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The National Pressure Injury Advisory Panel, European Pressure Ulcer Advisory Panel, and the Pan Pacific Pressure Injury Alliance are commencing a new (fourth) edition of the Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. The fourth edition of the International Pressure Injury (PI) Guideline will be developed using GRADE methods to ensure a rigorous process consistent with evolving international standards. Clinical questions will address prevention and treatment of PIs, identification of individuals at risk of PIs, assessment of skin and tissues, and PI assessment. Implementation considerations supporting application of the guidance in clinical practice will be developed. The guideline development process will be overseen by a guideline governance group and methodologist; the guideline development team will include health professionals, educators, researchers, individuals with or at risk of PIs, and informal carers.This article presents the project structure and processes to be used to undertake a systematic literature search, appraise risk of bias of the evidence, and aggregate research findings. The methods detail how certainty of evidence will be evaluated; presentation of relative benefits, risks, feasibility, acceptability, and resource requirements; and how recommendations will be made and graded. The methods outline transparent processes of development that combine scientific research with best clinical practice. Strong involvement from health professionals, educators, individuals with PIs, and informal carers will enhance the guideline’s relevance and facilitate uptake. This update builds on previous editions to ensure consistency and comparability, with methodology changes improving the guideline’s quality and clarity.

Objectives:The aim of this study was to establish an international, interorganisational consensus on wound infection terminology.Methods:This project consisted of definition scoping and a Delphi process to produce a consensus glossary for 18 wound infection terms. Recent guidelines/consensus documents were reviewed to identify 2–4 definitions for each term. An online consensus process was undertaken using the RAND Appropriateness Method, a consensus method for panels to reach agreement. International wound organisations nominated experts to participate, from whom 21 participants were selected to represent different organisations, geographic regions and disciplines. In the first consensus round, each term was presented alongside 2–3 definitions and participants nominated their preferred definition, with the majority vote used to select a baseline definition. The consensus process then proceeded, with participants using a 9-point Likert scale to score their level of agreement or disagreement with the definition for each term. Participants also provided a justification outlining the reason behind their rating. At the end of each round, an index was calculated to provide a quantitative evaluation indicating whether agreement or disagreement had been reached.Results:Reasoning statements were summarised and the definitions were adjusted to incorporate concepts identified by participants. The adjusted definition was presented in the next consensus round, together with the reasoning statements. Terms for which a final definition was not achieved in three consensus rounds were finalised with preferential voting using 2–3 definitions that had reached consensus.Project progress and significance:The project generated a glossary of wound infection terms, endorsed through participation of 15 international organisations, for dissemination of guidelines and clinical decision-making/teaching tools.

Abstract:Wound infection is a major challenge for clinicians globally, with accurate and timely identification of wound infection being critical to achieving clinical and cost-effective management, and promotion of healing. This paper presents an overview of the development of the International Wound Infection Institute (IWII)'s 2022 Wound Infection in Clinical Practice consensus document. The updated document summarises current evidence and provides multidisciplinary healthcare providers with effective guidance and support on terminology, paradigms related to biofilm, identification of wound infection, wound cleansing, debridement and antimicrobial stewardship. Integral to the update is revision of wound infection management strategies which are incorporated within the IWII's Wound Infection Continuum (IWII–WIC) and management plan. The aim of the 2022 IWII consensus document update was to provide an accessible and useful clinical resource in at least six languages, incorporating the latest evidence and current best practice for wound infection and prevention. Dissemination techniques for the consensus are discussed and highlighted.

Objective:After launching the 2019 International Pressure Ulcer/Injury Guideline, the National Pressure Injury Advisory Panel (NPIAP), the European Pressure Ulcer Advisory Panel (EPUAP) and the Pan Pacific Pressure Injury Alliance (PPPIA) collaborated with Sensorydata Corp., US, to develop a guideline app (InterPIP App). The app was designed to: present evidence-based guideline recommendations; incorporate search capacities and functionality to facilitate easy access to clinical guidance; provide accessibility in multiple languages; and to be available worldwide at a reasonable price, including opportunities for free access in low-resource countries. This paper describes the development, dissemination and formative evaluation of a mobile app providing evidence-based recommendations for pressure injury prevention, assessment/classification, and treatment at the point of care.Method:An evaluation tool was designed based on a framework developed by Nouri et al. and made available to all app subscribers.Results:The InterPIP App is currently available in 11 languages and had been downloaded 3616 times by February 2022 in 78 countries. A total of 62 individuals responded to the survey of end-users. In this formal evaluation of user experiences, the app was rated positively on criteria of: information/content; usability; design; functionality; ethics; and security/privacy (median=4 on a 1–5 Likert scale). Overall perceived value was ranked lower with a median of three. Users provided suggestions for ongoing app enhancement.Conclusion:The InterPIP App offers a unique opportunity to bring evidence-based guidance to the point of care. Formal evaluation of end-user experiences identified opportunities for quality improvement, and informed plans for future development and evaluation.

