A perfect place to apply the proverb "an ounce of prevention is worth a pound of cure" is surgical wounds. Never has that been truer than now, when facilities face a punch in the pocketbook for substandard quality of care resulting in healthcare-acquired infection (HAI) and pressure ulcers.

If you want to hit a healthcare facility where it hurts, aim for the pocketbook. John W. Morgan, president and CEO, HemCon Medical Technologies Inc., confirmed there is "increased scrutiny from reimbursement agencies on how reimbursement for surgical procedures is handled if infections are involved."

Mark Bleyer, president and CEO, Cook Biotech Inc., believes penalties have much to do with increased attention to surgical-wound care. "The new emphasis on penalties regarding surgical-site infections is fueling increased level of interest and diligence regarding wound care postsurgery. It is unfortunate it had to take that, but it has created some real diligence. Interestingly, hospitals are being much more careful in their preparatory work for surgery but even more careful in their postsurgical wound care. An incision used to be considered a sterile wound, and, other than a basic dressing, it was left alone. Now people realize surgical wounds must be more carefully watched. Where they see any kind of slow down in wound healing, they’ve got to jump in quickly and get it to respond. There is now more prophylaxis in preventing wound-care problems rather than just solving them when they occur."

Pressure ulcers, which are susceptible to infection, can start forming on the operating table. James G. Spahn, MD, FACS, co-founder and chief executive officer of WoundVision, talked about the effect of federal regulations and the prevention and treatment of pressure ulcers, noting that pressure ulcers are an indicator of quality of care. "Of course, you have the legal ramifications of unexpected results. We used to call them ‘complications’; now they’re called ‘medical errors’ and ‘quality-of-care’ issues. Since there’s financing through the government and other insurance companies, not only do you have to be aware of pressure ulcers but you have to be sure you know the right diagnosis of the wound. You need to be able to document and confirm why you’re making the diagnosis, because there is financial reimbursement involvement with many of the wounds we’re dealing with."

As a result of financial penalties and new federal regulations, today’s trends are prevention and intervention. "Trends are the necessity of prevention and early intervention," noted Spahn, "because the state and federal governments have brought in the new regulations dealing with wounds. There is a lot of attention put on wounds, ie, pressure ulcers and surgical-wound infection, but more so the latter because of the regulatory oversight and because of non-payment if they are hospital-acquired. It’s going to be pay-for-performance. We’re going away from being reactive to more proactive medical care, not just in our country but around the world."

Industry is providing a wide variety of solutions to prevent and treat surgical wounds and pressure ulcers. Healthcare Purchasing News talked to some of those companies that are coming up with novel approaches to the problems.

WoundVision is a web-based solution designed with the objective of preventing the formation of pressure ulcers. The process begins by gathering data regarding the patient’s physiological status upon admission. Answers to simple questions about the patient’s physiological history are used to indicate the probability of the patient’s risk for developing a pressure ulcer.

WoundVision cart

Other components of the WoundVision program include predictive modeling software and a thermographic camera, which shows blood flow and metabolic activity, to help clinicians predict and track wounds, as well as other health concerns. Once all of the information has been gathered and analyzed, a patient-care plan is developed. WoundVision also can help with compliance to best practices and government regulations.

"What this does is brings awareness and knowledge to bedside," said Spahn. "We’re not replacing physicians in clinical care, clinicians’ judgment is number 1, but the more scientific data you have the better chance that you can make a good clinical judgment. The whole idea is to make this a seamless continuum of care. Close to 35 people can be involved with a patient’s care during a 7-day stay. Wouldn’t it be nice to have a quick read on the patient during the first 5 minutes you meet versus going through the chart after you have a problem? It’s a proactive approach."

Spahn highlighted another significant benefit of WoundVision: "This approach can predict who will be at risk for readmission to the hospital. If clinicians recognize the status of the patient through this analysis, they may be able to send the patient to rehabilitation versus home care to prevent readmission to the hospital."

WoundVision is currently in the pilot stage. Published studies will follow.

WoundVision offers webinars. For more information, go to http://www.ehob.com/education/webinars.

