By Jennifer Hurlow, GNP, CWOCN, and Kara Couch, MS, CRNP, CWCN-AP
Chronic wounds are increasingly recognized as a global public health issue.1 Recent research revealed that nearly 15% of Medicare beneficiaries (>65 years of age) had at least one type of chronic wound in 2014.2 In the United States, there are an estimated 6.5 million chronic wounds, including leg ulcers, pressure ulcers, and diabetic foot ulcers, each of which carries a mean annual treatment cost of $11,000, $15,400, and $42,100, respectively,3 leading to an economic burden of $96.8 billion dollars2 for the treatment of chronic wounds. Prevalence of chronic wounds is estimated to be growing at a rate of 13% per year,4 further adding to this current problem. Wound chronicity has been directly related to the presence of wound biofilm. Costerton and colleagues were the first to link biofilm with general infection risk.5,6 Now, half a century later, the biofilm bacterial phenotype is increasingly recognized as a primary cause of wound chronicity, delayed wound healing, and infection recalcitrance.7–10 Further, these chronic wound infections have been observed to prevail despite the use of modern antiseptic dressings,11 which have been designed specifically to control wound infection.
Need for New Wound Treatment Algorithms
There remains a large gap between research and practice, and it is becoming more of an urgent clinical need to have an increased understanding of wound infection and clear treatment algorithms. As science has advanced and more is learned about infection, the paradigms must shift to re-align with the direction of the high-level evidence being produced.
Wound Infection Summit
With this paradigm shift in mind, the Association for the Advancement of Wound Care (AAWC) is hosting its inaugural Wound Infection Summit (WIS) on April 26–27, 2019 in Atlanta, Georgia, to take a deep dive into the challenge of wound infection. This issue will be examined from a specific level of treatment algorithms for patients to a more general, global level, with evidence-based guidelines and economic models.
Topics to be discussed include:
- The incidence and prevalence of wound infections
- The unique challenges of acute versus chronic wounds
- The financial and economic factors at play in wound care and wound infection
- The issues that impact patients and providers across wound care settings as we consider the whole patient approach to care
- An overview of scientific advances in biofilm, topical antiseptic, swab cultures, and planktonic bacteria
- Definitions of contamination, colonization, and other critical terms, as well as an opportunity to discuss the challenges of applying these areas to clinical practice
- The stakeholders involved in translating research to practice, how the ideology progresses through these stakeholders, and how different host factors sometimes require a different approach
- A multidisciplinary approach to examining case-based differential diagnosis, identifying gaps in assessment, and discussing diagnosis and the complexity of wound infections
- Review of varying host factors, the AAWC Clinical Practice Guidelines, and how tools are being developed to support clinical practice
- A point-counterpoint discussion in which the speakers will present the benefits of various approaches to infection data, by highlighting traditional methods, the polymerase chain reaction method, and the impact of biomarkers and matrix metalloproteinases
- The practical implications of radiologic imaging
- The physics and application of fluorescent imaging
- Topical treatments and strategies proven to manage wound infections in a clinical setting
- Challenges related to complications, superinfections, and resistance
- Research on the microbiome and how it impacts clinical decisions regarding systemic therapies and treatments
- Practical cases of osteomyelitis and the impact of bone biopsies and incision and drainage procedures
- Case study scenarios, which will explore various clinical examples of how different medical disciplines can bring their strengths to collaborative care
These exciting topics will provide a comprehensive and interactive review of wound infection for all stakeholders. In addition, 10.50 continuing education or continuing nursing education units will be available for participants.
AAWC members have asked for high-level educational opportunities in a regional setting. To help meet this request, the AAWC will be having additional Wound Infection Summits in Kansas City (October 5–6, 2019) and Detroit (August 16–17, 2019) to reach the majority of our members. In addition, a Lower Extremity Summit in Sacramento, California is planned on November 2–3, 2019.
The time has come to incorporate recent evidence from research on wound infection into current clinical practice. The AAWC Wound Infection Summits will provide wound care professionals with updated information on wound infection, as well as new evidence-based treatment strategies for optimal outcomes.
Make plans to attend in Atlanta and at the other regional summits. More information can be found at www.woundinfectionsummit.com or www.aawconline.org.
1. Sen C, Gordillo G, Roy S, et al. Human skin wounds: a major and snowballing threat to public health and the economy. Wound Repair Regen. 2009;17:763–71.
2. Nussbaum S, Carter M, Fife C, et al. An economic evaluation of the impact, cost, and Medicare policy implications of chronic nonhealing wounds. Value Health. 2018;21:27–32.
3. Chan B, Cadarette S, Wodchis W, Wong J, Mittmann N, Kran M. Cost-of-illness studies in chronic ulcers: a systemic review. J Wound Care. 2017;26(Suppl 4):S4–S15.
4. Guest JF, Vowden K. The health economic burden that acute and chronic wounds impose on an average clinical commissioning group/health board in the UK. J Wound Care. 2017;26:292–303.
5. Costerton J, Geesey G, Cheng K. How bacteria stick. Sci Am. 1978;238:86–95.
6. Costerton JW. Bacterial biofilms in nature and disease. Annu Rev Microbiol. 1987;41:435–64.
7. Metcalf D, Bowler P. Biofilm delays wound healing: a review of the evidence. Burns Trauma. 2013;1:5–12.
8. Wolcott R, Sanford N, Gabrilska R, Oates J, Wilkinson J, Rumbaugh K. Microbiota is a primary cause of pathogenesis of chronic wounds. J Wound Care. 2016;25(Suppl10):S33–S43.
9. Wolcott R. Biofilms cause chronic infections. J Wound Care. 2017;26:423–5.
10. Webb R. A chronic case of confusion. J Wound Care. 2017;26:421.
11. Hurlow J, Blanz E, Gaddy J. Clinical investigation of biofilm in non-healing wounds by high resolution microscopy techniques. J Wound Care. 2016;25(Suppl 9):S11–S22.
About the Association for the Advancement of Wound Care (AAWC)
The Association for the Advancement of Wound Care (AAWC) is the largest non-profit, interdisciplinary wound care organization in the United States and is focused on education, public policy, and the application of evidence-based wound care practice. Conceived in 1995, the mission of the AAWC is to advance the care of people with and at risk for wounds. For more information, visit www.aawconline.org.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.