An estimated 6.7 million Americans are living with chronic wounds.¹,² A chronic wound is one that fails to progress through a normal, orderly, and timely sequence of repair, or in which the repair process fails to restore anatomic and functional integrity after three months³ Some chronic wounds can take decades to heal and can ultimately lead to isolation and family distress.³

A summary of recent case studies illustrates the successful use of an antimicrobial foam wound dressing^* as part of the overall treatment approach to healing complex recalcitrant wounds.

^*The product used in the case studies was RTDTM Wound Dressing, Keneric Healthcare, Irvine, Texas. The RTDTM dressing was acquired in 2018 by DermaRite Industries, LLC and re-branded as DermaBlue+TM Foam. No data or conclusions have been altered in the case study materials.

Wound Types: The patients featured in the case studies suffered from a variety of longstanding wounds, including diabetic wounds, dehisced surgical incisions, vascular leg ulcers, pressure injuries and wounds due to Pyoderma Gangrenosum. 

Care Settings: All patients were being cared for in a nursing home or at home. Each patient’s wound care treatment plan was developed and directed by a wound care physician or a certified wound care nurse. 

Prior Course of Treatment: Patients had been treated for 60 days to 450 days prior to the addition of DermaBlue+TM Foam to the comprehensive treatment plan. A variety of dressings in the following categories had been used to manage moisture and bioburden and support autolytic debridement: 

Some of the patients also underwent surgical debridement or sharp debridement, and some received synthetic skin substitutes, IV antibiotics, hyperbaric oxygen treatment and/or NPWT as part of their wound care. 

Outcomes Achieved following the addition of DermaBlue+TM Foam to the treatment plan: 

As part of a comprehensive plan of care, DermaBlue+ TM Foam worked where other dressings failed. 87% of patients achieved wound healing in less than 90 days following the introduction of DermaBlue+TM Foam to their dressing regimen. 

DermaBlue+™ Foam and DermaBlue+™ Foam Transfer are flexible, ready-to-use absorbent antimicrobial foam dressings infused with Methylene Blue, Gentian Violet, and silver zirconium phosphate.

DermaBlue+™ Foam combines triple-action antimicrobial protection with a unique micro-pore foam that wicks exudate away from the wound and kills over 99% of bacteria within, helping to disrupt the formation of biofilm and aiding in the healing of even the most challenging chronic wounds. 

How DermaBlue+™ Foam works: ACS and triple antimicrobial actions 

The DermaBlue+™ Foam Dressing Advantage 

• Three effective ingredients, Methylene Blue, Gentian Violet, and non-cytotoxic silver provide broad-spectrum antimicrobial activity. 
• Patented process embeds the antimicrobials into the foam itself – ingredients will not wash away, no unwanted skin discoloration, and no interference in the foam’s absorbency. 
• Proprietary micro-pore foam wicks exudate vertically into the dressing and away from the wound bed. 
• Highly absorbent, flexible, light weight, comfortable and resilient. 
• Ready to use and easy to apply – either side can be applied to the wound and no need to hydrate before use. 
• Can be cut to fit, layered, and used for wounds with tunneling or undermining. 
• Promotes optimal wound bed temperature. 
• Gentle and effective for use during all phases of wound healing. 

References: 

1. L.E.K. Consulting 2014 Market Analysis “Market Sizing and Assessment of Outsourced Outpatient Wound Care”
2. US Census data 
3. Bowers S., Franco E. Chronic Wounds: Evaluation and Management. American Family Physician. 2020;101(3):159-166. 
4. Marcus B., Kaufman K., (2015, November) Treatment of a Complex Diabetic Foot Wound with RTD™ Wound Dressing: A unique absorbent antimicrobial polyurethane foam dressing [Poster presentation] Desert Foot Conference Phoenix, AZ 
5. Marcus B., Kaufman K., (2014, September, October) Uses of a Novel New Absorbent Antimicrobial Polyurethane Foam Wound Dressing [Poster presentation] Clinical Symposium on Advances in Skin & Wound Care – Sept 2014 and Symposium on Advanced Wound Care (SAWC) Fall – Oct 2014 
6. Warren S., Smith D., (2013) Use of RTD Wound Dressing in 168 LTC Patients [Poster presentation] Utah 

Liquid soap dispensers are used by millions daily, but as you reach for the soap dispenser to clean your hands you may want to look at the dispenser itself before pumping. All soap dispensers are not alike, and some can potentially harbor more bacteria than they remove!

