Skin Health Solutions

Katie James BA, RN, CWCN

Medline Education Specialist

A Sea of Innovation: 2019 Fall Educational Conference

•

Common Challenges

Bedside Nurse Confidence Levels

Survey sent via Nurse.com to over 750 acute care nurses

54

%

Strongly agree they have access

to skin care products to help

prevent skin breakdown and

pressure ulcers/injuries

53

%

Are very comfortable in following

the clinical guidelines for skin care

44%Strongly agree they have access

to education in skin and wound

care best practices

Educational blitz’s

aren’t enough to

sustain long-term

staff knowledge

and improvements

The solution

A Comprehensive Approach

Training and education that helps care providers function more consistently and effectively

Intuitive, complimentary and multi-functional system of products paired with utilization

recommendations to support best practice

SYSTEM of PRODUCTSCAREGIVER EDUCATION

Customized recommendations based on insights from industry, clinical

and operational benchmarks

BEST PRACTICE EXPERTISE

Discovery Assessment

Product Utilization• Identify opportunities for SKU

consolidation across all categories.

On-Site AssessmentsReview of preventative interventions

• Leadership Interviews

• Staff surveys

Unit environmental assessment

• Stock room assessment

• Mattress assessment

Product Utilization

•Full report of findings & recommendations to empower your frontline

staff

Discovery Assessment

Leadership SummaryIdentified opportunities and current

strengths of frontline staff & program

Staff InterviewsComplete reporting of staff

responses, including questions and

answers

ObservationsCurrent products available throughout

the facility

Analysis &

RecommendationsReport created and reviewed by Medline

board-certified WOC nurses

All recommendations based off of NPUAP

and WOCN

11

OPTIFOAM FAMILY OF

DRESSINGS

12

FOAM FOR TREATMENT AND

PREVENTION

• Used on wounds

• Cover dressing

• Absorb and retain wound exudate

• Protect skin with gentle silicone

• Used on healthy skin to prevent

wounds

• In OR & ICU, at risk patients

• Used on sacrum (mostly) to absorb

shear & friction forces

• Manage moisture and humidity to

help prevent skin breakdown

Treatment Prevention

MEDLINE AWC FOAM OFFERING

14

CHARACTERISTICS OF FOAM

OFFERING

• Border

• Non-Border

Adhesive or Non Adhesive

• Acrylic

• Silicone

Type of Adhesive

• Only Border

• Across the Face

Adhesive Placement

• Moderate Absorption & Retention

• Super Absorbent / High Retention

Absorbency & Retention

15

ABSORPTION & RETENTION

16

OPTIFOAM GENTLE SA

• Bordered

• 3x3, 4x4, 6x6

• Silicone adhesive on border and face

• Super absorbent

• Available in silver – 4x4, 6x6

Studies• 2 patient

• Microclimate, friction, shear

• Layers construction

17

SA 5 LAYERS

• 5 layer design

– Helps reduce shear and friction

18

19

Opticell

Chitosan

Gelling Fiber Family

Fiber Differentiation

•Three Major Types of Fiber Dressings

Alginate (Calcium Alginate)

Derived from seaweed

Carboxymethylcellulose(CMC)

Derived from wood pulp

Chitosan

Derived from the exoskeleton of shellfish

Chytoform Technology

•Key Features Proprietary blend of fibers, including

chitosan

Designed to maximize absorbency and strength while remaining gentle and conformable

Why Chitosan

Clinical Concerns

1. Inflammatory state (chronic)

2. Bleeding

3. Bacterial burden

4. Wound drainage

Chitosan

• Anti-inflammatory

• Hemostatic

• Antibacterial

Chytoform Technology

Incorporates chitosan into an

absorbent fiber dressing

Key Features

•Opticell and Opticell Ag+

Helps to control minor bleeding

• Beneficial for donor sites and after sharp debridement

Maintains dressing size integrity when absorbing exudate

• Protects all areas of the wound surface

Conformable for intimate wound bed contact• Won’t create dead space in the wound

Wicks fluid vertically into the dressing

• Protects the periwound skin

Versatility

•Opticell is indicated for use on a wide

variety of wounds Venous leg ulcers

Diabetic ulcers

Pressure ulcers

Lower extremity wounds

Partial- and full-thickness

wounds

First & second-degree burns

Mohs surgery, laser surgery

Surgical wounds (donor

sites/grafts, surgical incisions,)

