Caring for chronic wounds often consumes a large part of a nurse’s workday. We strive to provide better treatment for our patients. But like physicians, we have little education and training specific to wound care. We often learn it through trial and error.
Meanwhile, chronic wounds in the U.S. are becoming a major problem for healthcare and the economy. Forecasts suggest the $25 billion annual spending on management of chronic wounds will spiral upwards with the growing risk groups – diabetic patients and the elderly.
Currently more than six million chronic wound sufferers in the U.S. rely on wound care professionals and their treatment expertise. Despite all efforts, the increasing number of stalled and chronic wounds suggests current therapies are largely ineffective.
Modern Wound Care’s Major Flaw
With the mind-boggling variety of wound-care products available on the market, one might think wound treatment has been mastered. But that’s not the case. Conventional treatments fail because they approach a dynamic environment with static applications.
Wound care products have one thing in common: each is designed to treat one symptom at a time. They are successful at performing a single function. For instance, a super-absorbent dressing applied onto a highly draining wound does a great job removing excess fluids, but it will desiccate dry areas of the wound that need moisture. Similarly, a hydrating dressing will keep dry areas moist, but macerate the areas in need of absorption. The result is the same: the healing progress is stopped and the wound deteriorates.
The physiology of wound healing is taught at nursing and medical schools, but only briefly. The amount of time dedicated to the subject is utterly inadequate. One report shows the mean hours of education in physiology of tissue injury are 0.5 hours and 0.2 hours in the first and second years respectively, and zero hours in the third and fourth years. The hours dedicated to the physiology of wound healing are 2.1 hours and 1.9 hours in the first and second years.
The combination of poor wound-care education and the endless array of single-function dressings on the market is proving disastrous for both clinicians and patients.
Breaking New Ground
As a seasoned wound care professional, I’ve had my share of frustration with non-healing wounds. Like many other clinicians, I tried to accept the fact that no single dressing could do it all: absorb, hydrate, and adjust to the wound condition as needed.
In nursing and graduate schools, I was told to be prepared to order daily or every-other-day dressing options, especially in acute and long-term facility settings.
However, while participating in a study at Southwest Regional Wound Care Center under Dr. Randall Wolcott, I became one of the first clinicians to try a self-adaptive wound dressing (SAWD) made by OSNovative Systems, Inc. The dressing which uses a material is designed to adjust functions continually to match the wound condition.
The SAWD dressing dynamically balances the moisture levels in and around the wound and can switch its function from absorption to hydration as needed. This ability effectively prevents both maceration and desiccation and supports the optimal moist healing environment at all parts of the wound, at all times.
SAWDs present a novel approach to wound healing, something that hasn’t happened in decades. The self-adaptive technology makes the dressing suitable for almost any wound-from diabetic, leg and pressure ulcers to surgical wounds, graft sites, burns and lacerations-and produces some spectacular results, healing even the oldest chronic wounds that had lasted for years.
Improved Clinical Outcomes
I witnessed several dramatic instances of healing during the study at Southwest Regional Wound Care Center.
One in particular was a stalled venous ulcer that showed no signs of improvement following six months of various therapies. (A case study with images is available here.)
The wound was draining so badly that it required daily dressing changes and regular surgical debridements, bringing a lot of discomfort and financial strain to the uninsured patient whose overall health was also compromised by numerous other medical conditions.
Unbearable itching would push her over the edge. She simply could not leave the periwound skin alone, further irritating already inflamed areas around the wound. After only three days, dressing changes (now painless) were reduced to every other day and the patient reported a soothing and cooling effect of the dressing.
Within two weeks the wound accelerated out of its stalled state and into rapid healing. The itchiness and pain were gone, the granulation progress was evident, the dressing change frequency was further reduced, and the exudate containment allowed the patient to finally return to her normal daily activities.
At the end of the three-month study period, not only was the wound completely granulated, but also the patient saved significantly on out-of-pocket expenses due to the reduced frequency of dressing changes and fewer debridement procedures.
Better Care, Better Economics
Healthcare in the U.S. is facing vast and imminent changes, and wound care is no exception. Funding cuts and rising treatment costs require immediate measures to make wound care more efficient and economical. The study at Southwest Regional Wound Care Center showed that SAWDs can step up to that challenge as well.
In adopting SAWDs, the clinic was able to reduce its wound treatment costs by at least 30 percent through inventory reduction alone. Factor in the reduced frequency of dressing changes, simplified training, and lower expenditures in logistics and inventory control-and it’s fair to assume more cost savings will follow in any setting, be it a home health care agency, a hospital or long-term care facility.
An efficiently run provider can accept more patients, treat more wounds and increase its revenue-all with the same number of personnel. This is an especially attractive option for home health agencies that are paid per wound healed and can also bill for educating home caregivers -a process significantly simplified with SAWDs all-in-one functionality. (A new interactive mobile application developed by OSNovative also helps.)
Enluxtra self-adaptive dressing is covered by Medicare and Medicaid and is available through many distributors and DME services. Providers looking for ways to turn in a profit despite funding cuts, may find the ultimate answer in the adoption of SAWDs-a wise move that will result in economic benefits, better ratings and higher quality of care.
Patient Comfort & Quality Of Life
SAWDs provide constant support of the natural wound healing process that is marked by enhanced autolytic debridement – the body’s own way of removing dead tissue from the wound bed.
Surgical cleaning of the wound, i.e., sharp debridement, is an extremely painful procedure that is impractical for some (such as the elderly, or those taking blood thinners), and is feared by all patients. SAWD eliminates the need for sharp debridement, making lives easier for both clinicians and patients.
What’s more, the non-adherent dressing is painless to remove and, according to many providers, it even reduces pain without medication during wear. I’ve seen patients rate their pain level at 1-2 (on a 10-point scale) down from 8-9 immediately following dressing application.
Dressing change frequency is greatly reduced when a patient starts using SAWD. This is an additional blessing for patients who previously had to change their dressings once or twice a day.
Due to the SAWD’s high absorption capacity, it can be left on the wound for up to 10 days (depending on the drainage flow). The extended time between dressing changes further protects the delicate healing environment from shocks caused by removal and replacement of the dressing.
What we have in our arsenal now is an economical and easy-to-use product that supports the natural physiological healing process, reduces patient pain and works for all wounds.
Vicki Fischenich is the director of clinical affairs for OSNovative Systems where she is responsible for clinical trials, customer education, communication and support.