Enzymatic Debridement and NPWT for Chronic Pressure Ulcers

Chronic pressure ulcers that are difficult to heal present a continuous challenge in wound care. With decreased mobility and skin aging, the elderly are at particular risk for chronic pressure ulcers. Debridement is a significant process that is found to be effective in reducing the risk of infection and promoting healing. Enzymatic debridement with clostridial collagenase ointment (CCO) has been shown to help accomplish and maintain a clean wound bed in preparation for closure. Negative pressure wound therapy (NPWT) has also been used successfully for treating chronic pressure ulcers. A new study investigates the use of CCO and NPWT as a conjunctive treatment for chronic pressure ulcers.

This study published in WOUNDS Journal in March 2015 evaluates the effectiveness of wound closure using CCO in conjunction with NPWT vs. using NPWT alone for chronic pressure ulcer. As part of the study, a retrospective analysis of 114 adult patients was performed to assess the healing of chronic pressure ulcers. Of these patients, 67 were treated with NPWT + CCO and 47 received only NPWT. All of them were hospitalized in a long-tem acute care (LTAC) facility which provided comprehensive medical treatment that includes management of conditions such as diabetes and protein calorie malnutrition as well as placement of patients on appropriate pressure redistribution surfaces.

The results of the retrospective analysis were overwhelming. The patients who were treated with NPWT + CCO showed statistically significant changes in several critical areas such as initial Bates-Jensen Wound Assessment Tool (BWAT) score, changes in the overall BWAT score and in the necrotic tissue domain. In short, the analysis revealed using NPWT and CCO as a conjunctive treatment results in enhanced outcomes in speed of debridement and rate of wound closure compared to using NPWT alone in case of chronic pressure ulcers. However, this study has its limitations like all retrospective studies. It is not possible to control interventions or manage confounding variables. However, this issue is mitigated to a certain degree because of provider protocol observed in this study. Wound nurses followed a well-established protocol to treat the patients and obtain consistent, objective measurements on a weekly basis and record it on a validated wound assessment tool.

Although a combination of NPWT and CCO is much more effective for treating chronic pressure ulcer, accurate documentation of wound assessment is still important to improve the quality of treatment. With CCO used in conjunction with NPWT, you may have to confirm and document many things such as type of treatment, that the suction device is functioning properly, integrity of the surrounding skin, presence of rashes, presence and extent of or absence of signs of infection, volume/amount of drainage, color of drainage, progress of wounds, wound surface area before and after the treatment and so on. Wound specific EMR provides you with in-built templates exclusively for wound care so that it will be easier for you to add all these details quickly. The information exchange between wound care physicians and nurses can be very effective with a wound EMR supported with an interface for physicians and nurses. Customized reports can also be generated using a simple click with such a system.