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INTRUDUCTION

Biofilm, one of the main issues that prevent a chronic wound from healing, is a combination of bacterial and fungal cells, embedded in an extracellular matrix composed of hydrated polymers and debris [1]. Antibiotics are of limited use in biofilm-infected wounds, because biofilm can be polymicrobial [2] and the cells are many times more resistant to it [3]. Therefore the biofilm has to be physically disrupted and removed by debridement. This survey was designed to investigate on a 2 week wound management pathway, including the use of a monofilament fiber debridement pad (Debrisoft® - Lohmann & Rauscher) in combination with an antimicrobial dressing.

MATERIALS AND METHODS

The survey includes data of 706 professional users located in the UK. The users were asked to treat chronic non-healing wounds by following a 2-weeks wound management pathway including mechanical debridement and an antimicrobial treatment. Clinicians reported on the outcomes and the potential impact on the healing of chronic wounds. Even if the clinicians were asked to follow the wound management pathway, 21% of them were only using the debridement pad without the antimicrobial treatment. This analysis compares these two groups, showing the impact of mechanical debridement in combination with antimicrobial treatment compared to mechanical debridement alone.

RESULTS

454 (64%) of the users followed the 2-weeks wound management pathway (Group A). 147 (21%) used Debrisoft alone (Group B). 105 (15%) did not give that information. 76% of the treated wounds were static/non-healing and 9% were healing. 15% of the users did not give that information. 94% of all wounds in Group A showed a visible change after 2 weeks, but only 79% in Group B (p<0.0001). For static wounds only 94% of patients in Group A and 85% in Group B (p<0.001) showed improvement and for non-static wounds 97% and 52% respectively (p<0,0001). On a scale of 1 (completely satisfied) to 5 (dissatisfied) the overall clinical outcome was rated 1.543 in Group A and 1.617 in Group B. The healing progression and skin improvement was rated 1,657 in Group A and 1,807 in Group B. The patient satisfaction was rated 1.593 in Group A and 1.778 in Group B.

CONCLUSION

In conclusion the debridement with Debrisoft® shows its capability to put a biofilm-infected non-healing wound into the position to heal. By using mechanical debridement in combination with antimicrobial treatment by following the 2-weeks wound management pathway the positive effect is even more prominent.

Aim:

This study set out to examine the impact of a biofilm pathway in chronic static wounds.

Method:

A survey of 500 nurses who had been using a Biofilm treatment pathway combining a monofilament fibre pad and a topical antimicrobial on static wounds for a period of two weeks was undertaken to gather information on wound healing in those patients who received the new treatment pathway.

Results / Discussion:

A total of 142 nurses, out of 171 respondents, completed all questions in the survey. 82 % of the patients (n=156) had a leg ulcer. The average duration of the wounds was 6 months prior to the change in treatment (range 2-52 weeks). 12 patients had wounds for longer than one year, with one patient having her wound for 11 years. These patients were not included in

the statistical analysis. All wounds were reported as ‘static’ prior to implementing the change in treatment. A total of 66 (46%) wounds had healed following the change in treatment. 39 (58%) patients healed in 1 month or less, with 16 healed in 2 months and 11 taking more than 2 months to heal. A further 32 patients were recorded as having 50-75% healing since using the pathway, with 26 patients showing 25% healing.

Conclusion:

Although this data was non-comparative, it can be concluded that there is a positive effect from using a monofilament debridement pad in combination with antimicrobial dressings to remove and prevent biofilm build up in static wounds. This could result in significant cost savings to the health service and improved outcomes for patients with static chronic wounds.

Aim:

This abstract reports on a multi-centre, UK wide case series of a new monofilament fibre debridement (MFD) lolly in an acute and community setting for the management of cavity wounds and hard to reach areas.

Method:

Twelve UK Healthcare centres have produced 25 patient case studies. All of the clinicians involved utilised the same data collection form which included patient consent and images.

Results / Discussion:

Of the 25 patients 14 were male and 11 female with an average age of 70. Wound type was 11 surgical, 8 leg ulcers, 5 pressure ulcers and 1 hyperkeratosis. The MFD lolly was used once in 9 patients, twice for 6 patients and three times for 10

patients. In all 3 groups there was 100% reduction in devitilised tissue apart from 2 patients who had no devitilised tissue only signs of a biofilm. Pain was assessed using the VAS scale and 12 patients had a consistent score of 0. Average pain scores of 1-3 were obtained for 7 patients and a score of 4-6 for 4 patients. One patient was unable to communicate and one patients has an extensive painful ulcer score 9 and 10 but after MFD lolly this was 8. Free text comments reinforced this along with it being easy to use and handle.

