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PubMedDate not supplied

Impact of dressing materials on central venous catheter infection rates.

Transparent, semipermeable, polyurethane dressings have become widely accepted for dressing central venous catheter (CVC) insertion sites. However, there have been differing results in terms of their association with microbial growth under the dressing and the risk of subsequent CVC-associated infection. This study describes our positive experience in terms of the impact of a highly permeable transparent dressing on CVC-associated infection among patients at our facility.

Catheterization, Central Venous↗
PubMed1998

Sore nipples in breast-feeding women: a clinical trial of wound dressings vs conventional care.

BACKGROUND: Sore nipples in breast-feeding mothers are a common cause of premature weaning, and are difficult to treat owing to recurrent trauma and exposure to the infant's oral flora. OBJECTIVE: To compare the safety and efficacy of a hydrogel moist wound dressing (Elasto-gel, Southwest Technologies Inc, Baltimore, Md) with the use of breast shells and lanolin cream in the treatment of maternal sore nipples associated with breast-feeding. DESIGN: Randomized controlled trial comparing the above treatments for sore nipples. Patients were seen for a maximum of 3 follow-up visits within 10 days, or until the resolution of symptoms. SETTING: The Maternal-Infant Lactation Center at the Mercy Hospital of Pittsburgh, Pittsburgh, Pa, a tertiary care teaching hospital in inner-city Pittsburgh. PATIENTS: A referred sample of 42 breast-feeding women who presented to the Maternal-Infant Lactation Center for the treatment of sore nipples. All patients with breast infection or chronic unrelated pain conditions were excluded from the study. INTERVENTION: After informed consent, patients were randomized to receive either a hydrogel wound dressing or breast shells and lanolin. All patients underwent a history, physical examination of the infant and the mother's breasts, assessment of breast-feeding technique, and breast-feeding instruction. MAIN OUTCOME MEASURES: The degree of pain on self-report questionnaires and the change in scores for physical examination, breast-feeding technique, and pain behaviors during breast-feeding. RESULTS: Although both treatments, in association with instruction in breast-feeding technique, were effective, greater improvement was seen in the group using breast shells and lanolin. This reached statistical significance for physician-rated healing (P<.01) and self-reported pain (P<.05). There were significantly more infections in the dressing group (P<.05), which resulted in early discontinuation of the study. CONCLUSIONS: Prevention of sore nipples by teaching proper technique on the initiation of breast-feeding should be instituted. For those cases in which sore nipples do develop, breast shells and lanolin in association with instruction in breast-feeding technique are more effective than moist wound dressings. Lanolin and shells should remain first-line therapy.

Adult↗
PubMed1976

Comparison of coarse mesh gauze with biologic dressings on granulating wounds.

Twenty patients with large area granulating wounds were selected for the study. On each patient, a small area of uniform appearance was divided into four subareas, and each subarea was randomly assigned treatment with a single 24 hour application of cadaver allograft, fresh porcine xenograft, formalinized xenograft, or "wet-to-dry" applications of coarse mesh gauze changed three times daily. At 24 hours, all four areas were uncovered. The subareas were ranked in terms of appearance on a best, second best, third best, and worst scale by experienced paramedical personnel who were not told which area received which treatment. Contact sponge quantitative microbiology was performed on each subarea before and after treatment on seventeen of the twenty patients. The results of these rankings suggest that coarse mesh gauze, changed three times daily, was significantly better at improving wound appearance than any of the biologic dressings. Among the biologic dressings, formalinized xenograft was significantly the worst. There was no significant difference between cadaver allograft and porcine xenograft. Analysis of quantitative cultures was limited by the problems of applying statistical methods to series of paired cultures in which initial values are quite different. Within the framework of such limitations and our 24 hour study, there was not significant change in surface colonization when either coarse mesh gauze or biologic dressings were used.

Adolescent↗
PubMed1994

Alginate fiber dressing for oral mucosal wounds.

The aim of this study was to evaluate the effect on hemostasis and wound healing of a proprietary alginate fiber dressing when applied to a wound of the buccal mucosa of approximately 2 mm depth. The study showed a significant reduction in the number of residual bleeding points in shallow wounds when the alginate fiber dressing was applied for 5 minutes as compared with the use of non-alginate-impregnated surgical gauze. There was no significant difference in the rate of epithelial repair of the test and control sites nor in the area of the resulting mucosal scar. In addition, there was no significant difference in the numbers of tissue components in the submucosa. It is concluded that the alginate fiber dressing material evaluated in this study may be effective as a hemostatic mucosal dressing in shallow wounds, but it does not accelerate mucosal wound healing.

