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Pressure sore treatment: A case in point
Pressure Sore Treatment:
ACASE IN POINT is adhered an elastic mass composed (although not exogenously). of some combination of materials • They provide the ulcer with such as sodium carboxymethylcellu- thermal insulation. lose, elastomers, gelatin, and pee• They afford protection from sectin( I). Because oftheir makeup, they ondary infection. • They allow freedom from particpossess the properties desired in a wound dressing during the stages of ulate or toxic contaminants. MARY L. SHANNON • They allow removal without wound healing. BEVERLY M. MILLER • They remove excess exudate trauma(l). and toxic components. Impermeable dressings also seem In recent years, several studies have • They maintain high humidity at to alleviate pain originating in the stated that hydrocolloid dressings are the wound-dressing interface. wound. Turner hypothesizes that more effective in the treatment of • They allow gaseous exchange this finding is a result of two occurpressure sores than Op-Site, wet-todry gauze dressings, or air expoShea'sClassification of Pressure SoreStages sure(I-3). These dressings, containing hydrogels as well as elastomeric • Stage I: A moist superficial irregular ulceration limited to the epidermis and adhesive components, are usualexposing the underlying dermis and resembling an abrasion (the extreme of ly composed ofan outer semipermeShea's stage I classification) .. able polyurethane film layer to which • Stage 1/: The ulceration extends through the full thickness of the dermis to
This hydrocolloid dressing promoted rapid wound healing and time- and cost-efficiency.
Mar)' L. Shannon, RN, BSN, EdD, is a professor of'medical-surgical nursing at the University of Tennessee Collegeof Nursing, and Beverly M. Miller, RN, MSN, is a surgical clinical nurse specialist at the Memphis Veterans Administration Medical Center, Memphis, TN. The authors wish to acknowledge the financial support for laboratory and photographic services furnished by the spinal cord injury service.
154 Geriatric Nursing May/June 1988
the junction with the subcutaneous fat. • Stage 11/: Ulceration progresses into the subcutaneous fat where extensive and rapid undermining occurs . The deep fascia limits the depth of penetration of the ischemic necrotic process encouraging peripheral spread and undermining. • Stage IV: Ulcer penetrates the deep fascia causing extensive soft tissue spread with osteomylitis and septic, dislocated joints . Bone can be identified in the base of the ulceration. and there is profuse drainage and necrosis. SoufC8:Shea (4), " Shea's stage I classification was altered so that in the pilotstudy.
interrater reUabllity could be achieved
rences(l). First, the high humidity provided by the dressing protects the exposed neurons from drying and also produces pH changes. Second, the gels contained in the dressings immediately cool the wound surface and maintain the lower temperature for more than six hours. These dressings also have potential for adverse effects. All hydrogels should be avoided in cases where anaerobic infection is suspected and in deep fissure wounds or thirddegree burns prior to removal of necrotic tissue. Although there have been no reports of bacterial penetration when using gels, they can support the growth of microorganisms. Turner also raises another concern:
phis Veterans Administration Medical Center conducted a study on the effectiveness of the hydrocolloid dressing, DuoDERM, on pressure sores as compared with the usual hospital protocol. The pressure lesions were measured and staged using the Shea classification(4). The re-
ischial ulcer, both of stage II depth. Photographs of both lesions were taken for reference purposes for later comparison. Cultures, which were obtained prior to treatment and at weekly intervals, were negative throughout the study. Plan: The investigators decided to
Results showed that DuoDERM, the hydrocolloid dressing used, is easily applied, promotes rapid wound healing, and reduces the risk of infection.
