Chronicle
the
The Newsletter of the Queensland Wound Care Association
EDITOR’S NOTE
INDEX
Welcome to the 2011 Spring edition of The Chronicle.
Features
Edition 31 – Spring 2011
2011/2012 QWCA Committee
This edition provides highlights of recent and
upcoming events, including planned activities for
Case Study Report: Getting the pressure out
of the bend
Sub-Groups, the QWCA Conference in Townsville,
Article: Qld Government leaves wounded behind
and a case study report on a very challenging wound
management consultation. In addition you’ll find an
article written for us from a recent client, giving the
consumer’s point of view.
Regulars
From the President’s Desk
An Update from AWMA
Secretariat’s Report
The upcoming Summer edition of The Chronicle will
include a Conference report and some articles based
on the presented papers for the benefits of those
who were unable to attend.….. The overall feedback
from Conference delegates and Trade Exhibitors was
extremely favourable.
Upcoming Events
Wound Management Education/Courses in
Queensland
Crossword
As we move from Spring into Summer, I would like
ARE YOU AN ‘ELEPHANT’?
to invite all Members to share their experiences
Most wound sufferers receive no public funding on Medicare
and knowledge and consider contributing an
or PBS for their treatment………… “The Elephant in the
article or short ‘snap report’ for publication in The
Room” Campaign is calling on the Federal Government to
Chronicle. This could consist of recent evaluations of
examine this health problem and make a firm commitment
innovations in practice, case studies, involvement
to solving it.
in research projects or information gained from
QWCA supports this campaign and encourages members,
attendance at conferences or seminars. We are starting
up a regular ‘Case Study’ corner in the newsletter,
so pull out any cases you have found interesting
or challenging to share with your colleagues. All
contributions are very welcome!
Kathy Finlayson, RN, PhD
(k.finlayson@qut.edu.au)
WOUND
AWARENESS
WEEKS
15TH - 28TH
MARCH 2010
their colleagues and patients to not be ‘elephants’.
What you can do?
Sign the on-line petition
and encourage colleagues,
patients and carers to sign.
Go to:
www.elephantintheroom.com.au
Wounds affect
over
QWCA CHRONICLE SPRING 2011
1
YOUR NEW QWCA COMMITTEE FOR 2011/2012
At the QWCA Annual General Meeting in September, the
following members were elected to the QWCA Management
Committee:
President: Dr Di Smith
Vice President: Donna Hickling
Education/Research Officer: Damian Williams
Editor/Public Relations: Kathleen Finlayson
State Representative to AWMA: Michelle Gibb
Committee members: Kerrie Coleman, Sarah Elliott,
Maree Francis, Ewan Kinnear, Glenda Phillips
Treasurer: Nancy Magazinovic
FROM THE PRESIDENT’S DESK …
You will start to see a transition in the QWCA logo in the
coming months to the new AWMA Qld logo as confirmed
at our meeting earlier this year.
Information on the 2012 Wound Awareness Week will be
forthcoming in the Summer edition of The Chronicle but it
is never to early to plan your event concept for that week!!
Michelle Gibb
Immediate Past QWCA President
AN UPDATE FROM AWMA
STATE REPRESENTATIVE REPORT
The AWMA restructuring process is progressing
and to date we have achieved most of the steps in
the first phase:
­• Commonality of Association name – Australian Wound
Management Association Queensland Incorporated
(AWMA Queensland Inc)
• Adoption of a new Logo / letterhead
• Adoption of basic membership entitlements nationally
(no change to current Queensland membership
entitlements)
­• Migration of all state and territory Web site into
AWMA Web site – current Queensland page will be
improved
­• National Membership Secretariat engaged to manage
all membership matters throughout Australia.
QWCA MEMBER
FEEDBACK SOUGHT…
The Draft Pan Pacific Clinical Practice Guideline
for the Prevention and Management of Pressure
Injury were launched at the Pan Pacific Pressure
Ulcer Forum & Venous Leg Ulcer Forum in
Canberra in October 2011. The AWMA, together
with Pan Pacific partners, invites your feedback on
the consultation draft of this Guideline.
The Guideline is available for free download on
the AWMA Website and feedback can be provided
online.
