Meghann Price
Good evening everyone. My name is Meg, and I will be hosting tonight's webinar. In tonight's session of the Rural Health Webinar series, we will explore chronic wound care in rural communities, offering practical management strategies and best practice approaches for treating higher risk groups. You will also gain a deeper understanding of the key components of the Chronic Wound Consumables Scheme and Australian Government Department of Health and Aged Care program that funds wound consumable products for older people aged 65 and over, or First Nations people aged 50 and over who are living with diabetes and chronic wound.
We would like to begin tonight's webinar by acknowledging the traditional owners of the lands that we are coming together from, and the land on which this event is being broadcast. I would like to pay our respects to their elders, past and present, and would also like to acknowledge any Aboriginal or Torres Strait Islander people who have joined us this evening. Just before we start, a few housekeeping things to cover. The participants are set on mute to ensure that the webinar is not disrupted by background noise, but we encourage you all to use the Q&A and chat to ask questions, and finally, the webinar has been accredited for one hour of educational activities CPD.
To be eligible, you must be present for the duration of the webinar. We also kindly ask that you complete the short evaluation at the end of the webinar. This should only take a few minutes to complete and will help us improve the format and content of future webinars. I will now hand over to Andrew who can go over the learning outcomes and the presenters.
Andrew May
Thank you Megann, and thank you RACGP for doing this fantastic webinar. I am Andrew, I am from ESSITY Health and Medical and we are really excited to be able to present this to you today. These learning outcomes serve as a bit of an agenda for today. So, firstly the number one topic is to identify effective methods for assessing wounds that are slow to heal. We like to use that term slow to heal instead of chronic wounds.
We want to also be able to apply the best practices for the treatment and management of slow healing wounds, and along with this the use of compression to be able to help manage these slow healing wounds, and then finally outline the key features of the exciting new and upcoming chronic wound consumable scheme and learn more about it together today. And then finally, as Megann mentioned at the end a Q&A section. Please feel free to pop in questions as they come up through the presentation, and we will endeavour to answer them at the end as best we can. If not, we will follow up with you and get you the answer that you need.
The presenters today, we are very lucky to be joined by two fantastic presenters, Margo Asimus. She is a nurse practitioner in wound management. She is actually the first in Australia, the first nurse practitioner for wound management in Australia, so fantastic that we can get her here today to talk about these slow healing wounds and the ability to manage them, especially through this new scheme, and then Anita Daltrey. She is a lymphedema therapist and an OT by trade who will help us uncover and learn more about the use of compression in treating these slow to heal wounds. Then finally I will have my colleague Jaden, who will wrap up and he will also manage the Q&A for us and try to get through as many of these questions as we can.
Margo Asimus
Thank you, Andrew. Thank you to RACGP, and certainly Appreciate ESSITY supporting this webinar tonight. It is a great pleasure to be here and to share with you my 30 years of experience in the speciality of wound management, 20 years of those have been as a nurse practitioner, and what I would do want to say is that I am an independent nurse practitioner working in private practice. I do some consultation with ESSITY as a clinical advisory. Thank you. Tonight, what we want to talk about will be the as Mel and Andrew have mentioned to meet your learning objectives. I will go through wound assessment and then we will talk about delayed wound healing, the signs and symptoms of that, that you may be able to pick up and which will make you put a spotlight on it and be able to watch that wound to see what you need to be doing and then discuss best wound management practice. I will reinforce that with some case studies for you, and then we will talk about the chronic wound consumable scheme.
Let us get started. Got a bit to get through but I promised I will not go over time. When I am not busy with patients and consulting with great companies, I do try and make available online wound courses and this is one of my courses. You are very welcome to go to my website wound education, not hard to remember, wound education. Thank you. TIMERS, this is a way of systematically looking at a wound to assess it. I am sure you have come across this before where we have looked at the characteristics of the tissue. We have asked the question, is it inflammation or infection? How much moisture is in this wound or exudate? What is happening with the wound edge, and so that is called time. It has extended, and this document is certainly worth a read. Talking about TIMERS and can be for regeneration but I like to think it is referral and when to refer and as being the social factors and the impact on the person in having a wound.