Prevention Basics
Washing your hands with soap and water is universally considered one of the simplest steps you can take to avoid getting sick and spreading germs. This is especially important as flu season returns and COVID-19 rates continue to climb. But is the familiar wall mounted soap dispenser in the restroom or common area doing more harm than good? That may depend on what type of dispenser it is and how well it’s being maintained.

It’s What’s Inside That Counts
There are two common wall mounted soap dispensers: closed and open bulk-refillable systems. Closed liquid soap dispensers can be refilled with a sealed disposable bag or cartridge. Open bulk-refillable dispensers require soap to be poured into the dispenser from bulk stock soaps that may be concentrated, requiring tap water to dilute the soap.

Bulk-refillable soap dispensers are commonly found in public restrooms in many community settings. Recent studies have shown one in four bulk-refillable soap dispensers are contaminated.¹ While soap does not have to be sterile for effective hand washing, the number of bacteria in the soap needs to be minimal and free of harmful organisms. It should also contain enough preservative to prevent contamination of the soap.²

A study conducted in Japan examined contaminated soap dispensers and found 17 different species of bacteria, including Klebsiella pneumoniae, Serratia Marcescens, and Enterobacter, and Pseudomonas.¹ Various outbreaks have occurred from contaminated soap resulting in a variety of infections such as bacteremia, joint infections, skin ulcers, and urinary tract infections.²

As new soap is poured into the dispenser, contaminants such as dirt and bacteria can also be introduced during the refill process. Researchers also theorize that preservatives in bulk soap may deteriorate over time which can also lead to contaminated soap.²

Ideally, a refillable dispenser should be cleaned before filling. Wall-mounted dispensers may not have a removable soap container, so cleaning the container that houses the soap can be challenging and the effectiveness of cleaning short-lived. Studies show that even after cleaning a contaminated dispenser with a 10-minute soak of sodium hypochlorite (bleach) solution, the contamination levels return to pre-cleaning levels within 7-14 days.⁴

The Centers for Disease Control (CDC) discourages the practice of “topping off” or adding new soap to existing soap in the container due to the risk of contamination citing contaminates can enter the dispenser when the top is removed and new soap is added.³

How DermaRite Can Help You
DermaRite’s closed cartridge and bag systems are an easy solution to prevent liquid soap contamination. The disposable closed cartridge or bag provides clean, uncontaminated soap and a new nozzle for delivery of soap with every dispenser refill. A clean, mess-free system will enhance handwashing compliance.

DermaRite offers a variety of liquid hand soaps, hand sanitizers, and skin cleansers for use in a closed system refillable dispenser.

Our line of liquid hand soaps and total body cleansers include:

DermaKleen™: a pH balanced, Triclosan-free antiseptic hand cleanser enriched with vitamin E to soften and condition frequently washed hands. Contains chloroxylenol.
KleenFoam: a pH balanced antiseptic foam hand soap that moisturizes with Aloe Vera for clean, soft, conditioned hands. Contains chloroxylenol.
TotalFoam: a pH-balanced total body wash and shampoo enriched with Aloe Vera which offers a thick rich lather to leave skin soft and fresh.
TotalBath: a mild, pH balanced full body cleanser and shampoo enriched with vitamin E to moisturize and nourish skin.
DermaRain: a pH balanced, dye-free cleanser for sensitive skin that cleans and moisturizes without irritation.
DermaVera: a pH balanced cleanser enriched with shea butter to provide a rich lather with a fresh scent. Nourishes and moisturizes as it cleans.

References:

1. Zapka, Carrie & Campbell, Esther & Maxwell, Sheri & Gerba, Charles & Dolan, Michael & Arbogast, James. (2011). Bacterial Hand Contamination and Transfer after Use of Contaminated Bulk-Soap-Refillable Dispensers. Applied and environmental microbiology. 77. 2898-904. 10.1128/AEM.02632-10.
2. The Free Library. S.v. Occurrence of heterotrophic and coliform bacteria in liquid hand soaps from bulk refillable dispensers in public facilities..” Retrieved Dec 01 2020 from https://www.thefreelibrary.com/Occurrence+of+heterotrophic+and+coliform+bacteria+in+liquid+ha nd…-a0249684607
3. https://www.cdc.gov/mmwr/PDF/rr/rr5116.pdf
4. Lorenz LA, Ramsay BD, Goeres DM, Fields MW, Zapka CA, Macinga DR. Evaluation and remediation of bulk soap dispensers for biofilm. Biofouling. 2012;28(1):99-109. doi: 10.1080/08927014.2011.653637. PMID: 22257312.

