Invasive GAS in Long Term Care Facility 2016 - Wound Car

Study ID #: _R

Appendix 3. Invasive GAS in Long Term Care Facility 2016

Wound Care Survey

Form Approved; OMB No. 0920-1011

Exp. Date 03/31/2017

A. Employee Background	1. Name: 2. Age:
3. Sex:  Male  Female	4. Employed at Facility since: ______/______/______
5. What is your level of professional training on the wound care team?  RN  MD  LPN  LVN  Other___________ 6. a. Have you received training in infection control practices?  Yes  No  Unknown b. If yes, when was your most recent training?  < 1month  2-6 months  6-12months  >1year
B. Wound care	7. How many new wound consults do you see per day?  0-4  5-9  10 or more
8. On average, how many patients with wounds do you see per day?  0-10  10-20  20-30  30 or more 9. a. When evaluating a new consult or reassessing an old patient, do you perform a full skin examination?  Yes  No b. If so, how do you report new wounds found on your exam?  Medical Chart  Report to Nurse  Report to Doctor  Other 10. Is there a standardized risk assessment tool used to document skin breakdown/ pressure ulcer formation (e.g. Braden Scale)  Yes  No  Unknown 11. How often do you reassess wounds and document wound healing?  Daily  3-7 days  8-14 days  Monthly  Quarterly  Other: _________ 12. What types of care do you perform on the wound care team?  Incision and Drainage  Undressing/Redressing  Cleaning wound  Wound vac care  Other: ______________________ 13. Have you ever discovered pieces of foam/cotton gauze present in the wound from previous dressing changes?  Yes  No  Unknown
C. Negative-pressure wound therapy	14. Have you been specifically trained in the use of negative-pressure wound therapy?  Yes  No
15. If so, when was your most recent training?  < 1month  2-6 months  6-12months  >1year 16. How many residents require negative-pressure wound therapy/wound vac? _________ 17. What type of wound vac is used at your facility?______________________________ 18. Who is responsible for the original placement and replacement of the wound vac?  Patient RN  CNA  MD  Only wound care team  Other 19. Who is allowed to change the wound vac cartridges and settings? (select more than 1 if applicable)?  Patient RN  CNA  MD  Only wound care team  Other 20. How often is a patient with a wound vac reassessed?  Daily  2-3xweek  Weekly  Monthly  Other 21. Are their patients per week are found to have full drainage cartridges or fluid backing up into the drainage tubing? 22. If yes, how would this issue be reported?  Medical Chart  Report to Nurse  Report to Doctor  Other 23. When replacing the wound vac on the same patient, are any of the following re-used? (select more than 1 if applies)  foam/gauze  adhesive dressing  drainage tubing  other 24. If worsening wound is observed, is the wound vac replaced before a physician consult?  Yes  No  Symptoms specific 25. If symptoms specific please specify what symptoms would prompt you to replace the wound vac before a physician consult? 26. What symptoms for a “worsening wound” prompts a physician consult?  change in character of drained fluid  increase in fluid drainage  increasing erythema  pain  increase in size

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