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St. Joseph's Health Centre Toronto

New wound treatment therapy for high-risk patients reduces recovery time

At the end of last year, a patient came in to St. Joseph’s Health Centre with a condition that had caused a severe wound infection. He had a history of necrotizing fasciitis, also known as flesh-eating disease, putting him at high risk for complications. The patient had already had one surgery called wound debridement to have unhealthy tissue removed from around the wound and was scheduled to have at least one more. Cecilia Yeung and Daranee Pornsawanh, Clinical Nurse Specialists specializing in Wound Care, Ostomy and Continence, wanted to see if they could keep him out of the operating room by using a new advanced wound treatment therapy with instillation.

“Essentially, when you have a wound, it means that the skin is broken. At the surface of the wound, there is something called a biofilm where bacteria get trapped,” explained Pornsawanh. “And when you have trapped bacteria on the wound, it can make it more difficult to heal.”

Surgical wound treatment typically involves a process called negative pressure wound therapy, which involves a suction-like dressing going on the wound to remove excess fluid and enhance circulation. A new technology has one added element: it puts a special type of solution on the wound that helps break down any bacteria over a period of three-and-a-half hours before it’s all removed by the suction-like dressing.

Pornsawanh said with the typical treatment, the patient is well on their way to recovery within a couple of weeks. When they tried the new therapy, the patient had an almost full recovery in just a week.

“It’s amazing – when he first came in, he has extensive tissue damage and it was extremely painful even to remove the dressing,” Pornsawanh said. “But by cleansing the wound, you’re removing so much bacteria, reducing inflammation and helping speed up recovery.”

The patient was able to leave the hospital and, instead of having a second wound debridement surgery to remove tissue, he had a skin graft surgery to replace some of the skin he’d lost.

“It was incredible to see the outcome – it was really rewarding for us,” said Yeung. “And it opens up new opportunities – this was the first time we’d used this treatment so we are going to work with our surgical colleagues to identify who else may benefit from this. But it is mostly meant for high-risk patients.”

Identifying this patient and the potential use of the new treatment was done in collaboration with the plastics and reconstructive surgery team that helps support patients needing this type of treatment. Members of that team joined Pornsawanh and Yeung when they received education about how the treatment would work.

“It really strengthened our interprofessional relationship with the team and created this opportunity to continue working together,” said Yeung.

Kate MacWilliams, Manager of the Interprofessional Resource team, said she was proud of the initiative Pornsawanh and Yeung took in finding this new technology.

“I’ve always been really impressed with both of them and how current they are with the latest trends, technologies and literature,” she said. “They are always being adventurous and pushing forward to try new things that are going to benefit our patients. It’s awesome and a great example of what it means to be a clinical nurse specialist and really focused on providing the best care experiences to our patients.”

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