Do not attribute magical qualities to wound dressings.

This is a translation of the article published by the Dutch Branche organization for wound care companies.

Harm Jaap Smit is a wound biologist, CEO of BioMedServ and a member of the Wound Care Expert Group of the Netherlands Wound Platform. He also teaches at the Erasmus Medical Center and the Fontys Paramedic university of applied science.  Despite the encouraging developments in recent years, Smit sees that much has remained the same in “woundland”. According to him, the biggest gain can be achieved by making the correct diagnosis earlier.

“I always start the first lecture of the wound care course with the same case. Someone applies a bandage from knee to foot for a wound and then keeps it moist with water from a tea kettle, so I explain to the participants. What actually goes different nowadays, I ask them then. It often remains remarkably quiet, despite the body of practical experience gathered in the lecture hall. Sure, nobody uses a tea kettle anymore to achieve a moist environment. But otherwise, little has changed in the way we treat wounds. And that is telling, since this case dates from 1796. It is also easy to notice that little has changed when you open an average wound cabinet. Most of the products are still the same as they were 25 years ago. Not because no new products are being developed, on the contrary, but because it often proves difficult to incorporate new products into daily practice. ”

“Don’t get me wrong, we have pretty good wound treatment in the Netherlands. Even when you look at things like financing. If you have a problem, we will take care of you, no matter the cost. When I meet with colleagues from abroad I do realize the quality of care here. Still, at many points in the chain there is simply a lack of specialist knowledge in regard to wound care. Whether it concerns general practitioners, home care or medical specialists. No one needs to be blamed for that, it is just something like that has grown historically, but it is the situation we are in now. We all worked hard in recent years to bring about change, but at the moment there is still room for improvement. ”

Wrong conclusions

“Things go wrong in many ways. On the one hand, you have the doctor, who is not able to close a wound for months and then concludes that the dressing does not work. Then a vascular surgeon comes in, sets a proper diagnose, and both observe the wound does close. Here casual observation reinforces the faulty initial conclusion. On the other hand, you see that sometimes there is just too much faith in the products. “Wound care” which begins and ends with the selection of the proper dressing.  So we also should not attribute magical qualities to wound dressings. ”

“Of course, bandages can do a lot for a patient. I recently cut off a piece of my little finger while making a beetroot carpaccio. It is painful and takes quite a while to heal. At such a moment you think about the more serious cases you know. If the right dressing can relieve pain, remove it or make it unnecessary to redress the wound three times a day – that means something for a patient. Yet that is mainly caring, and not necessarily treatment. Keep in mind that although a wound dressing does contribute to faster healing, it is not uncommon for that effect to be masked by all other events happening in a patient with difficult wounds. If you only look at that nurturing aspect, at increasing the quality of life, you run the risk of missing something elsewhere – an infection or a tight vessel – and unintentionally cause new problems.  Conversely, this also applies if you carelessly reject the added value of bandages. “If you only have a hammer, every problem looks like a nail” is a serious challenge in wound care. ”

“In  95 out of 100 wounds; tracing and removing the cause is sufficient. If you have a wound that is difficult to heal, there is a good chance the root cause is an insufficient diagnose. And then there are the many underlying factors, ranging from behavior to (epi)genetic defects. The underlying issues are very difficult to identify. In the Dutch Journal of Wound Care, among others, I have therefore argued for the classification of wounds into five levels. At the lowest level, this is a normal wound without underlying pathology and at the highest level, for example, a wound with molecular pathology. Such a model forces treatment providers to think about the relevance of the interventions to be taken, thereby increasing the effectiveness of the treatment. ”

Costs of dressing materials negligible

“If you take a good look at the Dutch financial landscape, you will see that there is little reason to worry about the availability of dressing materials. There are around 500,000 patients in wound care each year, which together account for a cost of 3.2 billion euros. Within this, the proportion of dressing materials is 88 million euros. Relatively negligible. And the real gain in terms of costs, therefore, are to be found elsewhere

“We all know that the longer a wound exists, the harder it is to close it. If you consider that GPs hold a patient with a wound for an average of thirty weeks and/or home care often lacks specialist knowledge, you will see where the problem lies. It is therefore important that we move towards a system where expertise is more widely available and is deployed faster. Initiatives such as regional expert teams or the certification of wound professionals can play an important role in this. Such a change does not happen from today to tomorrow, but also a foot trip to China starts with the first step. “

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