Skin conditions (TENS, EB,

Steven Johnson)

Post debridement

Trauma wounds (abrasions,

lacerations, skin tears)

Oncology wounds, bleeding

tumors, biopsies

Conformability•Opticell conforms to wound beds of any shape and size, eliminating

dead space

Absorbency•Opticell absorbs the same amount or more fluid than competitor

products

Innovations in Wound Care:

PluroGel® Burn and Wound

Dressing

Daunting Challenges

Stalled Wounds / Complex Wounds

Risk of Surgery (Contraindication of Traditional Debridement)

Efficiency (Speed to Results)

Patient Satisfaction / Compliance

Sharp Debridement

Pros Cons

Remove visible non-

viable material

Pain Tolerance

Most expeditious

debridement pathway

Patient Satisfaction

Convert chronic wound

to acute

May not get to the

“Unseen” Biofilm

No Biofilm

Suppression

The complexity of patient care and healthcare requires advanced solutions that address today’s challenges…

• Debridement is one of the most important treatment strategies against

biofilms, but does not remove all biofilm, and therefore cannot be used

alone1

.

1. Consensus guidelines for the identification and treatment of biofilms in chronic nonhealing wounds Gregory Schultz, PhD1 ; Thomas Bjarnsholt, DMSc2,3; Garth A. James, PhD4 ; David J. Leaper, DSc5 ; Andrew J. McBain, PhD6 ;

Matthew Malone, MSc7,8; Paul Stoodley, PhD9 ; Theresa Swanson, MHSc10; Masahiro Tachi, MD11; Randall D. Wolcott, MD12; for the Global Wound Biofilm Expert Panel

PLUROGEL® BURN AND

WOUND DRESSING

Enhance Your Debridement

Protocol with PluroGel®Removes Necrotic TissuePluroGel’s surfactantcy effect (micelles

softening, loosening, and trapping

necrotic tissue and debris) helps achieve

a clean site.

Inhibits Biofilm Formation (in vitro)PluroGel has been shown to inhibit and disrupt

biofilm in vitro (in vitro)1.

Yang Q, Larose C, Porta AD, Della Porta AC, Schultz GS, Gibson DJ. A surfactant-based wound dressing can reduce bacterial biofilms in a porcine skin explant model.

Int Wound J 2016;

Disrupts Mature Biofilm (in vitro)PluroGel breaks through the EPS (extracellular

polymeric substance) that surrounds biofilm

microbes. This can outright prepare the wound

bed, or at least make the biofilm finally

susceptible to topical antimicrobials.

How Surfactants Behave

Low concentration of surfactants in a liquid

How Concentrated Surfactants Behave

High concentration of surfactants in a liquid (micelle formation)

Micelle

Surfactant molecules form the spherical micelle

Hydrophilic Surface

Hydrophobic Core

Water-Loving Surface

Oil-Loving Center

Surfactantcy Effect Concentrated Surfactant contains both a

hydrophilic portion and hydrophobic portion and water. At a certain concentration level, molecules form a Micelle Matrix.

Matrix is surface active, constantly expanding and contracting creating a “rinsing” action on a molecular level. This helps to solubilize exudate and debris and bacterial matter.

It disrupts non covalent bonds. PluroGel® helps to soften, loosen, trap and remove debris.

Micelle Matrix

Thickens in a warm environment for constant

contact with the wound bed

– promoting prolonged exposure to

wound debris

Inverse Thermodynamics

Protocol Friendly PluroGel is compatible with ANY wound

cleanser and ANY secondary dressing. In fact,

PluroGel was initially developed to deliver

topical antimicrobial agents for patients in a

burn unit.

Practical Advantages of

PluroGel®Reduced Pain at Dressing ChangePluroGel’s ease of application and removal is

patient and staff friendly. Any cleanser (e.g.

sterile water, saline, PHMB/HOCl solution)

will remove PluroGel and loosened necrotic

tissue with ease.