Let us start with looking at tissue, and years ago when I started nursing, if you got granulation in a wound, it is granulating, we never really talked about the quality of that granulation tissue, and it is so important because when you look at this granulation you can see the top one there, it is robust. If I rub it, it is not going to bleed easy. It is not going to fall away in the wound, and it reminds me of that beautiful watermelon where it is firm and not sloppy, where if we look at the bottom picture of granulation, it is dark, it is ruddy, it is hyper granulated, it will bleed easily on touch, and so that is not of good quality, and so there is a problem with that when you see it in a wound. When we talk about slough, we want to talk about the consistency of the slough, how much moisture is in that and why we talk about that is to look at how is it best to remove it?
Should we use a sharp debridement method to remove that? Or can we polish that wound with a soft debridement cloth to remove that slough from the wound bed? Non-viable tissue will that can be as simple as a scab on a wound, but certainly we should know the difference between a scab and when we have got necrotic tissue. It is thicker, it is leathery, and it really does remind me of an overripe banana where that skin of the banana is leathery, and that is what necrosis feels like, and it does not have to be black. We can have wet necrosis as well. It does not have to be dry. Thank you.
When we talk about infection this is a great document. If you go to the Institute of Wound Infection, they put a document out in 2016 and then followed it up in 2022, and in that document, they talked about the continuum of infection, and we are very familiar with the acute infection where it is red hot inflamed. There may be past present, but we are not so familiar with this local infection. We get a bit confused when we get to that one.
It is this group this local infection that we start to want to do wound swabs and prescribe antibiotics, and if there is one thing I get you to take away from tonight, the antimicrobial stewardship is we need to stop prescribing antibiotics for local infection. Local infection is that dark ruddy granulation tissue or over granulation or hyper granulation that you have got there and that is slough and that it starts to heal and then it stops and breaks down again, and it is usually the responsibility of Biofilm. Biofilm is a group of microorganisms that embed in the wound bed. We know that it is the responsibility of why wounds are delayed in healing 90% of the time.
In your practice, we have to have Biofilm based wound care to get rid of the biofilm, and where I am saying to you do not wound swab, do not prescribe antibiotics, I would prefer that you thoroughly cleanse and use topical antimicrobials after preparing the wound bed. Let us look at moisture. We think yes, we want moist wound healing for the majority of wounds except for when we are talking about fungal or tinea. We want to keep the wound moist so the cells can move across on the surface of the wound, but we do not want it wet, and when we have got a wound that is delayed in healing, that fluid that is coming from the wound is not ideal. It is toxic. It is full of cytokines that will eat away a good tissue. We need to lock this fluid up. Thank you.
That fluid needs to be locked in a super absorbent dressing and kept out of the wound bed. Otherwise, we break down the extracellular matrix. The extracellular matrix is what we grow granulation on, so it starts to come around. When you think about it, you think well too much exudate in a wound or not using an absorbent dressing, and we have got this caustic fluid that is floating around, well, the framework to grow granulation on is broken down, and so of course we get poor wound healing. Let us look at the wound edge. I think if the wound could speak, it would be at the edge where the voice box would be. If you look at this top wound here, we can see that we have got this thick rolled edge. See how the edges of the wound are turning over? That tells me that that wound is not progressing.
That wound is stagnant. It is stuck. There is no growth factor being released to progress that wound to the next phase. Even though the wound bed does not look so sloughy or it is not looking poor, but if I touch that and gave it a little rub, it would bleed easy, like gums bleed easy in dentistry when there is biofilm present, so that wound is not healing. If we go to the next wound and look at the sloping edge of that granulation tissue, we can see that sloping edge is giving us signs that this wound is healing. It is starting to fill up, and then if we look at the thinning edge up the top, we have got pockets of epithelialisation, and so that is a healing wound. We look at this crusty edge and that says to us, the wound cannot contract in and close because of this debris that is around the edge, so we need to remove that. Debridement is a big part of wound management, and then when we look at epithelialisation, you just want to protect that tissue and keep it healing.
In summary, when we look at wounds, we are looking at being able to accurately assess a wound and being able to do that to be able to select a wound product, and so I am saying to you that if you looked at it in the form of time, tissue, infection, moisture and edge, you will come up with what is happening in this wound and you will see signs of when things are working well and the treatment is working well, and when it is not working and the wound is stuck and you have got thick rolled edges.
