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The aim of this study was to measure the prevalence of (infected) chronic wounds in Dutch nursing homes and to explore which signs and symptoms are used to diagnose infected chronic wounds. Moreover, it was to determine which structural quality indicators related to chronic wound care at ward and institutional levels were fulfilled. In April 2012, as part of the annual National Prevalence Measurement of Care Problems of Maastricht University [Landelijke Prevalentiemeting Zorgproblemen (LPZ)], a multi-center cross-sectional point-prevalence measurement was carried out together with an assessment of relevant care quality indicators. The prevalence was 4·2%; 16 of 72 (22%) chronic wounds were considered to be infected. Increase of exudate (81·3%; n = 13), erythema (68·8%; n = 11), pain (56·3%; n = 9) and wound recalcitrance (56·3%; n = 9) were considered to be diagnostic signs and symptoms of a chronic wound infection. Although at institutional level most quality indicators were fulfilled, at ward level this was not the case. Despite the relatively low number of residents, we consider our population as representative for the nursing home population. It may be an advantage to appoint specific ward nurses and to provide them specifically with knowledge and skills concerning chronic wounds.

This study investigated the number and type of chronic wounds actually treated by Dutch nursing home physicians (NHPs). It was also the goal to know how many of the treated chronic wounds they considered infected. The NHPs were asked to choose and rank their top five out of several provided criteria for chronic wound infection. After this, the ranking was compared with the choices an international multidisciplinary Delphi group of wound experts made in 2005. A cross-sectional descriptive survey was conducted using the information from a self-reported questionnaire in a representative sample of Dutch NHPs. About 361 NHPs (25%) were sent a questionnaire. Of the 361 physicians, 139 (38.5%) filled in and returned the questionnaire of which 121 were valid. Of the NHPs, 73.5% actually treated at least one chronic pressure ulcers (PU), whereas 26.5% did not treat any. Of the responding NHPs,31.6 % treated at least one, but never more than two chronic post surgical wounds , whereas 68.4% of the NHPs treated none [corrected]. Chronic venous leg ulcers, arterial ulcers and diabetic ulcers scored infrequently and less than the other two sorts of chronic wounds. Of the Dutch NHPs, 53% considered that none of the PU infected. The other chronic wounds were judged far less frequently to be infected. Dutch NHPs appeared to use more 'traditional' criteria such as 'puss/abscess' and 'malodour' to identify infection and did not change their criteria by wound type. According to this study, NHPs do not frequently see many chronic wounds. The most frequent type of wounds treated was PU. For NHPs, the identification of infection of all types of chronic wounds is difficult. The use of criteria that is not in line with consensus documents may lead to ineffective treatment and even seriously damage patients: the clinical identification of infection is still dependent on experts' opinion. Further research on triggers for the suspicion of wound infection and the development of an evidence-based guideline is necessary.

The effect of Lactobacillus plantarum 299v on the bacterial composition and metabolic activity in faeces of healthy volunteers: a placebo-controlled study on the onset and duration of effects. Goossens D, Jonkers D, Russel M, Stobberingh E, Van Den Bogaard A, StockbrUgger R. Departments of Gastroenterology and Medical Microbiology, University Hospital Maastricht, Maastricht, The Netherlands. Dominique.Gossens@intmed.unimaas.nl AIM: To study the onset and duration of a possible effect of a fermented oatmeal drink containing Lactobacillus plantarum 299v on the composition of the faecal flora of healthy volunteers in a placebo-controlled, double-blind study. METHODS: Twenty-two participants consumed a fermented oatmeal drink with or without L. plantarum 299v for 4 weeks. Faecal samples were collected weekly: two samples before, four during and four after the consumption of the drink. Several bacterial species were counted and enzyme activities, short-chain fatty acid concentrations, endotoxin concentration and pH were determined. L. plantarum 299v was identified using randomly amplified polymorphic DNA. RESULTS: In contrast with the placebo group, median lactobacilli counts increased significantly from 4.2 (3.4-6.3) to 8.2 (7.3-8.5) log colony-forming units/gram faeces (P = 0.005) after 1 week of consumption of L. plantarum 299v, thereafter remaining stable during the treatment period. One week after cessation, a significant decrease in lactobacilli [to 4.4 (2.2-6.5) log colony-forming units/gram faeces] was observed (P = 0.003). These lactobacilli were identified as L. plantarum 299v. All other bacterial counts, enzyme activities, short-chain fatty acid concentrations, endotoxin concentration and pH remained unchanged. CONCLUSIONS: L. plantarum 299v significantly increased the number of lactobacilli in the faecal flora within 1 week, and this effect disappeared within 1 week after cessation of intake. No other changes in bacterial counts and metabolic products were observed.