an AAWC Member and would like to submit a pearl? Access the guidelines and submission form.

April 25, 2017
Pearl:
Did you know that visualizing, monitoring, and effectively lowering pressure can significantly reduce the risk of pressure ulcers? A recent meta-analysis demonstrated pressure monitoring devices are associated with an 88% reduction in the risk of pressure ulcers. Addressing risk factors are important, and pressure assessment is a vital component.
Reference:
Scott RG, Thurman KM. Visual feedback of continuous bedside pressure mapping to optimize effective patient repositioning. Adv Wound Care (New Rochelle) 2014;3:376-82.

Siddiqui A, Behrendt R, Lafluer M, Craft S. A continuous bedside pressure mapping system for prevention of pressure ulcer development in the medical ICU: a retrospective analysis. Wounds 2013;25:333-9.

Walia GS, Wong AY, Lo A, Mackert GA, Carl HM, Pedreira RA, Bello R, Aquino CS, Padula WV and Sacks JM. Efficacy of Monitoring Devices in Support of Prevention of Pressure Injuries: Systematic Review and Meta-analysis. Adv in Skin & Wound Care 2016;29:567-74.
Submitted by:
Susan Dieter, MS, RN, CWS

March 20, 2017
Pearl:
A(1c) Major Fake Out……….

Did you know HbA1c may not provide a relevant assay for glycemic control in patients with end stage renal disease (ESRD)? HbA1c can be lower in ESRD patients due to reduced numbers of red blood cells. These patients should submit logs or meters to clinicians for an accurate picture of glycemic control!
Reference:
Adams, M. (2009). Is HbA1c a reliable test in patients with diabetes and renal disease? Podiatry Today, 22(8). Retrieved from http://www.podiatrytoday.com/is-hba1c-a-reliable-test-in-patients-with-diabetes-and-renal-disease

Baboolal, K., & Sharif, A. (2010). Diagnostic application of the A1C assay in renal disease. Journal of American Society of Nephrology, 21(1), 383-385.
Submitted by:
Emily Greenstein, RN, BSN, CWON

Feb 22, 2017
Pearl:
Nursing time is the major driver of wound care cost; not the cost of the dressing!1

Quality dressings resulted in decreases of >50% in dressing change frequency and 75% overall cost of care, with 100% faster healing!2 Saving nursing time is the key.
Reference:
1. Vowden K, Vowden P, Posnett J. The resource costs of wound care in Bradford and Airedale primary care trust in the UK. J Wound Care. 2009. 18: 93-94.
DOI: 10.12968/jowc.2009.18.3.39814

2. Hurd T, Zuiliani N, Posnett J. Evaluation of the impact of restructuring wound management practices in a community care provider in Niagrara, Canada. Int Wound J. 2008. Jun 5(2): 296-304.
DOI: 10.1111/j.1742-481X.2008.00484.x
Submitted by:
Jenny Hurlow, GNP-BC, CWOCN

Jan 18, 2017
Pearl:
Malnourished diabetic foot ulcer (DFU) patients may be at higher risk for amputation.  A study reported use of the validated Mini Nutritional Assessment (MNA) on 478 DFU subjects. Seventy and a half percent of subjects were identified as having compromised nutritional status and at risk of lower extremity amputation.
Reference:
Gau B, Chen H, Hung S, et al. The impact of nutritional status on treatment outcomes of patients with limb-threatening diabetic foot ulcers. J Diabetes Complicat. 2016;30(1):138-142.
doi: 10.1016/j.jdiacomp.2015.09.011
Submitted by:
Latricia Love Allen DPM, MPH, FACFOAM

Dec 21, 2016
Pearl:
Close that incision and keep it closed!  Did you know that the use of incisional negative pressure has been shown to reduce surgical dehiscence rates secondary to infection?
Reference:
Sensarzadeh NN, et al.  Closed incision negative-pressure therapy is associated with decreased surgical-site infections: a meta-analysis.  Plastic Reconstruction Surgery, 2015, Sep;136(3):592-602.
doi: 10.1097/PRS.0000000000001519
Submitted by:
Terina DeVore, PT, DPT, WCC, CWS

Nov 22, 2016
Pearl:
Follow the DIME model for wound bed preparation and effective healing. Debridement of nonviable tissue, control of Inflammation or Infection, Moisture balance and Edge effect.
Reference:
Woo, K., Ayello, E.A., Sibbald, R.G.(2007).The Edge Effect: Current Therapeutic Options to Advance the Wound Edge. Advances in Skin and Wound Care, 20(2), 99-117.
Submitted by:
Susan Julian, DNP, RN, CNS, CWS

Oct 7, 2016
Pearl:
Did you know that elevated HbA1C (blood glucose) levels can impede wound healing?
Thus, it is important for clinicians, regardless of their discipline, who are treating wounds in diabetic patients to know what the patient’s A1C level is to appropriately set healing expectations and goals. Research shows that diabetic patients with higher A1C levels have reduced wound healing progression than those patients with lower A1C levels, regardless of treatment strategies.
Reference:
Christman et al. Hemoglobin A1c is a Predictor of Healing Rate In Diabetic Wounds. J Invest Dermatol. 2011 October ; 131(10): 2121–2127.
Submitted by:
Quiona Stephens-Russell, PhD