Wound Care: Sizzling Products and Trends

Are you looking for ways to increase your exposure in the marketplace while differentiating your business from the competition? Look no further than this list. Advanced wound management products are one of the fastest growth sectors in health care for the home care provider. If you have fallen behind on your wound care journal reading, haven't attended a show or conference in a while, or have been in "ulcer hibernation," this article is for you. Fasten your seat belts for a whirlwind tour of this year's sizzling wound care trends, topics and products in home care. Who knows, increased revenues may be right around the corner.

Fighting Bioburden and Infection with Ionic Silver

Microbial road blocks or bioburden create barriers to wound closure. Bacterial infection is one of the primary reasons for slow or poor healing of chronic wounds. All chronic wounds and many acute wounds are colonized with bacteria and other unfriendly microbes. The bacteria reside within the wound bed, but not in sufficient numbers to substantially disrupt wound healing substantially. All it takes is a slight shift and that bacteria and fungus can multiply and cause full-blown infection. For years clinicians have fought these germs with cytotoxic solutions that kill the bad inhabitants but also destroy good growing cells. Examples include povidone iodine or BetadineĀ®, sodium hypochlorite or Dakin's solution, hydrogen peroxide, and the like. Use of these products is on the decline and should only be used for a short period of time since they kill all cells, good and bad. Another universal concern is antimicrobial resistance. We have all heard of methicillin-resistant staph aureus (MRSA) and vancomycin-resistant enterococci (VRE), super bugs that have mutated and become resistant to most antibiotics. So, treating these patients with systemic antibiotics is not always the best course of action.

Newer dressings, effective against a broad spectrum of bacteria and fungi that incorporate controlled-release ionic silver, offer nontoxic alternatives to help keep wound microbes under control. Silver is broad spectrum in its ability to kill aerobic (those needing oxygen to live) and anaerobic (those that thrive without oxygen) gram-positive and gram-negative bacteria including MRSA, VRE as well as fungus and yeast. The wonderful thing about ionic silver is that there is no known resistance. So, clinicians can use it without fear. These dressings can come in a variety of categories, including a hydrogel sheet, a perforated sheet and a cavity version, as well as the versatile, amorphous (literally meaning "without form" or semi-liquid) hydrogel that can turn any dressing into a silver dressing.

Ionic Silver Dressings

What about metallic silver found in products? Metal coated silver dressings (metallic) contain far more silver than ionic silver products containing silver salts. This high level of silver can kill the good wound healing precursors, the fibroblasts and keratinocytes. They additionally tend to need additional moisture added at frequent intervals in order to keep the silver active.

Also beware of the outdated silver delivery, SilvadeneĀ®, or silver sulfadiazine (SSD). Although the compound has been widely used since the 1970s, it dumps silver into the wound, which quickly neutralizes and needs to be reapplied frequently. Therefore, it is not considered for the home care environment and is quickly becoming replaced in other practice settings.

Ionic silver dressings offer extended wear time for up to seven days, no need to pre-wet or re-wet, constant antimicrobial action in a product that doesn't require a physician's prescription.The HCPCS coding for these dressings depends on their category.

Managing Pain with Specialized Dressings

Pain management is a hot topic in health care and is quickly carrying over into the wound care market. Does your store offer dressings that reduce pain or diminish pain at dressing change? If not, it's high time you consider updating your product line. Standards and recommendations on pain management of patients with wounds are growing. Get on the pain-free dressing convoy or your dealership will be left behind.

Pain-related to wounds is caused by edema or swelling, lack of blood flow, bone involvement, infection or actual treatment of the wound such as dressings that stick to the wound bed, debridement, cleansing, or handling of the wound bed or surrounding skin (adhesive products).

Gauze and wet-to-dry routines should be avoided since they produce the most pain. Consider novel alternatives such as polyacrylate debriding which is quick and does its job without any discomfort (see Novel and Safe Wound Debridement below). Excellent examples of dressing strategies that reduce or relieve pain include: sheet and amorphous hydrogels, hydrofibers, alginates, soft silicones, cellulose, foams and polyacrylates. Also, consider not only the dressing category but how long the dressing can stay in place, decreasing the cycle of pain. Lastly, choose the right dressing for the right wound. For instance, select dressings with absorbency that matches exudate levels.

Closing Stubborn Incalcitrant Wounds with Negative Pressure Therapy

Negative pressure wound therapy (NPWT) is a noninvasive local treatment that employs the use of a contact or dead space foam dressing, an occlusive cover and the delivery of negative pressure via a tube to a negative pressure source to assist in closing and handling fluids of acute, sub acute and chronic wounds of various sizes and locations.

Although it has been around for about a decade, NPWT is still considered a newer adjunctive therapy in wound management. This progressive therapy is said to help to remove excess wound fluid, decreases edema or swelling, diminishes bacterial colonization while increasing blood supply, granulation tissue formation and enhancing epithelial and cell migration within the wound bed. The dressing is changed every 48 to 72 hours or if the occlusive seal is broken.

