Wounds need more than time to heal

The old adage “time heals all wounds” may apply to many things in life, however when it comes to the skin, time isn’t always enough to heal problematic wounds.

In fact, time can be an enemy of the person who has a skin wound. Many chronic wounds – that is, those that have been present for more than a month – heal more slowly when they do not receive timely assessment and care.

Chronic wounds, like leg ulcers, pressure injuries (or bed sores) and foot wounds, affect nearly half a million Australians and cost the healthcare system around $A3 billion each year.

Chronic wounds are associated with some of the most common chronic diseases (like vascular disease and diabetes), putting many Australians at risk.

Problems with the veins in the leg as a result of vascular disease can cause venous leg ulcers, and diabetes can predispose people to foot wounds.

As a nurse and researcher in the Department of Nursing at the University of Melbourne, I have cared for and conducted research with chronic wound patients for over 15 years.

My research has shown that the effect of leg ulcers on personal wellbeing can be significant.

Our interview-based research found that people with leg ulcers have their quality of life compromised across many areas, including physically, emotionally, as well as impacting on their lifestyles and their finances.

Research participants commonly tell us that their wound is painful, causes distress, disrupts day to day activities and costs them a lot of money.

In fact, we have identified that out-of-pocket costs for wound dressings and treatment-related expenses totals, on average, 10 per cent of the person’s disposable income.

This is money that won’t otherwise be available to spend on necessities like food, heating and rent.

There is no doubt that many patients will experience quicker and less complicated healing, if expert advice, assessment and care is started early.

It’s very important that patients and healthcare providers do everything they can to ensure that patients get the right advice if their wound isn’t healing. This is a shared responsibility, so we need the patients to work with us – that means seeking help before too long has passed.

So, what are the signs that a skin wound needs expert assessment and care?

If the wound has been present over 30 days, you should seek professional advice. Other factors, like pain, heat and odour may suggest infection, however, we must be very careful that antibiotics are prescribed appropriately. That means expert assessment is needed.

In the first instance, visit your local doctor and, if the wound isn’t healing, discuss a referral to a specialist wound clinic.

But there are some additional challenges when trying to manage and prevent some chronic wounds.

For example, pressure injuries often occur among people who are extremely vulnerable, and who may not be able to report their concerns to healthcare providers.

This is particularly the case among aged care residents who may have dementia and/or are unable to adequately communicate. We need to do much more to prevent wounds, and many other harms, among this vulnerable group.

The Royal Commission into Aged Care Quality and Safety has been a call to action for healthcare providers, services and researchers.

Our team has conducted an extensive program investigating interventions for preventing pressure injuries in aged care. This has included testing the effectiveness of dressings for preventing pressure injuries, and directly measuring the cost of pressure injuries in the aged care setting.

This research has shown that using multi-layer silicone foam dressings are effective for preventing pressure injuries on the tailbone and on the heel. However, we must remember that not all multi-layer silicone foam dressings are the same and not all have the research to support their use, so clinicians must do their homework.

We’ve also found that pressure injuries in aged care cost on average $A26 per day per injury.

Given many pressure injuries are preventable, this unnecessary expense; if it’s avoided, funding could be redirected to other health areas in need.

We also know that simple interventions that nurses undertake every day can prevent pressure injuries. Nurses inspect and clean the skin, as well as turn and position residents to relieve pressure.

We need to be sure that we have pressure injuries front-of-mind when performing these tasks.

Importantly, we need to communicate the necessity of the early identification of skin damage to other people involved in care of the elderly – particularity health care workers – who are ideally placed to be the voice of aged care residents, and report skin concerns early.

Turning and positioning patients is a particular area of interest to me and my program of research.

It’s a fundamental care activity that provides opportunities to care for the skin, provide hygiene and comfort and even a little extra time to talk to the person we are caring for.

Health care workers must make the most of turning and positioning, particularly given the extensive amount of time and effort that this activity requires.

The results of my recent research suggests that there are new approaches to turning and positioning that have the potential to be more effective in keeping residents in a particular position in bed – one that the keeps the pressure off the tailbone. This include using purpose-designed positioning devices.

So, in addition to testing new and innovative ways of preventing and managing wounds, we must also revisit well-adopted strategies and try to improve them.

What we all need to remember is that while the body is amazingly good at healing wounds, it always needs help. And the earlier the better.

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