Wound Care Update
Wound care providers need up-to-the-minute answers to their customer's toughest wound management challenges. The wound management industry is getting more complex each day with advancement in dressings, wound bed preparation techniques, bioengineered products, silver and other sustained release antimicrobials and space-age looking off-loading devices, to name a few. What does the savvy home health provider have in his or her wound care trunk? Follow along and discover cutting-edge products that can assist your home care customer while broadening your business horizons and profits.
Negative Pressure Therapy
When is negative really positive? In the case of negative pressure therapy, it's a useful and progressive device to help difficult-to-heal chronic and acute wounds close. Negative pressure uses a primary dressing that is in contact with the wound bed, a transparent drape or secondary dressing and tubing connected to gentle suction to help drain wound fluid and stimulate "tired" wound cells to wake up and start healing. The dressings are changed twice a week and the suction device and dressings are provided by you to the home care customer and clinical team. Increased outcomes are ahead for your patients and your home care agencies by using these innovative treatments. Decreasing time to heal as well as number of home visits equals good outcomes all around.
Silver Dressings
Perhaps one of the safest and easiest ways for clinicians to combat bioburden (overgrowth of bacteria, fungus and viruses) within a wound is to utilize ionic silver. Look for dressings that deliver sustained release ionic silver over a period of time (three to seven days or longer). Since silver has no known resistance, very limited sensitivity and is available over-the-counter (OTC), it makes a wonderful dressing for home care. It also allows for potentially less frequent home visits due to its ability to stay put and work effectively over several days.
The most versatile silver dressings are recommended since they are able to handle a variety of wounds and their changing needs. Dressings that perform double or triple duty are particularly popular with the home care nurse. Are you offering your customers what they want and need? If they are unsure where to start, choose ionic silver hydrogels. There are a few varieties:
Amorphous, literally meaning, "without form" or semi-liquid gel silver. They are great for dry wounds, to fill open spaces and to spread on other dressings to give them antimicrobial power.
Silver hydrogel sheets that come in flat pieces, cavity varieties and sheets with perforation for better drainage control may be the answer if the wound is wet or needs exudate control.
Ionic silver powder (sprinkled in difficult to reach spots or anywhere you want absorption and antimicrobial protection) is also a good choice since you can literally make any dressing a "silver" dressing.
Either way, the stalled out or critically colonized wound can be jump started on its way to a healing path.
Compression
Venous insufficiency ulcers will not heal without adequate compression and they will return if maintenance therapy (compression stockings) are not used. Leg elevation above heart level for two to four hours a day is helpful, but it's difficult to get clients to comply. Your clinical customers must have compression in their "trunk" since there is additionally a more than 70 percent recurrence rate of venous stasis ulcers.
The gold standard is a three or four layer wrap system that is simple to apply with proper training. After the wound has healed, placing the patient in compression stockings that they are able to apply and are compliant with daily use is easy given the wide array of compression hosiery, donning devices and zippered varieties now available.
Versatile Dressings
The name of the game in wound care dressings today is versatility and adaptability. Wound care dressings that do it all are desirable. Especially in the home care environment, dressings that perform several functions and morph with the changing needs of the wound are the ones that clinicians need and you should offer. Consider novel dressings such as bioengineered cellulose which is cool and soothing, non-adherent, strong, offers a pain-free environment and both absorbs and donates moisture, depending on the wound's situation as well as offering an antimicrobial version for infected wounds.
Off-Loading Devices
Wound care clinicians and clients have questions about and need for off-loading devices. Offer them solutions with high-quality products that provide effective pressure management, redistribution, positioning and off-loading for prevention and healing. There are many on the market to choose based on the patient's needs for pressure relief, off-loading, neutral foot and ankle positioning, suspension, protection, healing and cushioning. Again, flexibility and multiple use products rein high when choosing off-loading and heel protection devices.
Waterless Advanced Bathing Systems
Bed restricted home care patients present a basic skin care dilemma?keeping them clean and protected in a less-than-perfect setting. Getting patients into a home shower or bath can present many safety issues as well as practical concerns such as moving a patient and his or her wheelchair or ambulation device into a small bathroom. Waterless advanced bathing systems that provide a warm, sanitary, fresh cleansing alternative are now available. Imagine baby wipes gone high tech with larger-sized cloths that are thick and soft, made for each body area so no washcloth that is used in a "dirty" area is used on the patient's face, hands and neck. These systems utilize sophisticated cleansers that are soap and rinse-free, some even offering built in moisturizers and skin protectors, or antimicrobial versions, saving precious time and resources while preventing future skin issues and potential wounds. These bath-in-a-bag alternatives can be warmed to just above the patient's body temperature and closed up as each body area is cleansed so that only clean, warm cloths touch the client's skin. Bathing goes futuristic.
Novel Debriding Systems
Bioburden and biofilm are two big issues why wounds don't heal. Biofilm is the slimy stuff that collects on your pet's water bowl, the film that forms on your teeth that we call "plaque" and present road blocks to healing in many chronic wounds. Why can't we just attack biofilm with a good antibiotic or antimicrobial? Because these bacteria hide in a carbonydrate-rich matrix analogous to chunks of fruit in a Jello mold. The bacteria are protected, they multiply and have families, trading genetic information so that they are protected against being killed. The only real way to combat these troublesome varmints is to debride the wound and cleanse with every dressing change. "No time or the right staff to accomplish this in home care" or "the patient can't make it to the doctor's office for sharp debridement," your customers say? A simple solution is polyacrylate debriding systems.
Polyacrylate debriding systems provide quick, simple, safe and pain-free debriding. The dressing is activated by Ringer's solution, the most perfect physiologic fluid, and is only changed once per day making it a ideal home care dressing tended by clinical staff or taught to the family. Another plus is that this system is the only dressing that does not require wound cleansing. It provides constant cleansing of the wound bed, removing devitalized material and biofilm, debriding wounds at a mean rate of 38.11 percent per week.
Mission Accomplished
Above are the answers to some of your customer's toughest wound care questions and challenges. Partnering to provide outstanding products, training and services gives you the edge to be a vital part of the wound care team and helps your customers and patients reach their goal?a winning combination. Now, stock your trunk and go provide better outcomes to your wound care customers!
This article originally appeared in the June 2005 issue of HME Business.