Secret History: Return of the Black Death Channel 4, 7-8pm In 1348 the Black Death swept through London, killing people within days of the appearance of their first symptoms. Exactly how many died, and why, has long been a mystery. This Secret History documentary follows experts as they pick through the evidence and reveal why the plague killed on such a scale. And they ask, what might be coming next?

Medscape

The TIME acronym (tissue, infection/inflammation, moisture balance and edge of wound) was first developed more than 10 years ago, by an international group of wound healing experts, to provide a framework for a structured approach to wound bed preparation; a basis for optimising the management of open chronic wounds healing by secondary intention. However, it should be recognised that the TIME principles are only a part of the systematic and holistic evaluation of each patient at every wound assessment. This review, prepared by the International Wound Infection Institute, examines how new data and evidence generated in the intervening decade affects the original concepts of TIME, and how it is translated into current best practice. Four developments stand out: recognition of the importance of biofilms (and the need for a simple diagnostic), use of negative pressure wound therapy (NPWT), evolution of topical antiseptic therapy as dressings and for wound lavage (notably, silver and polyhexamethylene biguanide) and expanded insight of the role of molecular biological processes in chronic wounds (with emerging diagnostics and theranostics). Tissue: a major advance has been the recognition of the value of repetitive and maintenance debridement and wound cleansing, both in time-honoured and novel methods (notably using NPWT and hydrosurgery). Infection/inflammation: clinical recognition of infection (and non infective causes of persisting inflammation) is critical. The concept of a bacterial continuum through contamination, colonisation and infection is now widely accepted, together with the understanding of biofilm presence. There has been a return to topical antiseptics to control bioburden in wounds, emphasised by the awareness of increasing antibiotic resistance. Moisture: the relevance of excessive or insufficient wound exudate and its molecular components has led to the development and use of a wide range of dressings to regulate moisture balance, and to protect peri-wound skin, and optimise healing. Edge of wound: several treatment modalities are being investigated and introduced to improve epithelial advancement, which can be regarded as the clearest sign of wound healing. The TIME principle remains relevant 10 years on, with continuing important developments that incorporate new evidence for wound care.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1742-481X.2012.01097.x

Extending the TIME concept: what have we learned in the past 10 years?(*).

Wound antisepsis has undergone a renaissance due to the introduction of highly effective wound-compatible antimicrobial agents and the spread of multidrug-resistant organisms (MDROs). However, a strict indication must be set for the application of these agents. An infected or critically colonized wound must be treated antiseptically. In addition, systemic antibiotic therapy is required in case the infection spreads. If applied preventively, the Wounds-at-Risk Score allows an assessment of the risk for infection and thus appropriateness of the indication. The content of this updated consensus recommendation still largely consists of discussing properties of octenidine dihydrochloride (OCT), polihexanide, and iodophores. The evaluations of hypochlorite, taurolidine, and silver ions have been updated. For critically colonized and infected chronic wounds as well as for burns, polihexanide is classified as the active agent of choice. The combination 0.1% OCT/phenoxyethanol (PE) solution is suitable for acute, contaminated, and traumatic wounds, including MRSA-colonized wounds due to its deep action. For chronic wounds, preparations with 0.05% OCT are preferable. For bite, stab/puncture, and gunshot wounds, polyvinylpyrrolidone (PVP)-iodine is the first choice, while polihexanide and hypochlorite are superior to PVP-iodine for the treatment of contaminated acute and chronic wounds. For the decolonization of wounds colonized or infected with MDROs, the combination of OCT/PE is preferred. For peritoneal rinsing or rinsing of other cavities with a lack of drainage potential as well as the risk of central nervous system exposure, hypochlorite is the superior active agent. Silver-sulfadiazine is classified as dispensable, while dyes, organic mercury compounds, and hydrogen peroxide alone are classified as obsolete. As promising prospects, acetic acid, the combination of negative pressure wound therapy with the instillation of antiseptics (NPWTi), and cold atmospheric plasma are also subjects of this assessment.

/pdf/consensus-on-wound-antisepsis-update-2018-56xy5tzcqf.pdf

Consensus on Wound Antisepsis: Update 2018

Criteria used to identify infection may often be restricted to the presence of pus, or pus with inflammation1. Traditional criteria have been used in many surveys and their advantage is that they are simple, reproducible and easily recognised by different observers. However, identification of infection may be difficult in some circumstances, and identifying patients who are likely to develop infection is rare.

Criteria for identifying wound infection

This article is based on a second Hygienist Panel meeting held in London on 16-17 June 2010. The Panel discussed the current use of antimicrobials and care bundles in the prevention of surgical site infection; the need to comply with good antibiotic stewardship, to reduce the risk of antibiotic-resistant and emergent organisms; and the need to revisit the use of antiseptics. The discussion was driven by concerns of the use of triclosan, which had been raised by a publication from the Scientific Committee on Consumer Products of the Directorate General for Health and Consumers, European Commission. Uncertainties that excessive use of triclosan for preservation and in cosmetics could select naturally resistant environmental organisms or induce reduced triclosan-susceptibility or antibiotic resistance were considered. It was concluded that the uses of triclosan with demonstrable health benefits, as in some medical applications (such as antimicrobial sutures), need to be distinguished from those where there is no proven benefit, such as its use in certain consumer products. The addition of triclosan to a product must be substantiated in any claim of preventive or therapeutic health benefit. Triclosan is the most widely studied biocide and this same level of information should be available for other topically used antimicrobials, which are widely used in surgical practice and chronic wound care.

https://www.onlinelibrary.wiley.com/doi/pdf/10.1111/j.1742-481X.2011.00841.x

Antimicrobial sutures and prevention of surgical site infection: assessment of the safety of the antiseptic triclosan.

All authors were members of the consensus meeting panel; * Chair of the panel. Full author details in Box 1 In spring 2010, a multidisciplinary group of clinicians met in London to discuss the issue of bacterial management in wound healing. The clinical world is currently facing a range of new challenges and health care is becoming increasingly intensive with ever-higher expectations of positive outcomes from both the healthcare industry and those it serves. As our understanding of the intricate balance between wound healing and the bio-community of organisms living within the wound expands, clinicians face new challenges in providing effective strategies to manage wound bioburden without inducing pathogen resistance and negatively influencing the healing process.

PHMB and its potential contribution to wound management

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PHMB and its potential contribution to wound management