Virtual EWMA 2020 – curea Symposium – Fragen & Antworten

Nachfolgend haben wir die offenen Fragen & Antworten aus der abschließenden Q&A-Session zusammengefasst, für deren Beantwortung während des Live-Symposiums am 18. November 2020 keine Zeit mehr blieb.

"Hi how do you normally treat pseudomonas?"

Pseudomonas aeruginosa is an emerging cause of health care associated infection. These bacteria are difficult to treat due to high levels of antibiotic resistance. Therefore, we try to avoid the use of systemic antibiotics. We prefer cadexomer iodine products as they have the best evidence and work also in practice. Furthermore, prevention of Pseudomonas infection is very important; that is avoiding a wet wound and using dressings absorbent enough and perhaps with bacteria-binding capacities.

"Is the home care in Switzerland not good? In the Netherlands did the hospitals also close, we got more patients. In the Netherlands have many organisations wound care nurses and clinical nurse specialist wound care. And we worked together with the hospitals. We need each other to heal all the wounds!!!!!!!!!!!!!!!!!!!"

Thank you for your question. We do have specialized wound care community nurses. The community services work closely with the hospitals. The problem during the lockdown was that all wound care outpatient clinics closed. The community nurses had to take care additionally to their own wound patients the patients of the outpatient clinics. Therefore, also "non wound care specialist" nurses had to take care of the wound patients.

"Which compression was used when the patient was in a wheelchair and didn't load the calf muscle - high elastic?"

Yes, high elastic.

"I do encountered patients being readmitted back to hospitals for wound debridement because wound clinics were instructed to reduce the number of visit. So, I wonder if Europe has any issues on personal data protection if telemedicine was used to assess patients at home and HCW at hospitals or clinics."

Thank you for your question. If you want to use telemedicine in Europe the patient has to give the consent to use telemedicine. All data have to be transmitted in a secure way so all data are protected. According to my knowledge, currently in Europe we have had no issues/cases.

"Are these advanced dressings provided to the patient by the health system or do the patient have to buy them. Because the cost is another factor of wound healing if advanced dressings cannot be provided."

That is true and depends on the country and reimbursement and hospital politics. What it is good to know that wound care products consist only about 15 % of the total costs of wound healing, the major costs come from the worktime from healthcare professionals. That is why good products can save money (reduced healing time, fewer dressing changes).

"Are the retention and absorption capacity influence by the consistency of exudate? (e.g.: Serous vs bowel content from fistula? bile leak? chyle?)"

Thank you for your question. Both absorption and retention is influenced by consistency of exudate. This is also valid for superabsorbent dressings, where dressings with pure SAP cores absorb water and saline very well, but struggle with high viscosity exudate, while dressings with mixed cores of SAP and natural fibres (like curea) will also manage high viscosity well.

"We have several experiences of having medical related pressure ulcer with foam and superabsorbent dressing when they fully expand under compression. I have noticed that the Curea has expanded significantly when it fully absorbed the fluid. Have you experienced or encountered this kind of problem while using the Curea? Are these products available in UK? Thank you for the lovely presentations."

Thank you for your question – and thanks for the compliment. To answer the second part first – yes – curea is now also available in the UK (through Regen Medical). It is true that superabsorbent dressings swell, even if that swelling will be less under compression than under free swelling (which was done in demo by Dr. Katrin Kühler). Two things are important to minimize pressure related injuries – ability to spread out absorbed exudate in dressing, and to avoid sagging of dressing. curea medical will never say that pressure related injuries cannot happen with curea, but the company knows that the great fluid distribution in the dressings, and the patented locking mechanism of the core to avoid the sagging you often get with other superabsorbents, will both minimize pressure points and thereby risk of pressure injuries.

"I would like to add a note for the first case. Even it was said that the patient had no arterial circulatory problem, I guess the consultant meant the major arteries. Because the wound location is peripheric we may need to be extra careful about small arteries especially at this age and under LV conditions and treat the patient as he has also arterial inflammation. Avoiding mechanical debridement."

You are perfectly right. Because of time limitations, I did not tell the whole story. Before COVID the patient was several times at multidisciplinary consultations (dermatologist, vascular surgeon, plastic surgeon, tissue viability nurse) and the arteries were examined by the vascular surgeon. He was diagnosed with livedoid vasculopathy also, and had anticoagulant treatment. The patient was two times before COVID at our dermatological ward where the situation got always better, but as University Central Hospital we can not have the patients there for long perioids, it is too costly for he society.