When we talk about why do wounds get stuck, why do they slow, I have already mentioned that biofilm is the responsibility the majority of the time, but we need to think about what is the host like, what is the person like, their general health? Have they smoked for 40 years? Do they not have the haemoglobin? are they anaemic? Is their food water and oxygen getting to the cell to heal a wound? What is their vascular supply like? What is happening on the outside of the body? What is the environment? Are they having too much pressure on the wound like a diabetic foot or a pressure injury? Is there friction on the wound and it is causing it to break down? Or is it simple that the wound practice is not ideal? We are not absorbing that fluid enough to keep that toxic fluid out of the wound bed. These are all reasons why wounds will break down, but coming back to biofilm and talking about granulation tissue. I look at this donor site. It is an acute wound, but very quickly the granulation tissue changes. It goes from that beautiful firm watermelon flesh to this raspberry type flesh.
Think about a raspberry. You have cut it in half and you have got this oedematous tissue in there and it goes darker in colour. This is not normal. This is saying to me there is biofilm in this wound. We need to get rid of it. It is okay for wounds to have microorganisms in their free floating platonic, not grouping together and embedding into the wound bed tissue. We have got this window of opportunity of where we can turn an acute wound that is starting to go pear shape. It is starting to show signs of delayed healing. With this window of opportunity, we can halt that there and repair it before it gets down that pathway of being static or stagnant, and this is what we will end up with where this wound has been treated with antibiotics, on and off antibiotics. It is painful. There is odour.
The exudate has not stopped. It is just annoying that acute donor site has hung around for so long because we have not managed it well to begin with and that the practice could be improved. Let us just recap on some of the signs that you can see of why in wounds that are delayed in healing. We certainly talked about this thick rolled edge in this first wound, and you can see how that has all turned over. That is saying that this wound is not doing anything but sitting still. If we look very closely at that wound bed, we will see areas of capillary bleeding in it, and that also tells me things are not right. If I look at the hyper granulation, the dark colour, it is raised above the surface level there, this wound is failing to progress as well.
We look at the crusty edges around it. These are signs that if you see this in a wound, your treatment is not working or you need to start to use biofilm based wound care, and I will show you this. We said that we needed to make sure our practice in wound management aligns to best practice. It does not matter what type of wound you are looking after. These are the four main strategies that you need to get right each and every time. If you look at cleaning a wound but active cleaning, clean it like you mean it. Look at this wound. So often I see expensive dressings put over the top of this type of wound and expect the wound to respond to it, but in actual fact, what is going to happen is you are wasting your money because you have not prepared this wound to receive a dressing. If you cleaned that wound back thoroughly and then put the dressing on, it has got a chance of working. We are asking too much out of dressings to clean up wound beds. Actively cleaning the wound bed, reducing the amount of bacteria in the wound. When we have got wound biofilm embedding in the wound bed, they attach in the wound bed.
The only way to really remove them is to detach them physically, and that is where soft debridement comes in. Monofilament pads where we can polish these wounds and it detaches the group of biofilm. They scramble around trying to regather together again, and it is at this point that you are going to use a wound cleanser super oxidising solution to reduce those microbes that are scrambling around. We also look at refashioning the edge. Do not have crusty edges, do not have slough sitting on the edge or maceration. Clean that up, and we spoke about exudate management and how vital it is to keep toxic fluid off the wound bed and absorbed into a dressing so it is not leaving the wound wet. Cleaning a wound. I see so many of our colleagues that will dab-dab with the saline, and when you have got a wound as sloughy as this, you will think that dab-dab with saline is not going to do a lot for it. Wounds are not sterile.
We do not need to have a wound like this as a sterile procedure. It can have a clean procedure, and what I am talking about there is this person is going to feel a whole lot better if they can shower that wound, take the dressing off in their own bathroom, shower the wound that is supported by evidence and that evidence is available on Wounds Australia website, Aseptic technique. Shower the wound. Wrap it in gladwrap. Wrap a towel around it. Come in to the GP practice and have the dressing attended, so much better.
Saline is not going to lift that slough off that wound. You need to be using a wound cleanser if you have got wounds like this. Identifying when you have got abnormal tissue. We have got the same wound here, but the problem we have is that it has not been identified as local infection. Had we identified this in the first image and cleaned that back, rubbed it back and then used an antimicrobial, we would not then be experiencing spreading infection, as you can see here. Now spreading infection and cellulitis, as you know, no doubt we need to have systemic antibiotics to treat it. When we look at the edge, we spoke about how we need to refashion this edge. If we leave this sitting around the wound and a lot of nurses do think it is outside their scope of practice, this is dead tissue. This is non-viable tissue that you are simply removing. You are not going to do any harm.
