by Don Sadler
The field of wound management is as old as surgery itself. For as long as surgeons have been operating on patients, they have been looking for better ways to heal the incisions and wounds that are an unavoidable part of the surgical process.
Since at least the 20th century, tape and gauze have been the best solutions available for closing and healing surgical wounds and helping prevent healthcare-associated infections. But this is starting to change as new technologies are emerging that are leading to better and faster healing of surgical wounds, fewer infections and improved patient outcomes.
“We are finally starting to move away from old-fashioned tape and gauze as the primary methods of closing and healing surgical wounds,” says Suzanne Collins, MS BSN RN CWOCN DAPWCA, clinical director, marketing for the Wound Care Division of Molnlycke Health Care. “In many ways, they are detrimental to wound healing. I believe OR nurses should be highly suspect if gauze and tape are t
he best tools available for wound management because they are old-school and problematic.”
NEW STANDARD OF CARE
Collins says many surgeons and OR nurses are recognizing that “a moist wound healing environment predisposes surgical incisions to a faster healing and better patient outcome. As a result, advanced wound care technologies are becoming the standard of care in the OR — and gauze and tape are over.”
These technologies include anti-infectives, biological and sustained-release anti-microbial dressings, pressure relief devices and, most recently, negative pressure wound therapy. “This is a wound treatment technique that uses vacuum technology and special dressings to reduce the amount of infection-causing bacteria inside of a wound,” says Matt Dambeck, the chief operating officer of Innovative Therapies, Inc. “The negative pressure device pulls the fluid, blood and other infectious material out of the wound, which facilitates healing.”
A report released last year by research firm Kalorama Information found increased use of negative pressure wound therapy products. It predicted the total global wound care market will rise to nearly $21 billion in 2015 from $16.8 billion in 2012. Meanwhile, the negative pressure wound therapy market is forecast to grow from $2 billion in 2011 to $4 billion by 2018, with an increase in the use of single-use disposable devices and portable systems that can be used to help wounds heal after patients go home.
“Advanced wound care dressings interact with wounds and support, rather than oppose, healing. for example, blistering is a major side effect of gauze and tape, especially when they are used with abdominal and orthopedic procedures. Blisters can lead to very serious complications because any break in skin integrity can compromise the surgical site.” – Suzanne Collins, MS BSN RN CWOCN DAPWCA
Despite these projections, there is still a wide knowledge gap when it comes to the most effective wound treatments. To help close this gap, the federal Agency for Healthcare Research and Quality has awarded the Johns Hopkins Evidence-based Practice Center a nearly half-amillion dollar grant to review state-of-the-art wound care technologies and determine what is known about medications, antibiotics, dressings and surgery. The goal is to determine which types of wound management techniques and technologies are proven to be most effective.
According to Patricia Burns, RN, MSN, vice president of clinical affairs for Smith & Nephew, the use of negative pressure wound therapy on surgical incisions is a relatively new development in the OR. “Using negative pressure wound therapy on closed surgical incisions compresses tissue, reduces swelling, immobilizes wound margins and helps hold the incision together more firmly.
“What we’re seeing is the evolution of wound management therapy,” she adds. “When negative pressure was first used in the OR, it was only on the most complicated cases. But we’ve begun to expand the type of surgical wound on which it can be used, which puts the therapy within reach for more patients at more facilities. Based on early evidence, negative pressure wound therapy is helping surgical wounds heal better even in high-risk patients.”
Burns notes that while surgical site infections occur in only 1.9 percent of cases at large, according to the Centers for Disease Control, they are much higher (as high as 15-20 percent) on some types of surgeries and on high-risk patients. “For example, surgical site infections occur on up to 30 percent of C-sections performed on obese women. We need a higher degree of awareness of individual patients who are at greater infection risk — whether due to obesity, heart disease, diabetes or smoking — and could possibly benefit from negative pressure wound therapy.”
Smith & Nephew manufactures the PICO Single Use Negative Pressure Wound Therapy system. Burns says this portable device, which provides a week of wound therapy for patients after they leave the hospital, has been designed specifically for use on surgical wound incisions. “Its small size (it weighs less than a pound) and quiet operation enable patients to easily conceal or wear it and continue their daily life activities with minimal interruption.”
Innovative Therapies manufactures the Quantum Negative Pressure Wound Therapy system. Dambeck says Quantum is the first fully featured negative pressure wound therapy system with simultaneous irrigation, which enables it to provide continuous healing for patients. “Quantum delivers irrigation solution to the entire wound bed, including tunnels and undermined area, while simultaneously providing constant negative pressure.”
He adds that Quantum is available to all care settings via a cost-efficient purchase model in which hospitals only pay for the therapy hours their patients use, as opposed to the industry-standard rental model. “This can save hospitals a significant amount of money when it comes to delivering negative pressure wound therapy,” says Dambeck.
ADVANCED WOUND CARE DRESSINGS
Collins stresses that the type of wound contact layer used on surgical wounds is just as important as the type of negative pressure wound therapy system used. “Advanced wound care dressings interact with wounds and support, rather than oppose, healing. For example, blistering is a major side effect of gauze and tape, especially when they are used with abdominal and orthopedic procedures. Blisters can lead to very serious complications because any break in skin integrity can compromise the surgical site.”
Molnlycke Health Care manufactures a wide range of advanced wound care dressings, including Mepitel, Mepitel One, Mepilex Border in Post-op sizes, and Mepilex Border AG in Post-op sizes. Mepitel and Mepitel One can also be used underneath the negative pressure wound therapy sponge to protect structures in the wound bed while maintaining the negative pressure. These products allow removal of the exudate from the wound bed.
“Mepilex Border and Mepilex Border AG wound care dressings minimize trauma to the wound bed and patient pain when the dressings are removed,” says Collins. “They are highly absorbent, help maintain a moist wound healing environment, and help protect the wound from external offending agents like bacteria and superficial trauma. They are one-and-done surgical dressings with up to a seven-day wear time.”
INNOVATIVE WOUND THERAPY
Of course, helping prevent surgical site infections by maintaining a sterile field and caring for and managing wounds properly post-operatively is one of the OR nurse’s primary responsibilities. New wound management technologies like negative pressure wound therapy do not make basic preventive measures like following strict hand hygiene procedures and hygiene and patient safety checklists any less important.
But Burns believes that healthcare practitioners should be just as innovative and proactive when it comes to wound therapy as they are when it comes to surgical procedures themselves. “It doesn’t make sense to perform the most sophisticated, high-tech surgeries and then just close up the wounds with gauze and tape when we now have the technology to heal and protect wounds in a much better way. I think we should be taking an aggressive approach to healing that’s best for the patient all the way through the healing cycle, including wound care management.”