"And Hyperbaric Oxygen Treatment combined with electrical stimulation systems works well for Livedoid Vasculitis cases. Dealing with fungal infection is also necessary."

You are right. In Finland the use of hyperbaric oxygen is very low, because of lack of grade A-B evidence and the costly method. At present we do not have an electrical stimulation system in the market either. Fungal infection was indeed treated.

"Can CureaClean Breathable handle copious wound secretion during compression without maceration?"

curea clean breathable (CCB) is the non-sterile version of curea dressings. Even if absorption capacity is a bit lower than P1 and P2 it has the same percentage wise retention capacity and exudate handling functionality, so yes – we have good experience with CCB handling copious secretion during compression without maceration taking place of periwound skin.

"I noticed Curea dressing was swelling or expanded after absorption of the fluids. If this is on venous ulcer, usually compression dressing was used, would it cause discomfort to patients when Curea dressing expanded after absorption of the exudate?"

The swelling under compression will be less than under free-swelling situations (which was shown). Also, the swelling in percentage of the leg circumference isn’t really significant. What is really important is that the core of the dressing doesn’t sag/disintegrate (curea core will not sag – unlike most superabsorbers) as this will negatively influence exudate management and also create pressure points.

"Can the dressing lock down the microbes in the dressing like it locks down the fluids in the core layer?"

Yes! This will reduce infection risk by eliminating reinfection from dressing back to wound. Linked to covid – exudate is a potential risk to care givers and other patients (Gefen, JWC 2020). By having a dressing (curea) that effectively can handle fluid, and also bind this fluid in dressing, covid risk to care givers is logically reduced.

"I wanted to to know if the consistency of exudate makes any difference  to the curea dressing that to wounds that have deeper craters??"

Consistency of exudate is very much linked to the healing phase and what type of wound it is (pressure injuries are different from diabetes, which are again different from VLUs). Due to its design which is different from most superabsorbent dressings, curea should be able to manage it all (some superabsorbent dressings consisting pure SAP-sheet only tend to struggle with high viscosity fluid, but this is less of a problem for curea). Note - curea is not a cavity dressing and should not be used in cavities due to its expansion. Use whatever cavity filler you want and then use curea P1 as secondary dressing. P1 will then gather all exudate coming through the cavity filler and lock it in. You can then get long wear times and minimize risk of maceration and peri wound skin damage.

"Can curea use in cavity wound?"

curea is not a cavity dressing and should not be used in cavities due to its expansion. Use whatever cavity filler you want and then use curea P1 as secondary dressing. P1 will then gather all exudate coming through the cavity filler and lock it in. You can then get long wear times and minimize risk of maceration and periwound skin damage.

"Since it is superabsorbent... can it absorb effluent like bile? Example enterocutameous fistula, bile leak from duodenostomy site?"

Most superabsorbent dressings have a pure sodiumpolyacrylate (SAP) core, and these will struggle to manage high viscosity fluid. curea is different in its design as it mixes sodiumpolyacrylate with natural fibers. In general, this allows for absorption and binding of also higher viscosity exudate. We believe that this will also be the case with bile, but that hasn’t been one of our tested fluids.

"Can it be used in burn wound?"

Absolutely, and it is used in both Germany and UK for such wounds. If there is limited exudate we recommend P2, which has a non-sticking interface layer. P2 is also very suited for donor sites (non-sticking, long wear times).

"Every dressing with curea can last for how long? Is it like the current modern dressing, 5-7 days? Or it requires daily change of dressing?"

All wounds are different and it really depends on exudate situation. That being said, curea has among the highest exudate capacities in wound care. If you for instance use foams and need to change every day – curea can normally last 2-3 days. If you use a foam and foam can last 3 days – curea can normally last 5-7 days. This is specifically interesting for VLUs where cost of dressing only being a small part of cost (cost of compression and work the biggest parts). Key additional benefits beyond pure absorption capacity is its ability to bind fluid in dressing, which is beneficial for both wound and periwound. The binding of bacteria in the core reduces infection risk, while binding of MMPs facilitate for better healing.