Feedback is required by 15 December, 2011
Further details and links can be found here:
http://www.awma.com.au/news/news74.php
Upcoming AWMA events nationally:
• AWMA Conference 2012, 18th – 21st March 2012,
Sydney. Information available at www.awma2012.com
Di Smith
Incoming QWCA President &
QWCA Representative to AWMA
QWCA CHRONICLE
SPRING 2011
2
CASE STUDY
GETTING THE PRESSURE OUT OF THE BEND: A TALE OF
RESOLVING A PRESSURE AREA WITHIN A CONTRACTED LEG
Kerrie Coleman, Dip ApSc, BNSc, MN Clinical (Wound Management), MN(Chronic Disease), Nurse
Practitioner Complex Wound Management, Royal Brisbane and Women’s Hospital, Queensland
Introduction
An 84 year old gentleman was admitted to our facility with
a large ulcer posterior to the left knee (popliteal area) from
a nursing home. He was lying on his side, had significant
lower limb contractions and was emaciated. He was
bought in by ambulance due to “increase in wound size
with surrounding redness and pain”. The wound had been
present for 4–5 weeks, progressively deteriorating over time.
The patient and family denied any trauma to the area. The
wound had been reviewed by his local GP and the patient
had completed two courses of oral antibiotics with last
course completed five days ago. The staff reported that the
area started as a fungal skin infection secondary to wetness
inside the contracted knee. Almost all of popliteal fossa and
tendons were exposed.
First review by skin integrity team: 5th June, leg opened to
maximum flexion causing patient distress (Figure 1.)
Past Medical History
- Chronic AF
- Ischaemic Heart Disease
- Hypertension
- T2 diabetes
- Prostate Ca
- Partial gastrectomy for gastric ulcer
- Paget’s disease
- CVA with left sided hemiparesis
Medications
- Amlodipine
- Citalopram (ceased on d/c)
- Gliclazide
- Irbesartan
- Metoprolol
- Omeprazole
- GTN patch
- Isophane NPH insulin
- Movicol
- Polyvinyl alcohol
- Temazepam
- Coloxyl senna
- Polaramine
- Paracetamol
Allergies
Metformin toxicity previously, nil other stated allergies
Social History
The patient resided in a nursing home and required partial
assistance for feeding, full assistance for dressing, bathing
and toileting; and was faecal and urinary incontinent and
wheel chair bound. The family had requested the transfer to
the hospital and were very concerned about the contracted
left leg and exposed tendons.
QWCA CHRONICLE
SPRING 2011
3
CASE STUDY cont’d
GETTING THE PRESSURE OUT OF THE BEND: A TALE OF RESOLVING A PRESSURE AREA
WITHIN A CONTRACTED LEG
Physical Examination
On initial examination the patient was found to have severe
contractions of the left knee, elbow and wrist with the right
side having normal muscle tone. His vital signs were: PR
60, BP 82/52mmHg, T 36.6C. He was dehydrated with his
skin turgor being reduced (tenting), tongue coated and dry.
The wound size was 3x2cm, with a gaping hole in the left
popliteal fossa. Tendons exposed wound base thick slough.
There was surrounding erythema and nil odour. The patient
denied pain but declined physical examination due to pain/
discomfort, especially when attempting to straighten the
left leg. No obvious joint swelling was present. No heat or
redness was extending from the wound. Peripheral pulses
were difficult to palpate, both lower limbs were pale and cool
to touch and there was poor capillary refill.
Investigations
- Wound swab revealed mixed coliforms 3+ and MRSA
(new case of MRSA)
- Blood cultures NAD
- WCC 13.6 (3.5-11.0)
- Haemoglobin
99 g/L (120-180)
- Neutrophils 10.36 (2.0-8.0)
- CRP 97 mg/L (<5.0)
- Sodium & Chloride marginally below normal
- Urea
17.2 (3.0-8.0)
- Creatinine 151 (70-120)
- Albumin 28 g/L (33-47)
- X-ray no periosteal reaction, osteolysis or chronic new
bone formation detected. There is no other indirect
evidence of osteomyelitis. There is vascular calcification
in the popliteal artery.
Problem List
- Chronic ulcer query pressure or Fungal /Infection
- Dehydration
- Poor nutrition
- Contraction of involved limb
Wound Management
The skin integrity team was called in by the Medical
Registrar for an opinion regarding wound management at
the same time as being reviewed by the Plastics team. The
patient was a poor surgical candidate, therefore surgical
debridement was not available. The plastics team ordered
QID normal saline soaks with ribbon gauze. At the next
Plastics review, slough was still present but not as thick
and tenacious. They suggested a trial of topical negative
pressure (TNP). Another referral to the skin integrity service
was received as staff were unable to get a seal with TNP. In
discussion with the Plastics team, the dressing was changed
to a daily Hypertonic gauze dressing.