The release of monomers by degradation cannot be ignored and their cellular interaction must be precisely determined. The inhibiting and potentiating response of various mono- and disaccharide compounds in tissue culture is known and the ability of such compounds to block antigen antibody reactions has been demonstrated(1).
suIts recounted in the following case treat the larger right ischial ulcer with study are representative of the pre- the hydrocolloid dressing using the liminary results obtained from 8 pa- procedure advised by the manufactients who were each followed for a turer. The smaller left ischial ulcer period of three months. This six- was treated with the spinal cord sermonth-long pilot study was designed vice protocol. to evaluate the effect of DuoDERM Treatment: Before applying the on the following: hydrocolloid dressing, the right is• The promotion of wound heal- chial ulcer was cleansed for one mining in patients with pressure sores ute using a 3% hydrogen peroxide soranging from stages I to III lution diluted to half-strength with Studies done at the University of • The costs ofmanaging stages I to normal saline. The surrounding skin Pittsburgh School of Medicine in III pressure sores as compared with was then carefully dried, and the hy1982 showed that reepithelialization the pressure sore protocol of the spi- drocolloid dressing was applied. The and collagen synthesis occurred nal cord service dressing must be of adequate size to more rapidly with wounds treated • The incidence of infection in extend at least 11/4 in beyond the ulcer with DuoDERM, a hydrocolloid stages I to III pressure sores as com- surface (in this case, a 4 X 4 em dressdressing, than they did in those pared with those treated by the spinal ing was used) . The edges of the hydrocolloid wounds treated by Op-Site, wet-to- cord service protocol dressing were windowed with l-in dry gauze dressings , or air expoCase Study hypoallergenic tape. It was found in sure(2). The wounds protected by the A 51-year-old white male C5 qua- the larger study that taping was not hydrocolloid dressing healed a full day ahead of the other groups. It was draplegic who was injured in 1974 always required, especially on the safound that the hydrocolloid dressing was admitted to the Memphis VA crum. However, the location of this accelerated healing by 39 percent Medical Center with stage II bilateral patient's ulcers and his activity level when compared with wet-to-dry ischial pressure lesions. The patient, made it necessary. Because spinal cord service protogauze and 19 percent when com- who was able to sit evenly in his wheelchair, met the study criteria in col varies with the depth, location, pared with Op-Site. McGowan studied 23 patients that he had a spinal cord injury, and degree of infection, each ulcer with an average age of72.7 years who could serve as his own control, did must be evaluated independently. had one to three ulcers which were not have a temperature above 100°F, To use the spinal cord service prototreated with DuoDERM(3). Of 18 or have purulent drainage exuding col in this instance, the ulcer first was patients completing the study, 91.7 - from the ulcer. cleansed with 10%Betadine solution Upon admission, he was exam- and then a normal saline rinse. This percent of the ulcers healed, even though the majority had not re- ined by a physician from the spinal was followed by the application of a sponded to prior treatments. In 61 cord service where it was determined dry "fanny wrap" dressing which percent, a decrease in pain and im- by x-ray that he had no protuberant consisted in this case ofone unfilled 4 provement in patient comfort was ischial tuberosities. However, the pa- X 4 em gauze dressing, 2 combinatient was found to have a 3 X 3 em tion pads, and a Kerlix wrap covered also observed. Based on these findings, the Mcrn- right ischial ulcer and a 2 X 2 em left by a stockinette.
Geriatric Nursing May/June 1988 155
COMPARI SON OF ISCHIAL ULeER S
LEFT
RIGHT
. .'
c-=:=:::::=====~=====::::::==== Photogr aphs o f the left is chial ulcer t re ated with th e sp inal cord se rvice proto col a nd the ri ght isc hial ulcer tr eated w ith DuoD ERM . (A) The u lcers a t th e beg inning o f the s tudy ; (B) at one we ek : a nd (e ) at the t ime o f discharg e .
