unsigned

vbrut1@earthlink.net

Linda

Thanks,

Debra

---

Since your Dad has an open wound, he not only can get bacteria from the water into his wound and any bacteria has may have in the wound will be released into the water. Chlorine kills the bacteria in the water but you don't know how well the water is being maintained. He would be safer out of the water during the healing process. A. Whitesides, RN

---

It depends what dressing is being used. There are some waterproof ones out
there, and others may be covered by waterproof one as needed. Examples
include transparent film dressings, and to a lesser extent, hydrocolloid
dressings. The one problem is, if the waterproof dressing is used as a
secondary dressing (to cover the main dressing) and not a primary dressing in
itself (the main dressing), then it won't be covered by insurance. You could
purchase it yourself. I suggest you talk to his wound care provider about
waterproof options.

Renee C, PT, CWS

---

Dear Debra,
you should use DuoDERM Hydrocolloid Dressing (ConvaTec, Bristol-Myers
Squibb)
It´s occlusive and safe for use in water.

Best regards
Hakan Freijd
R.N.
Sweden

---

Debra, if the source of the directions not to engage in water walking is the woundcare
provider follow those instructions until your Grandfather discuss with the caregiver the option of covering the wnd with Opsite for the exercise period only. Do this by covering the wnd dressing with a dry drsg then cover with the opsite. When you remove the Opsite the loose drsg will also come off leaving the original drsg in place.
Try this on yourself first, testing it in the water to make sure you have applied the protective cover properly .

If the source is someone other than the Caregiver discuss this method , (and any other suggestions you may get) , with the caregiver .

Darrell, L.P.N.
Wound Team Member
Salt Lake City, Ut.

---

my name is Sylvia and I am an RN...I think it would be safe to go swimming
as long as the wound is not infected but I would recommend to put a clear
nonporous dressing on when going for s swim, such as Opsite.

---

You can't find support because it's not appropriate. An eggcrate provides no real pressure relief. You need 4 inches of foam, generally. The eggcrate
crunches down too much, and does not support body weight. There are overlays available for gerichairs, such as GeoMatt and Waffles. You'd have evaluate these and others to see what best suits your needs. If they need a support surface in the bed, they need one in the chair as well. Even low-air loss mattresses are not pressure relief. Only the air-fluidized beds (eg: Clinitron) are pressure-relieving. On a low-air loss mattress a person needs
to be turned, as they do on the geri-chair. Lying in a chair for hours without shifting pressure distribution will not help the patient. Even with a
pressure-reducing surface.

Renee C, PT, CWS

---

You should be managing wounds accoring to the AHCPR guidelines. they tell you the appropriate way to manage pressure. Egg crate mattresses are for comfort only. They do not have the correct indentation load deflection to decrease pressure. Why dont u consult with an ET nurse.

---

I don’t know of any literature supporting either your case or the surveyors. There is very little in the literature on seating in recliner chairs. However, there is plenty to say that pressure should be removed from an ulcer site, no matter what the Stage, and there is nothing that I know of to support the use of eggcrate or convoluted for any Stage ulcer, in bed or in sitting. Are you sure it’s reducing pressure on the coccyx? That is a very prominent bone, especially when there are contractures causing the patient to curl up in a recliner chair.

Laurie M. Rappl, PT, CWS
------

Dona-
Where did the wound nurse get her information? Also you may want to check out "The purple book" that the US Dept. of Health and Human services publishes; "The Treatment of Pressure Ulcers".

Chapter 3, page 39 reports "there is no evidence that one type of static support surface is more effective than another..." This might be able to help you out.