Management of Contraction
The medical team had discussed with Orthopaedics if
there was any benefit of surgically releasing the contracture
to allow access. If this was not viable there was discussion
regarding an above knee amputation. The patient did not
use the left leg to facilitate transfer. The family were refusing
surgery of any kind at this time and wanted to ensure that all
medical options had been explored. Occupational therapy
reported 80 degree flexion of knee only and at this time
no splints would be suitable to try and assist with further
improvement of flexion. The medical team discussed with
Neurology regarding the use of Botox injections to reduce
the contraction. Neurology thought the effect would likely
be limited by fibrous bands and the condition would not
meet funding criteria. The high cost of this medication
would need to be funded by the hospital and most likely the
patient would still need surgical release. Plastics suggested
applying traction to improve the contracture mechanically
(2.5-3 kg), however Orthopaedics reported that the use of
traction would not improve the situation and would most
likely increase his pain.
Pain Control
There was a need to improve his pain control, the patient was
on regular Panadol but was still experiencing intermittent
pain. The team added Endone PRN and prior to wound
dressings. This was found to be effective for the patient.
Management Issues
The family were distraught and very concerned that their
father would be sent back to the nursing home without any
resolution of the wound. This caused significant problems
at the ward level. A family and team meeting was requested
to try and resolve some of the issues.
The main issue for the patient was the contracture of his left
leg not allowing easy access to visualise and dress the wound.
Attempts to straighten the leg caused significant pain.
QWCA CHRONICLE
SPRING 2011
4
CASE STUDY cont’d
GETTING THE PRESSURE OUT OF THE BEND: A TALE OF RESOLVING A PRESSURE AREA
WITHIN A CONTRACTED LEG
Discussion
At the time, the issue of using Botox to reduce the contraction
had not been resolved. The remaining two options being
considered at that point were amputation or discharge back
to the nursing home for dressings. The family were against
amputation and it was considered that the wound would
be unlikely to fully heal if the contraction could not be
released, or at a minimum reduced. It was then suggested
to discharge the patient back to the nursing home on daily
dressings. However, the family wished to relocate their father
to another nursing home if this was the option chosen.
that the best way forward was to amputate the limb, but
this was not what the patient or the family felt was in the
patient’s best interest. With the inclusion of a multi-modal
management approach we were able to successfully move
the wound forward from non-healing to healing.
Conclusion
Initially there was a negative approach to the management
of the wound, mainly due to the chronic nature and difficulty
in overall management. It had originally been perceived
QUEENSLAND GOVERNMENT LEAVES WOUNDED BEHIND
David De Witt
Elderly and chronic wound sufferers are being forced to
leave serious injuries untreated without any support from
the Queensland Government according to medical experts
and sufferers.
Eighty-one-year-old Jim Cassidy wrestled with costs
averaging over $100 a week for 11 years to properly treat
the painful ulcers on both his legs and said the Government
should have better supported him.
Chronic Wounds
• Affect more than 270,000 Australians
• Cost the health system more than $2.6 billion
annually
• Chronic wounds can develop from scratches,
ulcers and simple operations.
• Can cost wounds sufferers over $100 a week
• Wound sufferers are often older adults or those
from lower socio-economic backgrounds who
struggle to afford costs
• Over 50% of chronic wounds reoccur within 5
years of healing
• Chronic wounds often take over 15 years to heal
• Many chronic wounds are preventable with
proper treatment and care.
Michelle Gibb treats a patient as part of the Wound Healing Community Outreach
Service at QUT Health Clinics, specialising in chronic wounds.
“I’ve worked and paid taxes all my life. I know I’m an old
model and it’s easy to forget about us middle aged and
elderly…but you’d think the Government would give us
rebates or let us claim costs. I only have my pension, it was
a struggle,” he said.
Mr Cassidy said while he had serious problems himself, he
hated to think about all the people who could not manage to
pay for the dressings.
During the recent Wounds Awareness Week, the Australian
Wound Management Association lobbied to bring the
financial struggles of wound sufferers into the public spotlight.
QWCA CHRONICLE
SPRING 2011
5
QUEENSLAND GOVERNMENT LEAVES WOUNDED BEHIND cont’d
Queensland Wound Care Association President Michelle
Gibb said wound sufferers were slipping through the gaps
of the health system and struggled to get proper care and
support in busy hospitals and then after release.
“Improperly managed chronic wounds can affect someone’s
quality of life in many ways from increased pain, reduced
mobility, depression and social isolation,” Ms Gibb said.