156 Ge riatric Nursing May/June 1988
The hydrocolloid dressing was inspected daily by one ofthe investigators for adherence, appearance, and drainage. The patient was also examined for any clinical signs of infection: fever, cellulitis around wound, atypical odor, or color ofwound exudate. Because no such signs were found during the course of the patient's treatment, the hydrocolloid dressing was changed at weekly intervals as planned at which time it was photographed and cultured. The left ischial ulcer treated with the spinal cord service protocol was, as planned, changed and inspected daily by specially trained nursing personnel in a designated wounddressing area. These personnel are assigned full time to a treatment area where patients with spinal cord injuries receive baths, bladder and bowel training, and dressing changes. Every week at the scheduled dressing-change time, photographs and cultures of the wound were made. These were taken at the same weekly intervals as that of the hydrocolloidtreated wounds. The literature accompanying the hydrocolloid dressing package states that liquefied material will usually be found under the dressing. This is because this type of dressing is impermeable and prevents the escape of both dra inage and odor as long it remains adherent. When the dressing is removed, the drainage will have the appearance of pus. In the absence of other clinical signs of infection, this drainage is normal. The odor that escapes when the hydrocolloid dressing is removed is characteristic and pronounced. It is a normal finding . As might be expected, these occurrences make personnel who are not familiar with the dressing likely to treat the wound as infected. In addition, they are not aware that using occlusive dressings in the presence of necrotic material (especially in stage III lesions) cause wounds to increase in size and depth during the initial phase ofmanagement as necrotic debris is cleaned away. However, this apparent deterioration is normally accompanied by a gradual improvement in wound appearance.
For this reason all medical and nursing personnel on the spinal cord service received a brief in-service presentation about the expected drainage. They were instructed not to remove the hydrocolloid dressing for any reason, but to call one of the investigators if they felt that the dressing needed to be removed. This never occurred. The patient was hospitalized for 17 days. During this time the hydrocolloid-treated ulcer was cultured, cleaned, photographed, and dressed a total ofthree times at weekly intervals. The spinal cord service protocol was performed daily. Both methods achieved excellent results as can be seen from the accompanying series of photographs. While not completely healed at discharge, the open area ofthe left ischial ulcer was less than 0.5 em in diameter and the open area ofthe right ischial ulcer was less than 1 em in diameter. Because the right ulcer was still open to some extent, the patient was instructed to leave the last hydrocolloid dressing in place for one week postdischarge, which he did . At that time, the right ischial ulcer was completely healed and remained healed after the patient was discharged. The results obtained with the hydrocolloid dressing in this study were excellent. Because the left ulcer treated with the spinal cord service protocol was untreated postdischarge, it worsened at home, resulting in the patient's readmission to the hospital 38 days later with a stage IV left ischial ulcer. At that time, the physician at the spinal cord service stated that the lesion was 1em in depth to outward appearance. However, the ulcer was in fact undermined to a depth of4 em. Bone was exposed, and the sinus tract went down the lateral side of the ischial tuberosity. The lesion was treated by surgical revision, with a myocutaneous flap to cover the defect. The suture line was cleaned with normal saline daily, followed by the application of PBN ointment and a dry dressing. Three weeks later, the sutures were removed from the 9.5-cm incision site. There was a small amount ofcrusting noted, as well as a 0.5-cm hole with
Cost Comparis on of DuoDERM with Sp inal Co rd Se rvice Pro tocol
,
DuoDERM Supplies
Sp inal Cord Servic e Proto cot« Supplies
Cost(S)
DuoDERM 4x4 wa fer Hyd rogen perox ide No rmal sa line Glove s Irrigation set Waterproo f pad 4x4 dress ing
2.35 .25 .81 .04 '. 74 .17 .165
Pe r week per dress ing 10 m in of staff nurse 's .time p er day
4.525
.
..
1.94
. Total pe r week
:..'
.
