Management and prevention of wound infections during Covid-19 - Part Two
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. Here is Part Two of the series of videos.
What might your treatment objectives be if patient contact is reduced or becomes less frequent?
If we know we're going to have a lighter touch with some of our patients, then actually, do we take a more prophylactic approach? Do we take a more proactive approach in looking at things that we can do to offset the risk of an infection?
For example, looking at appropriate wound bed preparation, we want to make sure that we are reducing the bacterial burden in a wound to lessen the consequence or the risk of a full blown infection and the need for changing the wound care plan at very short notice.
If a chronic wound then becomes infected, you're looking at changing your protocols to antimicrobial topical dressings, because what we need to make sure of is that we've still got sight of antibiotic guardianship and not prescribing systemic antibiotics on a just in case basis.
How does product selection differ between infected wounds and non-infected wounds?
Product selection comes as the next step after the wound assessment; knowing what you're trying to achieve, knowing what the patient's goals are and what your goals are and coming up with that combined holistic approach.
I think also what we need to make sure of is ‘stepping up’; knowing what products you've got available to you, what wound care products you can move on to should the wound change.
For example, using topical antimicrobials to reduce the risk of a patient having to require antibiotics. Antibiotic guardianship systemically is really important because we don't want to admit patients with bowel infections into hospital because they've had too many courses of antibiotics.
Why is wound bed preparation important to your patients?
With wound bed preparation, it is really important to reduce the bacterial burden to offset any deterioration.
We know pragmatically at the moment with COVID-19 pressures that we may not be able to push wounds and challenge wounds to heal within a normal timeframe because our interaction or intervention with the patients may be more remote. So therefore what we really want to prioritise is making sure that there is no deterioration in the patient's wound.
So from that perspective, the wound bed preparation, reducing the bacterial burden, particularly in chronic and vulnerable wounds, such as leg ulcers and diabetic foot wounds is really important.
We want to stabilise and then limit the risk of any further deterioration, limit the risk of an admission to an acute area where we may need to surgically intervene or even to admit just for antibiotics.