The chronic wound epidemic is growing uncontrollably. Over six million Americans suffer from chronic wounds and nearly $25 billion is spent every year to treat them. The elderly are particularly at risk…and with this a growing population, the need for a different, more cost-effective, approach is increasingly critical.
Because wounds are dynamic and non-uniform objects, changes are unpredictable while dressings are worn. Yet we keep expecting optimal results despite choosing static products for a dynamic environment. When any of today’s static dressings are applied to an area, they’re only performing one function. Once the area and its needs change, the dressing is no longer optimally aiding wound healing. On the contrary, a static dressing may actually impede healing, since it is no longer creating an ideal wound-healing environment. The growing number of deteriorated and non-healing wounds we see as healthcare professionals suggests this contraindication.
Can One Size Truly Fit All?
It’s hard for many clinicians to accept the idea that a one-size-fits-all dressing can provide multiple functions; e.g., hydrating, absorbing and adjusting to wound beds as needed. This attitude isn’t surprising, as we have been all taught to be become “dressing-ologists” – of over 450 brand names currently available.
I myself had a one-hour wet-to-dry class throughout my nursing and grad school education. One report, examining fifty American medical schools, shows the mean hours of education in physiology of tissue injury are 0.5 hours and 0.2 hours in the first year and second years respectively, and zero in both the third and fourth years. The mean hours of directed education in the physiology of wound healing are 2.1 hours and 1.9 hours in the first and second years.
Clinicians are overwhelmed by the wide array of products; dressing selection is complicated and error-prone, making effective outcomes problematic.
The SAWD Effect
The main obstacle to effective healing with currently available products lies in the fact that all are single-function products.
For years this was fine. Indeed, I’m part of the generation that was taught emphatically that no one dressing could work for all wounds…especially not for long-term use. I was accustomed to ordering either daily or every-other-day dressing options, especially in acute or long-term facility settings. The home health setting was the only one that forced extended-wear consideration due to issues like changes in health coverage. That limited visits allowed, often necessitating the lowest out-of-pocket expenditures for many patients.
I was fortunate to be one of the earliest users of the Self-Adaptive dressing (SAWD), as part of a study at Southwest Regional Wound Care Center under Dr. Randall Wolcott. With this “smart” dressing, health professionals finally got a product that made feedback-driven adjustments as needed. The novel concept is of a dressing being able to change its function while accommodating any wound, in any stage of healing, regardless of type and etiology, including the most complex wounds. The SAWD hydrates dry areas and absorbs excessive fluid from exuding areas while protecting peri-wound skin from maceration…all at the same time.
That means any type of wound can be much more effectively treated. Diabetic, leg, and pressure ulcers; surgical wounds; burns; graft sites, and lacerations are just a few of the chronic and acute treatment needs that can be addressed with SAWD. With this technology we’ve seen tremendous results healing even the oldest chronic wounds; e.g., from 12 years to only weeks.
Addressing Patient Pain
The patient experience is redefined with SAWD, which effectively supports the body’s natural autolytic debridement. It can reduce the need for sharp debridement – a dreadful procedure for patients in general, and virtually impossible in elderly patients and others using blood-thinners.
The dressing material is non-adherent, allowing easy, painless, removal and wear. Additionally, due to high-absorption rates (over 50 percent more than leaders on the market) it can be left on for up to 10 days (depending on drainage level) in comparison to twice-daily dressing changes necessary with other products.
All of this decreases pain remarkably. I’ve seen patients indicate immediate pain reduction, from 8-9 to 1-2 level on a 10-scale upon application. This not only makes it easier for clinicians to do their job, but to do those jobs in ways that better serve their patients.
Preserving Jobs, Enhancing Care
We are all facing payment cuts in the coming years, including up to 14% in home health care. We have to look at the benefits of every tool at our disposal, including Self-Adaptive dressings, which will allow us to move to a sole treatment option. I’ve seen SAWDs help decrease the number of negative pressure days for a patient. SAWDs can allow us to cut individual visits by at least two times, but professionals can service more patients and be more time-efficient…without decreasing quality of care.
Since it is covered by Medicare and Medicaid, available through many distributors and DME services, we could still see profits despite Medicare cuts. In Pennsylvania, an area I happen to know very well, implementation of self-adaptive technology could mean hundreds of millions of dollars in savings for institutions such as home health care agencies, LTCs, nursing homes and skilled nursing facilities.
West Penn Nurse’s Success with SAWD
One of the most remarkable success stories comes from Western Pennsylvania. Renetta Winkler is a wound, ostomy, continence, and foot care field nurse at VNA of Western PA. Due to the fast-moving progression of multiple sclerosis and deep chronic ischial pressure wounds, her patient (let’s call her “Kathy”) suffered from pressure ulcers, malnourishment, increasing loss of mobility, among other issues.
With SAWDs, Kathy dramatically improved her physical well-being, emotional outlook and overall quality of life. Among other milestones, she went back to sharing a bed with her husband, became more compliant with offloading and became more active in the life of her 9-year-old son.
In this age of innovation it is important for health professionals to stay open-minded and embrace new technologies, especially when it’s clear it will enable us to treat patients more efficiently, with consistently better results, while lowering material and labor costs. After all, it’s why I, and others like me, become nurses.
In Vicki’s 25+ years in the medical field, she has developed expertise in the clinical management of wounds, new product studies, and in the development of wound care prevention and treatment protocols. Vicki is an author of several articles on wound care as well.
Vicki received her Bachelor of Science in Radiology Technology from Midwestern State University, and her Bachelor of Science and Master of Science degrees in Nursing from Texas Tech Health Science Center in Lubbock, Texas under Dr. Randall Wolcott.