6. ~65
4x4 dress ing .165 Ke rlix (2) 2.16 Comb ination pa ds (4) .60 Betad ine so lution .90 '.81 . Norm a l sa line Wat erproo f pad .17 ' Gloves .04 , .74 Irrigat ion se t . Stock inette .285 Pe r da y p er dres sing 5.87 10 min o f sta ff nur se 's time 1.94 '. p er da y 10 min o f nur sing ass istan t's time c pe r da y p e r dre ssing c tian ge ~ . Total pe r da y 8 .94 , Tota l per wee k -, 62 .58 "
~
"
no depth located just above the suture line. The patient's remaining hospital stay was uneventful. Nursing Implications The hydrocolloid dressing used in this instance proved to have several valuable properties: • It was a rapidly applied, selfadherent dressing, which did not cause a skin reaction. • It was impermeable: it kept the wound moist and accelerated healing and prevented infection. • It eliminated the need for significant amounts of other supplies usually required in sterile dressing changes. • It was effective for a type of patient who is usually resistant to healing and the maintenance ofthat healing, for example, a patient who has spinal cord injuries. • It was extremely cost effective. The cost ofhydrocolloid dressings is often cited as a major consideration when determining whether to use it. The data collected in this study shows that it is extremely cost effective for the hospital when correlated with the cost of time and supplies needed for the spinal cord service protocol. A comparison ofboth treatments shows that it cost $2.475 more for each spinal cord service dressing change, which results in a cost of
.. Cos/ (S)
.'~
'"
$56.12 more for weekly care. The investigators believe that DuoDERM and similar hydrocolloid-type dressings have significant potential for use by nursing personnel. These products promote more rapid wound healing in animal studies and in the clinical studies that have been done to date. The dressings are easily applied and do not have to be reapplied as frequently as the usual gauze-type dressings. In fact, the manufacturer states they may be left in place up to 7 days if there is no leakage. They save considerable nursing time and , because they usually require fewer dressing changes, reduce the likelihood of infection in the wound. It was also observed that patients who were treated with this product had a reduced incidence of pain. References I. Turner, T . D. Serniocclusive and occlus ive dress ings. IN An Environmentfor Healing: The Role of Occlusion. ed . by T. J. Ryan . (Inte rna tional Congress and Symposium Serie s: No. 88) London, Royal Society of Medicine, 1985, pp. 6-14. 2. Alvarez, O. M.• and others. The effectofocclus ive dr essings on collagen synth esis and re-epith elializat ion in superficial wounds , J'surg.Res. 35:142148, Aug. 1983. 3. McGow an , C. A. Managem ent of pre ssure ulcers using DuoDERM hydroactive dressing. Nursing Research Symposium Proceedings. 1982, pp. 212218. 4. Shea, J. D. Pressure sore s: classificat ion and management. Clin.Orthop. 112:89-100, Oct . 1975.
ACASE IN POINT is adhered an elastic mass composed (although not exogenously). of some combination of materials • They provide the ulcer with such as sodium carboxymethylcellu- thermal insulation. lose, elastomers, gelatin, and pee• They afford protection from sectin( I). Because oftheir makeup, they ondary infection. • They allow freedom from particpossess the properties desired in a wound dressing during the stages of ulate or toxic contaminants. MARY L. SHANNON • They allow removal without wound healing. BEVERLY M. MILLER • They remove excess exudate trauma(l). and toxic components. Impermeable dressings also seem In recent years, several studies have • They maintain high humidity at to alleviate pain originating in the stated that hydrocolloid dressings are the wound-dressing interface. wound. Turner hypothesizes that more effective in the treatment of • They allow gaseous exchange this finding is a result of two occurpressure sores than Op-Site, wet-todry gauze dressings, or air expoShea'sClassification of Pressure SoreStages sure(I-3). These dressings, containing hydrogels as well as elastomeric • Stage I: A moist superficial irregular ulceration limited to the epidermis and adhesive components, are usualexposing the underlying dermis and resembling an abrasion (the extreme of ly composed ofan outer semipermeShea's stage I classification) .. able polyurethane film layer to which • Stage 1/: The ulceration extends through the full thickness of the dermis to
This hydrocolloid dressing promoted rapid wound healing and time- and cost-efficiency.
Mar)' L. Shannon, RN, BSN, EdD, is a professor of'medical-surgical nursing at the University of Tennessee Collegeof Nursing, and Beverly M. Miller, RN, MSN, is a surgical clinical nurse specialist at the Memphis Veterans Administration Medical Center, Memphis, TN. The authors wish to acknowledge the financial support for laboratory and photographic services furnished by the spinal cord injury service.
