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Case Study
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The use of antimicrobial gauze in a home care setting: a cost effective, proactive wound management plan Regina Sargent, RN, CWS, Patricia Mudrow, RN, Judy Mele, RN, Joan Sons, RN Wound care in home health settings can be expensive and time-consuming. Comorbidities and variable home environments can lad to challenges associated with wound healing and infection prevention. Current knowledge of wound bed preparation indicates a strong competition between proliferating cells and bacteria. "The goals of wound bed preparation include removing necrotic or fibrinous tissue, reducing the total number of senescent or abnormal cells, decreasing exudate, decreasing bacterial load, and increasing granulation tissue" (Falanga). Managing bacteria in the wound bed can have a significant impact on healing times, cost of treatment and patient safety Infected wounds are estimated to cost $15,646 (AJN) and have major economic and social implications that include: delayed healing, hospitalization and potentially death. In an effort to minimize cost, improve outcomes and simplify treatment regimen for patients and caregivers, the Wound Care Team trialed antimicrobial dressings impregnated with polyhexamethylene biguanide (PHMB) and amorphous hydrogel in place of costly silver products, negative pressure wound therapy, and prescription silver sulfadiazine on a variety of patients. In chronic wounds the Wound Care Team chose to take a proactive approach approach by utilizing the PHMB-impregnated dressings initially prior to instituting the use of enzymatic debriding ointments, collagens, or growth factors. The nursing team chose a wide variety of wound types for the trial. Those represented here include surgical incisions and pressure ulcers. Wounds showed significant signs of increased granulation tissue and epithelialization, decrease in wound size and decrease in slough. In addition some patients relayed an improvement in pain symptoms to the clinicians. Based on these patient outcomes and the ease of use, the home care agency was able to decrease nursing visits. Significant savings were realized due to a lower acquisition cost for the dressing The proactive selection of antimicrobial dressings helped to achieve the goal of the trial. All wounds showed significant overall improvement. No wound infections were noted during the trial. Ease of use was confirmed by patients and caregivers. Cost containment was achieved. Patient comfort was an unexpected benefit of utilizing the PHMB-impregnated dressing. Falanga V. Classifications for wound bed preparation and stimulation of chronic wounds. Wound Repair Regen. 2000;8:347Ð52 Stone, Larson. A systematic audit of economic evidence linking the nosocomial infections and infection control interventions. 1990Ð2000: AJN 2000 Wound Ostomy and Continence Nurses Society. Guideline for Management of Wounds in Patients with Lower Extremity Venous Disease. Glenview, IL: 2005.. |
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