Much of our focus in the year 2020 has been on preventing the spread of COVID-19, but the risks of infection and the need for infection control are not new. In healthcare settings we are continually challenged with preventing the spread of common organisms that cause disease and result in costly Healthcare-Acquired Infections (HAIs), such as Methicillin-resistant Staphylococcus Aureus (MRSA), Vancomycin-resistant Enterococcus, Clostridium difficile, often called C. diff., E. coli, as well as viruses causing flu, pneumonia and COVID-19.

The Staggering Impact of HAIs
The Center for Disease Control estimates that 1 in 25 hospitalized patients will get an infection contracted while in a healthcare facility and an estimated 75,000 patient deaths annually are a result of these infections¹. These infections carry an astounding price tag of over $9.8 billion to treat².

Who’s At Risk
HAI prevention is not a challenge exclusive to hospitals. It is a focus in Long Term Care (LTC) facilities, outpatient centers, medical offices and home-care settings. Estimates on the number of infections acquired in LTC facilities annually range from 1.13- 3.83 million³. Individuals most at risk for developing a Healthcare-Acquired Infection are those with chronic illnesses, immunocompromised, the very young and the elderly.

What’s Being Done About It
To curb the number of infections in the LTC setting the Center for Medicare and Medicaid Services (CMS) has mandated that facilities have at least one designated Infection Preventionist on staff. The role of the Infection Preventionist will be to oversee the development, monitoring and revision of the facility infection control program, infection surveillance, outbreak management, monitor antibiotic use, as well as employee infection control practices such as handwashing.

How You Can Help
The past 6 months of living with a pandemic have increased awareness of measures to control the spread of infection and disease. Basic infection control practices that are effective in controlling the spread of disease and infection should be incorporated into our daily routines, including:

• frequent hand hygiene (hand washing or hand sanitization when appropriate)
• use of personal protective equipment (masks, gowns or gloves)
• disinfection of frequently used surfaces
• maintaining safe distances for one another

How We Can Help You
Basic infection control measures require products such as hand soaps, hand sanitizers and surface disinfectants that will help prevent the spread of disease. It is important to choose products that are effective on a wide range of organisms, to minimize the transmission of disease.

DermaRite has a broad selection of infection control products to help you reduce the transmission of disease. You can explore the entire Infection Prevention & Control (IPAC) at dermarite.com/ipac.

References:

1. https://apic.org/monthly_alerts/who-are-infection-preventionists/
2. https://www.infectioncontroltoday.com/view/study-estimates-costs-hais
3. https://www.cdc.gov/nhsn/pdfs/training/2019/ltcf/infection-surv-ltc-508.pdf
4. https://www.cdc.gov/
5. https://www.provista.com/blog/blog-listing/infection-preventionist-mandate-for-ltc-takeseffect
6. https://www.sepsis.org/sepsisand/healthcare-acquiredinfections/#:~:text=Technically%2C%20any%20type%20of%20infection%20caught%20in%20a,di fficile%2C%20often%20called%20C.%20difficile%20or%20C.%20diff

Socially isolated seniors are at risk for developing dementia at a startling rate of up to 50% and nearly one fourth of adults 65 or older are considered socially isolated.³ Those statistics alone are disheartening, then along comes COVID-19. This disruptive life event, and the mandatory precautions to restrict family and friends from visiting nursing homes, initiated to keep seniors safe, have put them at even more risk.

Neurodegeneration and Pressure Injuries
Neurodegenerative conditions such as dementia, Alzheimer’s or Parkinson’s disease are more prevalent in the elderly and predispose seniors to skin issues and pressure injury. These conditions can result in motor, sensory and cognitive changes as well as behavioral changes. Seniors with neurodegenerative impairment tend to be less mobile and may suffer from spasticity or rigidness which can contribute to pressure injury development. It’s estimated that almost 40% of individuals suffering from dementia will develop ulcerations.¹

Pressure injuries can cause significant suffering including pain, depression, or infection and can result in a five-fold increase in mortality.² Pressure injuries may increase the care required for nursing home residents, resulting in stress on nursing resources and a financial strain to an already taxed health care system.