Alginates↗
PubMed1989

Ambulatory management of burns in children.

A randomized trial of three treatment methods for the ambulatory management of minor burns in children has shown Op-site to be superior. The dressing is cost-effective and well tolerated, with the advantage that children can return to their normal activities without jeopardizing the healing process.

Ambulatory Care↗
PubMed2006

Use of a new hemicellulose dressing (Veloderm) for the treatment of split-thickness skin graft donor sites A within-patient controlled study.

A multi-centre, open, within-patient controlled study was performed on 23 adult burnt patients to investigate the effectiveness, safety and tolerability of Veloderm in comparison with Algisite M and Jaloskin in split-thickness skin graft donor site care. The areas dressed with Veloderm completely healed within 10-13 days in a significant higher proportion than the other two dressings (47.6% for Veloderm versus 26.3% for Algisite M and 10% for Jaloskin, P<0.03), showing during the whole study less incidence of exudates and of peri-lesional erythema. The aesthetic outcome of the treated lesions after healing was significantly better for Veloderm (P=0.0016). Veloderm) and Jaloskin required very few renewals of the medication during the first week of treatment, while Algisite M needed several multiple re-dressings. Veloderm was judged better than the other two treatments as far as the acceptability (P<0.001), ease of use (P<0.001) and efficacy (P<0.00001). Both pain during application or at removal of dressings and local infections were negligible with all treatments. No scars were formed in any skin donor site. In conclusion Veloderm is a safe and effective dressing for the re-epithelialization of the skin graft donor sites: it showed higher activity than the other two compared dressings.

Adult↗
PubMed2001

Fabrication and characterization of a sponge-like asymmetric chitosan membrane as a wound dressing.

A novel asymmetric chitosan membrane has been prepared by immersion-precipitation phase-inversion method and evaluated as wound covering. This new type of chitosan wound dressing which consists of skin surface on top-layer supported by a macroporous sponge-like sublayer was designed. The thickness of the dense skin surface and porosity of sponge-like sublayer could be controlled by the modification of phase-separation process using per-evaporation method. The asymmetric chitosan membrane showed controlled evaporative water loss, excellent oxygen permeability and promoted fluid drainage ability but could inhibit exogenous microorganisms invasion due to the dense skin layer and inherent antimicrobial property of chitosan. Wound covered with the asymmetric chitosan membrane was hemostatic and healed quickly. Histological examination confirmed that epithelialization rate was increased and the deposition of collagen in the dermis was well organized by covering the wound with this asymmetric chitosan membrane. The results in this study indicate that the asymmetric chitosan membrane thus prepared could be adequately employed in the future as a wound dressing.

3T3 Cells↗
PubMedDate not supplied

Pediatric considerations in the use of Biobrane in burn wound management.

Biobrane offers a number of advantages as a wound dressing for children. It does not require the use of surgical instruments, noisy distractions, painful manipulation of the wound, or regimented daily dressing changes. Biobrane does offer the pediatric patient with burns immediate comfort and protection and enhances patient compliance and parental satisfaction.

Biocompatible Materials↗
PubMed1993

Microbiology and healing of the occluded skin-graft donor site.

Delayed healing of skin-graft donor sites may be costly and life-threatening, especially in patients with large body surface area burns. A donor site dressing should maximize the ability of the wound to heal without increasing the risk of local infection, systemic infection, or both. Specifically, the possibility of a secondary infection may either slow the healing process or ultimately convert the donor site into a full-thickness skin loss. A number of materials ranging from gauze to biologicals have been investigated for use as donor site dressings. The use of hydrocolloids for donor sites has been widely studied and has shown improved healing rates over the rates reported for conventional dressings. Our recent study using hydrocolloids confirmed earlier research that showed fewer infections and more rapid donor site healing.

Burns↗
PubMed1995

Topical treatment of diabetic foot ulcers: an economic analysis of treatment alternatives and strategies.