154 Geriatric Nursing May/June 1988
the junction with the subcutaneous fat. • Stage 11/: Ulceration progresses into the subcutaneous fat where extensive and rapid undermining occurs . The deep fascia limits the depth of penetration of the ischemic necrotic process encouraging peripheral spread and undermining. • Stage IV: Ulcer penetrates the deep fascia causing extensive soft tissue spread with osteomylitis and septic, dislocated joints . Bone can be identified in the base of the ulceration. and there is profuse drainage and necrosis. SoufC8:Shea (4), " Shea's stage I classification was altered so that in the pilotstudy.
interrater reUabllity could be achieved
rences(l). First, the high humidity provided by the dressing protects the exposed neurons from drying and also produces pH changes. Second, the gels contained in the dressings immediately cool the wound surface and maintain the lower temperature for more than six hours. These dressings also have potential for adverse effects. All hydrogels should be avoided in cases where anaerobic infection is suspected and in deep fissure wounds or thirddegree burns prior to removal of necrotic tissue. Although there have been no reports of bacterial penetration when using gels, they can support the growth of microorganisms. Turner also raises another concern:
phis Veterans Administration Medical Center conducted a study on the effectiveness of the hydrocolloid dressing, DuoDERM, on pressure sores as compared with the usual hospital protocol. The pressure lesions were measured and staged using the Shea classification(4). The re-
ischial ulcer, both of stage II depth. Photographs of both lesions were taken for reference purposes for later comparison. Cultures, which were obtained prior to treatment and at weekly intervals, were negative throughout the study. Plan: The investigators decided to
Results showed that DuoDERM, the hydrocolloid dressing used, is easily applied, promotes rapid wound healing, and reduces the risk of infection.
The release of monomers by degradation cannot be ignored and their cellular interaction must be precisely determined. The inhibiting and potentiating response of various mono- and disaccharide compounds in tissue culture is known and the ability of such compounds to block antigen antibody reactions has been demonstrated(1).
suIts recounted in the following case treat the larger right ischial ulcer with study are representative of the pre- the hydrocolloid dressing using the liminary results obtained from 8 pa- procedure advised by the manufactients who were each followed for a turer. The smaller left ischial ulcer period of three months. This six- was treated with the spinal cord sermonth-long pilot study was designed vice protocol. to evaluate the effect of DuoDERM Treatment: Before applying the on the following: hydrocolloid dressing, the right is• The promotion of wound heal- chial ulcer was cleansed for one mining in patients with pressure sores ute using a 3% hydrogen peroxide soranging from stages I to III lution diluted to half-strength with Studies done at the University of • The costs ofmanaging stages I to normal saline. The surrounding skin Pittsburgh School of Medicine in III pressure sores as compared with was then carefully dried, and the hy1982 showed that reepithelialization the pressure sore protocol of the spi- drocolloid dressing was applied. The and collagen synthesis occurred nal cord service dressing must be of adequate size to more rapidly with wounds treated • The incidence of infection in extend at least 11/4 in beyond the ulcer with DuoDERM, a hydrocolloid stages I to III pressure sores as com- surface (in this case, a 4 X 4 em dressdressing, than they did in those pared with those treated by the spinal ing was used) . The edges of the hydrocolloid wounds treated by Op-Site, wet-to- cord service protocol dressing were windowed with l-in dry gauze dressings , or air expoCase Study hypoallergenic tape. It was found in sure(2). The wounds protected by the A 51-year-old white male C5 qua- the larger study that taping was not hydrocolloid dressing healed a full day ahead of the other groups. It was draplegic who was injured in 1974 always required, especially on the safound that the hydrocolloid dressing was admitted to the Memphis VA crum. However, the location of this accelerated healing by 39 percent Medical Center with stage II bilateral patient's ulcers and his activity level when compared with wet-to-dry ischial pressure lesions. The patient, made it necessary. Because spinal cord service protogauze and 19 percent when com- who was able to sit evenly in his wheelchair, met the study criteria in col varies with the depth, location, pared with Op-Site. McGowan studied 23 patients that he had a spinal cord injury, and degree of infection, each ulcer with an average age of72.7 years who could serve as his own control, did must be evaluated independently. had one to three ulcers which were not have a temperature above 100°F, To use the spinal cord service prototreated with DuoDERM(3). Of 18 or have purulent drainage exuding col in this instance, the ulcer first was patients completing the study, 91.7 - from the ulcer. cleansed with 10%Betadine solution Upon admission, he was exam- and then a normal saline rinse. This percent of the ulcers healed, even though the majority had not re- ined by a physician from the spinal was followed by the application of a sponded to prior treatments. In 61 cord service where it was determined dry "fanny wrap" dressing which percent, a decrease in pain and im- by x-ray that he had no protuberant consisted in this case ofone unfilled 4 provement in patient comfort was ischial tuberosities. However, the pa- X 4 em gauze dressing, 2 combinatient was found to have a 3 X 3 em tion pads, and a Kerlix wrap covered also observed. Based on these findings, the Mcrn- right ischial ulcer and a 2 X 2 em left by a stockinette.
