Management and prevention of wound infections during Covid-19 - Part One

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Management and prevention of wound infections during Covid-19 - Part One

In September 2020, we interviewed Louisa Way, Interim Head of Clinical Practice – Falls Prevention, Moving & Handling and Tissue Viability at University Hospitals Dorset, about her experiences of working as a wound care / tissue viability specialist during the Covid-19 pandemic.

Managing infections has always been a key aspect of wound management. Covid-19 has disrupted wound care routines, with nurses having to treat patients at an arm’s length. In her interview, Louisa shares information about the challenges her team faced, some of the changes in treatment objectives when dealing with patients remotely, her opinions on wound bed preparation, antimicrobial dressings, infected wounds and more.

We hope you find the information interesting, actionable and inspirational.

Thank you Louisa

#YouAreNotAlone #TogetherInWoundcare

Hello my name is Louisa Way and I am currently working as head of patient safety at Royal Bournemouth Hospital down in Dorset. We are soon to go into merger, so we will be University Hospitals Dorset and that's an exciting opportunity working with our colleagues across an integrated care system across the whole of the County.

I've had the privilege of working in the NHS for the last 20 years and have experience as being a tissue viability nurse for the last 14 of those years. So I'm willing to share with you our local experience of the recent COVID-19 lockdown and the impact it's had on our patients and their wound care.

What were the main challenges regarding wound care that you experienced during the COVID-19 lockdown?

“I work in the acute sector and I work in the Southwest region and we saw thankfully one of the lowest rates in the country for infection, but we still experienced some significant challenges. I can only imagine what other areas experienced during their lockdown.

What we saw was, that where patients were shielding, their normal wound care routines were disrupted and this was just for the patients that were already known to services.

What we found recently is that there were a number of patients that were unable to access services in a timely manner. So they have possibly presented with wounds that are far more established or in a more severe state than we would have seen had they presented themselves to us earlier.

We also know that a small number of patients were admitted to hospital due to wound infections because their normal wound care routines had been disrupted. So patients with established chronic wounds that had deteriorated, leg ulcers, diabetic foot wounds for example, were presenting in crisis requiring emergency admissions. 

Self-imposed isolation was an issue for some of our more anxious and concerned patients. They didn't want health care professionals hopping from one home to another. They were concerned and kind of self-imposed some of that isolation and we also had reports of patients trying to self-treat and self-manage without accessing clinical support to do that.”

Can you tell us a little bit more about the situation for your patients regarding the state of their wounds?

What we know about wounds is that 9 times out of 10, they are a symptom of an underlying condition and I think that's what we've got to remember when we're looking at and assessing our patients holistically - the wound is there because of another underlying condition or comorbidity.
Where we're asking to manage patients’ wounds remotely, we can't lose sight of the fact that they may also being asked to self-manage their cardiac failure, respiratory failure, renal failure or other underlying conditions such as diabetes, for example.

So we've got to be able to give the patient permission and advice in their self-care, but also we need to help them make the link between their underlying health status and how their wounds are presenting.
I think we need to find the right balance of that to help them meet their multiple care needs and simplify their wound care routines as much as possible.
We can then maintain their safety, but also give them advice on their triggers, on signs / symptoms to look out for and the permission to escalate should something change and the details of who to contact.

After accounting for patient factors, such as compression, what is your primary treatment objective for the wound?

I think one of the things that we've got to start off with is knowing your patient and understanding what ‘gold standard care’ looks like for them, for example, what are their treatment priorities? You can then help to modify your wound care plans with that in mind.

Knowing the patient, developing good lines of communication, giving them permission to get in contact is extremely important and letting patients know what warning signs to look out for. 

Also, accurate wound assessment. We've seen that a number of staff who are very competent and confident in their clinical skills when they've got a patient in front of them, find that it's very different skillset to perform accurate wound assessment remotely using telemedicine, the telephone or other types of virtual consultations.
Having the awareness to ask questions maybe using different language or checking what the patient is saying to you is really important. Simplifying the information, simplifying the wound assessment, asking the patients to self-manage in a certain way is really important.

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