Despite the serious consequences of these wounds, the costs,
over $100 a week, means a majority of sufferers struggle and
often fail to afford the extra weekly expense, she said.
Nurse practitioner Kerrie Coleman, coordinator of the
Wound Clinic at the Royal Brisbane and Women’s Hospital,
said not taking steps to dress these wounds would lead to
life-threatening infections if left uncared for.
“The government has underestimated the effect of wounds
on Australians. It needs to be thought of like obesity…its
just something we don’t talk about. Wound care just isn’t
sexy.
“Diabetics get insulin provided, why not chronic wound
sufferers?”
Queensland Minister for Health Geoff Wilson said subsidies
are available through the Federal Government for eligible
people likely to have large medical bills because they need
ongoing care.
“Any Queenslander who is treated in our hospitals is given
free wound dressings,” Mr Wilson said.
Ms Coleman argues this isn’t enough to financially support
the great number of Queenslanders long-term after they
leave hospital.
“You often see patients who could not afford dressings readmit themselves into the crowded hospitals to get the care
they needed,” she said.
Mr Cassidy travelled to the Royal Brisbane and Women’s
Hospital three days a week for eight years but said the
hospital did not have the money or time to properly treat
his wounds.
After transferring to Michelle Gibb’s specialised practice
in Kelvin Grove he discovered the wounds had become
cancerous and was forced to have two operations.
“ It was frustrating…to know earlier treatment could’ve
prevented lots of pain and suffering…the hospitals just
don’t have the money to give us the proper attention and I
couldn’t afford a biopsy,” he said.
“Tell the Government not to forget about us.”
Shadow Minister for Health Mark McArdle did not return
calls to comment.
Tweet:
Queenslanders suffering chronic wounds
demand government funding to meet the $100
p/week financial burden.
UPCOMING EVENTS
QWCA Cairns & Hinterland Sub Group
Assessment and Management of Acute Burn Injuries
Presenter: Kristen Storey, NUM, RCH Burns Unit,
Brisbane
Date: Wednesday 7 December 2011
Venue: Cairns Diabetes Centre, Sheridan Street, North Cairns
Time: 3.30pm – 4.30pm
Visitors Welcome
RSVP: by 1 December – Jo_Sobb@health.health.qld.au /
07 4226 6477
2012 AWMA Conference
10th National Australian Wound Management
Association Conference
Harbouring Wound Care
18 – 21 March 2012
Sydney Convention & Exhibition Centre
www.awma2012.com
3rd Australasian Wound and Tissue Repair
Society Conference
Repair and Regeneration
22 – 24 May 2012
Dockside, Cockle Bay, Darling Harbour
http://awtrsasdr2012.mtci.com.au/
Fourth Congress of the World Union of Wound
Healing Societies (WUWHS)
Better Care – Better Life
2 – 7 September 2012
Pacifico Yokohama, Japan
http://wuwhs2012.com/
For more details on these and other Conferences,
please visit the AWMA website – www.awma.com.au
QWCA CHRONICLE
SPRING 2011
6
QWCA EDUCATION EVENING ACKNOWLEDGEMENTS
The QWCA would like to thank and acknowledge the
contribution of the speakers and sponsors for all our
education evenings. Our 2011 presenters and sponsors were
as follows:
19th April
Presenter: Jennie Banks, Clinical Nurse Consultant
TSG, Townsville Hospital.
Topic: Complicated and challenging wound management
Venue: Townsville Hospital
Sponsor:
12th May
Presenter: Dr Ken Thistlethwaite, Medical Director,
Wesley Centre for Hyperbaric Medicine, Qld.
Topic: Review of the evidence for Hyperbaric Oxygen Therapy to treat
chronic wounds
Presenter: Katrina Rooke, Hyperbaric Medicine
Service, Royal Brisbane & Women’s Hospital, Qld.
Topic: Review of the evidence for Hyperbaric Oxygen Therapy to treat
acute wounds
Presenter: Damian Williams, Clinical Nurse Consultant
Wound Management, Prince Charles Hospital.
Topic: Wound Photography
21st June
Presenters: Sue Gordon (Clinical Nurse – Palliative
Care), and Judy Metcalfe (Clinical Nurse – Transition
Care).
Venue: Townsville Hospital
Topic: Management of Palliative Wounds
Sponsor:
7th July
Presenter: Julie Boal, Clinical Nurse – Homeless
Program, Spiritus Care Services.
Topic: Wound Care in the Homeless Program.
