Tissue Viability- November 2014

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Table of Contents

Cochrane Reports. 2

National Guidelines. 2

Pressure Relieving Equipment 2

Pressure Ulcers – prevention and safeguarding. 4

Skin Assessment – grading, care, integrity issues. 6

SSKIN Bundles - effectiveness. 6

HCAS and Role in Tissue Viability. 6

HEFT Libraries-Good Hope, Heartlands and Solihull 8


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Pressure Ulcer Info App

An app has been developed for the prevention and management of pressure ulcers by a team from Society & Health, working with the NHS and Social Service partners as well as the private and independent sector in North West London, through funding from Health Education North West London. The app accesses a range of educational materials for patients and carers (family, domiciliary, care homes).

•        For laptops and desktops:

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Cochrane Reports


MCGINNIS, E. and STUBBS, N., 2014. Pressure-relieving devices for treating heel pressure ulcers. Cochrane Database of Systematic Reviews, (2), pp. 1-31.

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Nutritional interventions for preventing and treating pressure ulcers

Gero Langer and Astrid Fink Online Publication Date: June 2014


Risk assessment tools for the prevention of pressure ulcers

Zena EH Moore and Seamus Cowman Online Publication Date: February 2014

National Guidelines


Pressure ulcers: prevention and management of pressure ulcers. NICE guidelines [CG179] Published April 2014.


Pressure Ulcers –NICE Pathway


Parafricta Bootees and Undergarments to reduce skin breakdown in people with or at risk of pressure ulcers (MTG20)

Medical Technology Guidance Published November 2014.

NICE issues final guidance on ‘spray-on skin’ technology for healing burn wounds, and garments to prevent pressure ulcers

Published November 2014.

The Debrisoft monofilament debridement pad for use in acute or chronic wounds (MTG17)

Medical Technology Guidance Published March 2014.

EPUAP-NPUAP-PPPIA International Pressure Ulcer Guidelines released Sept 2014.


Pressure Relieving Equipment

Pressure-Sensing Technology Helps Caregivers Prevent Ulcers. 2014. Wounds: A Compendium of Clinical Research & Practice, 26(4), pp. A14

AMBUTAS, S., STAFFILENO, B.A. and FOGG, L., 2014. Reducing nasal pressure ulcers with an alternative taping device. MEDSURG Nursing, 23(2), pp. 96-100.

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BAATH, C., IDVALL, E., GUNNINGBERG, L. and HOMMEL, A., 2014. Pressure-reducing interventions among persons with pressure ulcers: results from the first three national pressure ulcer prevalence surveys in Sweden. Journal of evaluation in clinical practice, 20(1), pp. 58

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BATEMAN, S., DAWN, 2014. Utilising a foam positioning device for preventing pressure ulcers on the feet. Wounds U K, 10(1), pp. 78.

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BERRY, L., 2014. Referrals for equipment in relation to the scope and degree of heel damage: an audit. Wounds U K, 10(2), pp. 32.

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BOYAR, V., HANDA, D., CLEMENS, K. and SHIMBORSKE, D., 2014. Clinical experience with Leptospermum honey use for treatment of hard to heal neonatal wounds: case series. Journal of Perinatology, 34(2), pp. 161

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CALLAGHAN, R., 2014. Treating difficult-to-debride wounds using a manuka honey dressing: a case study evaluation.

Wounds U K, 10(2), pp. 104.

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CAVANAGH, N., O'BRIEN, N. and VICKERS, A., 2014. The developing role of the pressure area care equipment coordinators in a large acute trust. Wounds U K, 10(2), pp. 64.

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CHARLTON, S., 2014. Pressure ulcer grading and appropriate equipment selection. British Journal of Nursing, 23(15), pp. S4.

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CLEGG, R., PALFREYMAN, S., 2014. Elevation devices for the prevention of heel pressure ulcers: a review. British journal of nursing, 23 Suppl 20, pp. S4-S11.

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COLLIER, M., POTTS, C. and SHAW, E., 2014. Use of a coverlet system for the management of skin microclimate. British Journal of Nursing, 23(15), pp. S28, S30-5.

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FLETCHER, J., HARRIS, C. and MAHONEY, K., 2014. A small-scale evaluation of the Dolphin Fluid Immersion Simulation(R) Mattress. Wounds U K, 10(1), pp. 97.

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GLASGOW, D., MILLEN, I.S., NZEWI, O.C. and VARADARAJARAN, B., 2014. Device-related atypical pressure ulcer after cardiac surgery. Journal of wound care, 23(8), pp. 383.