To meet Medicare B criteria for negative pressure wound therapy a patient must present with wound(s) that qualify. For instance: stage III and stage IV (with sub criteria), diabetic/neuropathic ulcers (with sub criteria), venous ulcers (with sub criteria), documented medical necessity for accelerated formation of granulations tissue that cannot be achieved by other available topical wound treatments, a comprehensive wound management program including at least monthly documentation by a licensed medical professional, moist wound healing, debridement and evaluation along with completion of the initial statement of the ordering physician.

Real Life Science Fiction

ProvantĀ® Wound Closure, Regenesis Biomedical Inc. is a revolutionary adjunctive therapy that signals the secretion of growth factors and proliferation of fibroblasts and epithelial cells utilizing physical energies to promote wound healing. The treatment is non-invasive and does not require dressing removal. The signals penetrate through all soft tissue layers to promote healing of the wound site, increasing tensile strength and reducing reoccurrence. You want to talk about something that know one else is discussing? Lead the field? Then here's another product to help.

Novel and Safe Wound Debridement

Wound debridement is the cornerstone of wound bed preparation (preparing the wound to heal) and one of the hottest topics in wound care today. Some forms of debridement (removal of dead material from the wound bed) require special training, can be dangerous if the patient is on bleeding precautions, take a long time, are expensive, painful and require special prescriptions, not to mention, are not available in the home health care setting. A novel and safe form of wound debridement to consider that is especially cost-effective and tailored to the home care environment is polyacrylate debridement. Necrotic wounds are cleaned via a rinsing effect utilizing a physiologically compatible Ringer's solution. The dressing is changed only once in a 24-hour period, absorbing and retaining pathogens and trapping them in the polymer core.

This innovative dressing completely replaces outdated wet-to-dry or wet gauze therapy offering your customers easy application, an ideal healing environment, cost-effective once-a-day visits and a reduction in pathogens and bioburden. This therapy is a major paradigm shift in the moist wound healing and debridement arenas that can set your dealership apart from the others.

Support Surfaces that Do it All

With the countless preventative and therapeutic support surfaces on the market, what are providers and clinicians to do? There are different mediums, configurations and forms to choose from, not to mention different therapies. In order to address the risk factors and needs of home care patients, providers often find themselves perplexed with too many choices. Which products do clinicians want? What products must I stock? Are the products reimbursed by managed care and do the products have HCPCS codes? What are the allowables? What are the costs? How quickly can I recoup my investment? What kind of maintenance and cleaning is necessary? The list goes on and on.

Consider some of the newer more versatile products when choosing therapeutic support surfaces. Mattress replacement systems that offer all modes of therapy give decision makers a choice while offering flexibility. The following risk factors and clinical needs can be treated with support surface features: pressure, shear, friction, excess moisture, heat build-up, and pulmonary toilet (mobilization of lung secretions). Support surfaces that provide pressure relief in the form of redistribution and alternating pressure, a low friction and shear environment and covering, moisture and heat dissipation from low air loss therapy and kinetic or lateral rotation to reduce pulmonary complications in the acutely il, supply the greatest versatility. These products cover all your clinical bases, offering the most therapy and all the features your customers want and need. These multi-featured mattress replacement support surface products offer the ability to customize the support surface to the individual patient's needs, depending on their condition and risk, thus decreasing your inventory while simultaneously increasing your profits.

Put the Pressure on your Opposition

Want to solidify even more support surface leads? Consider purchasing a pressure mapping system. These high-tech, computerized tools measure interface pressure between patients and surfaces, providing you with a leg up on the competition. Think beyond the days of seating clinics and pressure mapping to the present where providers now can visualize the entire recumbent surface on one mat. Comparing apples to apples is easy as they see the pressure distribution of their body on various surfaces, in living color. As the saying goes, a picture speaks a thousand words.

Where do you go from here?

Your referral sources and clinical decision makers may be searching for new answers to their chronic wound care dilemmas. Why not offer some cutting edge products to capture these sales. First objective is to contact the manufacturers and distributors, perhaps getting in touch with them at a trade show such as Medtrade. Often there are special offers, discounts or financing available for show attendees who purchase within a short period of time. Next you will need to incorporate these products into your business plan. Finding those prescribing health care providers, wound care specialists, case managers and physicians, in the acute care facilities and community is of supreme importance for pull-through. Make sure that they know that you and your company offer progressive technologies in wound care. Consider sponsoring a local seminar and inviting referring clinicians. Ask the manufacturers and distributors to help share costs by providing expert speakers, value added giveaways and free trials to kick-off business. Another creative idea is to bundle certain complimentary wound care technologies such as negative pressure therapy and a silver gel to increase outcomes and set yourself apart from your rivals.

Think outside your usual parameters by consulting with a local decision maker, a wound care nurse for example, who can get your finger on the pulse of local trends and needs. Integrating these hot wound care products into your product mix can increase your visibility and your profits. Good luck and good selling.

This article originally appeared in the March 2004 issue of HME Business.

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