You are actually going to facilitate getting this wound to heal, so cleaning this back to reduce the amount of debris and reducing microbes in the area as well. And finally managing exudate, not only if we have leaky dressings, can you imagine how that affects the person with a wound? They certainly do not want the odour and exudate and leaking. We need super absorbent dressings. Years ago, we did not have access to that and we were changing dressings a couple of times a day. We are very fortunate that we have super absorbent dressings that can take up to two lighters of fluid from these leg ulcerations, these venous leg ulcerations and lock it away.
Here I just want to use an example of a patient that has a slow to heal wound. This guy he walked on hot tar. He has neuropathy and diabetes of course, and he sustained this injury, did not realise he had this injury. A couple of weeks later, he presents to the local GP because he had staining on his socks and he started to get some itch around his bunion area. Not a great candidate to have a wound, unstable diabetes, alcoholism and chronic renal failure, hypertension, and so this was going to cause us a problem to get it healed, especially when it is on the bottom of your foot. He progressed antibiotics were prescribed and 21 days later, he was instructed to change his dressings, wash the wound, change the dressings at home, but what had happened was that the pus had collected. It was not draining. It needed debridement, and as you know, antibiotics do not debride, so two things needed to happen there, debridement, antibiotics, but we also needed to offload this wound so that he was not walking on it and causing more pressure.
The staff thought that the foam dressing using a silver foam, not only are they very expensive, they do not offload, so no offloading. They collapse as soon as they walk, and so foam dressings do not relieve pressure on a diabetic foot wound. Six weeks later, this guy has still got a wound. His bandages are leaking. Because of the leakage, he is a falls risk at home. He cannot get access to the silver foam dressings, and they are not available in the local pharmacy. They have to be ordered in. There is a delay in treatment and the topical management was not that great anyway, even though they were very expensive. It was because he needed débridement and to get access to the wound bed.
Let us have a look at what this poor guy forked out in costs. If we were to say that he went off to the GP once a week for review, it would in six weeks of care it would cost, when you take into account just a simple dressing, a dressing pack, $130 for six weeks. If we look at the out-of-pocket cost for this patient, it ended up being $463 for three weeks of care, $926 for six weeks of care where we are very fortunate to have this opportunity with the chronic wound consumable scheme. What makes the difference is accessibility.
We can get quality products that are ideal to manage this person. Not only that, that healthcare professionals will be guided in their selection, and there is even offloading Podiatry Felt that we could have used with him, and at a cost of $240 for the six weeks of treatment. That is astounding to think that he would have still been left with the wound. As Mel had mentioned, the chronic wound consumables scheme is a funding that will commence in June and our prescribers will be able to enlist or enrol in June to start ordering, and the people that are eligible are over the age of 65 with a chronic wound. As Andrew mentioned, we try not to call them chronic anymore because that is like it is chronic disease. You are always going to have it where in actual fact, if we treat the underlying aetiology, we can get these wounds to heal, so delayed wound healing is a great way of referring to them. First Nations people, 50 years of age with the diabetes and a wound are eligible to be enrolled in this scheme.
The education resource, I have put the link there. You can do that education now and that prepares you to become a prescriber. To be a prescriber, you will have a proto account. You would all have a proto account now. By the 25 June, it will come up that the chronic wound consumables scheme is one of those other additions to your proto account and you will be able to order from there. The healthcare professionals that are eligible are registered nurses, podiatrists and GPs.
I think they have done it very well in what you can select from in that we can treat the whole person rather than from the pharmacy or currently we cannot treat the whole person. We cannot treat what is causing it. With this guy, the example I gave you, we had no offloading for him yet in the scheme minimal, but at least it is something, so they have divided up the dressing selection from the primary dressing, which is what is in contact with the wound bed. The secondary dressing, the absorbent dressing on the outside. What you clean the wound with? I spoke about wound cleansers. They will be available on the site. You will also get some skincare protective barrier wipes that you can use around the edges of wounds and offloading like the podiatry felt. You will have tapes that you can hold dressings on with like different brands of tapes that are available, the polysaccharide material tapes.