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HUGHES, M.A., 2014. Silicone pressure-reducing pads for the prevention and treatment of pressure ulcers. British journal of community nursing, Suppl, pp. S46-52.

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JIN, Z., BO, X., QIUYUE, T. and WUYONG, C., 2014. Application of the sheepskin mattress in clinical care for pressure relieving: a quantitative experimental evaluation. Applied Nursing Research, 27(1), pp. 47-53.

JONES, L., FLETCHER, J., 2014. Improved patient experience and outcomes using the Dyna-Form™ Mercury Advance mattress. Wounds UK, 10 (4).

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LEVY, A., KOPPLIN, K. and GEFEN, A., 2014. An air-cell-based cushion for pressure ulcer protection remarkably reduces tissue stresses in the seated buttocks with respect to foams: Finite element studies. Journal of tissue viability, 23(1), pp. 13-23.

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LIPPOLDT, J., PERNICKA, E. and STAUDINGER, T., 2014. Interface Pressure at Different Degrees of Backrest Elevation With Various Types of Pressure-Redistribution Surfaces. American Journal of Critical Care, 23(2), pp. 119.

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MASTERSON, S. and YOUNGER, C., 2014. Using an alternating pressure mattress to offload heels in ICU. British Journal of Nursing, 23(15), pp. S44-S49.

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MILBRATH, D., LINROTH, R., WILHELMY, J. and PATE, A., 2014. A Method of Comparing: Effectiveness of Mattresses for Pressure Management for Pediatric Patients. Journal of nursing care quality, 29(1), pp. 66


MOORE, Z., STEPHEN, J. and CALLAGHAN, R., 2014. Prevention and management of pressure ulcers: support surfaces. British Journal of Nursing, 23(6), pp. S36, S38-43.

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NEWTON, H., 2014. Evaluating a pressure-redistribution mattress replacement system. British journal of nursing, 23 Suppl 20, pp. S30-35.


ROBERTSON, F., THOMSON, H. and SIDDIQUI, H., 2014. Side effects of compression stockings: a case report. British Journal of General Practice, 64(623), pp. 316-317.

SONENBLUM, E., VONK, E., JANSSEN, W. and SPRIGLE, H., 2014. Effects of Wheelchair Cushions and Pressure Relief Manoeuvres on Ischial Interface Pressure and Blood Flow in People With Spinal Cord Injury. Archives of Physical Medicine & Rehabilitation, 95(7), pp. 1350-1358.

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Note: Collection notes: You will need to register (free of charge) with Clinical Key the first time you use it.


SUSSMAN, G., 2014. Ulcer dressings and management. Australian Family Physician, 43(9), pp. 588-592.

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TASKER, L.H., SHAPCOTT, N.G., WATKINS, A.J. and HOLLAND, P.M., 2014. The effect of seat shape on the risk of pressure ulcers using discomfort and interface pressure measurements. Prosthetics & Orthotics International, 38(1), pp. 46-53.

WHITE, R., 2014. The alginogel Flaminal®: an overview of the evidence and use in clinical practice. Wounds UK, 10 (3).

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WIEGAND, C., WHITE, R., 2014. An introduction to the regulation of wound healing by micromechanical forces. Wounds UK, 10 (3).

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ZHANG, Q.H., YUE, J.H. and SUN, Z.R., 2014. Electroacupuncture for pressure ulcer: a study protocol for a randomized controlled pilot trial. Trials, 15:7.

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Pressure Ulcers – prevention and safeguarding

Continuous Bedside Pressure Mapping Reduces Pressure Ulcers. 2014. AACN Bold Voices, 6(7), pp. 9-10.

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Nurse-led pressure ulcer project produces fast, impressive results. 2014. Nursing Standard, 28(32), pp. 8.

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Updated guidance on pressure ulcer prevention issued. 2014. Nursing Older People, 26(5), pp. 6.

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ACKROYD-STOLARZ, S., 2014. Improving the prevention of pressure ulcers as a way to reduce health care expenditures. CMAJ: Canadian Medical Association Journal, 186(10), pp. E370-E371.

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AYGOR, H., ESKIIZMIRLI, SAHIN, S., SOZEN, E., BAYDAL, B., AYKAR, F., SENUZUN and AKCICEK, F., 2014. Features of pressure ulcers in hospitalized older adults. Advances in Skin and Wound Care, 27(3), pp. 122-126.

BEHRENDT, R., GHAZNAVI, M., MAHAN, M., CRAFT, S. and SIDDIQUI, A., 2014. Continuous Bedside Pressure Mapping and Rates of Hospital-Associated Pressure Ulcers in a Medical Intensive Care Unit. American Journal of Critical Care, 23(2), pp. 127-133.

