Wound Management Update from Medline

What has changed in wound management over the past 10 years or so?

Over the past decade, one of the most notable changes in wound management has been the significant integration of technology. While the fundamental categories of wound care dressings have remained relatively consistent, the approach to identifying and preventing tissue damage, particularly pressure injuries, has undergone a remarkable transformation. Technological advancements such as SEM (Sub Epidermal Moisture) scans, infrared thermography, and other modalities have revolutionized early detection capabilities, allowing clinicians to intervene at earlier stages to prevent tissue breakdown. Additionally, these technologies allow for better care for patients across all skin tones. As early signs of tissue damage vary in their appearance based on skin tone, these technologies give objective data that helps determine an appropriate care plan.

Are there any new innovations in this space?

Pressure and excess heat can lead to skin breakdown and increase the risk of pressure injury development. Traditional routine skin assessments require removing the wound dressing multiple times per day, which can be taxing on both the caregiver and clinician, and puts additional stress on the dressing’s adhesive and underlying skin.

One development in wound dressings has been the introduction of new categories, exemplified by innovations like Medline’s OptiView Transparent Dressing with HydroCore Technology. This first-of-its-kind wound dressing features an innovative clear design that allows caregivers the ability to quickly and easily inspect, monitor, and blanch skin with the dressing in place. OptiView empowers caregivers to visualize the skin at all times, looking for color variances and early signs of breakdown without lifting the dressing. The innovative clear island allows for immediate visibility to the underlying skin, while the HydroCore Technology uses a gel center to help redistribute peak pressure and draw heat away from the skin to create a cooling effect.

What are the biggest challenges surrounding wound management?

One of the biggest challenges in wound management is looking at the bigger picture beyond just treating the wound itself. Chronic wounds often come with underlying chronic diseases, which complicates the overall care process. Without proper management of a chronic illness, the wound could be harder to heal. There are many extrinsic factors that impact a wound’s healing that are outside of the clinician’s control. Examples include malnutrition, medications, wound bioburden and infection, and comorbidities that require radiation or chemotherapy.  Plus, wounds don't always get the same attention as injuries to vital organs like the heart or lungs. Another challenge is making sure patients can take care of their wounds properly while also managing their chronic illnesses. Without addressing these underlying health issues, fully healing the wound becomes much harder.

What are some best practices?

When it comes to best practices in wound management, it's all about relying on evidence-based approaches. This means drawing on research and guidelines provided by reputable organizations like the Wound, Ostomy, and Continence Nurses Society (WOCN) and the National Pressure Injury Advisory Panel (NPIAP). Best practices should be rooted in solid evidence, not just traditional methods or anecdotal experiences. Key considerations include understanding the causal factors behind the wound, as treating the symptom alone without addressing the root cause increases the risk of recurrence. Additionally, maintaining an optimal wound environment is crucial for promoting healing. This might involve adjusting moisture levels or selecting appropriate dressings based on the wound's characteristics, such as its level of drainage, what the wound bed looks like, or the depth of the wound.  By combining evidence-based practices with tailored approaches that prioritize the specific needs of each wound, healthcare professionals can maximize the chances of successful healing.

How much training do nurses get regarding wound management? Are there any certifications they can receive? What do they learn in school?

Nurses typically receive limited training in wound management during their education. The gold standard for certification in wound care nursing is through organizations like the WOCN. In nursing school, the focus is more on the anatomy and physiology of the skin as an organ, rather than on specific wound treatment and physiology. As a result, unless they pursue specialized training, nurses often lack comprehensive knowledge about wound care and healing processes. It's crucial to simplify best practices and provide decision-making tools for general nursing staff, highlighting the importance of specialization in wound care. At Medline, our clinical team of board certified WOC nurses develops educational programs and workshops geared toward bringing needed information on prevention and treatment to the bedside staff in an engaging and enriching format. 

Did COVID impact wound management in any way?

COVID had a significant impact on wound management, particularly regarding pressure injuries.  The utilization of proning became vital with COVID patients, but it also increased the risk of pressure injury development. Pressure injury rates surged during the pandemic as healthcare providers were not accustomed to preventing pressure injuries in these new positions. COVID underscored the importance of pressure injury prevention, bringing about a renewed focus on this aspect of wound management.  

Desert Springs Hospital and Medical Center in Nevada was able to reduce Healthcare-associated pressure injuries during the pandemic. Read more here: https://www.medline.com/strategies/skin-health/las-vegas-hospital-reduces-healthcare-associated-pressure-injuries-with-medline/

What does this space look like in the next 5-10 years?

In the next 5-10 years, I hope to see significant advancements in wound management technology, specifically in understanding why wounds may stall, despite our best efforts. While current technology allows for early detection, there is a gap in our ability to comprehensively assess wounds and determine what specific factors are hindering the healing process. Wound physiology is complex and varies from case to case, often requiring a trial-and-error approach. It would be transformative to have technology that can pinpoint precisely what a wound is lacking in order to heal optimally. This would allow nurses and clinicians to tailor treatment to each wound. Technology that would directly tell you what the wound is missing would revolutionize wound care and significantly improve outcomes for patients.