Geriatric Nursing May/June 1988 155
COMPARI SON OF ISCHIAL ULeER S
LEFT
RIGHT
. .'
c-=:=:::::=====~=====::::::==== Photogr aphs o f the left is chial ulcer t re ated with th e sp inal cord se rvice proto col a nd the ri ght isc hial ulcer tr eated w ith DuoD ERM . (A) The u lcers a t th e beg inning o f the s tudy ; (B) at one we ek : a nd (e ) at the t ime o f discharg e .
156 Ge riatric Nursing May/June 1988
The hydrocolloid dressing was inspected daily by one ofthe investigators for adherence, appearance, and drainage. The patient was also examined for any clinical signs of infection: fever, cellulitis around wound, atypical odor, or color ofwound exudate. Because no such signs were found during the course of the patient's treatment, the hydrocolloid dressing was changed at weekly intervals as planned at which time it was photographed and cultured. The left ischial ulcer treated with the spinal cord service protocol was, as planned, changed and inspected daily by specially trained nursing personnel in a designated wounddressing area. These personnel are assigned full time to a treatment area where patients with spinal cord injuries receive baths, bladder and bowel training, and dressing changes. Every week at the scheduled dressing-change time, photographs and cultures of the wound were made. These were taken at the same weekly intervals as that of the hydrocolloidtreated wounds. The literature accompanying the hydrocolloid dressing package states that liquefied material will usually be found under the dressing. This is because this type of dressing is impermeable and prevents the escape of both dra inage and odor as long it remains adherent. When the dressing is removed, the drainage will have the appearance of pus. In the absence of other clinical signs of infection, this drainage is normal. The odor that escapes when the hydrocolloid dressing is removed is characteristic and pronounced. It is a normal finding . As might be expected, these occurrences make personnel who are not familiar with the dressing likely to treat the wound as infected. In addition, they are not aware that using occlusive dressings in the presence of necrotic material (especially in stage III lesions) cause wounds to increase in size and depth during the initial phase ofmanagement as necrotic debris is cleaned away. However, this apparent deterioration is normally accompanied by a gradual improvement in wound appearance.
