[Prevalence and management of chronic wounds in 14 geriatric institutions of the Haut-Rhin].

BACKGROUND: We carried out a survey to assess the prevalence of various therapeutic approaches for chronic wounds in 14 primary care and rehabilitation units (SSR) and long-term care units (SLD) in the Haut-Rhin department of France, and we attempted to gauge the interest of doctors and nursing staff in the creation of a Mobile Wound and Healing Unit (EMPC).
METHODS: Our anonymous transversal survey was based on the results of two questionnaires, one concerning patients and the other concerning medical and nursing staff.
RESULTS: 96 of the 1 163 patients hospitalised at the time of our survey met the inclusion criteria. The global prevalence of sores was 8.3%, while that of bedsores was 6.4% and that of leg ulcers was 1.6%. There were no cases of wounds on diabetic feet. The study population was characterised by a M/F sex-ratio of 0.37, with mean age of 86 years for women and 76 years for men. The mean duration of bedsores was 6 months, compared with 14 months for leg ulcers and a relapse rate of 36% for bedsores and 52.6% for leg ulcers. In more than half of all cases the aetiology of the ulcers was not stated. Bacteriological samples were obtained in 7 cases. Wounds were generally cleansed using soap and physiological saline, with mechanical debridement being used in 4 cases. Hydrocolloids were the dressings used most widely for bedsores, while interfaces were most commonly used in leg ulcers. No topical antibiotics were prescribed. A pain evaluation scale was used in only 18 cases and topical anaesthetics were administered in one case prior to debridement of a leg ulcer. A bedsore risk evaluation scale was completed for 27 of the 75 of the patients presenting bedsores and special preventive mattresses were used for two-thirds of these patients. Twelve of 19 patients with leg ulcers had compression bandaging that was changed daily. Most doctors considered their knowledge of chronic wounds to be good, in contrast with nursing staff, 72% of whom judged their knowledge mediocre or insufficient. All the nursing staff and 11 of the 13 doctors expressed interest in the use of a specialised team for difficult cases. DISCUSSION: The main practices consistent with the recommendations were use of modern dressings, although the latter appeared to be changed too frequently, anecdotal use of antiseptic solutions, abandonment of use of topical antibiotics and nutrition management plans. Two-thirds of patients with leg ulcers wore compression bandages. However, improvements remain to be made concerning the use of topical anaesthetics, manual debridement, use of pain evaluation and bedsore risk scales, and assessment of the aetiology of leg ulcers.
CONCLUSION: This survey, conducted prior to the creation of a mobile wound and healing unit based at the Colmar General Hospital, showed that doctors and nursing staff are extremely keen on the idea of specific training and practical advice concerning chronic wound management. It provided a clearer vision of the training requirements of SSR and SLD establishments in terms of chronic wound management.