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Case Study
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Cost effectiveness of a modified Dakins solution for wound management in the home care setting Trish Brooks, RN, MSN, ANP, CWOCN, Ronda Malmberg, RN Wounds being managed in the home care setting that are slow to heal or require frequent skilled nursing visits reduce profitability for home care agencies. Complicated treatment protocols that cannot be taught to home caregivers or require expensive dressings can also reduce cost effectiveness. Use of an inexpensive commercially prepared dilute form of Dakins solution in a simple wet to moist gauze dressing protocol applied by home caregivers and supervised by the home care nurse has resulted in effective, rapid healing of wounds with a minimal number of skilled nursing visits, often within one certification period Sodium hypochlorite diluted to a 0.0125% concentration—40 times more dilute than standard Dakins—functions as a broad spectrum antiseptic solution that reduces the bacterial bioburden within wounds, reduces inflammation and pain, and supports debridement. At this dilution, proliferative cells needed for wound healing remain viable. The home care givers are instructed by the skilled nurse in application of a wet to moist gauze dressing using the diluted sodium hypochlorite solution. Dressings are usually changed once a day because the amount of exudate decreases as the bioburden in the wound is decreased and disruption to the wound bed is minimized. Gauze that is allowed to dry to the wound bed can result in disruption of granulation tissue on removal. Therefore caregivers are taught to saturate gauze thoroughly with solution on application and moisten prior to removal minimizing trauma to the wound bed. The care givers usually do not find this protocol difficult or intimidating to learn. Skilled nursing visits may then be decreased to one to two times per week, further contributing to the cost effectiveness of this simple approach to wound management. Doughty D. A rational approach to the use of topical antispetics. JWOCN. 1994;21(6):224Ð231 Dow G, Browne A, Sibbald R. Infection in chronic wounds: controversies in diagnosis and treatment. Ostomy Wound Manage. 1999;45(8):23Ð40 Eaglestein W, Falanga V. Chronic wounds. Surg Clin North Am. 1997;77(3):689Ð699 Heggers J, Sazy J, Stenberg B, et al. Bactericidal and wound healing properties of sodium hypochlorite solutions: the 1991 Linberg award. J Burn Care Rehabil. 1991;12:420Ð424 Kozol R, Gilles C, Elgebaly S. Effects of sodium hypochlorite (Dakins solution) on cells of the wound module. Arch Surg. 1988;123:420Ð423 Lineweaver W, Howard R, Soucy D, et al. Topical antimicrobial toxicity. Arch Surg. 1985;120:267Ð270 McDonnell KJ, Sculco TP. Dakins solution revisited. Am J Orthop. 1997;July:471Ð474 McKenna P, Lehr G, Leist P,Welling R. Antipseptic effectiveness with fibroblast preservation. Ann Plast Surg. 1991;(27):265Ð268 Ovington L. Battling bacteria in wound care. Home Healthcare Nurs. 2001;19(10):623Ð630 Robson M. Wound infection: a failure of wound healing caused by an imbalance of bacteria. Surg Clin North Am. 1997;77(3):37Ð649 Rodeheaver G. Controversies in topical wound management. WOUNDS. 1989;1(1):19Ð27. |
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