Developing pathways to support clinical practice in the identification and management of wound infection

The estimated annual cost of caring for wounds within the UK has been reported to be between £2.3 and £3.1 billion, equivalent to 3% of the total NHS budget during 2005 and 2006 (Posnett and Franks, 2008). It can reasonably be assumed that these figures are now higher and will continue to rise with inflation. As such, it is important for organisations to have appropriate guidelines in place to ensure they are able to demonstrate adequate standards of care and safety when identifying and managing wound infection, and to make the best use of available resources. If a patient develops a wound infection it can have a significant impact on wound healing, causing pain, discomfort and increased risk of hospitalisation, contributing significantly to morbidity and escalating health care costs (Storm-Versloot et al, 2010). It is suggested that worldwide up to 10,000 people per million with an open wound will die as a result of microbial wound infection (Percival et al, 2012). It is also recognised within the literature that there is a growing resistance to the available antibiotics to treat wound infection and associated complications (including methicillin-resistant Staphylococcus aureus and Clostridium difficile (Leaper et al, 2010). Therefore, other strategies including early identification of those at increased risk of wound infection and early intervention to manage local bacterial bioburden, may be useful in reducing the risk of a patient developing systemic infection. The National Prescribing Centre (NPC; now part of the National Institute for Health and Care Excellence [NICE] Medicines and Prescribing Centre) guidance for the prescribing of dressings, suggests that healthcare professionals must consider all the associated costs of managing a patient with a wound, including both unit cost of the product and the overall impact on the health economy (NPC, 2012). Products selected should be initially based on the needs of the wound, including the type and stage of wound healing. However, wear time, ability of the patient to concord with treatment and the impact on clinical staff time should also be considered and continually evaluated (NPC, 2012). A local audit of online, non-prescription ordering data during 2011/2012 found that the annual expenditure on antimicrobial dressings was in excess of £130,000. This equated to 10.83% of the total dressing’s budget, suggesting that products are being used for longer than the recommended two to four weeks (Wounds UK, 2013). This prompted the authors of this article to develop and implement a local pathway for the effective management of wound infection, using antimicrobial wound dressings in an attempt to reduce spend and improve clinical outcomes by supporting clinical decision making.