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Konsensus „Higiena rany”: eksperci opracowali 4 kroki do czystej rany

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Międzynarodowy zespół ekspertów opracował Konsensus „Postępowanie z trudno gojącymi się ranami z wykorzystaniem strategii wczesnego zapobiegania tworzeniu się biofilmu: higiena rany”. Dokument przedstawia 4 kroki prowadzące do czystej rany.

– Ogromne obciążenia zdrowotne i finansowe związane z długotrwałym gojeniem się rany są niepokojąco często odnotowywane w dokumentacji badawczej na całym świecie. Osoby z trudno gojącymi się ranami cierpią z powodu zwiększonego bólu i są podatne na nawracające infekcje, ponieważ borykają się z problemem zdrowotnym, który nie jest dostatecznie rozumiany przez wielu pracowników ochrony zdrowia. Powszechnie przyjmuje się, że te rany się nie zagoją. Można nawet powiedzieć, że taki stan rzeczy jest po prostu akceptowany – zwraca uwagę Christine Murphy, przewodnicząca panelu ekspertów odpowiedzialnych za opracowanie Konsensusu „Higiena rany”.

Konsensus „Postępowanie z trudno gojącymi się ranami z wykorzystaniem strategii wczesnego zapobiegania tworzeniu się biofilmu: Higiena Rany” został opracowany przez międzynarodowy zespół ekspertów. Znaleźli się wśród nich m.in. Christine Murphy, Leanne Atkin, Terry Swanson, Masahiro Tachi, Yih Kai Tan, Melina Vega de Ceniga, Dot Weir oraz Randall Wolcott.

Najważniejsze założenia Konsensusu „Higiena Rany”

Autorzy Konsensusu skupiają się na wyjaśnieniu, dlaczego biofilm jest uważany za podstawową barierę w gojeniu ran, i w jaki sposób odpowiednio prowadzona higiena rany może mu przeciwdziałać. Eksperci podzielili proces higieny rany na cztery podstawowe etapy: mycie, opracowanie rany, zadbanie o brzegi rany i dobór opatrunku.

– W ostatnich latach rośnie liczba dowodów na to, że głównym czynnikiem patologicznym w przypadku niegojących się ran jest biofilm, podobnie jak płytka nazębna w chorobach jamy ustnej. W zaburzeniach związanych z biofilmem z powodu bólu i infekcji zwiększa się zapotrzebowanie na leki przeciwbólowe, opioidy i antybiotyki. Z tego powodu bardzo ważne jest zajęcie się stanem patologicznym, zanim stan chorobowy się nasili. Kontrola biofilmu jest zatem niezbędna do osiągnięcia lepszych wyników i zmniejszenia negatywnego wpływu choroby. Podobnie jak w przypadku higieny jamy ustnej, higiena rany ma na celu wyeliminowanie przyczyny tego stanu patologicznego, powszechnie występującego w światowej populacji – podkreśliła w Konsensusie Christine Murphy.

  1. etap higieny rany: mycie

Jak zalecają autorzy Konsensusu, w pierwszej kolejności należy umyć łożysko rany. Podczas mycia usuwa się powierzchowne obumarłe tkanki, zanieczyszczenia rany, ciała obce oraz biofilm. Następnie w celu usunięcia złuszczającego się naskórka i modzeli myjemy skórę wokół rany i odkażamy ją. Eksperci zaznaczają, że płukanie/przepłukiwanie rany solą fizjologiczną lub wodą nie doprowadzi do usunięcia biofilmu.

Jeżeli zachodzi potrzeba oczyszczenia skóry znajdującej się 10-20 cm wokół rany, należy stosować się do lokalnych wytycznych dotyczących oczyszczania obszarów „czystych” (najdalej od rany) oraz „brudnych” (najbliżej rany lub w samej ranie). W tym celu powinniśmy użyć antyseptycznego lub przeciwbakteryjnego środka myjącego bądź płynu na bazie surfaktantu.

Do umycia skóry najlepiej wykorzystać gazę lub dostępne w sprzedaży kompresy czyszczące. Potrzebne są także antyseptyczne lub przeciwbakteryjne środki myjące bądź środki powierzchniowo czynne do rany i otaczającej ją skóry. Ranę możemy również oczyścić za pomocą medycznych chusteczek oczyszczających skórę. Na tym etapie higieny rany przydatne będą również kleszczyki chirurgiczne.