I am so thrilled to say that compression is available as well and Anita will refer to that. This is how they have done it. They have given you lots of resources on the site and a lot of fact sheets as well, and all based in evidence and talking about antimicrobials and when they should be used and when they should not, and so forth. You go through this wound assessment, basically it is talking about the type of tissue. Is it infected, how much exudate is coming from it. You go through this chart and it will give you a nber once you have followed the flow chart down. That nber refers to the dressing product criteria that you would select from. For example, if it is a moderate exudating wound or a highly exudating wound, you will follow it down and it will direct you to a super absorbent dressing. Just taking a quick look there. Here is a wound cleanser.
We do not use saline in these really sloughing wounds. It is like washing up in cold water when you have had a fatty meal. You want to use something that breaks that tissue down and those chronic wound cleansers are available on the site. I spoke earlier about polishing wounds and getting them ready to receive a dressing. I am thrilled to say that DebriClean is available on the scheme as well. I would clean this wound back, and it is like an __ cloth. It is a monofilament cloth that the fibres will hold the slough in, and it is pretty robust, but it does not cause the pain if you scrubbed away as with a bit of gauze. These are available to help you clean up the wound before you put the dressing on.
We also have the super absorbers. We can get the exudate managed with this lock away technology that is highly exudating wounds, we do not get this maceration and we can absorb all this fluid into the dressing. It swells up, but it keeps the skin dry, which is certainly what we want. Looking at reducing bioburden. When you go through the education, you will see that there is a lot of concern about the use of topical antimicrobials like silver. They are costly with not a lot of evidence to show effectiveness.
This is Sorbact works like trapping the microbes. It reminds me of my grandmother's house when she had flypaper hanging in the doorway. The flies would move and get stuck on the fly paper. Exactly what happens in the wound when the microbes move, you come along, change the dressing and you remove the microbes out of the wound. The great thing about that, we are not going to get resistance and it is less likely to get sensitivity because we are not breaking the cell wall open. We are taking the microbe out whole.
Lastly, we look at oedema management. It is absolutely pointless trying to manage a wound on this foot if we do not get rid of that oedema. We have got to do both. I am so pleased to say that the chronic wound consumables scheme provides compression. It is going to be fabulous to listen to Anita to be guided in what compression that you need to be looking at. Thank you for listening. There are some references for you that you may enjoy taking a look at and certainly have a look at our website if you are interested in education. Thank you. Welcome, Anita. I will hand over to you. I am sure you have got a lot to share about compression and your speciality.
Anita Daltrey
Great. Thanks very much, Margo. Great to hear about the wound and wound management. I am an independent occupational therapist and a lymphoedema therapist. I work in both public and private practice, and I work as a clinical advisory for ESSITY. Today, I am just going to give you a very, very brief overview on compression and why we would use it and in what circumstances and what type of products you might want to choose. Compression can be used to manage quite a nber of conditions. You have got lymphedema, venous insufficiency, dependent oedema, flights, slow healing wounds, obesity, lipedema and scar management and burns. How does compression therapy work?
In very simple terms, it is just the application of an external squeezing force to a limb. This helps to decrease the venous hypertension. It reduces valvular reflux and it supports the tissues that support the vessel wall by reducing the diameter of distended veins increasing the venous flow. It allows less fluid to leak out of the capillaries and this encourages more fluid absorption. This in turn helps to reduce the oedema. It relieves heavy and aching legs and it improves the muscle pp. I am just going to talk very briefly about two principles of compression. If we look on the left side here, we can see resting pressure. This is a continuous force that is exerted from outside towards the limb. That is the force from the garment on the limb. The higher the compression class, the higher the resting pressure that is exerted by a stocking or a bandage. Then on the right-hand side, we talk about working pressure.
That is the pressure from the muscles pushing out against the garment or the compression and the stiffer or more rigid the bandage or stocking, the higher the working pressure. When we are applying compression, we want to make sure that it is graduated compression. It is not just any compression. Graduated compression provides the highest amount of compression at the ankle. That is also where the dosage of compression is measured, and it is measured in mmHg. This helps to promote the normal flow of blood by giving that large squeeze at the bottom and then reducing as it goes up the leg. You always want to make sure that you are checking that it is safe to apply compression. That is really important checking for any contraindications and where there is any concern, just making sure that you have done an ankle brachial index assessment. Where you have got a normal reading then it is okay to apply standard compression.