In a prospective study, 314 patients with diabetic foot ulcers were followed and 40 patients died before healing occurred. In those patients who healed, a retrospective economic analysis of the costs for topical treatment was performed. The aim of the study was to analyse the costs and discuss how different treatment strategies influence total costs. Data collected for each patient were total time to healing, treatment time for each type of dressing, and the frequency of dressing changes. Material costs for the dressings, labour, and travelling costs were calculated separately. A formula for simulation of economic consequences of different treatment strategies including the introduction of new strategies was designed. The cost for topical treatment was strongly related to the severity of the ulcer and wound healing time. The average weekly cost per patient for topical treatment varied between 40.3 pounds and 385 pounds. The dominating costs for topical treatment were expenses for staff and transportation. The most important factor to reduce costs is the frequency of dressing changes. The study emphasizes the need for prospective comparative studies of cost effectiveness in topical treatment strategies.

Bandages↗
PubMed1999

Infection control properties of some wound dressings.

The ability of some wound dressings to sequester and retain micro-organisms associated with wound fluid is perceived to provide beneficial properties regarding infection control. This study used an in vitro model to investigate and compare such properties in a range of fibrous absorbent dressings (alginate, hydrofibre and hydrophobic). Dressings were challenged with a simulated wound fluid containing common wound pathogens (Staphylococcus aureus or Pseudomonas aeruginosa). Bacterial sequestering and binding levels were monitored over time. A hydrofibre dressing and two calcium alginate dressings were shown to effectively sequester challenge organisms from a simulated wound fluid. However, the hydrophobic and hydrofibre dressings produced statistically significant results in their ability to adsorb and retain challenge organisms (p < 0.05). These investigations have demonstrated that a hydrofibre dressing effectively sequesters and retains micro-organisms upon exposure to simulated wound fluid, and may therefore provide a passive mechanism for reducing the microbial load in wounds and in the surrounding environment. Further in vivo studies are required to investigate these dressing properties.

Alginates↗
PubMedDate not supplied

Dressing spray enhances the adhesive strength of surgical dressing tapes.

BACKGROUND: The use of surgical adhesive tapes after minor surgical and dermatologic operations is widespread. Their use reduces the wound tension and separation and they ultimately improve the postoperative scar. The most commonly used wound adhesives to enhance the adhesiveness of the surgical tapes, are tincture of benzoin and mastisol. AIM: The purpose of the present study is to demonstrate the role of adhesive power of dressing spray with the adhesive tape application on the skin, which is widely used in clinics after the skin closure. METHODS: Fifteen volunteers who were chosen among the medical personnel of the hospital comprised the study group. The skin of the flexor aspect of the 1/3 middle forearm of the subjects was used as the procedure region. The data is collected in the first, second and eighth days of the study. At the first stage of the study, an adhesive wound closure tape was applied to the skin without any compound of adhesives (group A). In the second and third stages, a thin coat of transparent film dressing spray (group B) and an adhesive compound of tincture of benzoin (group C) were applied to the skin before the adhesive tape placement, respectively. Different values of weights ranging between 50-900 gm were hanged by hooking into the center of the adhesive tape. The weights that caused complete separations of the tape from the skin after exactly 20 seconds were recorded in all groups. The data was analyzed by using Friedman test in order to calculate statistical significance between groups A, B and C. RESULTS: The difference in adhesive power between control and groups B and C was found to be highly significant ( p CONCLUSION: The results indicated that dressing spray tested has an additional adhesive power besides its well known features and that it can be used as an efficient alternative material among other adhesive compounds.

Humans↗
PubMed1992

[Not a tourniquet, but compressive dressing. Experience from 68 traumatic amputations after injuries from mines].

In autumn 1991, 68 patients with traumatic amputations after injuries caused by mines were evacuated to the United Nation's field hospital in the demilitarized zone between Iraq and Kuwait. Most were seen during a three week period when civilians harvested mines. During the first days of this period, continuous bleeding distally to applied tourniquets was frequently observed. Orders were issued to remove any tourniquets and cover the wounds with a very tight elastic bandage. Prehospital intravenous infusions were decreased. Three out of 18 patients died prior to the change of routine compared with one out of 50 afterwards. The new directives led to visibly less haemorrhage. Haemoglobin on admission was mean 8.6 g/100 ml during the first part of the observation period compared with mean 10.5 g/100 ml with the new routine. 23 patients received blood transfusions. Fewer patients needed transfusions after the use of tourniquets was discontinued. A tourniquet should not be used in the treatment of bleeding extremity injuries. In extensive crush injuries and traumatic amputations a compressive dressing should be used, applied from the end of the extremity in a proximal direction.

Adult↗
PubMedDate not supplied

Use of semiocclusive, transparent film dressings for surgical wound protection: experience in 3637 cases.

