The Skin 

The skin is the largest organ in the body and it protects against environmental toxins and microorganisms. Its key function is therefore to serve as a protective barrier to the external environment. Loss of skin integrity due to injury or illness may lead to substantial physiologic imbalance and ultimately - significant disability or death. Regardless of the wound care product, the goal would be to reform tissues so that both the structural and functional properties of the wounded skin is restored (1).

 

The Economic Impact

The immense social and economic impact of wounds worldwide is due to its high occurrence and its increasing frequency in the ageing population. There are high numbers of chronic (hard-to-heal) wounds associated with diseases and abnormalities that damage the skin, including venous, diabetic and pressure ulcers. The prevalence of these chronic wounds increases with age. For example, it has been estimated that chronic wounds affect 120 per 100,000 people aged 45 and 65 years and rises to 800 per 100,000 people over 75. Also, due to the complications that accompany acute wounds when healing does not progress normally, conversion to chronic wounds can occur (2). 

 

Wound care has been described as being a high-volume, high-risk and high-cost healthcare activity. Delayed healing and infections related to inappropriate treatment (both pharmacological and physical) may result in a poor quality of life (3). Wound dressings account for about £120m of prescribing costs in primary care in England each year as of 2011 (3). There are more than 8,400 wound care products to choose from. It is therefore important that evidence-based choices are made.

 

The economic cost of wounds is measured in literally billions of Dollars, Euros and Pounds. Healthcare professionals may be unaware of this cost as much of it is “hidden” (it’s not apparent in the cost of materials). Current estimates indicate that wounds account for almost 4% of total health system costs, and rising (4). Hospitalisation itself is the main cost driver for wound care for the system. Nursing time is another factor that far outweighs the cost of materials (4). 

 

 

 

 

 

 

 

 

 

 

 

 

 

Roles Of the Pharmacist

Dressing selection is commonly decided by nurses, as general medical staff often limited understanding of wound care. For the fact that some dressings have important interactions with medicines, a knowledgeable pharmacist can have a great impact on patient care. Furthermore, pharmacists can help identify factors that contribute to trauma and delayed wound healing. With a growing aging population and a rapidly rising number of patients with diabetes and other chronic conditions, pharmacists will see a vast number of people with leg ulcers and other chronic wounds that will be under the care of teams in the community. Interventions by pharmacists in wound care are therefore vital (5). From a visit to the Solent tissue viability clinic, it was concluded that pharmacists must know about the costs and appropriate use issues associated with wound dressings, ensure dressings are appropriate for the wound, prevent dressing-medicine interactions, actively partake in pain management and generally influence the health status of the patient. Other roles different from those previously mentioned, include participation in guideline development and technical committees, pain management, teaching, purchasing and distribution of appropriate materials.

 

Dressings 

Traditional fabric wound dressings were used extensively in the past. Their primary function was considered to keep the wound dry, by allowing evaporation of exudate. Therefore, It was assumed that dressings were a passive product with a minor role in the healing process. However, it is now realized that a wound heals faster and more successfully in a moist environment. This has led to a greater understanding of the influence that wound dressings can have on wound healing and greater attention has been given to the design of more effective dressings. There is still no single dressing suitable for the management of all types of wounds or for the treatment of a single wound during healing. Many new dressings aim to manage chronic wounds that are difficult to treat because wound physiology is altered (6).