Tom Carter, product manager, marketing, AlloSource, believes "trends are moving more toward biologic wound coverings. The evolution of wound-healing procedures toward biologic tissue is a result of positive patient outcomes and a better understanding of the benefits in providing natural healing factors for wound healing."

AlloSource’s AlloWrap, a membrane derived from human amniotic tissue, acts as a defensive barrier, allowing the surgical site to heal properly.cart

Carter described how AlloSource’s biologic wound covering works: "AlloWrap is a human amniotic tissue that provides a wound cover for a variety of surgical applications. The tissue is a thin and pliable biologic membrane that can be wrapped around tissue or placed as an onlay cover. The membrane acts as a defensive barrier to allow the surgical site to properly experience the healing phase. The implant is derived from scheduled and serological screened cesarean sections, processed, sterilized, and packaged. The tissue is stored at room temperature and is available in a variety of sizes to meet most surgical needs."

Carter indicated the future will offer "continued improvements in the biologic wound coverings through the use of enhanced processing and sterilization technologies."

Cook Biotech Inc.

Cook Biotech Inc. also offers implants for repair of soft tissue. Bleyer explained that there are three ways to protect a wound from postoperative infection: (1) occlusive dressings that cover and protect the wound; (2) dressings with an antimicrobial component, such as silver, to kill bacteria; and (3) assist the body’s natural defenses. "That is where more and more interest is going as we learn more about biology, that there is this ability to come alongside the body and assist its natural healing response and its natural defense against bacteria and infection."

Cook Biotech’s OASIS Wound Matrix is a biologically derived extracellular matrix-based wound product compatible with human tissue.

Bleyer emphasized the importance of new vasculature to healing of a wound. "OASIS encourages the body’s own healing response. OASIS extracellular matrix serves as a scaffold to allow blood vessels to grow into it and has things in it that encourage those blood vessels to grow in, so that you rapidly get a blood supply. Now you can fight off infection, and rebuild and repair the wound with strong, normal tissue very rapidly."

The reason wounds stall in the healing process, explained Bleyer, is because "the body does not have this scaffold on which to lay down new vasculature and new skin in most cases. That’s when you start getting scar tissue and necrotic tissue. OASIS extracellular matrix sits in the wound bed, providing that scaffold. Over time OASIS goes away. It doesn’t need to be removed, and it leaves behind normal tissue. You’re guiding the repair instead of letting a chaotic repair take place."

The efficacy of OASIS is well-documented in peer-reviewed literature, with approximately 700 published studies in a variety of applications. View the studies at http://www.cookbiotech.com/Tech_references.php?ref=Wound Care.

Cook Biotech also offers an educational program and technical support. Go to http://www.cookbiotech.com/productinfo.php?product=oasishead&page=0.

Bleyer talked about what’s in store for the future from Cook Biotech: "Imagine if we could take our OASIS wound-care matrix and bring to bear with it some antimicrobial; you get the best of both worlds. People want as much as they can in one product so they don’t have such a plethora of products on their shelves. This has to be done at a reasonable price. It’s a challenge but a challenge that we, as devices manufacturers, should step up and meet. We do have increasing regulatory burdens. I’m not fighting regulations, they do serve a purpose. However, if we keep ratcheting up the regulatory constraints, then it’s very hard to meet those constraints and still bring it at a price that’s reasonable. That’s the real balance."

Cook Biotech already has a new product in the works. A multicenter trial has surgeons putting some of the matrix material in the suture line. The objective is to encourage stronger healing of an incision and avoid postoperative herniation. "It’s a little different than a wound product; it’s more of a surgical prophylaxis product."

Quick-Med Technologies Inc.

BIOGUARD barrier dressings with advanced NIMBUS technology

Quick-Med Technologies Inc., develops broad-based technologies for infection prevention and control in the consumer and healthcare markets. Their NIMBUS technology is designed for wound care and other applications. NIMBUS destroys the bacterial cell wall; thus, it carries no danger of antimicrobial resistance. The nonleaching, permanently bound microbiocide is effective against common wound pathogens.

Gregory Schultz, PhD, professor for the Institute for Wound Research, University of Florida, and past president, Wound Healing Society, was quoted as saying this about NIMBUS: "NIMBUS poses no danger of bacteria developing resistance or of releasing toxic material into the wound and impeding the healing process. It is a novel technology, bonded and effective even in high concentrations of body fluids."

