A COMPLETE PROGRAM

The management of wounds presents a financial, legal and ethical challenge to healthcare organizations and

health caregivers. Wound management

requires a multidisciplinary, individualized, scientifically sound approach. All Patients at risk should be placed on a protocol as outlined by the Agency for Health Care Policy and Research. All patients with wounds should be managed in a manner consistent with

current documented principles of moist wound management. Medix Pharmaceuticals Americas, Inc. recognizes the value of incorporating the A.H.C.P.R. standards and guidelines into a Wound Management Program. When developing a protocol, MPA offers "BiafineFirst" an optimal, cost effective, wound management program that delivers positive clinical outcomes. Successful Wound

Management Programs Include all of the following components:

Identifying individuals at risk should be done initially, then routinely using an assessment tool such as, the Braden scale. Push tool, etc. Assessment should include nutrition, sensory perception, psychosocial, managing tissues loads, wound care, managing bacterial colonization and infection, operative repair and education. All patients at risk should have a daily skin inspection and documented observations. An important part in maintaining and improving tissue tolerance is to minimize dry-ness and control moisture, either from incontinence, perspiration or a draining wound.

The goal is to protect patients against the adverse effects of external mechanical forces, [pressure, shear and friction]. At risk bed bound patients should be repositioned every two hours. Devices should be used to keep bony prominences from direct contact with one another. Completely immobile, bedridden individuals should have devices to relieve pressure on heels. When side lying; avoid positioning directly on the trochanter. Maintain the head of bed at the lowest degree of elevation consistent with medical conditions [30 degrees]. Limit the amount of time the head is elevated. Use lifting devices to move individuals. At risk chair bound patients should be repositioned every one-hour, and those who can change their own position, should be taught to do so every 15 minutes. Individuals at risk should be placed on a pressure reduction device,

When apparently well nourished individuals develop an inadequate intake, the health care provider should assess factors compromising intake, offer support with eating, provide nutritional supplements and suggest more aggressive nutritional interventions, such as Nutritional Support consults.

There is a high correlation between non-healing wounds and high bacterial counts as seen in necrotic tissue. Through effective wound cleansing, debridement and dressing choice, colonization can be minimized. Foul odor is usually associated with anaerobic organisms but not always with infection. Healing can be impaired when bacterial levels exceed 10 organisms per gram of tissue, or if osteomyelitis is present. IV, IM, oral antibiotics and wound culture are preferred if signs and symptoms of infection are systemic.

Dressing selection should be aimed at keeping the wound continuously moist, control exudate, removal of non-viable tissue, and eliminate dead space. Frequency of dressing changes, caregiver time, healing time and cost effectiveness should also be considered.

BIAFINE^?. MODES OF ACTION

BIAFINE^?is and oil in water emulsion that provides deep hydration, transferring over 40% of its' water content into the underlying tissue the first hour of application. It has an emollient action to soften tissues, black eschar or other non-viable tissues, and aids in autolytic debridement It significantly increases the amount of macrophages recruited to the wound site, and protects the wound from harmful germs and contaminants. BIAFINE? is the first wound dressing emulsion to impact all three phases of the wound healing process and is compatible with exudates (osmolarity changes). BIAFINE^?  is water-soluble, making it very user friendly. Because it is a usual once a day dressing change, BIAFINE^?usage will decrease product costs, and caregivers time. BIAFINE^?contains a non-toxic; herbal based fragrance, and has been very well tolerated for over 25 years.

Education programs should be structured, organized; comprehensive and directed at all levels of health care providers, patients & families. Educational offerings should address, risk & skin assessment, support surface selection, skin care program implementation, good hand washing, universal precautions, positioning, documentation and be responsible to the needs of the learner.

THE BiafineFirst? WOUND CARE PROTOCOL

Assess Patient Risk for Skin Breakdown Utilizing the Appropriate Skin Management Tool/Scale.

Norton ? Braden ? Push

? Implement Turning Plan
? Instruct Responsible Parties
? Post Turning Schedule Documentation Form
? Chart/Record All Activity.
? Choose Appropriate Support Surfacing Products for Bed/Chair
? Prevent Further Breakdown, Pressure and Shear

Heel Protection ? Wheelchair Pad ? Chair Pad Overlay ? Therapeutic Mattress ? Air Mattress

? Monitor Intake & Output
? Assist with Feedings
? Provide Nutritional Supplements
? Request a Nutritional Support Consult

Stage I-IV Pressure Ulcers
Surgical Wounds
Ischemic Ulcers
Hypertensive Ulcers
Traumatic Wounds
1st and 2nd Degree Burns
Undermining
Diabetic Ulcers
Venous Ulcers
Vasculitic Ulcers
Acute Wounds
Skin Tears
Dry Skin Conditions
Tunneling

BIAFINE^?is effective on many types of wounds, making it extremely versatile.

AUTDLYTIC DEBRIDEMENT

Apply a generous amount [1/4 to 1/2 inch thick] of BIAFINE^? on and around the necrotic area. Area may be crosshatched using sharp instrument to accelerate debndement.

Cover with a semi-permeable membrane or gauze, depending on the amount of exudate [i.e., semi-permeable membrane for low exudate and gauze for moderate to heavy exudate.]

Repeat applications and dressing changes daily, or as necessary until autolytic debridement is achieved.

ELIMINATING DEAD SPACE If wound is heavily exudating, generously impregnate a fluffed 4x4[s] with BIAFINE pack dead space; top with dry 4x4[s] gauze and a protective dressing(s].

If wound is lightly exudating, first moisten gauze with saline, then generously impregnate with BIAFINE pack dead space; top with lightly moistened 4x4[s] and a protective dressing[s].

ALL WOUNDS

Cleanse or irrigate area with sterile saline or wound cleanser. If necrotic tissue or other non-viable tissue is present, consider sharp or autolytic debridement [see instructions above] using BIAFINE.

Apply 3 generous amount [1/4 to 1/2 inch thick] of BIAFINE in and around the wound surface, making sure to eliminate dead space [see instructions above].

Cover with a moistened 4x4(s] and a protective dressing[s].

Change dressing every 24 hours, or as necessary, depending on the amount of exudate.

1st & 2nd DEGREE BURNS 

Cleanse or irrigate area with sterile saline or wound cleanser.

Completely cover the burned and surrounding areas with a generous amount [1/4 tol/2 inch thick] Of BIAFINE.

Cover with lightly moistened 4x4[s] or other protective dressing(s|.

Change dressing every 24 hours, or as necessary depending upon the severity of the burned area.

TUNNELING AND UNDERMINING

Irrigate areas with sterile saline or wound cleanser using a bulb syringe and light pressure.

Using a "needleless" syringe, remove the plunger and squeeze the amount of BIAFINE required directly into the barrel of the syringe, replace the plunger, and inject the BIAFINE directly into the tunneling and/or undermining completely filling the cavity. Moistened strip gauze may be used if packing is required.

DRY SKIN CONDITIONS

Massage BIAFINE into affected area until emulsion is absorbed.

Repeat every 24 hours

For severely dry skin, repeat application 2-3times daily.

INFECTED WOUNDS

BIAFINE can be used on infected wounds provided that first, you cleanse and disinfect then follow the same application as given for "ALL WOUNDS."

Swab cultures only reflect surface bacteria, and do not accurately diagnose wound infection.

If a wound develops clinical signs of related sepsis, obtain a blood culture and treat with specific antibiotics to cover the identified organism.