Complicated Skin and Skin Structure Infections

MDNG Hospital Medicine, December 2010, Volume 4, Issue 6

//The Educated PatientPreventing Infection

Although infections occur most frequently in hospitals and other health care settings, healthy people can get infections even when they are not in the hospital, according to this site from the Massachusetts Department of Public Health, which outlines the steps patients can take to help prevent the spread of infections before and after surgery. The tips provided in the fact sheets remind patients to wash hands regularly, care properly for cuts and wounds, get all vaccines, use prescription drugs responsibly, stay home when sick, and practice good hygiene at the gym and with exercise equipment. In the hospital setting, patients are urged to wash their hands and make sure all health care professionals and visitors to do the same, and given tips on how to protect their skin and properly use catheters.

Take Care of Your Feet for a Lifetime

This resource from the National Diabetes Education Program—a partnership of the National Institutes of Health and the CDC—is designed to help patients who have diabetes or are at risk for the disease avoid serious problems by taking better care of their feet. Visitors can learn which patients have to be extra vigilant about foot care and why blood glucose control is important, and obtain several tips, such as checking feet and washing them every day, trimming toenails each week, wearing socks and shoes at all times, protecting feet from hot and cold temperatures, and keeping blood flowing to the feet.

//Medical WebsitesPractice Guidelines for the Diagnosis and Management of Skin and Soft-Tissue Infections

“Clinical assessment of the severity of infection is crucial, and several classification schemes and algorithms have been proposed to guide the clinician,” according to the Infectious Diseases Society of America, which aims to simply the diagnosis and management of skin and soft-tissue infections by providing one solid set of recommendations for clinicians. Published in Clinical Infectious Diseases in 2005, the guidelines cover several classes of infections, including: impetigo, erysipelas, and cellulitis, necrotizing infections, infections following animal or human bites, infections associated with animal contact, surgical site infections, and infections in the immunocompromised host.

Prevent Surgical Site Infections

As part of its 5 Million Lives Campaign, an initiative launched in 2006 to protect patients from incidents of medical harm, the Institute for Healthcare Improvement provides this listing of resources to help prevent surgical site infections (SSIs). Providers can download a how-to-guide for implementing changes within an organization; access recommendations for preventing SSIs in a pediatric setting; view the Campaign Mentor Hospital Registry, a listing of organizations that provide support, clinical expertise, and tips for hospitals seeking help with implementation efforts; and download a number of tools, including tips for safer surgery, frequently asked questions about SSIs, an SSI checklist, fact sheets for patients and families, and the CDC’s Hand Hygiene Training Module.

//Online CMENon-Pharmacologic Prevention of Surgical Wound InfectionCredits: 0.50

Fee: None

Expires: June 22, 2011

Multimedia: None

In this article, Daniel I. Sessler, MD, reviews the incidence and pathophysiology of surgical wound infections, and discusses strategies for preventing these infections, which “are generally detected five to nine days after surgery and are usually attributed, even by surgeons, to poor surgical technique or failure to maintain sterility.” Sessler also explains the host defense mechanisms that prevent most contamination from developing into clinical infections, and when host defense is most important.

//eAbstractsHospitalizations with healthcare-associated complicated skin and skin structure infections: Impact of inappropriate empiric therapy on outcomesJournal: Journal of Hospital Medicine (September 2010)

Authors: Zilberberg M, Shorr A, Micek S, et al.

Purpose: To investigate the association of inappropriate empiric therapy with outcomes in patients with health care-associated complicated skin and skin structure infections (cSSSI).

Results: Of the 717 patients with culture-positive cSSSI, 73.5% had healthcare-associated infections, and of those, 76.9% received appropriate treatment. A higher proportion of patients receiving inappropriate than appropriate treatment had a decubitus ulcer, a device-associated infection, or bacteremia, said researchers, concluding that patients with health care-associated cSSSIs are “less likely to receive inappropriate empiric therapy for their infection,” and therefore often experience prolonged hospitalization.

Factors Associated with Pressure Ulcers in Patients in a Surgical Intensive Care UnitJournal: Journal of Wound Ostomy & Continence Nursing (November-December 2010)

Authors: Slowikowski G, Funk M.

Purpose: To examine the occurrence of pressure ulcers in patients managed in a surgical ICU, and to report preliminary work toward development of a pressure ulcer risk assessment tool that incorporates comorbidities and other factors not addressed in previous instruments.

Results: Of 369 patients, 88 (23.9%) experienced a hospital-acquired pressure ulcer; a low Braden Scale score, presence of diabetes mellitus, and patient age >70 years were identified as independent predictors of the development of a pressure ulcer. These factors, said the authors, will be incorporated into the preliminary Surgical ICU Pressure Ulcer Risk Assessment scale, which “requires some additional psychometric testing before its use can be recommended for the research or practice settings.”

PHARMA FOCUSAutoloGel System (platelet-rich plasma gel)

//Clinical TrialsThe AutoloGel Post-Market Surveillance (TAPS) ProgramStudy Type: Interventional

Age/Gender Requirements: 18-95 years (male/female)

Sponsor: Cytomedix

Purpose: Patients with exuding wounds, such as leg ulcers, pressure ulcers, and diabetic ulcers and for the management of mechanically or surgically-debrided wounds, are being recruited to participate in this three-year, multisite study, which seeks to “evaluate the incidence of hematologic and immunologic adverse events, including coagulopathies in patients with wounds to which AutoloGel was applied.”

//eAbstractsChronic Wounds Treated with a Physiologically Relevant Concentration of Platelet-rich Plasma Gel: A Prospective Case SeriesJournal: Ostomy Wound Management (June 2010)

Authors: Frykberg R, Driver V, Carman D, et al.

Purpose: To evaluate how a physiologically relevant concentration of an autologous platelet-rich plasma (PRP) gel impacts the initial wound healing trajectories of chronic, nonhealing wounds of various etiologies in patients at long-term acute care hospitals and outpatient clinics.

Results: After wounds were assessed and measured in 49 patients with 65 nonhealing wounds, a skin barrier was applied to the periwound skin and the gel applied and protected with cover dressings. Researchers observed reductions in wound volume, area, undermining, and sinus tract/tunneling in patients, following a mean of 2.8 weeks of treatment with 3.2 applications. These results, they wrote, suggest that “the application of this PRP gel can reverse nonhealing trends in chronic wounds.”