Wound care
into conventional dressings. Now, it’s becoming clear to manufacturers, national health boards and health insurance providers that the downstream savings associated with faster wound healing and lower bed occupancy are enormous,” O’Mahony says. In Ireland, a hospital bed costs about €306,000 per year to run, while changing a dressing adds up to well over €100 in nursing time and resources. “When you factor in the overheads, the materials, the clinical time, it’s very expensive,” O’Mahony says. “Convincing the companies, reimbursement agencies and health boards that downstream savings must be paid for
up front has been challenging. But the mindset is changing, especially due to the evolution from ‘pay- for-care’ to ‘pay-for-cure’ reimbursement models.”
A coming together
The technological limitations that have hindered the development of the field until now are slowly being stripped away, according to O’Mahony. “There are quite a lot of ultra-flexible printed electronics out there now, which is very exciting,” he says. “They’re becoming available on medical-grade materials with low profiles so you can put them in a wound dressing without the patient knowing they’re there.” Although for Tessarolo, the patient is not the problem. “If they can have something personalised for them, which improves the procedures for their specific problem, they are happy to have an additional sensor in their bandage,” she remarks. Her group is also investigating new parameters to measure wound healing such as pH, which has been shown to correlate with the healing stages of a wound, potentially giving clinicians direct access to the status of a wound without disturbing the wound bed.
While it is not as far along as the group’s research on moisture level measurement, their device, which integrates a sensing layer including a two-terminal pH sensor and iridium oxide particles, and an absorbent layer ensuring the delivery of a continuous wound exudate flow across the sensor area, was successfully validated in flow analysis using synthetic wound exudate.
“The holy grail is pH sensing,” O’Mahony says. “But pH sensors are not there yet. They're not stable enough, small enough or calibration-free enough for commercial adoption in wound dressings. But it’s certainly a very hot topic, and one that is being pursued by many research teams worldwide.” At the Tyndall Institute, their most advanced smart dressing was designed so that new sensors can be added when technologies such as pH monitoring become viable. O’Mahony and his colleagues are also looking into sensors that can measure the infection levels of wounds and alert the clinician when needed, as well as technology that could stimulate the wound
Practical Patient Care /
www.practical-patient-care.com
bed by passing low-level currents through it to promote healing.
Biodegradable materials are another area of interest. “The circular economy is becoming a massive focus for many medical device companies. Disposable devices will soon go the way of the paper coffee cup. It will become socially unacceptable to bin or burn medical devices without good reason,” O’Mahony says.
He believes that consumer sentiment will just accelerate this shift. “If you could envision a biodegradable circuit with an RFID antenna in there, suddenly the entire thing is battery-free, there's no power and you can put it in the incinerator or even composter afterward,” he says. “I think that’s where the field is going to go.”
“If the patient can have something personalised for them, which improves the procedures for their specific problem, they are happy to have an additional sensor in their bandage.” Dr Marta Tessarolo
Meanwhile Tessarolo’s group is interested in the potential of artificial intelligence and machine learning and hopes to eventually combine several sensors to give a more specific report on what is happening under a dressing. The final major barrier, of course, is the regulatory process. “These are full-blown medical devices and it takes several years for something to get through the regulators and reach commercialisation,” O’Mahony says. And yet he feels like we may be on the cusp of significant advancement in wound healing technology. “I do sense that there might be a very rapid coming together of technology readiness and user needs at some stage fairly soon,” he predicts. “There's always a tipping point I think where many of these technologies are simultaneously being developed and then they could all become ready for commercial deployment together. We could see a big progression when that point is reached, and the future is certainly bright for smart wound dressing technologies.”
39
Diagram showing how the team at the University of Bologna’s smart dressing works using RFID.
Frontiers in Physics. 9:722173.
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