When pondering the multitude of considerations that go into treating chronic wounds, climate is not likely one of the first factors that comes to mind. However, in their track at WoundCon Summer, Maria Goddard, MD, CWS, MAPWCA, and Laura Swoboda, DNP, APNP, FNP-C, FNP-BC, CWOCN-AP, WOCNF highlighted climate-related concerns that could be impacting your patients.

Dr. Swoboda commented that, as a whole, the world is warmer, and that health care outcomes may experience physical disruptions due to things like temperature, humidity, ultraviolet radiation, or air pollution. For instance, how has ocean temperature had an effect on wound care? Vibrio is an anaerobic, gram-negative organism that is native to ocean water. It is not usually pathogenic, they shared, but can result in wounds, cellulitis, sepsis, or death. In the United States, the CDC notes 80,000 cases of Vibrio infections yearly.¹ Dr. Swoboda also pointed out that Pseudomonas can also flourish in this ocean conditions, and encouraged providers to think about others, as well.

Extreme weather events can also trigger Vibrio infections, such as in flooding, where quick “blooms” of the organism can take place due to short generation times. These weather events can also increase risks of trauma leading to wounds, and infectious and noninfectious dermatological conditions, said Dr. Swoboda. For instance, one study they shared found that most post-tsunami infections were polymicrobial, but gram-negative bacteria were the leading cause.2

Moving onto heat-related concerns, Dr. Swoboda cited a statistic that for every one degree increase in temperature, direct heat illness morbidity and mortality increases by 18 and 35 percent, respectively.³ Additionally, a murine model exhibited delays in wound healing due to heat. Specifically, the stages of wound healing experience challenges due to activation of matrix metalloproteinases from visible light and infrared radiation, resulting in damage to the matrix and healthy skin.⁴ Dr. Swoboda also touched on connections between heat and skin cancer, edema, issues with the cutaneous microbiome, and atopic dermatitis.

It is also important to keep in mind how pressure injuries and microclimate relate to one another. Specifically, Dr. Swoboda explained that providers should be aware of the interface between the dermal microclimate and the support surface. This microclimate can impact skin condition and wound characteristics, along with altering the adherence capabilities of dressings.

Patient-Specific Clinical Implications

Dr. Goddard then led the discussion by pointing out that wound patients often have comorbidities to consider as far as clinical impact of climate issues. Of note to wound care providers, studies show that changes in weather can exert an impact on things like autonomic function, inflammation, cardiovascular disease, hypertension, and lipids.^5,6 Additionally, climate can have both direct and indirect consequences on diabetes, including medication efficacy, glucose metabolism, dehydration risk, infection risk, and equipment efficacy.^7,8

Dr. Goddard added that climate issues may result in more emergence of atypical wounds, and that fungal infections should be a consideration if a wound does not respond to antibacterial treatment, especially in warmer regions. She reminded that special tests are needed to detect fungus, which often take a longer time to produce results, so in some cases, wound biopsy may yield answers faster.

She then went on to discuss the relationship of climate concerns to social determinants of health, sharing that extreme weather conditions can impact all 5 domains thereof. Additionally, it is important to consider the relationship in these situations to mental health for both patients and colleagues. These weather-related disasters and circumstances can also result in medication or food shortages that impact care. There can also be shipping delays, production challenges, financial limitations, or loss of health care access for patients. As a result, it is important for providers to be agile and consider alternative treatment options, keeping wound characteristics in mind. This will hopefully allow providers to choose other treatment options with similar properties.

Dr. Goddard urged the audience to be aware of local disaster management plans and to participate in patient education related to things like fire, hurricanes, tornadoes, and frostbite. Overall, a multidisciplinary team approach may reduce challenges with both medical and community-level involvement.

References

1.        Centers for Disease Control and Prevention. About Vibrio Infections. Available at: https://www.cdc.gov/vibrio/about/index.html#:~:text=How%20common%20is%20vibriosis%3F,result%20of%20eating%20contaminated%20food. Published May 14, 2024. Accessed June 11, 2024.

2.        Dayrit JF, Bintanjoyo L, Andersen LK, Davis MDP. Impact of climate change on dermatological conditions related to flooding: update from the International Society of Dermatology Climate Change Committee. Int J Dermatol. 2018;57(8):901-910.

3.        Faurie C, Varghese BM, Liu J, Bi P. Association between high temperature and heatwaves with heat-related illnesses: A systematic review and meta-analysis. Sci Total Environ. 2022;852:158332.

4.        Dos Santos-Silva MA, Trajano ET, Schanuel FS, Monte-Alto-Costa A. Heat delays skin wound healing in mice. Exp Biol Med (Maywood). 2017;242(3):258-266.

5.        Jacobsen AP, Khiew YC, Duffy E, et al. Climate change and the prevention of cardiovascular disease. Am J Prev Cardiol. 2022;12:100391.

6.        Khraishah H, Alahmad B, Ostergard RL Jr, et al. Climate change and cardiovascular disease: implications for global health. Nat Rev Cardiol. 2022;19(12):798-812. 

7.        Zilbermint M.(2020) Diabetes and climate change. J Comm Hosp Int Med Persp. 2020;10(5):409-412.

8.        Westphal SA, Childs RD, Seifert KM, et al. Managing diabetes in the heat: potential issues and concerns. Endocr Pract. 2010;16(3):506-511.