Trends and treatments in wound and skin care

At Medline Industries, Greg Olk, senior director of product management, Advanced Wound Care, pointed out one of the factors that contribute to slow wound healing, and detailed a solution to overcome the challenge faced by patients and physicians. 

“More than 90% of chronic wounds contain biofilm, which are bacterial structures physically attached to a surface and characterized by tolerance to antibiotics and biocides. Biofilm stalls wound healing and contributes to chronicity. It is also very difficult to remove because it firmly adheres to surrounding tissue and is highly tolerant to antibiotics. Recent evidence suggests that ‘slow-release’ iodine is more effective on biofilm than many standard antimicrobials, such as silver and Polyhexamethylene Biguanide (PHMB),” Olk said. 

He continued, “Slow-release iodine dressings release iodine in a slow, controlled manner over a three-day period to sustain antibacterial activity and reduce cytotoxicity. Perhaps more importantly, with today’s growing concern of superbugs and multidrug-resistant organisms (MDROs), iodine’s multiple modes of action ensure the rapid kill of microbes and help prevent the development of bacterial resistance.” 

Citing the benefits of Medline’s foam dressing, Olk said, “An example of Medline’s innovative wound care dressings is IoPlex foam dressing. It is the only foam dressing with controlled-release iodine, which has been shown to be effective in-vitro on a broad spectrum of mature biofilms. This allows healthcare workers to treat significantly recalcitrant wounds effectively, which previously may have been stalled. For example, a venous leg ulcer that was present for six years and did not respond to other dressings was closed in six months using Medline’s IoPlex foam dressing.” 

Silver and honey saves time and money 

As evidenced by many patients in hospitals and healthcare facilities, chronic and infected wounds are often slow to heal. At Gentell, President and CEO David Navazio offered an explanation as to the reason behind the slow healing process. 

“One of the causes of delayed wound healing is the presence of microorganism overgrowth in wounds. When wounds exhibit this, it is tempting to reach for cleansers or packing solutions to treat the overgrowth. However, routine use of some types of these products—such as sodium hypochlorite solution, hydrogen peroxide, or povidone iodine—may also remove essential components for wound healing, such as regenerating tissues, growth factors, and chemokines. Ultimately, these solutions may be potentially harmful to the wound tissues; cytotoxic (cell death), delay wound healing, and exhibit other adverse effects,” Navazio reported. 

He continued, “If the products mentioned above are cytotoxic, and could potentially delay wound closure, then what are the alternate advanced wound care products that can be used in their place? The answer is that silver or honey products may be the ideal treatment option. Silver and honey dressings kill microbial organisms at the source, which is why wound care best practices indicate them as preferred treatment options.” 

Navazio elaborated on the benefits of silver and honey products, and when each one is the best choice for the patient’s wound. 

“Silver has been used as an antimicrobial agent for centuries; it is effective against a broad range of bacteria (including methicillin (MRSA) and vancomycin-resistant strains), yeast, fungi, and viruses. In infected wounds, dressings containing nanocrystalline silver are helpful in the early treatment phase (i.e., the first two to three weeks) to reduce bacterial counts and mitigate wound odor. Silver ions engage directly with bacteria on the wound bed, thus eliminating the source of the infection. These dressings are best used as an adjunct to surgical debridement. As the wound becomes cleaner, you should use silver-free dressings to minimize toxicity toward keratinocytes and fibroblasts.” 

Silver products available from Gentell include Collagen Ag dressings, Calcium Alginate Ag dressings and Foam Ag adhesive dressings. Among the honey products available from Gentell are Honey Alginate/Fiber dressings. 

Navazio pointed out, “Honey has been used as a wound dressing for thousands of years; it is a biologic wound dressing with multiple bioactivities and physical properties that work together to expedite the healing process. Honey’s acidity increases the release of oxygen from hemoglobin, thereby making the wound environment less favorable for the activity of destructive proteases, and the high osmolarity of honey draws fluid out of the wound bed to create an outflow of lymph fluid.” 

He added, “Honey has a broad-spectrum antibacterial activity, but there is much variation in potency between honey products, due to levels of hydrogen peroxide, but much of this is inactivated by the enzyme catalase present in blood, serum, and wound tissues. Honey also has bioactivities that stimulate the immune response (thus promoting the growth of tissues for wound repair), suppress inflammation, and support rapid autolytic debridement.” 

So which is the best to use for optimal wound care? “Best practice is to avoid the use of cytotoxic wound cleansers such as sodium hypochlorite, hydrogen peroxide or povidone iodine to treat chronic or infected wounds. Use of a silver or honey product should be considered. Silver dressings control biofilm in wound beds, manage exudate, and promote autolytic debridement. However, you should never use silver on clean wounds; chronic wounds healing as expected; or wounds being treated with an enzymatic debriding agent. Honey would be the better choice in those cases,” Navazio summed up. 

Addressing wound care dressings 

Before addressing what kind of wound dressing is most appropriate for optimal patient healing, healthcare professionals must look to the most appropriate products for cleaning the skin and wound area itself. At Angelini Pharma, an important consideration in choosing a cleanser is the potential for irritation from continued use, as noted by Artee Hazari, U.S. marketing head. 

“A common problem with skin and wound cleansers is irritation with continued usage. ExSept Plus from Angelini Pharma has been shown to be non-sensitizing, non-allergenic, and non-irritating. This antimicrobial skin and wound cleanser is a highly effective antimicrobial solution that provides rapid and long-lasting protection against a wide range of pathogens, including bacteria, viruses, and fungi.” 

She added, “It is a multi-faceted infection control across several indications – debridement, post-surgical cleansing, Stage I-IV pressure ulcers, debriding agent, catheter exit site cleansing, and diabetic foot ulcers, as well as graft and donor sites.” 

Infection prevention and staff shortages 

According to Robert Garcia, a 40-year infection preventionist, an increase in the number of hospital-acquired infections (HAIs) during the pandemic is only partially to blame for slow healing among patients. Garcia pointed out that the impact of the continuing exodus of experienced patient care staff has also contributed significantly to a rising trend in hospital and healthcare facility patient complications. 

“In addition to the rise in pandemic-related HAIs, the problem for hospitals is compounded by the related ‘Great Resignation’ of over 100,000 nurses, which is directly linked to the pandemic and is expected to grow to 800,000 by the year 2028. This has had, and will continue to have, a severe impact on hospitals and healthcare facilities, as well as patient care,” Garcia said. 

He continued, “Hospitals need to turn to established protocols while assuring compliance with all elements. Facility leaders need to expand oversight and intravascular teams. In addition, consideration should be made of benefits achievable with new technology.” 

Garcia summed up, “In order to best address staff shortages, hospitals need to standardize applications and procedures as much as they can throughout their facility. By doing this, patients can benefit because there will be little deviation in what all staff members do at the bedside.”