Collagenase Ointment versus a Hydrogel Dressing for Treatment of Pressure Ulcers - Differences in Wound Bed Scores

Background:
The effective treatment of pressure ulcers (PU) in long-term care (LTC) setting poses substantial difficulties for LTC providers. The removal of necrotic nonviable tissue is an essential component of proper wound bed preparation and a necessary prerequisite for PU epithelialization. Enzymatic and autolytic debridement are both frequently used in LTC settings and are considered safe, practical debridement methods. This study compares the change in wound bed scores (BSC) resulting from the two debridement methods.

Objective:
To report the change in Wound Bed Scores between pressure ulcer patients debrided with clostridial collagenase ointment (CCO) compared to autolytic debridement with a hydrogel dressing in a long-term care setting.

Methods:
LTC patients with PU were randomized to receive daily dressing changes with either hydrogel or clostridial collagenase ointment (CCO) covered with a standard semi-occlusive dressing. The assessed outcomes included the WBS classification system developed by Falanga et al. WBS were assessed weekly for 7 weeks. A linear-regression was used to analyze the impact of time and treatment on wound bed progression.

Results:
Twenty-seven patients were enrolled in the study with 13 assigned to CCO enzymatic debridement and 14 to the hydrogel autolytic debridement. Baseline WBS were similar between the CCO and hydrogel groups at 8.9 and 9.8, respectively. At week 7 the CCO group exhibited a larger average improvement in WBS compared to the hydrogel group at 4.8 units compared to 1.4 units, respectively.

Conclusion:
LTC patients debrided with CCO demonstrated a significant improvement in their PU compared to autolytic debridement with a hydrogel. This study supports the evidence that enzymatic debridement provides greater efficacy compared to autolytic debridement with a hydrogel when treating pressure ulcers in a LTC facility.