Wound Care Resources

Venous leg ulcers (VLUs) are known to place a significant burden on healthcare services, with unhealed ulcers costing 135% more than their healed counterparts over the course of a year (Guest et al, 2016). This is a consequence of unwarranted variation in care attributed to difficulties experienced by non-specialist clinicians caring for VLU in the community. VLU healing rates are relatively unknown, and national targets for healing do not yet exist, but there is evidence in the literature that specialist VLU services improve healing rates (Moffatt et al, 1992). Healogics is a specialist third party provider of VLU and lymphoedema services to the NHS, that takes a systematic approach to the assessment and management of these co-existing conditions. This paper presents the healing rates of 1015 people with VLU treated by Healogics for the full 65-month duration of an any qualified provider (AQP) contract. Healing rates of 86.14% were obtained in an average of 117 days in line with the published healing rates from other specialist leg ulcer services (Moffatt et al, 1992; Edwards et al, 2005). The healing rates reported in this paper demonstrate that a consistent, specialist approach to VLU management that is underpinned by best practice and national guidelines can help to achieve timely healing in the majority of patients, and can identify more complex patients for whom healing is not possible, enabling them to be placed on a maintenance pathway. The authors suggest that grading of VLUs according to complexity and data collection and analysis of healing rates could help to improve healing outcomes on a national level.

With an ageing population, it is likely that the numbers of leg ulcers requiring intervention will increase proportionately. Given that most leg ulcer care is conducted in the community, this will place an extra burden on primary care staff. Therefore, any cost-effective interventions which improve management are worth considering. The Complex Wound Clinic team (Central and North West London NHS Foundation Trust) undertook a 12-month evaluation of using octenidine-based antimicrobial wash mitts as an alternative to
bucket washing. The aim was to monitor both patient and staff reaction to the use of wash mitts instead of bucket washing, track reported incidents of staff musculoskeletal injuries, and monitor infection rates, including Pseudomonas and wound infections requiring antibiotics.

In each issue we investigate a hot topic currently affecting you and your community practice.

The JCN clinical skills series looks at different aspects of wound management in the community, with useful tips on patient care and improving practice. The fourth and final part focuses on dressing selection.

The last part of our clinical skills series looks at dressing selection. Wound dressings should create an environment that supports the wound healing process. However, with an ever-increasing array of dressings available, selecting the correct product can seem daunting. Holistic patient assessment, including assessment of the wound environment, needs to be undertaken before choosing a dressing and will help in the decision-making process. This article explores the principles of appropriate dressing selection and how they can be applied in clinical practice.