Kim
LPN/Wound Assessment Nurse

---

I was taught that convoluted foams (of which an egg crate is one) are of little value other than comfort. A foam must be 3-4" thick to offer any pressure reduction and convoluted foams are usually not that thick. Check to see if the patient is "bottoming out" when in the gerichair by putting your palm between the chair and the foam under the area of the patient's ishial tuberosities and/or where the pressure ulcer is located. Get a copy of the Clinical Practice Guideline Number 15 put out by the US Dept. of Health and Human Services. It will give you something in writing to use with the DOH. Becky DeSantis, PT

---

I don't know what state you are in
NYS does not allow eggcrate due to IDC issues. we use gel/foam cushions that have a gortex like covering they can be used for all stages of pressure sores. there is also an inflatable waffle cushion for chairs.
There are also computer programs to evaluate the seating system and determine how much pressure is at any spot a heat picture is created
that way you can choose from different cushions which relieves the best
hope this helps. don't have the names here at home.

---

Dear Donna, the surveyor is going by the MDS 2.0, which notes 'relief' device as opposed to 'reduce'. The MDS needs many corrections and that is one of them. The 3.0 hopefully will be adopted soon and the NPUAP suggestions are on that one, which include changing the term of 'relief' to 'reduce'. She is not a very informed surveyor. Also, it will finally have us be able to note correctly the stages of a pressure ulcer and include 'unstaged' as many are and currently the MDS triggers 'ST IV' for anything we document as unstaged. It will also have the MDS use the staging system correctly as it was developed by the NPUAP as a tool for staging pressure ulcers only and we do not 'back-stage' pressure ulcers (the PUSH tool is useful for identifying the pressure ulcer's progression toward closure--not 'healing', as pressure wounds do not heal, they close). All other ulcers, venous and arterial, will not be staged, the staging system is was designed for pressure ulcers. Finally, some of the frustration can end for having the correct documentation be had on the MDS. Section M, #5, is where the surveyor is receiving the idea and I wonder if s/he has ever read any research about relief or reduce or anything herself; not meaning to sound critical here, its just that it can appear as a play on words and then what manufacturers are promoting their products as too.
Donna, look at the information that the vendor/manufacturer has about the support surface you have in-place; it should indicate what it is promoting itself as, this is the information that you can give to the surveyor. See below and also go to the Web site at: http://www.woundheal.com/healing/factsheet01.htm where I obtained the following info and more.

Pressure Reducing, Pressure Relieving and Advanced Pressure Reducing - Class II and III - Support Surfaces & Specialty Beds have all passed the HCFA /SADMERC/ Medicare product review process demonstrating their ability to relieve pressure over the body's bony prominences to below 32 mm Hg for sustained periods of time. And the equipment has demonstrated its durability, the ability to withstand prolonged usage and cleaning.

Good luck with the survey,
Monica

---

I am a physical therapist from Texas, your case seems so familiar to me as I have worked with that kind of problem for so many years now. In therapy, I have use a combination of treatment approach that includes Biofeedback, Ultrasound, Soft Tissue Mobilization and Myofascial Release, Silica Gel foam Padding applied directly into the affected area and its purpose is to soften this scar tissues and Therapeutic Exercises. The result is always 80% to 95% better than without any treatment and in just 1 month of treatment. I hope that this will gives you some hope and faith with your therapist.

Art

---

They are both roll gauze. Kerlex is a little thicker. Made by different companies

---

I have found Kling to be less absorptive, but most importantly, it tends to shed fibers, whereas Kerlix does not.

---

Hi! Actually they both can be used in wounds except: the kling wrap should only be used when you have a extremely large wound with tunneling because its thick, holds saline well, absorbs drainage better , and can be easily removed. But you have to be careful when packing with kling wrap because people tend to pack the wound to tight. Wounds should be lightly packed to
allow the wound edges to contract.

---

Was this a pilonidal cyst? It sounds like it. I'd be concerned about soaking in the pool, as there could be a lot of organisms there. Things like Iodosorb
( a controlled-release iodine) might be helpful, as would an absorptive dressing like an alginate or hydrofiber. That would let the dressing be
changed on a less frequent schedule. Also, many people find the VAC system helpful in healing large wounds like these. A wound specialist could help you find the best treatment.