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BIGLARI, B., BUCHLER, A., REITZEL, T., SWING, T., GERNER, H.J., FERBERT, T. and MOGHADDAM, A., 2014. A retrospective study on flap complications after pressure ulcer surgery in spinal cord-injured patients. Spinal Cord, 52(1), pp. 80-83.


BISHOP, H. and DROSTE, R., 2014. Pressure Ulcer Prevention in the Patient with Spinal Cord Injury on Hemodialysis. Nephrology Nursing Journal, 41(1), pp. 93-99.

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BRENNAN, R. and LACONTI, D., 2014. Using Conformational Positioning to Reduce Hospital-Acquired Pressure Ulcers. Journal of nursing care quality, 29(2), pp. 182-187.

CAMERON, R., RODGERS, A., WELSH, L. and MCGOWN, K., 2014. Developing eLearning for pressure ulcer prevention and management. British Journal of Nursing, 23(15), pp. S16-S23.

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CLARK, M., BLACK, J., ALVES, P., BRINDLE, C., CALL, E., DEALEY, C. and SANTAMARIA, N., 2014. Systematic review of the use of prophylactic dressings in the prevention of pressure ulcers. International Wound Journal, 11(5), pp. 460-471.

COBB, J.E., BELANGER, L.M.A., PARK, S.E., SHEN, T., RIVERS, C.S., DVORAK, M.F., STREET, J.T. and NOONAN, V.K., 2014. Evaluation of a pilot Pressure Ulcer Prevention Initiative (PUPI) for patients with traumatic spinal cord injury. Journal of wound care, 23(5), pp. 211-227.

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CRAWFORD, B., CORBETT, N. and ZUNIGA, A., 2014. Reducing Hospital-Acquired Pressure Ulcers. Journal of nursing care quality, 29(4), pp. 303-310.

DELLEFIELD, M., ELLEN and MAGNABOSCO, L., 2014. Pressure ulcer prevention in nursing homes: Nurse descriptions of individual and organization level factors. Geriatric nursing, 35(2), pp. 97-104.

DOWNIE, F., 2014. Pressure ulcer prevention: how documentation can help. Wounds U K, 10(2), Suppl, 1 pp. 14-18.

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GADD, M., 2014. Braden scale cumulative score versus subscale scores: are we missing opportunities for pressure ulcer prevention? Journal of Wound, Ostomy and Continence Nursing, 41(1), pp. 86-89.


GILLESPIE, M., CHABOYER, W., SYKES, M., O'BRIEN, J. and BRANDIS, S., 2014. Development and Pilot Testing of Patient-Participatory Pressure Ulcer Prevention Care Bundle. Journal of nursing care quality, 29(1), pp. 74.


GRZELA, T., NIDERLA-BIELINSKA, J., LITWINIUK, M., WHITE, R., 2014. The direct inhibition of MMP-2 and MMP-9 by an enzyme alginogel: a possible mechanism of healing support for venous leg ulcers. Journal of wound care, 23(5), pp. 278-285.

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HAM, W., SCHOONHOVEN, L., SCHUURMANS, J. and LEENEN, P.H., 2014. Pressure ulcers from spinal immobilization in trauma patients: a systematic review. Journal of Trauma & Acute Care Surgery, 76(4), pp. 1131-1141.

HOPPER, B., MORGAN, S., 2014. Continuous quality improvement initiative for pressure ulcer prevention. Journal of Wound, Ostomy and Continence Nursing, 41(2), pp. 178


JAQUES, H., 2014. Prevention and treatment of pressure ulcers. Nursing times, 110(8), pp. 19.

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JOHANSEN, E., MOORE, Z., VAN, M. and STRAPP, H., 2014. Pressure ulcer risk assessment and prevention: What difference does a risk scale make? A comparison between Norway and Ireland. Journal of wound care, 23(7), pp. 369-379.

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KEEN, D., CATHERINE and GAUDARIO, M., 2014. Implementing pressure ulcer prevention in a Welsh nursing home... including commentary by Arkley K. Journal of Community Nursing, 28(4), pp. 38-48.

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KISS, A. and HEILER, M., 2014. Pediatric Skin Integrity Practice Guideline for Institutional Use: A Quality Improvement Project. Journal of pediatric nursing, 29(4), pp. 362-368

MCGINNIS, E., GREENWOOD, D.C., NELSON, E.A. and NIXON, J., 2014. A prospective cohort study of prognostic factors for the healing of heel pressure ulcers. Age & Ageing, 43(2), pp. 267-71.