The International Pressure Injury Clinical Guideline (NPUAP, EPUAP, PPPIA 2014) is currently being revised. The guideline is used internationally as a resource for nurses and other health professionals to deliver [...]

ObjectiveTo achieve international consensus relating to clinical indicators for a chronic wound, wound infection and biofilm presence to inform the development of international clinical guidance for assessing and managing wound infection.MethodAn online Delphi consensus process of international key opinion leaders in infection was undertaken. A literature search underpinned the development of issue statements related to terminology, emerging topics and debate in the field of wound infection. Experts participated in three rounds of consensus voting, sharing their opinions and indicating their level of agreement with the issue statements. Votes were calculated using web-based software that implements a nominal group voting methodology previously published by Research and Development/University of California at Los Angeles.ResultsA total of 14 experts took part in the development process. Consensus was reached on clinical indicators of wound chronicity, wound infection and biofilm presence. Agreement was also reached that the term ‘critical colonisation’ should no longer be used to refer to a stage in the wound infection continuum.ConclusionOutcomes from the consensus process were used to inform the development of international, evidence-informed guidance on the assessment and treatment of wound infection to promote improved outcomes for people with wounds.

IntroductionIt is well documented that the prevalence of venous leg ulcers (VLUs) is increasing, coinciding with an ageing population. Accurate global prevalence of VLUs is difficult to estimate due to the range of methodologies used in studies and accuracy of reporting.1Venous ulceration is the most common type of leg ulceration and a significant clinical problem, affecting approximately 1% of the population and 3% of people over 80 years of age2in westernised countries. Moreover, the global prevalence of VLUs is predicted to escalate dramatically, as people are living longer, often with multiple comorbidities. Recent figures on the prevalence of VLUs are based on a small number of studies, conducted in Western countries, and the evidence is weak. However, it is estimated that 93% of VLUs will heal in 12 months, and 7% remain unhealed after five years.3Furthermore, the recurrence rate within 3 months after wound closure is as high as 70%.4-6Thus, cost-effective adjunct evidence-based treatment strategies and services are needed to help prevent these ulcers, facilitate healing when they occur and prevent recurrence.The impact of a VLU represents social, personal, financial and psychological costs on the individual and further economic drain on the health-care system. This brings the challenge of providing a standardised leg ulcer service which delivers evidence-based treatment for the patient and their ulcer. It is recognised there are variations in practice and barriers preventing the implementation of best practice. There are patients not receiving appropriate and timely treatment in the initial development of VLUs, effective management of their VLU and preventing recurrence once the VLU has healed.Health-care professionals (HCPs) and organisations must have confidence in the development process of clinical practice guidelines and have ownership of these guidelines to ensure those of the highest quality guide their practice. These systematic judgments can assist in policy development, and decision making, improve communication, reduce errors and improve patient outcomes.There is an abundance of studies and guidelines that are available and regularly updated, however, there is still variation in the quality of the services offered to patients with a VLU. There are also variations in the evidence and some recommendations contradict each other, which can cause confusion and be a barrier to implementation.7The difference in health-care organisational structures, management support and the responsibility of VLU management can vary in different countries, often causing confusion and a barrier to seeking treatment. These factors further complicate the guideline implementation process, which is generally known to be a challenge with many diseases.8

It is important to develop an individualised plan of care for people at the end of life to prevent pressure ulcers, and to treat them if they do occur. This article discusses patient and risk assessment, prevention and care for pressure ulcers for the palliative care patient and the recommendations given in the palliative care section of the Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline(National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance, 2014).