Renee C., PT, CWS

---

I am a nurse working with patients at Children's Hospital in Columbus Ohio. We use Vacuum Assisted Closure on as many as possible of these types of wounds (70) in the past 2 years and have had great success. Ask your physician about VAC therapy or go to www.woundvac.com for more info.

---

I think you might want to get a second opinion. If the doctor went in deeper than the dermis, the incision will fill in by secondary intention or scar. A scar has no hair follicles, these are found in the dermis and once removed, cannot regenerate. Soaking it four times per day will definitely help keep the wound open by washing away the growth factors. Soaking in a pool will allow chlorine into the wound which is cytotoxic and will prolong closure. It sounds like this wound may benefit from the V.A..C. which would speed the healing process. Traditional dressings which maintain a moist wound environment might be ok as well. The longer the wound is open, the greater the chance for infection! Good luck. Sheryl PT, CWS

---

Technically, you are both correct.

The wound should be irrigated, not cleansed by swabbing the wound, prior to obtaining wound swab sample. By doing this, the exudate and debris is removed providing a clean wound bed. Swabbing prior to removing this matter will result in a false pathology result as you will have provided a sample of the debris, not a swab of the wound.

To collect the sample, wipe the swab in a zing-sag motion from the top of the wound to the bottom while rotating the swab as you go. This provides a sample from the entire wound. Pathology do the same when applying the sample to the growth medium.

Hope this helps clear this matter for you.

Students are usually the best sources of up-to-date information and techniques. Unfortunately, those of us who have been around for a while tend to forget this.

Good luck.

Martin EN
Workplace Trainer and Assessor

---

Hi Denis/Denise

I am a Tissue Viability Nurse in W. London, and I am afraid your student is right. Prior to taking a wound swab, the wound bed should be cleaned with normal saline. The rationale for this is that a true infection comes up from the base of a wound, whereas if you merely swab the surface which contains exudate then you are likely to pick up all matter of bacteria which are merely contaminating the wound. by cleansing it first you are more likely to wipe these away and detect what is the cause of infection.

I don't have any of the research at my finger tips but seem to remember seeing supporting evidence on one of the Pubmed sites.

Hope this is helpful

Chris

---

Dear Denis,
I just make some research in infection control and, in my readings on internet I found the following address that could guide you:.
As I could understand the Guide is from U.K. That is healpful for you.The true in your story concern specimen collection is between your knowledge and yours coleague knowledge.
Nice to "meet" you,
Ana-Maria Iuonut RN, chief nurse i surgical hospital,
Cluj-Napoca, ROMANIA

---

The student is correct. See work by Garry Sibbald and /or Heather Orsted on Pub Med.
Good luck!

Donnie
Best Practice Specialist - Clinical Services
Good Samaritan Society

---

When culturing a wound you have several routes for which a culture can be obtained. Swab cultures do not effectively reveal the infecting organism. Swab cultures only collect the surface contaminating organisms. Tissue biopsy and culture, fluid aspiration cultures are better alternatives for culturing infection..

Here is protocol for obtaining swab culture from a wound

Sutured wound: Carefully wipe surrounding area. Remove the swab from the specimen collector, being careful to touch only the top of the cap. Gently express exudate/pus from incision, swab culturette in exudate/pus with out touching surrounding skin.

Nonsutured wound: Gently cleanse wound with saline ( low pressure irregation) and dry surrounding skin. Remove swab from the specimen collector, being careful to touch only the top of the cap. Press the swab against the wound margin/ulcer base, using significant force to express fresh exudate. Avoid touching surrounding skin.

Hope this answers your questions. Good luck......Jan, LPN,IC

Second email from Stein

I found the definitive answer in the "HIM-11" guidelines from Medicare. If your particular state PT practice act allows woundcare, then therapist visits performing those services would count towards the OASIS MO825 High Case-Mix number.

Stein