MEEHAN, A. and BEINLICH, N., 2014. Peer-to-peer learning/teaching: An effective strategy for changing practice and preventing pressure ulcers in the surgical patient. International Journal of Orthopaedic & Trauma Nursing, 18(3), pp. 122-129

MEESTERBERENDS, E., WILBORN, D., LOHRMANN, C., SCHOLS, M.G.A., MGA and HALFENS, J.G., JG, 2014. Knowledge and use of pressure ulcer preventive measures in nursing homes: a comparison of Dutch and German nursing staff. Journal of Clinical Nursing, 23(13), pp. 1948-1958.


MOORE, Z., STEPHEN HAYNES, J., CALLAGHAN, R., 2014. Prevention and management of pressure ulcers: support surfaces. British Journal of Nursing, 23(6), pp. S36-43.

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NEILSON, J., AVITAL, L., WILLOCK, J. and BROAD, N., 2014. Using a National Guideline to Prevent and Manage Pressure Ulcers. Nursing Management - UK, 21(2), pp. 18-21.

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OLSHO, E.W., SPECTOR, D., WILLIAMS, S., RHODES, W., FINK, V., LIMCANGCO, R. and HURD, D., 2014. Evaluation of AHRQ's On-Time Pressure Ulcer Prevention Program: A Facilitator-assisted Clinical Decision Support Intervention for Nursing Homes. Medical care, 52(3), pp. 258-266.

PADULA, W.V, MISHRA, K., MAKIC, F., BETH and VALUCK, J., 2014. A framework of quality improvement interventions to implement evidence-based practices for pressure ulcer prevention. Advances in Skin and Wound Care, 27(6), pp. 280-284.

PARK, K.H., 2014. The effect of a ceramide-containing dressing in preventing pressure ulcers. Journal of wound care, 23(7), pp. 347-353.

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PAYNE, D., 2014. How to…prevent, manage and treat pressure ulcers Nursing and Residential 16(6), pp. 356–356. Full Text

SCHLUER, A.B., SCHOLS, J.M. and HALFENS, R.J., 2014. Risk and associated factors of pressure ulcers in hospitalized children over 1 year of age. Journal for Specialists in Pediatric Nursing: JSPN, 19(1), pp. 80-89.


STANSBY, G., AVITAL, L., JONES, K. and MARSDEN, G., 2014. Prevention and management of pressure ulcers in primary and secondary care: summary of NICE guidance. BMJ (Clinical Research Edition), 348(7955).

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SVING, E., IDVALL, E., HOGBERG, H. and GUNNINGBERG, L., 2014. Factors contributing to evidence-based pressure ulcer prevention. A cross-sectional study. International Journal of Nursing studies, 51(5), pp. 717-726.


VAN, G.I., GI, SCHOONHOVEN, L., MINTJES-DE, A.J., AJ, DEFLOOR, T., HABETS, H., VOSS, A., VAN, A., THEO and KOOPMANS, T.C.M., TCM, 2014. Concurrent Incidence of Adverse Events in Hospitals and Nursing Homes. Journal of Nursing Scholarship, 46(3), pp. 187.

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WELSH, L., 2014. Ethical issues and accountability in pressure ulcer prevention. Nursing Standard, 29(8), pp. 56.


WHITE, R., 2014. An interview with Richard White. British journal of community nursing, pp. S54-S55.

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Pressure ulcers: avoidable or otherwise?

Wounds UK, 10 (4). 

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Skin Assessment – grading, care, integrity issues

BUTCHER, M., WHITE, R., 2014. Factors affecting cost-effectiveness in wound care decision making. Nursing standard, 28(35), pp. 51-58.

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BUTCHER, M., WHITE, R., 2014. Remedial action in the management of wound-related pain. Nursing standard, 28(46), pp. 51-60.

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CHARLTON, S., 2014. Pressure ulcer grading and appropriate equipment selection. British Journal of Nursing, 23(15), pp. S4-S13.

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GARCIA-FERNÃNDEZ, F., PEDRO, AGREDA, J., SOLDEVILLA, VERDU, J. and PANCORBO-HIDALGO, L., 2014. A New Theoretical Model for the Development of Pressure Ulcers and Other Dependence-Related Lesions. Journal of Nursing Scholarship, 46(1), pp. 28-38.

