Wound
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Wounds can be acute or chronic. Acute wounds are wounds that go on to heal without issues and follow a normal healing process (ex. minor cuts and burns, abrasions, skin tears, skin breakdown, and surgical wounds). Chronic wounds are wounds that are open for a prolonged period and do not heal in a normal manner. Chronic wounds commonly occur with vascular disease (venous and arterial), pressure ulcers, and diabetic foot wounds.
With this rise in wounding, the wound care product market has had unprecedented growth with wide availability of wound products. Understanding which products to use with a particular wound, how to apply them, when to change them, and how to teach them can be a challenge for clinicians with limited wound experience. Several Internet resources and common wound care products are available commercially and are affordable, to support efforts with wound closure in the outpatient setting.
Wound care and Ostomy Products
Wet to dry dressings are no longer recommended for first line use in wound care, and several affordable and more effective options for wounds are available. The wet-to-dry method is a non-selective debridement method that harms good tissue while removing devitalized tissue.
When clinicians choose wound products and treatments, utilization of DIME (Debridement/devitalized tissue, Inflection or inflammation, Moisture balance, wound Edge preparation/wound depth) treatment guidelines for wounds supports a patient-centered approach, considers wound etiology, and wound bed preparation planning. Utilizing DIME guides which product category to use. Wound care supplies can be costly. Choosing an effective product to match wound type, and moisture levels can be aided by product navigator tools available on the Internet through WoundReference. The free site includes several helpful tools to assist with product choices based on wound characteristics. Several affordable wound care products and dressings can be purchased through Amazon that support wound closure and are commonly used in wound care including but not limited to Silver Alginate, Medihoney, Iodosorb, Iodoform, and Mesalt. Silver Sulfadiazine Cream 1%, a prescription topical antibacterial cream, used in a variety of wounds, costs under $10 for a 50g jar when utilizing GoodRx.
Educating patients on wound healing and what is good and bad for wounds can be reviewed with the use of the attached poster. In addition, WoundReference offers a free customizable wound dressing education brochure in English and Spanish that can assist with patient education of general wound care, when to change the dressing, and customizable steps of a patients wound dressing regimen.
Ostomy supplies can be challenging to access and are costly when uninsured or underinsured. In addition, ostomy needs may change, requiring the trial of different products and wafer sizes. The St. Josephs Hospital Ostomy Clinic (Kindness closet) is a free resource for ostomy patients. They carry ostomy supplies, including bags and wafers, as well as several additional ostomy-related products.
Ostomy Supplies at St. Josephs Hospital and Medical Center Kira McClinton, Transitional Care Supervisor 350 W. Thomas Road Phoenix, AZ 85013 602-406-1190
Manufacturers of Ostomy Products also have patient assistance programs:
Convatec: 800-422-8811
Hollister: 888-808-7456
Coloplast: 888-726-78972
Wound Prevention
Preventing wounding and re-wounding (after a wound has closed) is a priority in the outpatient setting. Several resources on the Internet provide brochures that support diabetic foot care patient education and prevention. If a patient has had a wound or amputation, checking feet at every visit ensures close monitoring and identification of clinical findings that place the diabetic foot at risk for a wound (callus development, areas of pressure, early blister formation, skin changes from improperly fitting shoes, long-thickened toenails). Callus removal, early coverage and monitoring of blisters, controlled blood sugars and offloading the foot, as well as changes in footwear are just some of the measures that can be instituted in the outpatient setting to prevent diabetic foot ulcers. Primary care providers can peform routine toenail trimming and callus removal.
Wound DME
DME utilized in wound includes offloading shoes (wedges), boots, compression stockings, and compression bandages. Access to offloading shoes and boots, and tubular compression bandages such as Tubigrips for edema management can be purchased through Amazon. Additional local resources that provide DME include Arizona Prosthetic Orthotic Services (APOS), Hanger Orthotics and Prosthetics, and Artisan Prosthetics.
Wound Specialty Care
The goal of wound care in the outpatient setting is rapid closure without complications (ex. infection). The longer the wound remains open, the higher the risk it becomes a chronic wound. When a wound becomes chronic, the cells responsible for closure down-regulate and the wound stalls. Prolonged or chronically open wounds are difficult to heal without wound interventions such as debridement or access to specialty wound products that address these stalled wounds.
If you do not have the resources available to provide care for a chronic wound or acute wounds, they can be referred to St. Vincent de Paul’s medical clinic. The clinic has a nurse practitioner certified as a wound specialist that is skilled in sharps wound debridement and the management of acute and chronic wounds. The wound clinic provides for patients wound care supplies, wound vac management, dressing application education, and any additional needs that may arise. They also have volunteer registered nurses skilled in wound care that assist with dressing changes. If you work for an FQHC or a local charity clinic, see if your organization has the process set up with St. Vincent de Paul, otherwise feel free to contact the clinic at medical@svdpaz.org to inquire about setting up these services for your patients.
Wound Professional Resources Link
https://aawconline.memberclicks.net/guidelines
https://aawconline.memberclicks.net/resources
Wound Product Information, Patient Education (English and Spanish), and Wound Care Algorithms