Phage therapy for diabetic foot infection

      The treatment of diabetic foot infections (DFIs) represents a costly and growing challenge to the NHS. DFIs can be difficult to treat for a variety of reasons, including late presentation of advanced infection, and antibiotic tolerance or resistance. Bacteriophage (phage) are ubiquitous viruses that infect and kill bacteria in a species-, sometimes even strain-, specific manner. Phages have been used to treat bacterial infection since 1919, but their use in the geopolitical West ceased in the 1930s due to a variety of factors, including the mass production of antibiotics. The modern antibiotic resistance crisis has driven renewed interest in phage therapy and 2,241 patients with mostly with antibiotic refractory infections have been treated since 2000, 79% of whom improved. This includes at least 310 patients with chronic wound infections, among whom 86.1% achieved clinical resolution or improvement of infection. Reassuringly, the available evidence suggests that phage therapy is safe and without notable side effects. Some phages also possess enzymes capable of degrading the biofilms that afford antibiotic tolerance to bacteria and underpin many chronic infections. Phages also act independent of antibiotic resistance, allowing the treatment of even pan-resistant bacteria, and topical or local application to DFIs means antimicrobial activity is independent of a patient’s peripheral perfusion. Presently only an option when antibiotics are not meeting a patient’s clinical needs, future integration of phage therapy at all levels of DFI care will radically transform the outlook for DFIs in the UK. Reducing the number of serious infections and amputations will not only benefit patients but will deliver vast savings to the NHS and reduce the amount of antibiotics used, making phage therapy a tangible response to the antibiotic resistance crisis.

Authors:

Matthew J Young, Lesley ML Hall and Joshua D Jones

This article first appeared in our sister publication, The Diabetic Foot Journal, in the November 2022 issue. Citation: Young MJ, Hall LML, Jones JD (2022) Phage therapy for diabetic foot infection 25(4): 30–7

Matthew J. Young is Consultant Physician, Royal Infirmary of Edinburgh, Edinburgh, UK;

Lesley ML Hall is Consultant Physician, Diabetes and Endocrinology, Queen Elizabeth University Hospital, Glasgow, UK;

Joshua D Jones is Consultant Physician, Infection Medicine, Edinburgh Medical School: Biomedical Sciences, University of Edinburgh, UK; Clinical Microbiology, Ninewells Hospital, NHS Tayside, Dundee, UK

Meeting patients’ needs and healing wounds sooner: Using NICE guidance to deliver gold standard care

ABSTRACT: One of the most common questions asked to specialist healthcare professionals and educators in wound management is how to choose a suitable dressing. The importance of holistic assessment and diagnosis to accurately identify wound aetiology, the effect of comorbidities and associated risks for non-healing is paramount. This initial holistic assessment should be the starting point and given continued consideration throughout the wound healing process. In practical terms it is also acknowledged that there is a basic need for an appropriate wound dressing that will promote a moist wound healing environment, prepare the wound bed and prevent infection, all factors known to be important for progression of the wound healing process (Dowsett and Hall, 2019). It is therefore important that healthcare professionals delivering wound care are confident in the wound assessment process and in choosing a dressing that is going to promote wound healing and minimise the risk of wound complications.

KEY WORDS

NICE guidance

Nano-Oligosaccharide Factor (NOSF)

Wound care

UrgoStart Plus Treatment Range

JOY TICKLE

sTissue Viability Nurse Consultant Isle of Wight NHS Trust.

Management of wounds in Indian patients with poly-absorbent fibres impregnated with a silver lipidocolloid matrix dressing — a case series

Wound infections and biofilms play a significant role in delaying wound healing and present a challenge in chronic wound management. The presence of sloughy tissue is a prominent feature in these wounds and is considered a barrier against successful wound healing. Effective wound care integrates evidence-based dressings that provides continuous cleaning, antimicrobial activity and thus, is also effective against biofilms. Poly-absorbent fibres impregnated with a silver lipido-colloid matrix dressing has shown good outcomes, both in vitro and in vivo, in the management of slough and biofilm in wounds. The evidence originates from Europe and the authors of this case series attempted to assess the dressing in wounds from different regions of India to evaluate if positive results would be obtained.

Authors:

Anoop Vasudevan Pillai, Riju R Menon, KVNN Santosh Murthy, Divya Prakash, Sangeetha Kalabhairav, Anshumali Misra and Bhavin Ram

Anoop Vasudevan Pillai is Assistant Professor, Department of General Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India;

Riju R Menon is Professor Department of General Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India;

KVNN Santosh Murthy is Consultant General, Podiatric & Burns Surgeon, Advanced Wound Healing Clinics, Nalgonda, Telangana state, India; Founder of Advanced Wound Healing Clinics, Nalgonda, Telangana State, India;

Divya Prakash is Consultant Plastic Surgeon, Kauvery Hospital, Trichy, India;

Sangeetha Kalabhairav is Diabetic Foot, Nail Surgeon and Podiatrist; Sushrutha Multi-speciality Hospital, Vidyanagar, Hubli, India;