During an eight-year period, the author used a semiocclusive, transparent film surgical dressing as a protective cover for 3637 surgical incisions. The wet environment facilitated healing, and no patient exhibited any symptoms of wound infection. Compared with traditional methods, the semiocclusive dressing resulted in faster wound healing, decreased pain, and less scarring. It also permitted visual assessment of wound healing, as well as promoting patient mobility and hygiene.

Bandages↗
PubMed2004

A pilot study of the reaction forces at the heel during walking with the application of four different wound dressings.

A laboratory investigation was conducted to ascertain the shock-absorbing properties of four wound dressings applied to the heel area of a convenience sample of volunteers. Four subjects walked across a force plate. Data were recorded for each subject barefoot, and then while the subject had a wound care dressing stuck to the plantar aspect of their heel. Eight trials were undertaken in the five different conditions resulting in 40 trials per subject. The results suggest that one dressing, Allevyn (Smith and Nephew Healthcare Ltd, Hull, UK), when compared to other dressing materials, exhibits similar reaction forces to the normal barefoot walking data for all subjects. However, results from the anterior posterior force show no major differences across the dressings when compared to barefoot walking. Wound care dressings that have an inherent shock-attenuating property may be advantageous when dealing with areas of the foot that come under excessive force.

Biomechanical Phenomena↗
PubMed2006

Observational study of bone-anchored hearing aid infection rates using different post-operative dressings.

INTRODUCTION: Avoidance of infection at the implant site is a crucial element to the success of bone-anchored hearing aid (BAHA) implantation. However, little evidence exists to suggest the best post-operative wound dressing to use. MATERIAL AND METHODS: We report our experience with 160 consecutive BAHA patients, using four types of post-operative BAHA wound dressing (Tri-adcortyl, Mepitel, Allevyn, and Acticoat 7 with Allevyn). Patients were reviewed at week one and week two post-operatively. Infection was defined as a positive wound swab culture or evidence of cellulitis at the BAHA site. RESULTS: Post-operative BAHA infection rates were 16 per cent, 50 per cent, 10 per cent and 5 per cent, for each of the four dressings respectively, and the mean number of additional visits to wound care clinic were 1.5, 3.7, one and 0.4, respectively. DISCUSSION: Acticoat 7 with Allevyn produced the lowest infection rate and thus became the dressing of choice for our BAHA programme.

Adult↗
PubMed2005

Interface dressings influence the delivery of topical negative-pressure therapy.

BACKGROUND: Topical negative-pressure therapy is a widely used wound management system that generates a negative pressure at the wound surface through a foam pad, which aids in wound stimulation through mechanical forces on the wound bed. System guidelines state that the foam dressing should be placed in direct apposition with the wound surface; however, an interface dressing is often inserted at this point to promote comfort at dressing changes. METHODS: Topical negative-pressure dressings were applied to 40 healthy volunteers. Pressures at the skin surface under the dressing were recorded and compared with those measured by a topical negative-pressure machine using the Therapeutic Regulated Accurate Care pad system. These were repeated, inserting different types of interface dressings: petroleum jelly (Vaseline)-impregnated gauze, nonadherent silicone dressing, and mylar polyester film dressing. RESULTS: Pressures recorded at the skin interface with no interface dressing were close to those set on the topical negative-pressure machine (mean pressure change, -5.11 +/- 0.55 mmHg). Interposition of dressings at the skin/foam interface affected pressure transmission through the foam, and some caused significant decreases in pressures recorded at the skin surface (e.g., Vaseline-impregnated gauze: mean pressure change, -11.76 mmHg; maximum pressure change, -41 mmHg). CONCLUSION: The loss in negative pressure means that pressures designated by the machine cannot be relied on as a measure of wound pressure when certain dressings are used at the interface. This could be important in determining the outcome of some wounds under topical negative-pressure therapy treatment.

Bandages↗
PubMed2006

The use of gauze: will it ever change?

Although the benefits of healing in a moist environment have been published worldwide, the use of woven gauze as a wound contact material still prevails in many countries. This article traces the history of gauze and problems associated with usage against the introduction of one of the first modern materials, the hydrocolloid. Why this revolution in dressing material did not herald an immediate change of practice away from gauze is examined. Since the 1970s, the range, availability and sophistication of these and other moisture-retentive dressings have increased dramatically, and yet it seems that some practitioners remain unconvinced. The processes that underpin personal and organisational change that may contribute to this reluctance are also considered.

Bandages↗