BIOGUARD antimicrobial barrier dressing, marketed and sold by MEDLINE Industries, is based on NIMBUS technology. Quick-Med currently is targeting more partnerships to apply NIMBUS technology in wound-care products and other medical devices.

ConvaTec

Silver continues to be a popular component of wound dressings. Amy Firsching, associate director, communications, ConvaTec, described their offering: "AQUACEL Ag SURGICAL cover dressings are a combination of a skin-friendly hydrocolloid technology and ConvaTec’s patented Hydrofiber Technology, with the added benefit of silver. The dressing provides a waterproof viral and bacterial barrier that allows for flexibility and extensibility during body movement."

ConvaTec’s AQUACEL Ag SURGICAL cover dressings provide a flexible, waterproof barrier that can be worn for up to 7 days.

Whereas the dressing can be used on any surgical incision, Firsching explained that it’s particularly beneficial to orthopaedic patients. "Patients who have undergone knee and hip surgeries are required to walk within 24 hours of their operation. This, along with rehabilitation, requires repetitive flexion and extension of the joints. Most current dressings cannot stand up to the rigor of rehabilitation and may require additional dressing changes. AQUACEL Ag SURGICAL’s design enables the dressing not only to stay on through rehab but to be worn for up to 7 days, depending on the amount of drainage."

"This extended wear time is beneficial in other ways," continued Firsching. "The dressing is a viral and bacterial barrier. The more times the dressing is changed, the more exposure the wound has to external contaminants. As reported in the Journal of Bone and Joint Surgery (2010;92:1815-1819), a well-known orthopaedic hospital performed nasal swabs of both orthopaedic surgeons and residents. Results showed that 35.7% of the 135 surgeons and 59% of the residents tested positive for Staphylococcus aureus. Repetitive dressing changes may expose the patient to an increased risk of skin infection."

"In a separate prospective study (J Wound Care 2009;18:5-8, 10-11) involving 428 patients undergoing hip or knee surgeries, AQUACEL dressing with a competitive non-woven cover dressing on top of it was compared to an AQUACEL dressing covered with DuoDERM Extra Thin dressing on top of it. The new dressing demonstrated a reduction in superficial surgical-site infections by 67%, a reduction in blistering by 88%, and a reduction in delayed discharge by 80%."

John W. Morgan, president and CEO, HemCon Medical Technologies Inc., observed: "Increased emphasis is being placed on infection control in hospitals for postsurgical wound care. Surgical-site infections are a hot topic and goals for infection management are at zero tolerance."

HemCon GuardIVa Antimicrobial Hemostatic IV Dressing, distributed by Cardinal Health

"Patients recovering from surgery in surgical step-down units or ICUs will have a catheter or IV placed to provide nutrition and medications. These lines are often at risk for infection or may have nuisance oozing. HemCon GuardIVa Antimicrobial Hemostatic IV Dressing is one of HemCon Medical Technologies’ latest innovations. GuardIVa is a complete IV-site care solution that combines the antimicrobial activity of chlorhexidine gluconate (CHG) with broad-spectrum antimicrobial and antifungal activity with the unique properties of HemCon’s proprietary hemostatic oxidized cellulose."

"GuardIVa is the only IV dressing on the market that enhances its antimicrobial efficacy with a compound that controls surface bleeding from percutaneous devices," said Morgan. "Unlike other IV dressings, GuardIVa can be used in the first 24-hours after placement of any percutaneous device to control surface bleeding, protect the IV site from contamination, and provide sustained antimicrobial activity. The dressing provides sustained antimicrobial protection for up to 7 days and contains the ideal amount of CHG to support normal wound healing. GuardIVa is a foam-based dressing able to absorb up to 11 times its own weight in fluid, minimizing the need for dressing changes, thereby reducing the risk of site exposure."

"The Centers for Disease Control and Prevention ‘Guideline for the Prevention of Intravascular Catheter-Related Bloodstream Infections,’ in its final draft revision as of May 2010, recommends the use of a CHG sponge dressing if the rate of infection is high despite adherence to other strategies. GuardIVa, being a CHG-based foam antimicrobial dressing, fits nicely within these guidelines."