Biofilm ImpactAs shown in vitro, PluroGel disrupts mature

Biofilm and inhibits microbial adhesion, inhibiting

Biofilm from reforming.

Surfactant based, PluroGel softens, loosens and

traps wound debris. PluroGel breaks the non-

covalent bonds that hold devitalized tissue in

place.

Removes Barriers to Healing

What Evidence Exists?

http://www.woundinfection-institute.com/wp-content/uploads/2017/07/IWII-Consensus_Final-2017.pdf

A surfactant-based wound dressing can reduce

bacterial biofilms in a porcine skin explant model.

Qingping Yang, Christelle Larose, Alessandra C Della Porta, Gregory S Schultz & Daniel J Gibson International

Wound Journal 2016

Key Applications for Use

Dehisced Surgical

Wounds

Inflamed Lower

Extremity Wounds Stalled Wounds

Inflamed Ulcerations Patient with Pyoderma Gangrenosum

Patient could not withstand pain of silver sulfadiazine (SSD)

Day 4 switched to PluroGel® and continued treatment daily

All ulcerations resurfaced by week 12 and limb saved from amputation

Day 1 Day 10

Multiple Malodorous Bilateral Lower Extremity Ulcerations Managed with a Burn and Wound Dressing By Priscilla Grant, BSN, RN, HT, CWCN

• 36 y/o male, wheelchair bound, DM II, dysphagia, diabetic polyneuropathy, HTN, neuromuscular dysfunction of

bladder, anxiety, GERD, hyperlipidemia, depression.

• Wound measured 3.4cm x 3.4cm x 4.0cm

• CST applied 3x per week

Diabetic Foot Ulcer

44

VNA Home Health Kaleida Home Health Buffalo, NY Poster presented at 2018 SAWC Conference Andrew Wheeler, DPT, CWS; Gina Overfield,

BSN, RN, WCC

Day 1 Day

25

Day 5

• Age 52, Toe amputation, slow healing (wound present for > 4weeks), Diabetes

• CST Applied Daily

Day 1 Day 28

Day 42

Catherine Ratliff, PhD, NP, CWOCN University of Virginia Health System -- Charlottesville, VA

Amputation

45

PBD 4, CST Day 0 CST Day 10

32 yr old, patient presented 4 days after burn

Flame Burn

46

Clinical Rationale Enhances your Debridement protocol

• Removes barriers to healing / Manages biofilm

• Compatible with anti-infective agents

• Thermo gelling property provides better adherence to wounds

Assists with Healing

• Micelle chemistry promotes optimal moisture balance critical for healing

• Modulation of inflammation

Reduces Pain at Dressing Changes

• Ease of Application and Removal

• Up to 3 day wear time

Length (cm) Width (cm)

Wound Area

(cm2)

# of

Dressings Cost/ Dressing

1 1 1 167 0.69$

2 2 4 42 2.76$

3 3 9 19 6.21$

4 4 16 10 11.04$

5 5 25 7 17.25$

6 6 36 5 24.84$

7 7 49 3 33.81$

8 8 64 3 44.16$

9 9 81 2 55.89$

10 10 100 1.7 69.00$

Assumes PluroGel is applied 3mm thick

Cost Effective Way to Manage Biofilm

481. Wilcox J R., RN; Carter M J., PhD, MA; Covington S, MD. “Frequency of Debridements and Time to Heal: A Retrospective Cohort Study of 312,744 Wounds.” JAMA

Dermatology July 24, 2013

Investment of $3 to $6 per dressing

to effectively manage biofilms.

