The publication of Guest et al’s study on the economic burden that acute and chronic wounds have on the NHS has provided a national picture and a better understanding of the true cost of wound care (Guest et al, 2015).
One thousand patients’ notes held within the Health Improvement Network (THIN) database were retrospectively examined and cost differences between having a wound or not were analysed. Indeed, from assessing wound care service delivery and costs for the year 2012/13, based on 2013/14 prices, the study estimated that the cost amounted to £5.3 billion, which is on a par with obesity treatment costs. The study also identified that the majority of wound care takes place in a community setting and is nurse-led. Guest et al (2015) has been cited in several recent studies and has even been raised in a debate in the house of Lords. The study also suggested that a ‘high proportion of wounds were unclassified’, highlighting shortcomings in undertaking wound assessment and accurate documentation.
The community nurse may come across a range of wounds in the community setting, particularly with the rise in comorbidities such as diabetes and cardiovascular disease due to unhealthy lifestyles and an ageing population. Accurate assessment is the key to identifying the most appropriate wound treatment programme; one that will promote healing and/or relieve symptoms associated with chronic wound healing. Product choice is secondary to getting the assessment process right and accurate assessment and methodical documentation not only help protect against legal challenges, but also aim to reduce waste, dressing change frequency (and thereby nurse time), and patient discomfort. The community nurse should always seek to match their wound-healing knowledge with what they see in the wound bed and the patient’s history, which in turn will enable the nurse to make informed therapy choices and provide expert patient advice.
A chronic heavily exuding wound can have a devastating impact on a patient’s quality of life, often resulting in symptoms such as increased pain, depression, anxiety and stress, as well as a loss of independence and social isolation. For community nurses, wounds with high levels of exudate can incur increasing costs, both in time and resources. It is imperative to heal these wounds as quickly as possible and the community nurse should undertake a robust and holistic assessment before implementing a clear and evidence-based management plan, potentially including wound debridement and the use of an effective absorbent dressing in combination with compression therapy, where appropriate, to manage exudate. This article examines the development of chronic wounds and the problem of excess exudate production specifically, before going onto look at the benefits of one particular superabsorbent dressing (Flivasorb®; Activa Healthcare/L&R). The author uses extensive evidence as well as clinical expertise to provide an overview of the dressing, and presents a case study to demonstrate its benefits in practice.
Throughout history, it has been observed that wounds tended to heal more quickly with fewer complications when larvae found their way onto open wounds. Larval therapy (LT) is used for the debridement of chronic wounds and to create a wound bed conductive to effective healing. The aim of this article is to discuss the effectiveness of larval therapy for the debridement of chronic wounds through a critical analysis of the relevant literature.
Laura Wood, BA (Nursing). Previously Staff Nurse, AMU, Heartlands Hospital, Birmingham
Mark Hughes RGN, DN, HV, BSc (Hons), MSc, PGCE, Lecturer, University of Birmingham
Article accepted for publication: December 2012
Sylvie Hampton, Andy Kerr & Cathie Bree-Aslan discuss the use of oxygen on intractable wounds and describe three case studies using OxyzymeTM
Sylvie Hampton MA, BSc (Hons), Dp SN, RGN is a Tissue Viability Consultant
Andy Kerr RN, Dip HE is a Tissue Viability Consultant
Cathie Bree-Aslan RGN, Dip N., RS Hom, Dip HERB is a Tissue Viability Consultant, Eastbourne Wound Healing Centre
Article accepted for publication: May 2008
Yvonne Franks discusses the use of low level LASER therapy in the management of chronic wounds.
Jacky Edwards unravels some of the mysteries of growth factors used in wound healing.
Jacky Edwards BSc (Hons), PGDE, DSPN, RGN, ENB 264, 998, 870, N49 is a Clinical Nurse Specialist, South Manchester University Hospitals Trust
Article accepted for publication May 2001.
In her fourth article, Rosie Pudner discusses the use of iodine in wound care.
Rosie Pudner BA (Hons), RGN, RCNT, DipN.Ed, Dip.App.S.S.(Open) is a Senior Lecturer - Tissue Viability, Faculty of Health and Social Care Sciences, Kingston University and St. George’s Hospital Medical School, London
Article accepted for publication April 2001.
Sylvie Hampton explores the definition of slough and the biofilms of bacteria that inhabit it and will review methods of successfully debriding a wound of necrotic tissue and slough.
Sylvie Hampton MA BSc (Hons) DpSN RGN. Article accepted for publication: March 2005
Sylvie Hampton gives an overview of wound bacteria and their effect on wound healing
Sylvie Hampton MA BSc (Hons) DpSN RGN Tissue Viability ConsultantEastbourne
Article accepted for publication: August 2007
