Wound Management Resources

Wound care in the UK has long been overlooked, often treated as a consequence of underlying health conditions rather than a distinct medical concern. However, as the prevalence of chronic wounds continues to rise, it is becoming increasingly evident that this perspective is unsustainable. Chronic wounds impact around 7% of the UK population, imposing a substantial burden on both patients and the healthcare system, with the NHS spending over £8.3 billion annually to manage the issue (Making wound care work: 9). Despite these alarming figures, wound care services remain understaffed and undervalued, straining to meet the rising demand for their expertise (Making wound care work: 4). 

A recent economic analysis has reported a £8.3 billion cost to the NHS for wound management. This overwhelming cost has meant alternate wound management strategies are needed. One example is a Hospital @ Home (H@H) negative pressure wound therapy (NPWT) service, whereby patients are discharged from hospital with an open wound and traditional NPWT (tNPWT) and/or single-use (sNPWT) is provided in their own home. The aim of the service evaluation presented here, which was conducted from the H@H nurse base within Brighton General Hospital, was to highlight the clinical outcomes of utilising NPWT in a homecare setting, to assess changes in patient quality of life through a validated instrument, and to understand the anticipated cost savings to the NHS. Thirty-one patients, all of whom had received surgical intervention resulting in an open wound requiring NPWT and were receiving H@H NPWT, were included in the evaluation. A statistically significant reduction in wound dimentions and improvement in patient reported general quality of life was found. Overall, the delivery of this H@H NPWT service enables patients to return home, with ongoing wound management which results in wound closure. The service evaluation also enabled a cost saving analysis to be reported, suggesting that this locally implemented H@H service can reduce costs of approximately £5,256 per patient by utilising H@H NPWT compared to hospital inpatient managed NPWT.

Wound care specialist and NHS supplier, Daylong Direct, is introducing the world’s first adhesive-free, wearable wound care solution specifically designed for people living with hidradenitis suppurativa (HS), HidraWear, to the UK.

Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease that causes recurrent and painful nodules, boils, abscesses and lesions of the skin (Revuz, 2009). This recurrent and often painful disease is frequently overlooked and can have a profound impact on a patient’s quality of life (Matusiak, 2018).

The founder of HidraWear, Suzanne Moloney, has been living with HS for decades. She and her team have successfully listed HidraWear for reimbursement through the public health service in Ireland, making it the first country in the world to make HS specific dressings available through its public health provision. She is now working with Daylong Direct towards making HidraWear available for patients on prescriptions in the UK. Here, she talks about the difficult journey to getting her diagnosis, the daily struggles of living with HS, and the importance of raising awareness of the condition.

HARTMANN UKI has launched a new initiative — HOME (acronym for holistic, outline, manage, evaluate/educate) — to help healthcare professionals introduce and manage shared-care solutions for patients at home.

Appropriate and accurate assessment and management of lower limb wounds requires a timely, holistic assessment of the patient and their wound, including the recording of an ankle-brachial pressure index (ABPI) (Wounds UK, 2019a). A manual ABPI procedure requires advanced skills, using a handheld ABPI device, and is undertaken by a healthcare professional who is appropriately trained. In addition, the procedure is time consuming, taking a minimum of 40 minutes, and is subjective in its results, based on the technique and skill of the operator. This article describes an innovative service evaluation project that has seen the introduction of 20 automated ABPI machines into 19 general practices and a community vascular clinic in Staffordshire. The project has included the development of a care pathway, recruitment of wound champions, and training within each of the practices. Evaluation of the project is ongoing but tracks ABPI readings, assessment and wound management of patients, onward referrals and outcomes for patients, to ensure that the project’s potential to improve patient care is realised.

Evidence suggests that biofilm is present in at least 78% of nonhealing wounds, and it is widely accepted that its presence may be a cause for delayed healing in some patients. As the majority of chronic wounds are managed in a community setting, it is important that clinicians have an understanding of what biofilm is, how to identify its presence in the wound, and how to carry out biofilm-based wound care (BBWC). AQUACEL® Ag+ Extra™ is a unique dressing that has been specifically designed to manage biofilm. It combines antimicrobial and anti-biofilm components, which work in synergy to successfully disrupt biofilm, expose microorganisms to the broadspectrum antimicrobial activity of ionic silver in chronic wounds and to help prevent biofilm re-formation, thus making it worthy of inclusion in the biofilm care pathway. 

Meningococcal disease is a contagious bacterial condition that can result in life-threatening sepsis as well as the development of extensive blistering and lesions. This article presents the topical management regimen for one young patient’s wound care in conjunction with the community and outpatient paediatric teams. Practical tips on how to manage complex wounds in children will be outlined to demonstrate that such cases can be managed effectively by nursing teams in a relaxed home environment and outpatient setting, preventing readmission and supporting the emotional recovery of the child and parents. The success of this case study and the reintegration of the child back into daily life and school was attributed to the joint working and collaboration between parents and child, and tissue viability, paediatric and community nursing teams.

There are a number of mechanisms at play that can delay wound healing. Wounds can become stuck in a prolonged inflammatory stage resulting in high volumes of wound exudate, which contains agents that contribute to delayed healing. Exudate plays an essential role in wound healing but at excessive volumes it can also facilitate biofilm formation, which can further delay healing. Maintaining optimum levels of exudate is vital for healthy wound healing, as is the prevention or disruption of biofilm formation in the wound bed. This article also looks at Sorbion Sachet S® (BSN medical), a triedandtested uperabsorbent dressing, which is now back on the Drug Tariff, but at a lower price. This article discusses the mechanisms used in the reintroduced superabsorbent dressing and how it provides a cost-effective solution to the problem of treating highly exuding chronic wounds where clinical efficacy and budgetary concerns are both top priorities.

Depending on the patient’s presenting factors, managing complex or ‘hard-to-heal’ wounds can be a significant challenge for the community nurse. Increased longevity, while a positive also means that people are surviving medical and surgical procedures which were life-threatening in the past, with a 20% reduction in avoidable deaths. The delivery of complex community wound care is not a new concept, however, it is dependent on a number of factors such as the expectations of commissioners, providers, and health and social care policymakers, as well as the patient and the skill of the clinicians performing the care. Financial cutbacks in the NHS have also had a negative impact on the delivery of some community healthcare services. This article investigates whether all of these factors have impacted on the amount of complex wounds now being managed in the community setting.

The specialty of wound care is one that has expanded exponentially in modern times with a plethora of theories and technologies, including wound bed preparation, the role of proteases, negative pressure wound therapy (NPWT), and an almost bewildering array of dressing formulations, from antimicrobials to larval-based products. However, for the clinician on the ground who may not have time to appraise all the theory — or indeed afford all of the new technologies — there is still a high premium placed on having a range of wound care dressings that can be used on a variety of wounds, are simple to use, patientfriendly, and, increasingly important in this day and age, cost-effective (Chandan et al, 2009). In a follow-up to a previous article (Morgan, 2015), this piece looks at one particular dressing (Actilite Protect®; Advancis Medical) and reviews the latest in a series of case studies that show how it can be effective in a range of wounds, in particular infected wounds, due to its innovative use of honey.