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Hydrofiber® Technology - Controlling Cost Drivers

Controlling cost drivers

While skin ulcers are largely preventable, or, if present, can be resolved with appropriate management, wound care currently remains a large cost burden on healthcare systems.

In a recent wound care audit of a local population of approx. 590,000 (in the United Kingdom):1

  • 1 person in 360 had a wound
  • 1 in 4 (24%) patients with wounds have had their wounds for 6 months or more
  • 1 in 6 (16%) patients with wounds have had their wounds for 12 months or more
  • 42% of the leg/foot ulcers had not healed in the previous six months
  • 1 in 8 (12.8%) wounds were reported as showing signs of infection

An important finding was the relatively high number of patients who have had their wounds for six months or longer.1
Furthermore, a review of several wound care audits has highlighted the lack of appropriate diagnosis and treatment as a key driver of delayed healing.2

Initiatives focused on improving diagnosis and treatment of wounds is likely to significantly impact cost.1

The cost to the patient

Wound management has traditionally been focused on healing, sometimes at the expense of patient-centered outcomes such as pain and other quality-of-life issues.3 Pain is a major issue for patients suffering from many different wound types, with the time of greatest perceived pain being on dressing removal.3

Factors affecting quality of life that have been studied in leg ulcer patients include: 4

  • depression and psychological distress
  • loss of dignity
  • ulcer leakage & odor
  • restricted work and leisure capacity

Some of the key causes of delayed wound healing include:

  • Presence of necrotic or unhealthy tissue5
  • Type and volume of exudate6
  • Chronic inflammation or infection6

The body has developed a structured process for repairing skin and tissue damage. In chronic wounds the process of repair is
disrupted and the barriers to healing need to be removed in order to progress the wound.7 Good wound management,
of both chronic and acute wounds, is focused on supporting the body's natural processes to ensure efficient and effective wound closure.7

Debridement is an essential part of the management of many wounds and involves the removal of dead, damaged, or infected tissue
that would otherwise impair the healing.7

Once unhealthy tissue has been removed the main considerations for wound progression are management of exudate and infection control.

The importance of Exudate Management

The importance of infection control

"An important aim of wound management is to minimize the detrimental effects and maximize the positive effects of exudate; healing may be affected if there is too much or too little exudate".8 Excess exudate is not only harmful to the wound itself but also to the periwound skin if transferred.9 The exudate of wounds that fail to heal contains excessive or “uncontrolled” enzyme activity, which if not controlled can lead to further tissue breakdown.10

Wounds are inherently susceptible to contamination and colonization by bacteria that naturally exist on the skin or other parts of the human body. Although wounds are colonized with bacteria, only a small percentage progress to infection.11 If bacterial colonization results in no delay to healing or infection, this is considered to be in bacterial balance (ie. the host controls the bacterial levels in the wound).12 However, bacteria thrive in moist tissue which can lead to bacterial proliferation. If left uncontrolled, the wound is likely to progress to a state of bacterial imbalance (“critical colonization”), and in this situation the wound is at risk of infection.12

The role of dressings

“In local wound management, dressings are the main option for managing exudate.”8

Fluid absorption capacity of a wound dressing is an important attribute but not the only consideration. Equally important are the attributes
of fluid retention and lateral transmission of fluid in order to minimize the transmission of wound exudate and its corrosive contents to the
surrounding skin. 9

Choosing the appropriate dressing is essential to managing infected wounds or those at risk of infection. Selection of a wound dressing should
be based on the characteristics of the dressing technology as they relate to the wound need.

“Dressings and other delivery systems that provide sustained doses of effective antimicrobials have been shown
to be valuable in the treatment of critical colonization and infection and enhance optimal wound management.”13

Proactive use of silver dressings “...can inhibit the progression of bacterial penetration and can be effective against MRSA and most other superficial pathogens.” 14
 

References

  1. Drew P, Posnett J, Rusling L. The cost of wound care for a local population in England. Int Wound J. 2007;4:149-155.
  2. Posnett J, Franks P. The costs of skin breakdown and ulceration in the UK. In: Skin Breakdown – The silent epidemic. The Smith & Nephew Foundation. 2007:6-12.http://www.snfoundation.org.uk/content/download.aspx. Accessed March 31, 2009.
  3. Moffatt CJ. Understanding wound pain and trauma: an international perspective. In: Pain at Wound Dressing Changes. European Wound Management Association Position Document. http://ewma.org/fileadmin/user_upload/EWMA/pdf/Position_Documents/2002/Spring_2002__English_.pdf. Accessed April 1, 2009.
  4. Herber OR, Schnepp W, Reiger MA. A systematic review on the impact of leg ulceration on patients' quality of life. Health and quality of life outcomes. 2007;5:44-56.
  5. Harding KG. Understanding healing after skin breakdown. In: Skin Breakdown - The silent epidemic. The Smith & Nephew Foundation. 2007;6-12. http://www.snfoundation.org.uk/content/download.aspx. Accessed March 31, 2009.
  6. Cutting K. Wound exudate: composition and functions. Br J Community Nurs. 2003;8(9):4-9.
  7. Schultz GS, Sibbald GR, Falanga V, et al. Wound bed preparation: a systematic approach to wound management. Wound Repair Regen. 2003;11:1-28.
  8. World Union of Wound Healing Societies. Principles of best practice:Wound exudate and the role of dressings. A consensus document. London: MEP Ltd; 2007.
  9. Chen WYJ, Rogers AA, Walker M, Waring M, Bowler PG, Bishop SM. A rethink of the complexity of chronic wounds - implications for treatment. European Tissue Repair Society Bulletin. 2003;10(2,3):65-69.
  10. Walker M, Bowler PG, Cochrane CA. In vitro studies to show sequestration of matrix metalloproteinases by silver-containing wound care products. Ostomy Wound Manage. 2007;53(9):18-25.
  11. Vowden P, Cooper R. An integrated approach to managing wound infection. In: Management of wound infection. European Wound Management Association Position Document. 2005.
  12. Bowler PG, Cochrane CA. Progression toward healing: Wound infection and the role of an advanced silver-containing Hydrofiber® dressing. Ostomy Wound Manage. 2003;49(8) (suppl):2-5.
  13. White RJ, Cutting K, Kingsley A. Topical antimicrobials in the control of wound bioburden. Ostomy Wound Manage. 2006;52(8):26-58.
  14. Driver VR. Silver dressings in clinical practice. Ostomy Wound Manage. 2004;50(suppl 9A);11S-15S.