Jacqui Fletcher: Wound Bed preparation

I think wound bed preparation is still very relevant. If you look at recent papers like the Guest paper that shows how little people are doing around assessment, it really reminds us that we need to focus on doing the basics and I think Wound Bed Prep does that, focuses on the basics. What do you need to do to get a clean, healthy wound bed? So I do think it's still very relevant. Cleaning the wound bed is quite tricky. I think it's something that's very much up for debate at the minute and certainly the terminology we use is interesting. So we've just been doing a workshop on de-sluffing, debridement and cleaning. And if you listen to clinicians and how they use the words, it's clear that they don't always understand fully what the terminology means and what it is they're dealing with. There's such a breadth of methods now from cleaning mitts and cleaning cloths through solutions containing things like surfactants. And there's still the big debate around can we use buckets of water from people who are very much involved in infection control. I certainly think we should be doing a lot more work on looking at the benefits of cleaning and the ways we clean and not forgetting to focus on cleaning the surrounding skin which is very important for the patient. Antimicrobials are coming to the fore again as we know more about the role of biofilms in delaying wound healing and we're seeing new generations of antimicrobial, different preparations of antimicrobial. I think what's interesting is getting people to understand when to use them and how to use them and very importantly when to stop using them and that's quite difficult because actually our knowledge of that is is not as strong as it could be. So there are some new consensus documents about to come out from organizations like the International Wound Infection Institute talking about how to use antimicrobials in a cyclical way, doing the two-week challenge, thinking about which antimicrobial you're using, but also really emphasizing that in biofilms that it is a maintenance kind of thing, so you need to do maintenance debridement and you really need to get on top of those bacteria using topical antimicrobials. I think preparing the wound is a continued thing until the patient actually achieves the healing, then this is something that's ongoing. The inflammatory phase we know is often continued and maintained and we need to take the patient through that as quickly as we can because that's what delays the healing process. So that maintaining those basic tenets of wound bed preparation is important right through all the phases of healing. Time is being put forward as the way of implementing wound bed preparation. It's kind of the framework by which we apply the basic tenets that we're dealing with. So it encourages the clinician to think about what it is they want to achieve, whether they're addressing the tissue type in the wound, whether the problem is inflammation or infection, whether really what they're managing is moisture or whether they're looking at the edge of epithelialisation. In reality it's most of those most of the time because it's rare that a wound only has one stage but it does help them to focus on what their objectives are and what they're trying to achieve. When healing is not an outcome I still think we have to be clear what our primary objectives are and for all patients there is something that we can do, whether that's symptom management, even if it's not an aim towards healing. And I think the principles of time still apply to that, so if we are thinking about things like managing exudate and managing odour, those fit very nicely into the time framework. The end point may be slightly different but what you're still aiming to achieve is something that's satisfactory for the patient and that usually comes about by trying to have as clean as possible a wound bed and reducing the moisture levels as much as you can.