For this reason all medical and nursing personnel on the spinal cord service received a brief in-service presentation about the expected drainage. They were instructed not to remove the hydrocolloid dressing for any reason, but to call one of the investigators if they felt that the dressing needed to be removed. This never occurred. The patient was hospitalized for 17 days. During this time the hydrocolloid-treated ulcer was cultured, cleaned, photographed, and dressed a total ofthree times at weekly intervals. The spinal cord service protocol was performed daily. Both methods achieved excellent results as can be seen from the accompanying series of photographs. While not completely healed at discharge, the open area ofthe left ischial ulcer was less than 0.5 em in diameter and the open area ofthe right ischial ulcer was less than 1 em in diameter. Because the right ulcer was still open to some extent, the patient was instructed to leave the last hydrocolloid dressing in place for one week postdischarge, which he did . At that time, the right ischial ulcer was completely healed and remained healed after the patient was discharged. The results obtained with the hydrocolloid dressing in this study were excellent. Because the left ulcer treated with the spinal cord service protocol was untreated postdischarge, it worsened at home, resulting in the patient's readmission to the hospital 38 days later with a stage IV left ischial ulcer. At that time, the physician at the spinal cord service stated that the lesion was 1em in depth to outward appearance. However, the ulcer was in fact undermined to a depth of4 em. Bone was exposed, and the sinus tract went down the lateral side of the ischial tuberosity. The lesion was treated by surgical revision, with a myocutaneous flap to cover the defect. The suture line was cleaned with normal saline daily, followed by the application of PBN ointment and a dry dressing. Three weeks later, the sutures were removed from the 9.5-cm incision site. There was a small amount ofcrusting noted, as well as a 0.5-cm hole with
Cost Comparis on of DuoDERM with Sp inal Co rd Se rvice Pro tocol
,
DuoDERM Supplies
Sp inal Cord Servic e Proto cot« Supplies
Cost(S)
DuoDERM 4x4 wa fer Hyd rogen perox ide No rmal sa line Glove s Irrigation set Waterproo f pad 4x4 dress ing
2.35 .25 .81 .04 '. 74 .17 .165
Pe r week per dress ing 10 m in of staff nurse 's .time p er day
4.525
.
..
1.94
. Total pe r week
:..'
.
6. ~65
4x4 dress ing .165 Ke rlix (2) 2.16 Comb ination pa ds (4) .60 Betad ine so lution .90 '.81 . Norm a l sa line Wat erproo f pad .17 ' Gloves .04 , .74 Irrigat ion se t . Stock inette .285 Pe r da y p er dres sing 5.87 10 min o f sta ff nur se 's time 1.94 '. p er da y 10 min o f nur sing ass istan t's time c pe r da y p e r dre ssing c tian ge ~ . Total pe r da y 8 .94 , Tota l per wee k -, 62 .58 "
~
"
no depth located just above the suture line. The patient's remaining hospital stay was uneventful. Nursing Implications The hydrocolloid dressing used in this instance proved to have several valuable properties: • It was a rapidly applied, selfadherent dressing, which did not cause a skin reaction. • It was impermeable: it kept the wound moist and accelerated healing and prevented infection. • It eliminated the need for significant amounts of other supplies usually required in sterile dressing changes. • It was effective for a type of patient who is usually resistant to healing and the maintenance ofthat healing, for example, a patient who has spinal cord injuries. • It was extremely cost effective. The cost ofhydrocolloid dressings is often cited as a major consideration when determining whether to use it. The data collected in this study shows that it is extremely cost effective for the hospital when correlated with the cost of time and supplies needed for the spinal cord service protocol. A comparison ofboth treatments shows that it cost $2.475 more for each spinal cord service dressing change, which results in a cost of
.. Cos/ (S)
.'~
'"
$56.12 more for weekly care. The investigators believe that DuoDERM and similar hydrocolloid-type dressings have significant potential for use by nursing personnel. These products promote more rapid wound healing in animal studies and in the clinical studies that have been done to date. The dressings are easily applied and do not have to be reapplied as frequently as the usual gauze-type dressings. In fact, the manufacturer states they may be left in place up to 7 days if there is no leakage. They save considerable nursing time and , because they usually require fewer dressing changes, reduce the likelihood of infection in the wound. It was also observed that patients who were treated with this product had a reduced incidence of pain. References I. Turner, T . D. Serniocclusive and occlus ive dress ings. IN An Environmentfor Healing: The Role of Occlusion. ed . by T. J. Ryan . (Inte rna tional Congress and Symposium Serie s: No. 88) London, Royal Society of Medicine, 1985, pp. 6-14. 2. Alvarez, O. M.• and others. The effectofocclus ive dr essings on collagen synth esis and re-epith elializat ion in superficial wounds , J'surg.Res. 35:142148, Aug. 1983. 3. McGow an , C. A. Managem ent of pre ssure ulcers using DuoDERM hydroactive dressing. Nursing Research Symposium Proceedings. 1982, pp. 212218. 4. Shea, J. D. Pressure sore s: classificat ion and management. Clin.Orthop. 112:89-100, Oct . 1975.