77% of DFUs and 66% of VLUs are 5 square centimeters

or smaller1

Using Hyalomatrix® Esterified Hyaluronic Acid Matrix

Innate Properties of Hyaluronic Acid

9. Erbatur S, Coban YK, Aydın EN. Comparision of Clinical and Histopathological Results of Hyalomatrix Usage in Adult Patients. Intl Jour Burns and Trauma. 2012;2(2):118-125. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3462522/ . Access June 18, 2018.10. Frenkel JS. The Role of Hyaluronic Acid in Wound Healing. Intl Wound Jour. 2014;11:159-163. Available at: https://pdfs.semanticscholar.org/f9a7/aaa8a2454cfa7a09d38ff92e68d3ee3c9675.pdf. Accessed July 11, 2018.11. Fakhari A, Berkland C. Applications and Emerging Trends of Hyaluronic Acid in Tissue Engineering, as a Dermal Filler, and in Osteoarthritis Treatment. Acta biomaterialia. 2013;9(7):7081-7092. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3669638/ . Accessed July 11, 2018.12. Litwiniuk M, Krejner A, Grzela T. Hyaluronic Acid in Inflammation and Tissue Regeneration. Wounds. 2016;28(3):78-88. Available at: https://www.woundsresearch.com/article/hyaluronic-acid-inflammation-and-tissue-regeneration . Accessed July 11, 2018.

Covering Chronic Wound & Bone/Tendon: Hyalomatrix®Resists Infection WellWith its open, non-crosslinked scaffold,

Hyalomatrix allows for native cellular

infiltration and angiogenesis –

facilitating the body’s natural defense

systems3,4,5,6

Builds Granulation Tissue Quickly

Prevents Tendon Desiccation Hyalomatrix’s hyaluronic acid has a high affinity

for binding water, which makes it ideal for

structures like tendons that are at risk during

exposure and often require rehydration while

granulation is taking place2

Hyalomatrix often incorporates after 14-21

days for chronic ulcers, and at that point, can

either support autografting with sufficient

granulation (especially in conjunction with

NPWT)1 or lead to natural re-epithelialization

.

1. Vaienti L, Marchesi A, Palitta G, Gazzola R, Parodi PC, Leone F. Limb trauma: the use of an advanced wound care device in the treatment of full-thickness wounds. Strategies Trauma Limb Reconstr. 2013;8(2):111–115. doi:10.1007/s11751-013-0165-8

2. Longinotti C. The use of hyaluronic acid based dressings to treat burns: A review. Burns Trauma. 2014;2(4):162–168. Published 2014 Oct 25. doi:10.4103/2321-3868.142398

3. Simman R, Mari W, Younes S and Wilson M. Use of Hyaluronic Acid-Based Biological Bilaminar Matrix in Wound Bed Preparation: A Case Series. ePlasty. 2018; 18:e10. Available at:

http://www.eplasty.com/index.php?option=com_content&view=article&id=1924&catid=15&Itemid=116 . Accessed June 18, 2018.

4. Caravaggi C, Grigoletto F, Scuderi N. Wound Bed Preparation With a Dermal Substitute (Hyalomatrix® PA) Facilitates Re-epithelialization and Healing: Results of a Multicenter, Prospective, Observational Study on Complex Chronic Ulcers (The FAST Study). WOUNDS

2011;23(8):228–235. Available at: http://www.medscape.com/viewarticle/749515_1 Accessed June 18, 2018.

5. Gravante G, Delogu D, Giordan N, et al. The Use of Hyalomatrix PA in the Treatment of Deep Partial-Thickness Burns. Jour Burn Care Res. 2007;28(2):269-74.

6. Gravante G, Sorge R, Merone A, et al. Hyalomatrix PA in Burn Care Practice: Results From a National Retrospective Survey, 2005–2006. Ann Plast Surg. 2010;64(1):69–79.

Chronic Wounds: Case 2

• 71 y/o female, ulcer on left big toe

• Type 2 Diabetes

• Patient originally had gangrene and osteomyelitis• Treated with IV antibiotics, HBO and 3 applications of acellular fetal bovine matrix, wound did not heal

• 3 applications of Hyalomatrix, wound closed on week 8

Week 2: reapplication of HM

Week 1: HM still intactDay

0

Shaun Carpenter, MD, FAPWCA, CWSP Roy Brabham, MD Todd Shaffett, APRN, CWS Rebecca Hunt, APRN Brandi Flanagan, APRNMedCentris -

Hammond,LA

Week

8

Chronic Wounds Case: 10

• 66 y/o male, 6 week stalled chronic wound

• Gangrene present, bypass of the left femoral to posterior tibial artery as well as debridement of the left dorsal including skin, subcutaneous tissue, muscle, tendon and fascia.