Conclusion:

The new MFD lolly was shown to be very effective at removing devitilised tissue and biofilm, easy to use and handle and was either pain free or associated with low levels of pain.

Aim:

Clinical nurses specialist - Tissue Viability Nurses (TVNs) are no exceptions to significant change and challlenges in terms of their role and scope of practice. The use of advanced treatment modalities such as Conservative sharp debridement (CSD) and Negative pressure wound therapy (NPWT) are amongst the skill they posses for the healing of complex wounds. Debridement in wound bed preparation is a well recognised concept to aid wound bed prepation in order to facilitate wound healing. This can be an intergral part in the management of complex infected surgical wounds where devitalised tissue is present prior to application NPWT. Sharp debridment over a vital organ is high risk, costly and can be life-threatening if done under aneasthetic. And CSD over bowel can equally be a high risk procedure and this will demand a surgeons skill for precision and safety. However, if left untreated this can impead wound healing and lead to other serious complications. Many TVNs are competent to perform CSD but the associated risk and complications of CSD over bowel cannot be ignored. This case study will look at the efficacy of the use of a Monofilament Fibre Lolly (MFL) by a TVN to debride devitalised tissue over bowel in a high risk patient.

Method:

Patient BH is a 46 year old lady who was admitted with a wound infection two weeks after a midline incisional hernia repair with application of mesh. She has asthma and was also diagnosed with alcoholic liver disease . On admission, she was septic and was treated with intravenous antibitiotic and she was taken to theatre for wound debridement. She went to theatre twice for repeat debridement of necrotic tissue causing significant bowel exposure at wound bed with some loose mesh. NPWT was used post-operatively by the surgical team to manage the wound. TVN input was sought to complete a wound assessment and for the re-application of NPWT due to patients compromised medical condition. And she was deemed unfit for anaesthetic. The use of the MFL was chosen as part of a product evaluation by the TVN. MLF was deemed to be atraumatic and has the ability to reach deep undermined areas to an open abdominal wound. It was moistened with 10mls of normal saline and was used to gently lift the devitalised tissue over the bowel using a circular motion with light pressure. Two MFL were used to cover all areas of the wound bed to effectively remove all devitalised tissue and reduce bacterial bioburden. NPWT was applied with careful consideration and protection applied over all exposed bowel.

Results / Discussion:

With the TVNs knowledge and competence in CSD the use of a new debridement tool such as MFL over bowel at the bedside was performed safely and in a timely fashion. MFL for debridement showed significant reduction of bacterial bioburden through removal of devitalised tissue and infected loose mesh with no complications such as bleeding and trauma that

are associated with other forms of debridement. 40% of slough/infected loose mesh were removed using the MFL and 60% were loosened and softened).

Conclusion:

This case study is an example of the increasing complexity of cases and ithe wound management faced by TVNs. With the availability of a new debridement tool such as the MFL, high risk patients not fit for anaesthetic are able to receive timely and safe wound bed preparation. The MFL was found to be less invasive compared to CSD and can be safely used over bowel.

Aim:

To investigate the synergistic use of monofilament debridement (MFD) in conjunction with three different types of common debridement methods -enzymatic (ED) conservative sharp debridement (CSD), and autolytic debridement (AD) in order to determine the reduction of devitalized tissue and improve overall effectiveness of wound management.

Method:

Three patients with recalcitrant wounds of similar condition were managed with the above mentioned debridement methods in outpatient clinics and skilled care settings. In this small study a monofilament debridement pad was introduced to improve overall effectiveness. The study period was four weeks with dressing changes three times per week. Following debridement, the wounds were covered with prescribed dressing and managed according to standard local practice. Percentage of necrotic tissue removal and wound size were measured prior to implementing the monofilament debridement with dressing changes and afterward to determine effectiveness of a synergistic approach to appropriate wound bed preparation. Photographs were taken.

Conclusion:

Use of the monofilament debridement device was found to work synergistically with all three types of debridement modalities to efficiently and effectively remove devitalized tissue safely and painlessly. There was noted reduction of devitalized tissue, which allowed for appropriate wound bed preparation and healing environment.