Wound care Prevention versus cure


It is well understood that the vacuum effect created by NPWT minimises the chance of infection in many ways. It encourages the drainage of interstitial fluids that contribute to inflammation and oedema, it improves local blood circulation and draws more oxygenated blood to the wound site and facilitates the formation of granulation tissue. This fact is not lost on clinicians. “We are now seeing more focus on prevention, at least in my department,” says Gonçalves. “We show the numbers to the hospital board and they clearly see the benefits and the cost savings, so we are now expanding the use of NPWT to other areas. It is now being used after C-sections and other abdominal surgeries.” “I would like to see it used much more widely, but this is a marathon and we are still in the first five miles,” she adds. The key issue, it seems, is not a technological one – the concept is the same as ever, and the equipment has not fundamentally changed over the years – but a political and social one. The structure of healthcare systems, and the ways in which they are funded, largely determine patients’ level of access to NPWT.


Portugal, which is hardly a rich country by EU standards, has a public healthcare system that pays for everything. Patients do not pay for any treatment, and they do not have to go through any reimbursement system. “The biggest obstacle is how healthcare is structured at societal and political level,” states Gonçalves. “The reimbursement system in France and Germany has come a bit late. I worked in the UK ten years ago and it was available there, and here in Portugal we use the most expensive NPWT devices – the best machines – so the technology is affordable in other countries.”


“There are thousands of research papers on how effective NPWT is, so richer countries are a little bit late in adopting it,” she adds. “It is about national health systems. The UK and Portugal have similar systems, but France, Spain, Germany and others are different. In Austria, for example, a patient can have NWPT for four weeks, but who can say if that is long enough for any individual patient? Healing can take months.”


A time for change?


On the technology side, there is some discussion with equipment manufacturers to improve the porous foam dressings on which suction is applied, but any change in the equipment will just be tweaks. The mechanism works well, though tapes and foams could be further refined, and some would like to see the machines improve communication with clinicians, particularly if a patient is at home, to monitor compliance and stay on top of the healing progress. The technical side, however, is a lower priority than the way in which wounds – and wound treatment – are viewed. Gonçalves is a council member of the


Practical Patient Care / www.practical-patient-care.com


European Wound Management Association (EWMA), which is pushing for a new approach to wound care that could see NPWT become more widely available. The organisation believes it is important for national healthcare systems to see wounds as a disease.


“Then everything changes, and you have reimbursement, but it is hard to see a wound that way,” she explains. “We are working now to see if the WHO can classify wounds as a chronic disease. There has been no response yet, but the door is open.”


“We are working now to see if the WHO can classify wounds as a chronic disease. There has been no response yet, but the door is open.” Viviana Gonçalves


Changing how wound care is approached could have a seismic impact. The UK alone spends around more than £2bn each year on treating pressure ulcers, according to some estimates, and there are many – including Gonçalves – who feel this could be cut significantly by using NPWT more extensively. “The future of NPWT in community care is promising,” adds Guedes. “Continued advancements in technology, coupled with increasing awareness and support from healthcare providers and policymakers, will likely drive the further expansion of NPWT services in this setting.”


Though it seems there is a long way to run before NPWT is a staple in community care settings, and much more needs to be done in order to encourage its adoption, at least we can say that the race has actually begun. 


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NPWT devices lower the pressure on wound sites, drawing away excess fluid and creating a better healing environment.


Pepermpron/Shutterstock.com


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