Volume 43 Number 2
Complexity of care: Mitigating insidious infection
Jenny Prentice
For referencing Prentice J. Complexity of care: Mitigating insidious infection. WCET® Journal 2023;43(2):7
DOI https://doi.org/10.33235/wcet.43.2. 7
To add to our President and President Elect’s message and in acknowledging the ongoing influence of Florence Nightingale on modern medicine and nursing Nightingale not only expounded the benefits of ‘best care’ she recounted “Wise and humane management of the patient is the best safeguard against infection”1. Further, Ayello on her reflections of Nightingale’s principles for practice reiterates Nightingale’s belief in the importance of skin health whereby, “in almost all diseases, the function of the skin is, more or less disordered; and in many most important diseases natures relives herself almost entirely by the skin”2.
There are many variables that contribute to the development of wound infection; the person, the type and origin of the wound, environmental factors, whether the wound is acute or chronic as well as the specific characteristics of causative organisms and what treatments may be available to prevent or treat infection3.
A common theme within all articles presented here is infection, either as a primary cause of skin infection or a secondary complication of wound healing. The challenges of diagnosing and differentiating between superficial and deep infection in the sternal wounds of paediatric cardiac surgical patients and implementation of wound management pathways and staff education in conjunction with early intervention strategies to manage these wounds are described by Kumar et al.
Shukalek et al use case histories to demonstrate the complexity of diagnosing cellulitis in their third essay on skin and soft tissue infections and other conditions that may mimic cellulitis. The clinical manifestations, pathogenesis, microbiology, differential diagnosis, and prevention of cellulitis are discussed.
The use of negative pressure wound therapy (NPWT)to manage severe infection in the presence of retracted stomas is described by Cwaliński et al. They report on seven patients where severe peristomal infection failed to respond to conventional local treatment using ostomy appliances or specialist dressings and were consequently and successfully treated with NPWT preventing the need for further corrective stoma surgery.
The historical and current use of sugar and variations of dressings for treating wound infection and stimulating wound healing in resource limited settings is outlined by Haesler. Specifically, how granular white sugar is thought to work in reducing wound exudate, facilitate autolytic and mechanical debridement and lessening peri-wound oedema. Sugar’s ability to inhibit bacterial growth is also discussed.
In combatting infection, as described in the above articles, are that an interprofessional and holistic approach are two key elements essential to the prevention, assessment, diagnoses and treatment of infection.
It is always a delight to recognise those who have contributed to the advancement of medical or nursing practice in the same way as we continue to acknowledge Florence Nightingale. On behalf of the Editorial Board I would like to offer our congratulations to Dr Elizabeth A Ayello, PhD, MS, BSN, ETN, RN, CWON, MAPWCA, FAAN for being the recipient of two prestigious awards: the NPIAP JoAnn Maklebust Lifetime Achievement Award for her contribution to the prevention and treatment of pressure injuries and the International Academy of Nursing Editors’ Margaret Comerford Freda Award for Editorial Leadership in Nursing Publication. These awards are exceptionally well-deserved accolades. Dr Ayello’s advice will continue to resonant with current and new practitioners for many years to come.
Best wishes to you all, Jenny.
护理的复杂性：减轻隐性感染的影响
Jenny Prentice
DOI: https://doi.org/10.33235/wcet.43.2. 7
请允许我对主席和候任主席的致辞略加补充，同时也感谢弗罗伦斯·南丁格尔（Florence Nightingale）对现代医学和护理的深远影响，南丁格尔不仅阐述了Åg最佳护理Åh的好处，她还讲述了Åg对患者进行妥当的、人性化的管理是预防感染的最佳保障Åh1。此外，Ayello在反思南丁格尔的实践原则时，重申了南丁格尔对皮肤健康重要性的信念，Åg在几乎所有疾病中，皮肤的功能或多或少都是紊乱的；在许多主要疾病中，自然几乎完全通过皮肤状况来进行治愈Åh2。
导致伤口感染发生的因素很多，包括：人本身、伤口的类型和来源、环境因素、伤口是急性还是慢性，以及致病微生物的具体特征和可用于预防或治疗感染的治疗方法3。
这里所有文章的一个共同主题就是感染，可能是关于皮肤感染的主要原因，也可能是关于伤口愈合的继发性并发症。Kumar等人描述了儿科心脏手术患者胸骨伤口的浅表和深部感染诊断和鉴别难题，以及实施伤口处理路径和工作人员教育，并结合早期干预策略来管理这些伤口。
Shukalek等人在其第三篇关于皮肤和软组织感染以及其他可能类似蜂窝织炎的病症的文章中，用历史案例证明了诊断蜂窝织炎的复杂性。文章还讨论了蜂窝织炎的临床表现、发病机制、微生物学特征、鉴别诊断和预防。
Cwaliński等人描述了在存在造口回缩的情况下使用负压伤口治疗（NPWT）来处理严重感染。他们报告了7例存在严重造口周围感染的患者，这些患者对使用造口装置或专业敷料的常规局部治疗没有反应，因此采用并成功进行了NPWT治疗，从而无需进一步进行造口矫正手术。
Haesler概述了在资源有限的情况下，在治疗伤口感染和刺激伤口愈合方面，糖和各种敷料的历史和当前使用情况。具体而言，文章介绍了颗粒状白糖被认为是如何在减少伤口渗出液、促进自溶和机械清创以及减轻伤口周围水肿方面发挥作用。此外，还讨论了糖抑制细菌生长的能力。
在防治感染方面，如上述文章所述，跨专业和整体方法是预防、评估、诊断和治疗感染的两个关键要素。
我们始终感谢南丁格尔的贡献，同时也很感谢对医疗或护理实践的进步做出贡献的人们。我谨代表编委会祝贺Elizabeth A Ayello（PhD、MS、BSN、ETN、RN、CWON、MAPWCA、FAAN）获得两个享有盛誉的奖项：一项是NPIAP授予的JoAnn Maklebust终身成就奖，表彰她在预防和治疗压力性损伤方面做出的贡献；一项是国际护理编辑学会授予的Margaret Comerford Freda护理出版物编辑领导奖。这些奖项都是实至名归的荣誉。Ayello博士的建议将会在今后很多年里持续引起当前从业人员和未来从业人员的共鸣。
谨致问候，Jenny。
Author(s)
Jenny Prentice
PhD, BN, RN, STN, FAWMA
References
- Health of houses. In: 160th Anniversary Edition Notes on Nursing: What it is, and what it is not. Eds: Florene Nightingale ; with an Introduction by Maureen Shaw Kennedy and commentaries by contemporary nursing leaders. Philadelphia, PA. Wolters Kluwer, 2020; p.21.
- Ayello EA. From Bedsores to Global Healthcare – Insights from Nightingale’s Notes on Nursing. In: 160th Anniversary Edition Notes on Nursing: What it is, and what it is not. Eds: Florene Nightingale ; with an Introduction by Maureen Shaw Kennedy and commentaries by contemporary nursing leaders. Philadelphia, PA. Wolters Kluwer, 2020; p.57.
- International Wound Infection Institute (IWII) Wound Infection in Clinical Practice. Wounds International. 2022.
