Tackling Potentially Preventable Hospitalisations in Wound Care

The ongoing burden placed upon Hospital and Health systems due to the Covid-19 pandemic has brought the importance of employing strategies for the prevention of Hospitalisation wherever possible into focus like never before.

Ominous projections of the potential impacts of Antimicrobial Resistance (AMR) suggest that the current pandemic may be preview of worse to come. A 2016 review on Antimicrobial Resistance predicted that by the year 2050, AMR will be responsible for 10 million annual deaths worldwide.¹ It is also estimated that at least 30% of antibiotic courses prescribed in the outpatient setting are unnecessary².

The Australian Institute of Health and Welfare defines potentially preventable hospitalisations (PPH) as hospital admissions that could potentially have been avoided through preventative health interventions, or appropriate individualised disease management. These include the treatment of infections or management of chronic conditions in Primary and community health care.³

This is particularly relevant to patients that either already suffer from, or are at risk of developing chronic wound conditions. In a 2020 guidance document, Lipsky et al⁴ concluded that whilst evidence is limited, applying principles of Antimicrobial Stewardship (AMS) to the care of patients with wounds should help to reduce the unnecessary use of systemic or topical antibiotic therapy.

As the first contact with the health system will often occur within a Primary or community health setting, early identification and appropriate interventions at this point can have a positive impact toward preventing hospitalisation and the requirement for systemic antibiotics.

A recent study aimed at improving standard of care through the early recognition and management of wound infection in a community health setting has shown positive results by standardising to a first-line antimicrobial dressing⁵. As any standardised framework would need to apply to all patients within a Health service (including children and potentially breast-feeding mothers), it is imperative that the product is safe for all patients. After careful consideration, Cutimed® Sorbact® (Essity) was selected due to its safe, physical mode of action.

As well as standardising care, and thus reducing variation, implementation of the pathway resulted in measurable improvements in cost-efficiency. A 47.68% reduction in spend on antimicrobial dressings containing silver, and a 14.34% reduction to spend across all antimicrobials was reported. Decreases in Antibiotic prescribing as well as a considerable reduction in wound swabs were also observed over the period.

This builds on a similar Community Health study utilising Cutimed Sorbact as first-line in a wound infection pathway.⁶ This study was based on the early intervention for patients deemed to be at high risk of wound infection, as well as those already displaying signs and symptoms of local infection.

Patients were classified for wound management purposes into one of the following pathways:

• Red: presenting with an established infection
• Amber: presenting with wounds that were positive for signs and symptoms of local infection
• Green: deemed to be at high risk of wound infection

Patients in the Green and Amber pathways received Cutimed Sorbact as the first-line dressing for prophylaxis, and treatment respectively.

In the audit, 85.6% of patients assigned to Green pathway displayed no signs of wound infection, whilst 75% of those assigned to the Amber pathway had shown improvement to the status of their wounds, which included resolution of infection, and were transferred to the Green pathway.

The authors recognised overall improvements to patient safety and standard of care outcomes and cost; observing a reduction of 47.3% in spend for products used to treat active wound infection.

As a leader in wound management solutions, Essity understand the significance that pro-active wound management strategies can play in addressing PPH and combatting AMR. Please contact Essity to find out more.

Figure 1

For more information: au.woundwarriors.com

References:

^{1 Tackling drug-resistant infections globally: Final Report and Recommendations – The Review on Antimicrobial Resistance chaired By Jim O’Naill, May 2016}

^{2 Fleming-Dutra, K., et al. (2016). “Prevalence of Inappropriate Antibiotic Prescriptions Among US Ambulator Care Visits, 2010-2011.” JAMA: The Journal of the American Medical Association 315(17): 1864-1873}

^{3 Australian Institute of Health and Welfare (2020) Disparities in potentially preventable hospitalisations across Australia: Exploring the data, AIHW, Australian Government, accessed 11 April 2022.}

^{4 Antimicrobial stewardship in wound care: a Position Paper from the British Society for Antimicrobial Chemotherapy and European Wound Management Association: Benjamin A Lipsky 1 2, Matthew Dryden 3, Finn Gottrup 4, Dilip Nathwani 5, Ronald Andrew Seaton 6, Jan Stryja 7}

^{5 The Leeds Wound Infection Framework: Development and implementation of a new pathway to improve care: Kate Williams Wounds UK, Vol 18, No 1, 2022}

^{6 An audit to determine the clinical effectiveness of a pathway for managing wound infection.: Grothier, Stephenson Wounds UK, Vol 11, No 2, 2015}

Image: Supplied