11.03.11
Seeking consensus
Although there are many consensus guidelines for the treatment of wounds available to practitioners in the NHS. The question is whether they are being implemented properly, reports Richard Mackillican
Although the quality of wound care services in the UK is good, one of the biggest problems facing those who work in wound care is a broad lack of agreement over antimicrobial treatment options.
“I think that there is a need for a single consensus wound care document advising on antimicrobial treatment options to be put into place for the NHS and implemented by all of the trusts and PCTs,” says Valerie Edwards- Jones, director of research and professor of medical microbiology at Manchester Metropolitan University.
“I have found that although there are a number of consensus documents on aspects of wound care available globally, they are still not implemented in a standardised way. For example, there are no consensus guidelines available on the use of topical antimicrobial dressings for infected and/or heavily colonised wounds. This means that rather than having one set of guidelines, the choice of antimicrobial dressing is often left to the individual practitioner carrying out wound care treatment and this relies on personal preference or the selection of treatment options available to them.
“You only have to look at trusts throughout Britain to see the very different ways in which they manage their wound care. For example, some trusts have a referral centre for wound care and will employ a team of specialists in tissue viability and some don’t.
“Consensus wound care treatment guidelines are in place in a number of countries across the world. I know that Australia has them, along with America and areas of Europe. However, it is not just about having guidelines in place. They must be put into practice and evolve following further evidential research.
“I think that where wound care has really been brought to the forefront in recent years has been as part of the fight against multi-antibiotic resistant organisms (MRO). There has been a great deal of research into the cause and spread of MROs like MRSA, leading to researchers to discover / correlate spread between patients with heavily colonised wounds and the development of associated disease in susceptible patients..
“This has led to awareness by wound care practitioners that the presence of MRO such as MRSA in a chronic wound does not always cause infection in the colonised patient but that they can pose a risk to other susceptible patients. This has led to wound care practitioners being bombarded with many different types of antimicrobial dressings to help remove/ reduce colonisation or prevent cross-infection. This is a positive step but the practitioner is left unsure exactly what to do i.e. which dressing to choose, how long to use it. This is why the wound care community needs some strong guidance.”
Given the lack of clarity in what is such a vital area of healthcare, why was there not already such consensus guidelines in place and why has wound care had not been a priority in the past?
“I don’t think it the case that wound care was not a priority; people who are passionate about wound care have always been passionate about it. However, there is now such a large number of advanced wound care products on the market that there needs to be guidelines that support and underpin their use.”
This rise in the age of the population will drive demand for wound care services, as there will be a significant increase in the number of cases of venous ulcers, poor cardiovascular health, diabetes and obesity. These are all problems which can lead in one way or another to wounds.
“Because of these increased risks, the number of people with chronic wounds is increasing and causing increased pressures and costs on the healthcare system. I think that now consensus guidelines have become a pressing issue because of an increase in demand on services rather than wound care being overlooked in anyway. ”
“However, this upturn in demand has also driven a surge in research around the microbiology of wounds which has led to doctors and nurses understanding more thoroughly the way in which micro organisms can affect wounds and healing process.”
So given the urgent need for consensus to be made and the significant challenge facing the NHS as it has to deal with larger and larger elderly populations, what is being done?
“There have now been calls from within the wound care community for consensus guidelines on treatment lines and strategies, for example giving a practitioner some idea of which the best kind of dressing to use on a particular wound.”
Although there is no one body looking into this problem, there is a growing group of people who are very interested in seeing this consensus being reached.
“People are definitely talking about this more as an issue and there are also certain organisations who will try to offer support at a local level to practitioners.”
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