EWMA 2013-Ep446-ULTRASONIC ASSISTED WOUND DEBRIDEMENT – AN AUSTRALIAN EXPERIENCE

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ULTRASONIC ASSISTED WOUND DEBRIDEMENT – AN AUSTRALIAN EXPERIENCE

Gillian Butcher1, Theresa Swanson2, Loreto Pinnuck1, Meagan Shannon3

1Southern Health (Melbourne, Australia); 2South West Healthcare (Warrnambool, Australia); 3Peninsula Health (Melbourne, Australia).

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EWMA 2013-Ep446-ULTRASONIC ASSISTED WOUND DEBRIDEMENT – AN AUSTRALIAN EXPERIENCE

  1. 1. Email: gillian.butcher@southernhealth.org.au Ultrasonic Assisted Wound Debridement: An Australian Experience Gillian Butcher1,Theresa Swanson2, Loreto Pinnuck1, Meagan Shannon3 1.Monash Health, Melbourne Australia 2.South West Healthcare, Warrnambool Australia 3.Peninsula Health, Melbourne Australia MonashHealth
  2. 2. Background and Aim • 4 public hospitals' in Victoria Australia • Funded by Department of Health New Technology program • The aim of trial was to implement Ultrasonic Assisted Wound Debridement (UAWD), into different clinical environments with different wound types
  3. 3. Method • A central minimum data set (CMDS) • Policies, procedures and patient education material • Quarterly meetings of all sites with the Dept of Health to review cost, issues and activity • A train-the-trainer model to ensure the ongoing availability of suitably trained staff. This trial focussed on four types of wounds: • Diabetic Foot ulcers • Chronic leg ulcers • Pressure ulcers/injuries • Dehisced surgical wounds
  4. 4. Results : 29% 47% 12% 12% Types of wounds treated DFUs Chronic leg ulcers Pressure injury/ulcer Dihisced surgical wounds • The total number of treatments was 1056 on 223 patients: • Average number of treatments per patient = 4.7 • 50% of wounds had greater than 75% of wound bed slough removed with this therapy at each debridement • While data is still being analysed for percentage of healing, • one site has shown 60.32% reduction in size of leg ulcers and • 36% reduction in size of diabetic foot ulcers over the course of treatment.
  5. 5. Clinical outcomes Decreased hospital admissions due to: • Effective debridement in an outpatient setting and for patients not suitable for theatre • Improved, rapid and safe debridement of wet slough • Bioburden reduction and antibacterial activity improved • Decreased infection rates – only one patient was admitted to hospital for a wound infection
  6. 6. Clinical outcomes Cost effectiveness: • UAWD can be performed in an outpatient or inpatient setting. • The total cost of a UAWD treatment was calculated at $180AUD (including staff time and all consumables) compared with: • Simple theatre debridement $3500 AUD • Average inpatient bed day $800AUD • One patient had 32 hospital admissions from 2006-2010 for wound management. After commencing on UAWD therapy in January 2011 he had no admissions that year due to weekly treatments Ease of use: • Training is simple and straightforward and the train-the-trainer model ensures a continuous skilled workforce. • All staff trained found the Sonoca 185 easy to use Pain: • Not painless as suggested by the literature • Topical analgesic applied to the wound at least 30 minutes prior to UAWD • 7.9% of participants discontinued treatment due to pain issues.
  7. 7. Case Studies:1, – Dehisced surgical wound and decreased bioburden Morbidly obese 60 year old female: • Dehisced abdominal wound following bowel surgery. • UAWD performed at 60% amplitude for 30 minutes • After one treatment this wound was ready for Negative Pressure Wound Therapy (NPWT) • While the patient was on NWPT the wound developed pseudomonas aeruginosa • UAWD in contact mode was used consecutively for 3 days. At this time pathology testing showed the wound to be pseudomonas free.
  8. 8. Case Study 2 – Non-healing donor site Three months post-Coronary Artery Bypass Graft this graft donor site had not healed and was infected with Staphylococcus Aureus: • The base of the wound had 90% slough and 10% granulation tissue • Systemic antibiotics were implemented • LFUD was used in contact mode at 60% amplitude for 20 minutes, followed by moist wound dressings • The following day the wound remained slough free and Negative Pressure Wound Therapy was applied • The wound healed within 4 months. • No theatre debridement was necessary
  9. 9. Conclusions: • Safe and effective • Selective debridement • Antibacterial activity • Wound stimulation effects • Sustainable ongoing treatment modality Further investigations: A randomized control trial currently being conducted at Monash Health comparing UAWD to conservative sharps debridement will hopefully provide us with a better comparison of healing rates.
  10. 10. References Butcher G, Pinnuck L. Wound Bed Preparation - ultrasonic-assisted debridement. British Journal of Nursing, 2013 (Tissue Viability Supplement), Vol 22, No 6 Shannon MK, Williams A & Bloomer M. Low-frequency ultrasound debridement (Sonoca-185) in acute wound management: A case study. Wound Practice & Research 2012 Vol 20 Issue 4 Michailidis L, Low Frequency Ultrasonic Debridement: A case of healing against all odds. Connective Issues, Vol 15 Issue 1 2012

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