Anshumali Misra is Senior Consultant Plastic Microvascular and Cosmetic Surgery Max Hospital, New Delhi, India;

Bhavin Ram is Consultant Vascular and Endovascular Surgeon, Yashoda Hospitals, Secunderabad, Hyderabad, India

Development of aids for sharp debridement training in wound care

      The European Wound Management Association (EWMA) 2020 Level Seven curriculum recommends the provision of training on sharp debridement, primarily targeting specialist practitioners in wound care. Given the current lack of regulation for wound specialists in the UK, the quality and fidelity of training play a crucial role in health professionals' confidence when performing sharp debridement. Consequently, it is vital that training aids and methods accurately represent the realities of this procedure. Existing literature outlines training approaches using animal tissue or grapefruit models for sharp debridement. The University of Salford has developed a new simulation aid to teach tissue viability students about sharp debridement. This article details the development process and the creation of this innovative training aid designed to support sharp debridement education. The proposed simulation aid enables accurate representation of various wound tissue types requiring debridement in clinical settings, while eliminating the production of organic waste and the need for animal products, which may be objectionable to some learners.

KEY WORDS：Necrosis Sharp debridement Simulation Slough Wound

MATTHEW WYNN Lecturer in Adult Nursing, University of Salford

Correspondence: Room 3.42 Mary Seacole Building, University of Salford, Salford

 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。 DANIELLE MAYO Clinical skills technician, University of Salford

Active treatment of non-healing wounds in the community: Identifying people at risk of non-healing wounds

      Non-healing wounds are common, have a negative impact on patients, increase workload for clinicians and are a source of rising costs for the NHS. Early identification of people who are at risk of non-healing is important to ensure best practice interventions including the use of active treatments. This article will discuss best practice recommendations from the new Wounds UK Best Practice Statement (BPS; Wounds UK, 2022) with a focus on patient assessment and identification of risk factors for non-healing wounds, as well as examples of early intervention with active treatments to improve patient outcomes.

KEY WORDS

Best Practice Statement Non-healing wounds Patient assessment Risk factors

DR CAROLINE DOWSETT Clinical Nurse Specialist Tissue Viability, East London NHS Foundation Trust and Independent Nurse Consultant Wound Care.

This article and the best practice statement were sponsored by Smith+Nephew. The views presented in this document are the work of the author and do not necessarily reflect the views of Smith+Nephew.

Best Practice Statement SSI Surveillance: Promoting a seamless patient journey from surgery to community

EXPERT WORKING GROUP:

■ Jacqui Fletcher, Independent Nurse Consultant and Clinical Editor of Wounds UK

■ Melissa Rochon, Trust Lead for SSI Surveillance, Research and Innovation, Directorate of Infection, Guy’s and St Thomas’ NHS Foundation Trust

■ Joshua Totty, Clinical Lecturer in Plastic Surgery, University of Hull

■ Jennie Wilson, Professor of Healthcare Epidemiology, College of Nursing, Midwifery and Healthcare, University of West London

■ Lucy Woodhouse, Clinical Lower Limb Tissue Viability Lead, Wye Valley NHS Trust

■ Kylie Sandy-Hodgetts, Associate Professor, Centre for Molecular Medicine & Innovative Therapeutics; Director, Skin Integrity Institute, Murdoch University; Adjunct Senior Research Fellow, School of Biomedical Sciences, University of Western Australia

REVIEWERS:

■ Mel Burden, Consultant Nurse & Joint Director, Infection Prevention and Control, Tissue Viability, Royal Devon and Exeter Hospital

■ Lisa Butcher, Lead Nurse for Infection Prevention & Control, Oxford University Hospitals NHS Foundation Trust; President of Infection Prevention Society

■ Lilian Chiwera, Independent Surgical Site Infection Surveillance & Prevention Consultant, IPC/SSI Prevention Matron, Sherwood Forest NHS Trust

■ Rhidian Morgan-Jones, Consultant Revision Knee Surgeon, Schoen Clinic, London

■ Judith Tanner, Professor of Adult Nursing, Faculty of Medicine & Health Sciences, University of Nottingham

BEST PRACTICE STATEMENT: SSI SURVEILLANCE: PROMOTING A SEAMLESS PATIENT JOURNEY FROM SURGERY TO COMMUNITY

PUBLISHED BY:

Wounds International A division of Omniamed, 108 Cannon Street, London EC4N 6EU, UK

Tel: +44 (0)20 3735 8244

Web: www.woundsinternational.com

© Wounds International, 2023

This document has been developed by Wounds International and is supported by an unrestricted educational grant from Essity.

This publication was coordinated by Wounds International with the Expert Working Group. The views presented in this document are the work of the authors and do not necessarily reflect the views of Essity.

Suggested citation:

Wounds International (2023) SSI Surveillance: Promoting a seamless patient journey from surgery to community. Wounds International, London

Available to download from: www.woundsinternational.com