  1. etap higieny rany: opracowanie rany

Na tym etapie higieny rany ważne jest, aby usunąć wszystkie obumarłe tkanki, zanieczyszczenia rany, ciała obce oraz biofilm. Co istotne, jak podkreślają autorzy Konsensusu, opracowanie, podczas którego nie dochodzi do punktowego krwawienia, takie jak autolityczne opracowywanie, może fizycznie nie usuwać biofilmu. Dlatego jeżeli pacjent wyrazi zgodę i będzie to tolerował, należy kontynuować oczyszczanie do momentu, w którym wystąpi punktowe krwawienie.

Istotne jest również to, aby łożysko rany pozostawić w stanie zapewniającym optymalne działanie opatrunku. W celu usunięcia wszelkich pozostałych zanieczyszczeń w ranie po opracowaniu łożysko powinniśmy jeszcze raz umyć.

Jak tłumaczą eksperci, w praktyce wyróżnia się mechaniczne, ostre, ultradźwiękowe lub biologiczne opracowanie rany. Można je przeprowadzić z zastosowaniem środka antyseptycznego, przeciwbakteryjnego lub powierzchniowo czynnego. Na tym etapie niezbędne będzie zastosowanie siły mechanicznej oraz ścinania, ponieważ pozwoli to na naruszenie i zakłócenie funkcjonowania biofilmu.

 

  1. etap higieny rany: zadbanie o brzegi rany

Jak podkreślili autorzy Konsensusu, ważne jest nieustanne monitorowanie oraz pocieranie brzegów rany do momentu pojawienia się punktowego krwawienia. W celu zniszczenia bądź zminimalizowania ryzyka wystąpienia biofilmu w obrębie brzegów rany, a także umożliwienia rozwoju zdrowych tkanek należy usuwać skręconą lub zawiniętą pod spód tkankę, suchą, stwardniałą lub hiperkeratotyczną tkankę oraz tkankę martwiczą. W tym celu stosuje się opracowanie aktywne (mechaniczne), ostre, ultradźwiękowe lub biologiczne.

  1. etap higieny rany: dobór opatrunku

Dobór opatrunku jest niezwykle istotny, ponieważ opatrunek odpowiada za eliminację wszelkich pozostałości po biofilmie oraz zapobiega zanieczyszczeniom i rekolonizacji.

W doborze opatrunku należy uwzględnić nie tylko to, czy ma on właściwości przeciwbakteryjne i zdolność niszczenia biofilmu, ale również to, czy skutecznie radzi sobie z wysiękiem, potrafi go wchłaniać i zatrzymywać. Takie właściwości mają takie opatrunki jak m.in. AQUACEL® Ag+ Extra™ i AQUACEL® Foam.

Opatrunek AQUACEL® Ag+ Extra™ jest w stanie przerwać i niszczyć strukturę biofilmu, pozbawiając go tym samym ochronnej bariery. Ponadto dzięki zawartości srebra opatrunek jest skuteczny nawet przeciwko antybiotykoopornym drobnoustrojom. Resztki biofilmu pochłaniane są i zamykane w opatrunku, minimalizując możliwość ponownego odrodzenia się.

Opatrunek AQUACEL® Foam dzięki stworzonej w technologii Hydrofiber™ warstwie kontaktowej, która w kontakcie z wysiękiem przekształca się w żel, pchłania nadmiar wysięku i zatrzymuje go w swojej strukturze, co chroni skórę i pozwala zapewnić optymalne środowisko w procesie gojenia rany.

Jak podkreślili autorzy Konsensusu, z uwagi na fakt, że biofilm jest zdolny do szybkiego ponownego uformowania, wielokrotne opracowanie rany może nie wystarczyć. Dlatego, jak zalecają eksperci, niezbędne jest także stosowanie skutecznych miejscowych środków przeciwbakteryjnych, które będą w stanie niszczyć biofilm po jego fizycznym naruszeniu, usunąć jego pozostałości, a także powstrzymać jego ponowne tworzenie się.

Materiał powstał we współpracy z firmą ConvaTec.

 

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