Presenter: Prof. Helen Edwards, Head, School of
Nursing & Midwifery, Queensland University of Technology.
Topic: Psychosocial factors and wound healing outcomes
Sponsor:
20th September
Topic: Feedback on the QWCA 2011 Wound Management Conference
21st September
Venue: Royal Brisbane and Women’s Hospital
Sponsors:
Presenter: Maggie Whitehead
Topic:Referral and Assessment of Hight Risk Foot
Sponsor:
17th May
18th October
Presenter: Amanda Trezona, Occupational Therapist,
Townsville Hospital.
Topic: Scar Management
Venue: Townsville Hospital
Sponsor:
31st May
Presenter: Rav Iluri & Ravi, Occupational Therapists,
Maryborough Hospital.
Topic: Occupational Therapy and Wound Care
Venue: Maryborough Hospital
Sponsor:
Presenter:
Derelle
Young,
A/CNC
Wound
Management, Townsville District Health Service
Topic: Wound Management and Hyperbaric O2 Therapy
Sponsor:
10 November
Presenters: Damian Williams, Dr Dianne Smith,
Jane O’Brien, Kerrie Coleman
Topic: A Potpourri of Case Studies
Venue: The Education Centre, TPCH
Sponsors:
7th June
Presenter: Wendy White, Clinical Nurse Consultant,
Lecturer in Wound Management.
Topic: Wound Pain
Venue: Cairns Base Hospital
Sponsor:
QWCA CHRONICLE
SPRING 2011
7
SECRETARIAT’S REPORT – MEMBERSHIP
Total Financial Members 661
QWCA Sub Groups
Please note that some of the Sub Groups have not been
very active in the last 12 months, the Committee will review
each Sub Groups and update in the next edition of The
Chronicle. All education updates will be sent to all members.
Cairns & Hinterlands Darling Downs/Toowoomba Fraser Coast Central Queensland/
Rockhampton Sunshine Coast/Gympie Townsville/Tropical North 53 members
56 members
53 members
65 members
86 members
77 members
QWCA Fraser Coast Sub Group
Townsville Sub Group Report
COMMITTEE MEMBERS 2011/2012
By: Townsville Sub Group Secretary, Katherine
Lang
President / Chairperson
Theresa Winston: Theresa_winston@health.qld.gov.au
Secretary
Cheryl Manning: Cheryl_manning@health.gld.gov.au
Treasurer
Deb Mahony: tfpnursedeb@hotmail.com
Education Resource Officer
Helen Gibson: Helen_gibson@health.qld.gov.au
Committee Member
Joanne Proudley: joanne_proudley@health.qld.gov.au
This has been another year of exciting and interesting
evening seminars for the Townsville Sub Group. It has
been very heartening to see that attendances have grown.
We hope that this is an indication that Townsville is able to
offer varied and interesting presenters as strong drawcards.
Topics have ranged from nutrition, scar management,
biodebridement, management of palliative wounds,
complex wounds and a paper on calciphylaxis.
The Sub Group’s award & prize for International Nurses
Day, donated to the Townsville Hospital Nursing Research
Unit was presented to Nadine Laffin & Tania Bennett for
their research project on skin care in radiation therapy.
The year’s high note was be having the QWCA 2011 State
Conference in town.
We wish to thank all out presenters, sponsors and
supporters for making this another successful year for the
Sub Group.
Fraser Coast Wound Awareness Week
(left to right) Helen Gibson, Chris Murree, Marie Gilmore, Paula Falk
QWCA CHRONICLE
SPRING 2011
8
WOUND MANAGEMENT EDUCATION / COURSES IN QUEENSLAND
Master of Clinical Practice (Wound Management)
(via distance education)
Contact
Jenny Anastasi
School of Nursing & Health Studies
Central Queensland University, Rockhampton Campus,
Queensland 4700
Phone: 07 4930 9823
Email: j.anastasi@cqu.edu.au
QUT Wound Management Education 2011
Fundamentals of Wound Care Workshop
Wed 30 Nov & Thurs 1 December
Further Information
For further course details including information on
registration fees, venue and to register your attendance
access the following website:
http://www.cpe.qut.edu.au/course_pages/2011/
WMEC011.html
Contact Information
For
course
details:
woundhealing/index.jsp
http://www.ihbi.qut.edu.au/
For further information regarding course content please
contact:
Michelle Gibb
Nurse Practitioner Wound Management
Wound Healing Community Outreach Service
Institute of Health & Biomedical Innovation
Queensland University of Technology
60 Musk Avenue Kelvin Grove Qld 4059
Phone: 07 3138 6109
Email: michelle.gibb@qut.edu.au
More References
A list of courses throughout Australia is available on the
AWMA website (www.awma.com.au). In addition, Wound
Practice and Research without implying endorsement of
education programs, lists providers of wound management
courses.