Depression
Social isolation has also been linked to loneliness and depression. Depression is characterized by feelings of sadness, sleep disorders, decreased appetite, energy, and difficulty concentrating.³ Loneliness is a symptom of depression. Maintaining relationships with friends and family helps to prevent psychological stress and loneliness. These relationships provide a sense of value and meaning and are an important source of social support for older adults.⁴ Virtual interaction with family is encouraged during this time of isolation due to COVID-19, however, access to the internet or computers, computer literacy and comfort with this form of communication all impact the success of virtual connectedness.

Malnutrition
Social isolation and loneliness also contribute to malnutrition in the elderly. By nature, humans are social beings and healthy eating habits are closely tied to eating meals with others.⁵ Malnutrition can lead to decreased mobility and weight loss which also increases the risk for pressure injury.¹ Nutritional assessments are a critical component in predicting risk for pressure injury. Poor nutritional status can delay wound healing, and even contribute to infection or sepsis.⁶

What You Can Do
While it is necessary to isolate residents to keep them from exposure to COVID-19, it is also necessary to bolster skin care prevention to minimize the effects of isolation, immobility, and poor nutrition. Consider increasing the frequency of skin assessments during this time. Follow the National Pressure Injury Advisory Panel guidelines for preventative skin care that recommend avoiding alkaline soaps and cleansers for bathing, keeping the skin hydrated, using barrier products to protect skin from moisture and cleansing promptly after incontinence episodes. These interventions are essential to keeping skin intact. Boost a poor diet with liquid protein to bolster the nutritional status of residents impacted by the effects of social isolation related to COVID-19. At this unprecedented time, prevention is key.

How DermaRite Can Help You

Education
Additional guidance for caregivers is offered in the new COVID-19 Recovery Series. DermaRite Academy, our free online learning portal, also offers several courses on dementia as well as many other topics that will benefit every caregiver.

Nutritional Products
DermaRite offers two great tasting liquid protein options to meet the nutritional needs of your residents – ProHeal and ProHeal Critical Care. Both are easy to use, provide up to 17 grams of protein in a convenient 1 oz serving and provide all the essential and non-essential amino acids to support the nutritional requirements needed during this stressful time. The ProHeal line is sugar, soy, lactose, and gluten free, and can be safely used with most diets. More information can be found here.

Skin Care
DermaRite is your go-to-source for all your preventive skin care needs. Explore the whole line of skin protectants here.

ProHeal™ and ProHeal™ Critical Care Liquid Protein

ProHeal is a medical food developed for the dietary management of wounds and conditions requiring supplemental protein. ProHeal is a liquid protein supplement that contains a concentrated blend of hydrolyzed collagen and whey protein for maximum protein content and absorption.

Learn more >

References:

1. Jaul, E., Barron, J., Rosenzweig, J. P., & Menczel, J. (2018). An overview of co-morbidities and the development of pressure ulcers among older adults. BMC geriatrics, 18(1), 305. https://doi.org/10.1186/s12877-018-0997-7
2. https://www.bmj.com/rapid-response/2011/10/31/pressure-ulcers-advanced-dementia-may-need-different-approach
3. National Academies of Sciences, Engineering, and Medicine 2020. Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System. Washington, DC: The National Academies Press
4. Berkman, L. and T.A. Glass. 2000. Social integration, social networks, social support, and health. In L. Berkman and I. Kawachi (eds.) Social epidemiology, New York: Oxford University Press. Pp. 137-173
5. https://thevarsity.ca/2019/03/15/loneliness-and-isolation-associated-with-malnutrition/
6. https://woundeducators.com/nutritional-assessment/
7. https://npiap.com/

The current healthcare crisis with COVID-19 has left many providers scrambling for a way to meet the needs of their residents and patients while physical contact is restricted during the current pandemic. This is certainly true for Wound Care physicians and nurse practitioners that would normally visit residents in Long Term Care facilities and perform sharps debridement to facilitate wound healing.

