Podcast Episode 59: Wound Hygiene - What it can do for you

Hi, my name is Bronwyn Lafferty and I'm one of the Clinical Strategy Managers for CombiTech. I'm a registered nurse and was a Tissue Viability Nurse Specialist before working for CombiTech and prior to that a District Nurse. I'm here to talk to you about wound hygiene and define chronic or hard to heal wounds with an early anti-biofilm intervention strategy. This strategy has arisen from an international consensus document that was published in 2020 and is the work of an international panel of specialists including tissue viability nurses, vascular consultants, podiatrists and dermatologists. Increasing numbers of patients are living long term with hard to heal wounds. For the patients affected by these wounds, they are suffering from increased pain and are vulnerable to recurrent infections. For healthcare systems, the cost of managing these wounds is considerable. The annual NHS cost of wound management was £8.3 billion in 2017-18 for example. Despite best practice and advances in dressing technology, the burden of wounds globally isn't getting smaller. We are missing a piece of the puzzle, and evidence is increasing that biofil management is that missing piece. Biofilms are complex microbial communities containing microorganisms embedded in a protective slimy barrier of sugars and proteins. These can form on living and non-living surfaces. A wound bed is just one example of a living surface on which biofilm can form. This causes a sustained subclinical wound infection but can protect itself from the host's immune response and is tolerant to antibiotics and antiseptics. This keeps the wound in a low-grade inflammatory state and delays or even stalls and prevents healing. healing. To improve the management of these hard-to-heal wounds, we need to manage this tenacious biofilm that we can assume is present in all hard-to-heal wounds. The goal of treatment is to disrupt and remove the wound biofilm and prevent its reformation. Wound hygiene provides health professionals with a toolkit to do this. Wound hygiene should be implemented at the same time that the underlying causes of the wound and the patient's comorbidities are being addressed. Wound hygiene consists of four steps that should be performed regularly and repetitively as part of a protocol of care. These steps are cleanse, debride, refashion and dress. We will be covering this in more detail but And simply this involves cleansing the wound, debriding the wound and refashioning the wound edges to make sure the wound bed is as clear as possible before dressing the wound with a suitable anti-biofilm dressing. Let's look at what these four steps mean. Firstly, cleanse. We need to cleanse the wound bed to remove devitalised tissue, debris and biofilm. In addition, we need to cleanse the peri-wound skin to remove dead skin scales and callus and to decontaminate it. Removing unwanted materials from the wound bed and surrounding skin is a cornerstone of wound management. Secondly, debridement. The goal of debridement is to remove or minimise all unwanted materials from the wound bed and the peri-wound skin. Debridement can be defined as the physical removal of biofilm, devitalised tissue, debris and organic matter using mechanical aids such as sterile gauze, soft debridement pads or gauze, curettes, surgical blades or when available ultrasonic debridement. The exact methods chosen will depend on local pathways and formularies and the level of experience of the practising clinician. Thirdly, refashioning. This may be a new term to many clinicians but we are extending what we already know about debridement on the wound bed and extending it to the edges of the wound. In all full thickness wounds, the primary cells that facilitate epithelialisation are located at the wound edges and hair follicles. Biofilm is most active at the wound edges where it promotes cell senescence. This is a loss of the cell's power of diffusion and growth, thereby preventing the ingrowth of new healthy tissue. Refashioning the wound edges is therefore an important component of wound hygiene. Like debridement, the method chosen to refashion the wound edges will depend on local pathways and fulneries and the level of experience of the practicing clinician. And the final stage is dress. After the wound bed and peri-wound skin have been cleansed, the wound bed has been debrided and the wound edges refashioned, there is a window of opportunity in which to address the residual biofilm that may be present and destroy and prevent its deformation. Before choosing a dressing, a comprehensive assessment of the patient, the wound bed and the environment should be conducted to ensure it meets the needs of the patient and the local wound environment. When choosing a suitable antimicrobial dressing to dress the wound with at Step 4 of the Wound hygiene protocol of care, the anti-biofilm properties of the dressing should be considered, along with other requirements such as its exudate management capabilities. The International Wound Infection Institute highlights that when undertaking biofilm-based wound care, a dressing that incorporates antimicrobial and anti-biofilm technologies needs to be considered. An example of this would be a silver gelling fibre dressing incorporating a metal collator and a surfactant. This class of dressings incorporate a combination of ionic silver to kill bacteria alongside anti-biofilm components to disrupt and destroy the biofilm. These dressings also use gelling fibre technology to ensure exudate in the wound is appropriately managed. Wound Hygiene was launched in 2020 and since launch, Comvitec have supported clinicians around the world to implement these simple four steps into their standard of care to help progress the challenging wounds on their caseloads. In the UK, it has been shown that in a multi-centre, four-week evaluation, when the Wound Hygiene Protocol is implemented, with the silver gelling fibre dressing incorporating the anti-biofilm technology is used at step 4, 89% of the patients either healed or progressed towards healing. Of the patients included in the study, over 50% had their wound for more than 12 months. During the same period of implementation, the nurses also saw a reduction in the frequency of dressing change, saving the nurses time in not needing to complete as many patient visits. Try it for yourself. Introduce these simple four steps at each dressing change and see what outcomes you have with your patients. More information can be found on www.woundhygiene.com where you can download a copy of the original consensus document, clinical case studies and the latest publication from the Journal of Wound Care on proactive wound healing with Wound Hygiene. Thanks for listening.