This paper is an update to a systematic review that presents the best available evidence on the factors that are most effective in promoting constructive staff-family relationships in the care of older people in the institutional healthcare setting.

Modern healthcare philosophy espouses the virtues of holistic care and acknowledges that family involvement is appropriate and something to be encouraged due to the role it plays in physical and emotional healing. In the aged care sector, the involvement of families is a strong guarantee of a resident's well-being. The important role family plays in the support and care of the older adult in the residential aged care environment has been enshrined in the Australian Commonwealth Charter of Residents' Rights and Responsibilities and the Aged Care Standards of Practice. Despite wide acknowledgement of the importance of family involvement in the healthcare of the older adult, many barriers to the implementation of participatory family care have been identified in past research. For older adults in the healthcare environment to benefit from the involvement of their family members, healthcare professionals need an understanding of the issues surrounding family presence in the healthcare environment and the strategies to best support it.

Executive summary Background The promotion of sleep in older adults is a significant issue in high-level residential aged care facilities, with as many as 67% of residents experiencing disruptions to their sleep patterns. Not only do health concerns such as cognitive impairment, pain and incontinence impact upon this population's sleep quality and quantity, but environmental factors including noise, light and night-time nursing care also affect sleep of those residing in institutions. In order to address the issue of sleep disruption, assessment and diagnosis of sleep problems and implementation of interventions that are effective in promoting sleep are essential. Objectives The objective of this review was to determine the most effective tools for the assessment and diagnosis of sleep in older adults in high-level aged care. The review also sought to determine the most effective strategies for the promotion of sleep in this population. Outcome measures for this review were: indicators of improved sleep quality and quantity, including an improvement in daytime functioning and improved night-time sleep; reduction in use of hypnotics and sedatives; and increased satisfaction with sleep. Search strategy A literature search was performed using the following databases for the years 1993-2003: AgeLine, APAIS Health, CINAHL, Cochrane Library, Current Contents, Dissertation s International, Embase, Medline, Proquest, PsycInfo, Science Citations Index. A second search stage was conducted through review of reference lists of studies retrieved during the first search stage. The search was limited to published and unpublished material in English language. Selection criteria The review was limited to papers addressing sleep diagnosis, assessment and/or management in adults aged 65 or over who were residing in high-level aged care. The review included randomised controlled trials (RCTs) and, due to the limited number of RCTs available, non-RCTs, cohort and case control studies and qualitative research were also considered for inclusion. Research was included if it addressed the assessment, diagnosis or management of sleep using outcome measure of improved night-time sleep or daytime function, improvements in resident satisfaction with sleep or reduction in medication use associated with sleep. The types of interventions considered by this review were alternative therapies including massage, aromatherapy and medicinal herbs; behavioural or cognitive interventions; biochemical interventions; environmental interventions; pharmacological interventions and related nocturnal interventions such as continence care. Instruments and strategies to diagnose and assess the sleep of older high-level care residents, including objective and subjective assessment tools, were considered by this review. Data collection and analysis All retrieved papers were critically appraised for eligibility for inclusion and methodological quality independently by two reviewers, and the same reviewers collected details of eligible research. Papers were grouped according to the type of intervention or type of assessment tool used and findings were presented in a narrative summary. Findings Wrist actigraphy was found to be the most accurate objective sleep assessment tool for use in the population of interest, and issues surrounding its use are presented. Although no subjective sleep assessment tools were identified in this review, the evidence suggested that subjective reports of sleep quality are an important consideration in sleep assessment. Evidence suggested that behavioural observations may be an effective assessment strategy when conducted on a frequent basis. The review found no evidence on the effectiveness of any assessment tools for the diagnosis of specific sleep problems in older adults. The use of multidisciplinary strategies including reduction of environmental noise, reduction of night-time nursing care that disrupts sleep and daytime activity is likely to be the most effective strategy for the promotion of sleep in older high-level care residents. The use of sedating medications did not appear to have a substantial effect in promoting sleep, and health practitioners in high-level aged care should consider their use cautiously.

The article reports that the International Pressure Injury Clinical Guideline is undergoing a revision. Topics discussed include the function of the guideline as a resource for preventing pressure injuries that nurses and other healthcare professionals can use, the international pressure injury-related health organizations leading the revision of the guideline and the ways in which the developers of the guideline are trying to get patients involve in the revision work.