To limit exposure to COVID-19, many providers are turning to telehealth modalities in order to virtually “see” patients. As of March 6th, 2020 CMS temporarily expanded benefits to allow Medicare recipients to receive increased telehealth services.⁵ Providers can assess and recommend treatment for residents, but are faced with the challenge of how to perform a virtual wound debridement.

Types Of Debridement
A quick review of debridement modalities and getting back to basics can help. There are several types of debridement available for effective removal of non-viable tissue:

• Surgical/ Sharps Debridement: This type of debridement is performed with sterile surgical instruments such as curettes or scalpels by the healthcare provider.1 Sharp debridement quickly removes devitalized tissue from the wound bed leaving healthy tissue intact and can be performed in a wound clinic or at the bedside. Surgical debridement is more aggressive and is performed in an operating room and may be non-selective removing healthy tissue as well as devitalized tissue.¹
• Enzymatic Debridement: This debridement method is performed by applying an enzyme enriched topical preparation to the wound bed that helps to liquify devitalized tissue.¹ Enzymatic debridement is less painful than a surgical/sharps debridement and can be a nurse applied treatment. The negative to this therapy is the high cost of the enzymatic preparation.
• Mechanical Debridement: This type of debridement can be achieved through wet-to-dry dressings or hydrotherapy.¹ While this is an inexpensive method, it is usually a painful treatment. This process removes viable and devitalized tissue from the wound bed. Due to the pain involved, this is a less acceptable form of debridement.
• Biological Debridement: This is the use of sterile maggots, Lucilia sericata (the green bottle fly) to debride wounds.¹ These maggots are grown in a sterile environment and are applied to the wound bed. Maggots may be applied with custom pre-constructed dressings or individually created dressing to keep the maggots securely in the wound bed.
• Autolytic Debridement: This is a commonly used debridement modality. Autolytic debridement is painless and uses dressings to promote moist wound healing. The wound dressing provides a moisture balanced environment that allows the body’s natural enzymes to liquify devitalized tissue.⁶ While notably a slower method, the benefit of decreased pain, easy to apply dressings, and lack of trauma to the wound bed makes this a commonly used debridement method.

How To Select A Dressing For Autolytic Debridement
Characteristics to consider in selecting dressings for autolytic debridement include the wound exudate, depth, and condition of the peri-wound skin.⁴ Commonly used autolytic debridement dressings include products that either add moisture to a wound or those that absorb excess moisture from the wound bed.⁷ The goal is to maintain a moist wound environment and proper moisture balance in the wound bed to facilitate moist wound healing.⁸

Dressings to add or retain moisture in the wound include :

• Hydrogels such as DermaSyn, DermaSyn/Ag, or DermaGauze
• Transparent films such as DermaView or DermaView II
• Hydrocolloids such as DermaFilm (clear, HD, thin)
• Collagen gels such as SilvaKollagen Gel

Dressing that absorb excess exudate in the wound, and gel in contact with wound exudate include:

• Alginates such as DermaGinate or DermaGinate/Ag
• Carboxymethyl cellulose (CMC) dressings such as AquaRite Extra CMC
• Collagens such as DermaCol, DermaCol/Ag, DermaCol 100 Sheet or DermaCol 100 powder

Interactive Dressing Selection Guide App
DermaRite’s interactive dressing guide is a unique digital catalog that allows users to input wound information to see which DermaRite dressings are suited for use with that wound. Available for iPhone, iPad and Android.

References:

1. https://www.woundsource.com/blog/wound-debridement-options-5-major-methods
2. https://www.verywellhealth.com/debridement-of-a-wound-3157191
3. https://www.woundsresearch.com/article/evidence-intensive-autolytic-debridement-self-adaptive-wound-dressing
4. https://journals.lww.com/aswcjournal/Fulltext/2004/06000/QUICK_TIPS__Dressings_for_Autolytic_Debridement.7.aspx
5. https://journals.lww.com/aswcjournal/Citation/publishahead/Expanded_Telehealth_Services_Offer_Smart_Wound.99927.aspx
6. https://factdr.com/health-conditions/wound-debridement-dressing/
7. https://www.nursingtimes.net/clinical-archive/tissue-viability/the-role-of-debridement-in-the-healing-process-10-10-2013/
8. https://www.woundsource.com/blog/benefits-moist-wound-healing