John Timmons, head of clinical services at Activa Healthcare, discusses approaches to the management of chronic wounds and highlights the importance of effective wound bed preparation.
There are a number of factors which may influence wound healing. Local systemic and environmental factors can all impact negatively on the wound. Guest et al12 estimated that there are 2.2 million wounds being treated by the NHS today and a large proportion of these wounds are chronic in nature. The estimated cost of treating these wounds is £5.3 billion, which is a significant drain on already scarce NHW resource.12 Recently, NHS England have announced a new Commissioning for Quality and Innovation (CQUIN) target focusing on improving assessment of wounds which have failed to heal after four weeks.24 This CQUIN and those, which follow, could have a positive impact on the care of patients with wounds. Seventy nine per cent of acute wounds healed during the study period, however, only 43% of chronic wounds healed during this time.12
In order to address the problem of chronic wounds, there is a need to improve wound assessment, diagnosis and implementation of a truly holistic management plan for the individual patient. Wound bed preparation and the removal of local barriers to wound healing can help establish healing in chronic static wounds. An expert group explored the concept of wound bed preparation further and produced the TIME acronym to assist with wound assessment and wound management. Local barriers to wound healing include increased bacterial burden, biofilm, necrotic eschar, sloughy tissue, and excessive exudate levels.
Role of wound bed preparation
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