Chronic wounds are suffered by ~100 million people around the world and are an urgent issue lacking effective solutions. While hospitals and specialised clinics often have the most advanced and effective means of treating these wounds, these treatments are typically ill-suited for use outside of a healthcare environment. Moreover, the majority of patients do not access a hospital, rather, they receive treatment in the community, either at home or in their GP surgery. This means that community nurses are typically the primary healthcare professionals who are treating patients on the front line.
We spoke with specialist nurses from HomeWoundCare Ltd – Maria and Liz (research nurses from private practice), Judy and Sally (NHS nurses) – all experts in wound healing, for their first hand insights on wound bed preparation, exploring the challenges across both private and national health systems.
Treatment
Typical treatment for chronic wounds involves cleansing the wound, assessing it, and performing debridement followed by application of appropriate primary and secondary dressings. “Assessment includes determining the aetiology”, elaborates Judy, “requiring full investigations to determine the treatment plan, namely blood tests, doppler ultrasounds and ankle-brachial pressure index (ABPI) tests”. Lifestyle factors such as diet, exercise, smoking cessation, and alcohol reduction are also discussed, and referrals to tissue viability nurses are made when necessary.
“The main objective is to assess the leg and wound effectively to enable provision of the gold standard treatment,” explains Liz. “All wounds are different”, she continues, “and go through different stages of healing, and therefore need to be assessed regularly to ensure the most appropriate treatment and dressings.” For venous leg ulcers (VLUs), the goal is to achieve full compression by managing pain and patient comfort while ensuring patient understanding of its
importance.
Key challenges
Treating chronic wounds involves managing exudate, providing effective debridement, infection control, and maintaining a moist wound environment. Depending on the wound, a combination of all these factors is necessary, leading to several challenges for both the patient and the attending nurse.
Patient compliance: “Most patients are not equipped with understanding and education about their wound and how they can take steps to encourage healing,” Liz points out, highlighting how the limited appointment times in the NHS leave little time to educate patients on aiding their own healing. “Care plans are created and followed,” she says, “but not always adjusted based on wound assessment” due to inadequate training among some healthcare professionals.
“Most patients are not equipped with understanding and education about their wound and how they can take steps to encourage healing.”
Pain management and debridement: Pain can significantly impede effective debridement, presenting a challenge for patients with chronic wounds in both clinical and home settings.
Time and resource constraints: Chronic wounds require significant time to treat, often more than the average time allocated in NHS settings — which is only “20 minutes per leg” according to Judy. This time constraint, says Judy, affects her dressing choices and consequently the overall care quality. Private practice nurses can spend more time per patient, often over an hour, allowing for gold standard care and patient education, which is not always possible in the NHS. Maria, previously an NHS nurse and now a private nurse, reflects, “visit times were often not long enough” when she worked as an NHS community nurse so “gold standard care could not be provided”, noting how, for example, washing was skipped. “We are lucky to be able to give patients the time they need and are very aware this certainly isn’t the case in NHS settings,” Liz adds.
“Visit times were often not long enough, and so the gold standard care could not be provided.”
Limitations on resources and formularies are also significant challenges. “In clinic settings, the appropriate equipment should be available,” says Sally, but it is dependent on local formularies, and “many dressings may not be available,” adds Judy. In Liz’s experience as a private nurse, “patients like being seen at home due to convenience and privacy. However, you’re limited to what you carry with you in terms of dressings and other supplies.” Sally, an NHS nurse, however, notes that some homes can be “too non-sterile, dark, and not in the patients’ best interests to actively manage a wound.”
Consistency and specialisation: Consistency in caregiver and specialisation in chronic wound care are crucial. “Where there are wound care clinics or specialists within GP surgeries,” Liz continues, “there is consistency of care and better standards of care due to well trained staff and specialist
knowledge.”
The need for innovation, investment and expertise
“We are doing the same now as we were doing 20 years ago,” says Maria. The current state of wound care, marked by resource constraints and variability in standards, needs urgent attention. “I would like to see a dedicated, specialist leg wound team that has the time and expertise to apply advanced wound care treatments if needed,” comments Maria.
“We are doing the same now as we were doing 20 years ago.”
Due to their high cost, there is a lack of upfront investment in wound care in the NHS, particularly in the use of new treatments, therapies, and technologies. However, if this shifted, the overall cost of wound management could be reduced, as faster healing wounds would decrease long-term
expenses.
“I would like to see wound care set as a higher priority,” Liz states. She continues, “community teams have such competing priorities and unfortunately, but understandably, wound care drops low on the list when urgent and emergency care is required.” Elevating the priority of wound care and standardising care could enhance overall wound care quality. She explains, “the wound care strategy sets out standards that should be adhered to. However, standards of wound care are extremely variable, even within small geographies and are very dependent on the knowledge, expertise, and resources available.” Simplified education and “staff being trained in best practice,” alongside clearer care structures, would support this standardisation.
By prioritising wound healing, investing in advanced treatments, and standardising care practices, we can improve outcomes for patients with chronic wounds.
At SolasCure we are developing a highly innovative enzymatic debridement product, Aurase Wound Gel, to break the decades-long lack of progress in how chronic wounds are treated and to overcome several of the key challenges highlighted by the nurses. Aurase Wound Gel is practical to carry and can be easily and quickly applied. Not only is it effective, but also safe and pain-free, meaning that patients will be able to receive optimal care, even within a time and resource-constrained environment outside the hospital. Given that Aurase Wound Gel can also be used in multiple environments, it will help create a more consistent standard of care across different settings, facilitating a clearer treatment pathway for both nurses and patients, helping different types and stages of wounds to heal. We’re excited to play our part in driving a huge transformation in how chronic wounds are treated, aiming to provide front line nurses and physicians with effective, easy to use tools, allowing all patients to receive the best in class care that they deserve, while improving efficiency and reducing burden on health care systems.