• Due to varying complications, amputation was discussed but patient refused

• HBO treatments along with 2 applications of HM, limb salvaged. STSG to closure. 15 weeks to closure

Presented at SAWC Fall 2018 By: Tracy Robertson, RN/NP, Leonard D. Benitez, MD, McLaren Bay Wound and Hyperbaric,

Bay City, MI

Gangrene present,

1 month hospital

stay

Week 0, post hospital stay

4 exposed tendons Week 15 post

STSG

Week 7, post second HM

application

Week 3, second HM

application

Chronic Wounds Case: 14

• 55 y/o male with head trauma to the scalp due to being hit by a car

• 1 application, 2 weeks to 94% closure

Presented at SAWC Spring 2018 by: Naz Wahab MD, FAAFP, Wound Care Experts, Las Vegas, Nevada

Exposed Bone and Tendon: Case 1

• 58 y/o veterinarian, fracture to third metacarpal due to dog bite

• Type 2 Diabetes

• Patient originally had gangrene and osteomyelitis• Treated with IV antibiotics, HBO and 3 applications of acellular fetal bovine matrix, wound did not heal

• 3 applications of Hyalomatrix, wound closed on week 7

Day

0

Shaun Carpenter, MD, FAPWCA, CWSP Roy Brabham, MD Todd Shaffett, APRN, CWS Rebecca Hunt, APRN Brandi Flanagan, APRNMedCentris -

Hammond,LA

Week 1, Exposed

tendon

Week 1, HM

reapplication

Week

2

Week

7

Chronic vascular ulcers

Venous ulcers

Diabetic ulcers

Draining wounds

Partial- and full-thickness

wounds

Pressure ulcers

Second-degree burns

Hyalomatrix® Indications for Use

Surgical wounds (donor

sites/grafts, post-Mohs surgery,

post-laser surgery, podiatric,

wound dehiscence)

Trauma wounds (abrasions,

lacerations, skin tears)

Tunneling/undermining wounds

NOTE: Third-degree burns do not receive immediate skin substitute treatment – they typically undergo escharectomy. After this procedure, the remaining

site is a

full-thickness, surgical wound…both of which are on-label indications for Hyalomatrix.

•Customized programs to empower clinical staff, elevate preventative

interventions and standardize treatment guidelines

Education

Medline University

Convenient, online

education platform

Available on

HealthStream

Over 55 courses

15+ CEs

Skin Champion Program

• Each module contains the following, printed and digital:

Module Components

Presentations with

Teaching Guide

Unit-based Bulletin Boards

References From

NPUAP and

Others

Tools to

Reinforce

Learnings

• Developed by certified WOC nurses, based off of WOCN and NPUAP

Guidelines

24 Months of Education

Pressure Injuries• Pressure Injury Overview

• Pressure Injury Staging

• Wound Assessment

• Braden Risk

• Pressure Injury Prevention – Offloading

• Pressure Injury Prevention – Defense

Skin Care• Skin Anatomy And Physiology

• Skin Care Basic Steps

• MASD – IAD

• MASD – ITD

• MASD – Peritubular, Peristomal, Periwound

• MARSI

Wound Etiologies• Wound Physiology & Factors Affecting

Healing

• Lower Extremity Wounds – Arterial

• Lower Extremity Wounds – Venous

• Lower Extremity Wounds – DFU

• Skin Tears

• Dressing Selection and DIMES

Special Populations• Bariatric Considerations

• Skin and the Aging Process

• Pediatric Population

• Nutrition

• Palliative and Conservative care

• Wound Infection and Bioburden

•• Clinical reviews to track progress

• Bi-monthly educational emails for staff

• Training materials including posters, videos, and online education

Ongoing Engagement

Results

61%Reductionin days to heal arterial ulcers. 2015: 78 days >> Today: 30 days

32% Increased volumeWounds center patients

57% MoreWounds closed

17% IncreasedVisits to wound center

93% NursesVery satisfied or satisfied with process

Reduced HAPIsImproved ability to identify skin issues at admission

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Kajames@medline.com

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