Continuing Education in Wound Care: It’s A Big Deal
Almost everyone who provides health care has some basic “smarts” or they would not have made it through school to become a practitioner. I would be the first to agree that professional schools and postgraduate training programs are difficult, requiring significant dedication to finish. Once one walks out of that room or auditorium with the final certification and license to practice, there is a great feeling of finally being “done.” Unfortunately, that time in our lives only marks the beginning.
Despite all we have learned, it has been shown by many people through the years that at least half of what we learn in school and postgraduate programs will be useless or proved wrong by the time we finish our careers.1 I can truthfully say that fully half of the technologies and products we use daily in our wound treatment center did not exist 10 years ago. For these reasons, continuing to look for the best approach to treating wounds is critical.
A recently published book, Wound Care Certification Study Guide, 2nd Edition, edited by Drs. JB Shah, PJ Sheffield and CE Fife is a resource I would recommend to help with your search for information.2 As one can tell by the title, it has been developed to assist anyone planning to take any of the wound certification examinations, but the amount and scope of the information in the book can serve as a textbook for anyone who wants an updated source of wound care information.
The book contains 33 chapters covering all the basic and advanced topics likely to be faced by someone treating patients with any type of wound. Since the first edition was published in 2011, all of the chapters have been updated, and a chapter introducing the use of hyperbaric oxygen has been added. Each chapter has numerous references to the topics if further reading is desired. There are illustrative questions included at the end of each chapter to help the reader evaluate his/her comprehension of the subject before moving to the next.
Each chapter contains numerous photos that detail the issues being discussed. The underlying pathophysiology of each condition is included, leading the reader to a better understanding of the problem and why certain treatments are selected. Chapter 7: Patient Preparation and Education presents a unique perspective for helping the patient and family understand what to expect from having a chronic wound and the proposed treatments, including pain management, dressing changes and possible treatments outside of the wound center.
Because of the importance of bacteria in chronic wounds, the editors have included three chapters dealing with the topic. The first is an overview of microbiology to refresh one’s memory about the basics of the subject. This is followed by a chapter on infection control and subsequently, an overview of wound infections. If a biopsy culture is to be obtained and anesthesia is required, it is important to remember many topical anesthetics have antimicrobial actions of their own, which should preclude their use when taking specimens for culture. Berg and associates reported that any topical anesthetic, especially Emla cream, has a rapid and powerful antibacterial effect within 30 minutes of applying it to the wound surface.3 Use of this anesthetic can lead to unreliable tissue culture results. For this reason, the only anesthetic recommended for tissue biopsies done for culture is 1 percent preservative-free lidocaine.3
The chapter on lymphedema reminds the reader of the importance of this condition. Lymphedema is often overlooked when one deals with chronic wounds, but it should be remembered that the periwound lymphatics are always damaged, resulting in much of the periwound swelling being due to high-protein lymphedema fluid and not just low- protein edema fluid. This should remind all of the importance of compression bandaging and other forms of compression therapy in the treatment of any patient with swelling of the periwound tissues. It should also be realized that compression therapy can be successfully and safely used in the treatment of patients with an ankle/brachial index (ABI) of less than 0.8. Many feel this should not be done, but the safety and efficacy of careful compression in this group of patients has been well documented.4,5,6 If these patients are denied compression therapy, they will not improve or get well.
The chapter on burns presents a brief overview of the types of burns that may be encountered. Most severe burns are the purview of burn surgeons treating these patients in burn units. The topical treatment of second-degree burns is mentioned, but care should be taken when using any silver dressing in the treatment of these wounds. The toxicity of silver-containing products is well-recognized and is known to delay the healing of these burns. It must be noted that silver-containing topicals and dressings can be especially hazardous in infants and children.7-12
The chapter on dermatological review and unusual wounds should be of importance to all.
Treating patients in a wound-center setting does not rule out the possibility of being asked to see any patient with a skin defect or problem. Many times differentiating one skin defect from another can be difficult and must be done accurately and timely to avoid treatment that can be inappropriate, wasting both resources and time. The number of patients seen with “unusual wounds” may depend on where one lives and one’s diagnostic abilities. For example, in the South, brown recluse spider bites are not uncommon, whereas in the Northeast they are rarely seen. Many people say they never see pyoderma gangrenosum in their wound centers. I did not either until I was able to make the diagnosis. Do malignancies occur in or masquerade as ulcers? It depends on how hard one looks for them. I encourage wound biopsy if you are unsure of the diagnosis or if the wound has failed to respond to what you consider good therapy after four weeks of treatment.13-14
All in all, this is a good book for learning about and updating one’s knowledge of wounds, whether in preparation for a certifying exam or for continuing learning. Many consider continuing education a waste of time or something for others. If we do not continue to learn throughout our professional careers, we will soon find ourselves behind everyone else. We certainly want to provide the best care possible for our patients. By increasing and updating our knowledge, we can provide better care for our patients.
- Vetto JT. Reflections: The Other Half. J Cancer Edu. 2014; 29:808-809.
- Shah JB, Sheffield PJ, Fife CE, eds. Wound Care Certification Guide, 2nd Edition. North Palm Beach, FL: Best Publishing Company; 2016.
- Berg JO, Mossner BK, et.al. Antibacterial properties of EMLA and lidocaine in wound tissue biopsies for culturing. Wound Rep Reg. 2006; 14:581-585.
- Woo KY,Alavi A, Evans R, et al. New Advances in Compression Therapy for Venous Ulcers. Surg Technol Int. 2013; 23:61-68.
- Mosti G, Iabichella ML, Partsch H. Compression Therapy in Mixed Ulcers Increases Venous Output and Arterial Perfusion. J Vasc Surg. 2012; 55:122-128.
- Neill K, Turnbull K. Use of Specialist Knowledge and Experience to Manage Patients with Mixed Aetiology Leg Ulcers. J Wound Care. 2012; 21:168, 170, 172-174.
- McCauley RL, Li YY, Poole B, Evans MJ, et.al. Differential Inhibition of Human Basal Keratinocyte Growth to Silver Sulfadiazine and Mafenide Acetate. J Surg Res. 1992; 52(3):276- 285.
- Cho Lee AR. Effect of Silver Sulfadiazine on the Skin Cell Proliferation and Wound Healing Process in Hairless Mouse 2nd Degree Burn Model. J Kor Pharm Sci. 2002; 32:113-117.
- Cho Lee AR, Moon HK. Effect of Topically Applied Silver Sulfadiazine on Fibroblast Cell Proliferation and Biomechanical Properties of the Wound. Arch Pharm Res. 2003; 26(10):855-860.
- Treadwell TA, Fuentes ML, Walker D. Treatment of Second Degree Burns with Dehydrated, Decellularized Amniotic Membrane (Biovance) vs. a Silver Dressing (Acticoat). Wound Rep Reg. 2008; 16:A39.
- Poon VKM, Burd A. In Vitro Cytotoxicity of Silver: Implication for Clinical Wound Care. Burns. 2004; 30:140-147.
- Wang XQ, Kempf M, Mott J, et al. Silver absorption on Burns after the Application of Acticoat: Data from Pediatric Patients and Porcine Burn Model Reported Raised Serum Silver Levels in Pediatric Burn Patients. Journal of Burn Care and Research. 2009; 30(2):341-348.
- Ackroyd JS, Young AE. Leg Ulcers That Do Not Heal. Br Med J.1983; 286:207-208.
- Hansson C, Anderson E. Malignant Skin Lesions on the Legs and Feet at a Dermatological Leg Ulcer Clinic During Five Years. Acta Derm Venereol 1997; 78:147-148.