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GRAP, M., JO, SCHUBERT, K., CHRISTINE, LUCAS, V., MUNRO, C., BURK, R. and WETZEL, P., 2014. EB108 Ultrasound Scanning for Evaluation of Skin Integrity in the Critically Ill: Procedures for Obtaining the Best Scan. Critical Care Nurse, 34(2), pp. e31-e32.

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HIGASHINO, T., NAKAGAMI, G., KADONO, T., OGAWA, Y., IIZAKA, S., KOYANAGI, H., SASAKI, S., HAGA, N. and SANADA, H., 2014. Combination of thermographic and ultrasonographic assessments for early detection of deep tissue injury. International Wound Journal, 11(5), pp. 509-516.


Predictive Validity of 4 Risk Assessment Scales for Prediction of Pressure Ulcer Development in a Hospital Setting. Advances in Skin & Wound Care. 27(2):70-76.


KOTTNER, J., KENZLER, M. and WILBORN, D., 2014. Interrater agreement, reliability and validity of the Glamorgan Paediatric Pressure Ulcer Risk Assessment Scale. Journal of Clinical Nursing, 23(7), pp. 1165-1170.

OUSEY, K., 2014. Identifying and categorising skin damage. Wounds U K, 10(2), Suppl, 1 pp. 20-23.

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POKORNY, E., ROSE, M., ANN, WATKINS, F., SWANSON, M., KIRKPATRICK, K. and QIANG, W., 2014. The Relationship Between Pressure Ulcer Prevalence, Body Mass Index, and Braden Scales and Subscales: A Further Analysis. Advances in Skin & Wound Care, 27(1), pp. 26-31.


RUTHERFORD, C., NIXON, J., BROWN, J.M., LAMPING, D.L. and CANO, S.J., 2014. Using mixed methods to select optimal mode of administration for a patient-reported outcome instrument for people with pressure ulcers. BMC Medical Research Methodology, 14:22.

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TUME, N., SINER, S., SCOTT, E. and LANE, S., 2014. The prognostic ability of early Braden Q Scores in critically ill children. Nursing in critical care, 19(2), pp. 98-104.


WHITE, R., COOPER, R., 2014. Biofilms in wounds: the chicken or the egg? Journal of wound care, 23(8), pp. 425.

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WHITE, R.J., 2014. Flaminal enzyme alginogel: a novel approach to the control of wound exudate, bioburden and debridement. Journal of tissue viability, 23(2), pp. 78-80.

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SSKIN Bundles - effectiveness

SMITH, A., 2014. Pressure ulcer prevention... This practice profile is based on NS711 Jones D (2013) Pressure ulcer prevention in the community setting. Nursing Standard. 28, 3, 4755. Nursing Standard, 28(31), pp. 61.

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HCAS and Role in Tissue Viability



BEINLICH, N. and MEEHAN, A., 2014. Resource nurse program: a nurse-initiated, evidence-based program to eliminate hospital-acquired pressure ulcers. Journal of Wound, Ostomy and Continence Nursing, 41(2), pp. 136.

BURCH, J., 2014. Looking after the stoma and the surrounding peristomal skin. Nursing & Residential Care, 16(4), pp. 190.

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CLOTHIER, A., 2014. Do no harm: reducing pressure ulcers in a care home setting. Independent Nurse, 14 pp. 25.

JONES, M., LLOYD, 2014. Personal hygiene 3.2: anatomy and physiology (A&P) of the skin. British Journal of Healthcare Assistants, 8(8), pp. 374-376.

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MURPHY, C., 2014. Keeping Australia's nurses safe: the importance of choosing and using gloves correctly. Australian Nursing and Midwifery Journal, 21(9), pp. 44. Full Text

OMERY, A., MUSSELL, D., RONDINELLI, J., ECKER, M., BAKER, J., SHANKS, H. and KLEINHELTER, P., 2014. Under pressure: Nursing interventions help prevent HAPUs. Nursing Management (USA), 45(4), pp. 36

PIEPER, B. and ZULKOWSKI, K., 2014. The Pieper-Zulkowski Pressure Ulcer Knowledge Test. Advances in Skin and Wound Care, 27(9), pp. 413






The following sources have been searched for evidence published in the previous three months Please contact the editor for further information.


  • British Journal of Nursing
  • Cochrane Library
  • European Pressure Ulcer Advisory


  • National Patient Safety Agency
  • NHS Institute for Innovation and Improvement
  • NHS Scotland Guidelines
  • NICE Guidelines
  • Nursing Older People
  • Nursing Standard
  • Nursing Times
  • Wound Essentials
  • Wound UK


Some key Nursing journals were also scanned. For a full list of sources used for the update, Please contact the Editor for further information.



































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