Should one size fit all?

“There is no value in applying silver dressings to all wounds, but equally no value in dismissing their evident benefits in one clinical area of wound care”

The VULCAN study results were published in 2009 in the British Journal of Surgery. A multicentre, prospective randomised controlled clinical, its objective was to examine the efficacy and cost effectiveness of antimicrobial silver dressings in treating venous ulcers.

This study raises several interesting issues about wound care, its multifactorial role and the application of randomised controlled trials in this discipline. In this article, IWII member Rebecca Drake provides a critical overview of the VULCAN study and examines the issues that it raises for all those interested in treating wound infection.

Curriculum

Ever wondered how to go about teaching or learning about wound infection? See the IWII’s essential guide!

Our education committee has provided both an outline curriculum for those wishing to teach and learn about wound infection and an indispensable slide set on the subject that can be expanded or contracted at will.

Wound infection management needs to be taught, and it needs to be learned – but how? First of all we need to understand the appropriate levels of knowledge and experience, then we need to understand the appropriate subject areas. That’s why we have divided our curriculum into 3 levels of knowledge (basic, intermediate and advanced) and 3 subject areas (microbiology, assessment & diagnosis and management & evaluation).

This is not a curriculum in itself, but a guide, or outline, provided to give some structure to this complex and multidisciplinary subject. Use it, add to it, but most of all, let us know if it is useful, if it is interesting, and how it can be improved.

The slide set includes some original material and clinical pictures from our contributors. Please respect our copyright and acknowledge the IWII whenever you use it.

Happy reading!

Wound infection glossary

Confused by terminology? You’re not the only one! We’ve put together a comprehensive glossary listing all the important terms relating to wound infection

Wound infection carries with it traditions and terminology from medicine, microbiology, epidemiology and just plain common sense. As with all complex fields of healthcare, terminology can cause confusion and controversy, and frequently needs updating. Here at the institute we have identified over 30 terms relevant to wound infection and suggested a useful and practical explanation for each one.

Disagree with any of the definitions? Good. Then please let us know. Consider this as an advanced draft, we would be happy to consider all additions and amendments. Download the glossary here. Happy reading!

Biofilms

Is critical colonisation a euphemism for colonisation with a biofilm?

Biofilms are gaining in notoriety as a component of wound infections, but what exactly are they? Most importantly, how can you detect them, how do they behave and how can you eradicate them from wounds? Val Edwards-Jones, Greg Schultz and Jude Douglass from the International Wound Infection Institute provide a review on biofilms, examine these 3 crucial questions and propose the potential for effective methods of detection and sampling.

Please download the Biofilms Review and 12 Frequently Asked Questions.

Download the evidence matrix!

This was one of our original key objectives when founding the International Wound Infection Institute. See how we put it together.

This process originally began with a simple listing of references and will conclude with a comprehensive list of reviewed, surveyed and abstracted papers on wound infection and its treatment. We see the provision of an evidence matrix as the next step along the route. The current version of the matrix is incomplete, but we believe that it is at an appropriate stage to be reviewed by our members. We welcome all of your comments.

One of the main features that we wanted to include was a rating system for the evidence. This is always problematic. The literature reveals multiple classifications and evidence hierarchies for ranking evidence (see the matrix). However, these evidence classifications and hierarchies contain many inconsistencies in interpretation and ranking. Although the gold standard for best evidence is generally considered to be a meta analysis or systematic review of double blinded ranndomised controlled trials, few, if any, such reviews are to be found in regards to the diagnosis and treatment of wound infection. Our rating system is focussed towards the level of evidence as follows:

  1. Meta analysis and systematic reviews
  2. Randomised controlled trials
  3. Non randomised controlled trials, case control trials, prospective cohort studies, animal studies, evidence summaries or evidence guidelines
  4. Case reports, case series
  5. Expert opinion, other literature series

Highly influential pieces have been published within all the above levels, some of which have contributed to change in practice. Therefore we are considering the addition of an “impact” rating, separate to the evidence rating, based on the importance or significance of certain papers.

We hope that you find this draft of the evidence matrix to be useful. Equally importantly, please give us your opinion on how to improve and add to this document. In particular we would like your feedback on the following:

  • How useful is the evidence matrix as provided?
  • What other papers should be included?
  • What impact scores would you give to significant pieces?

Keryln Carville, Chair, Evidence sub-committee, 2009