If you or your Organisation offers wound
management education or have an upcoming
event that you would like to advertise in the QWCA
The Chronicle, please contact Secretariat Martin
Bishop, (07) 3348 7380 or email info@qwca.org.au
See your work published!
Moving?
All members are encouraged to submit material
for inclusion in The Chronicle. This can be in the
form of research results, book reviews, management
dilemmas and wound care problems, as well as reports
and feedback on wound care events. This is YOUR
newsletter.
If your contact details have changed (email, phone or
address), remember to advise the QWCA Secretariat
to ensure you continue to receive information from
Queensland Wound Care Association.
Reports are requested to be emailed to: info@qwca.org.au
Deadline for Summer Edition:
Friday 3rd December 2011.
Disclaimer
The opinions expressed by authors are their own and not necessarily those of the Queensland Wound Care Association,
the Editor, nor the Management Committee. The Queensland Wound Care Association, the Editor and the Management
Committee therefore accept no responsibility for the accuracy of statements appearing within. If in any doubt, please seek
expert advice before commencing treatment.
QWCA CHRONICLE
SPRING 2011
9
QWCA 2011 BIENNIAL WOUND
MANAGEMENT CONFERENCE
Wound Care –
New Horizons
8-10 SEPTEMBER • JUPITERS TOWNSVILLE
QWCA would like to thank all our Sponsors and Exhibitors
Platinum Sponsor
Gold Sponsors
Silver Sponsors
QWCA CHRONICLE
SPRING 2011
10
WOUND CROSSWORD 10
ACROSS
Dr Dianne Smith
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3
1. Remove necrotic tissue and bacteria from
wound (8)
4. Superficial burn caused by hot liquid or
steam (5)
7. Inner side of the body (6)
9. Organism infected by a pathogen (4)
12. Oxygen dependent bacteria (7)
13. Reluctant and difficult (12)
15. Area around the ankle and lower calf (6)
16. Apple Isle wound management group (4)
19. Type of joint deformity (7)
21. Blood sucking invertebrate (5)
23. Chemical element with antibacterial and
antifungal activity (6)
25. Deep vein thrombosis (3)
27. Type of vapour permeable sheet dressing (4)
28. Type of bandage impregnated with gelatinglycerin-zinc paste (4)
29. Disease of the kidney (11)
30. Dried serous exudate on wound surface (4)
34. Phagocytic white blood cell (8)
36. Type of skin cancer (abbreviation) (3)
39. Type of leg ulcer secondary to hypertension (9)
40. AWMA branch for wound care research
scientists acronym (5)
41. Fungal infection (7)
42. Wound care technique (7)
43. Localised area of hard skin (6)
46. Skin pigment (7)
47. Silver’s chemical symbol (2)
48. Fat (7)
49. Latin red (5)
E
S
G
36
L
I
A
G
T
A
E
T
29
R
I
A
O
L
A
N
2. Wound care product with high water content
in polymer matrix (3)
3. Pertaining to the back of the body (9)
4. Lateral curvature of the spine (9)
5. To split apart (4)
6. Gram negative bacterium (13)
7. Visible to the naked eye (11)
8. Clinical examination by feeling with the hands (9)
10. Wound care organisation in South Australia
acronym (5)
11. Northern Territory Wound Management group
acronym (4)
14. Thin tissue layer (6)
15. Standard microbiological laboratory stain (4)
17. Mobility aid (10)
18. Prevents bacteria from multiplying (14)
20. ‘Non-self’ substances (7)
22. Epithelial lined tube from the outside of the
body to an internal cavity (5)
24. Alcohol containing solution for painting on
skin surface (8)
26. Fibrous scar tissue abnormally connecting
structures (8)
31. Latin term for heat (5)
32. Bacterial load on wound surface (9)
33. Advanced state of poor health (8)
35. Capable of being stretched without tearing (7)
37. Push or pull (5)
38. Protein in connective tissue that provides
flexibility (7)
41. Rate of moisture passage through a dressing
material and evaporation (abbreviation) (4)
42. Australia’s professional wound care
organisation acronym (4)
44. Final stage of wound healing (4)
45. Colour indicating granulating wound (3)
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QWCA CHRONICLE
SPRING 2011
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