In the management of slow healing wounds, we normally recommend 30 to 40 mmHg. If there is any abnormal reading or any lower reading, then you need to consider reducing compression or referring for further vascular treatment. As a general rule, in venous oedema, higher pressure is better than lower pressure and some pressure is better than no pressure. As I said previously, 30 to 40 mmHg or a class III compression is what is recommended for people with venous leg ulcers or slow healing wounds. If they are not able to tolerate that, then reducing that is recommended.
In the wound consumable scheme, when you go in to do your training, if you have not done that already, it does show you what products are available and talks through what they are. You have got tubular compression, short stretch and elastic compression bandages, multi-layer compression bandaging, adjustable Velcro compression bandaging, graduated hosiery and undercast padding. I have just put together a summary table of those items so that you can see at a glance what you may use those items for.
In terms of the tubular compression, that is really only used as a retention bandage to keep any non-adhesive wound dressings in place. It is not used for graduated compression. The short stretch inelastic compression bandages can be used for the management of wounds and oedema. They do need to be applied by a trained clinician. They can be left in place for up to seven days and they are disposable. You will find with some of these compression bandages that they form sort of like a rigid container around the limb, and as the size of the limb goes down, then the bandage does not necessarily go down with it. You have got multi-layered compression bandaging, again, can be used for wounds and oedema. It does need to be applied by a trained clinician. It is generally used for those larger legs with multiple skin folds and it needs to be applied daily. The bandages are washable and padding is disposable.
With the multi-layered bandaging, it is quite time consuming to apply that. It is hard to get a consistent level of compression with it, and you will find that when it is on when the size of the limb goes down, you will get some slippage of the bandages. Just bear that in mind because it can create some falls issues for some patients. You have got the adjustable Velcro compression bandaging or Velcro wraps. These can also be used in the management of wounds and oedema. They can be applied by a patient or carer. You do not need to have special training to actually apply them. You do get very consistent application each time. These are washable and they are reusable. There is graduated compression hosiery. This can be applied by the patient or the carer. This is usually best used when the wounds are in remission. When you have got some healing just to avoid them from coming back. When you have got active open wounds, then one of the other options is generally better. The undercast padding is used to pad out any bony prominences or as a layer with multi-layered compression bandaging.
You will find with some legs, if you do not have a regular shape, you might need to pad them out with that padding. Just putting on here some examples of ineffective compression. You want to make sure that what you do put on is going to be tolerated by the client or the patient, and that it is not going to cause any additional harm. In the picture on the left, you can see here we have got a long stretch garment that has been applied to somebody with fairly significant skin folds. With that particular garment, it is digging into those skin folds and it is one that is likely to cause a tourniquet at the top of the leg and could cause a pressure injury around the ankle. For somebody like that, you would want to be applying more of a Velcro wrap instead of something like this. The one on the right you can see you may have heard of the triple layer compression bandaging that can use the tubular bandaging. I do not recommend that. That is not seen as best practice because it can slip down and really does not cause anything other than a leg warmer.
Some of the products that are available in in the wound consumable scheme that are available through ESSITY. In the short stretch inelastic compression bandaging section, you have got the Jopst Compri2. This is a short stretch bandage system. It has got a high working pressure. It is a two-level bandage system that is disposable. It can be left in place for seven days. With this one, there is a very slight bit of elasticity in it, so as the size of the limb goes down, it will still conform to the limb. There is an indicator on the bandage to support the correct application, so you know you are putting it on right each time. It will need to be removed each time a new dressing is applied and it does need to be applied by a trained clinician.
You have got the adjustable Velcro compression bandaging. There is Jobst FarrowWrap. This is a great product. It is short stretch. It has got a high working pressure. It can be applied by a patient or a carer. It ensures a safe and consistent compression. It is quick and easy to apply, reducing the work health and safety burden for staff and for carers because with the other bandaging systems, it does take a bit longer. It is a bit more labour intensive to put on. It minimises the risk of skin, tears, friction and other skin traumas. It can be removed for personal hygiene. You may remember, as Margo was saying earlier, that showering the wound is really important and promotes best practice. If somebody is wearing a Velcro wrap system, then it does enable them to remove that themselves to perform their personal hygiene and then enable easier wound dressing. It can be adjusted by the patient themselves as they notice that, any swelling is going down.
Then with the graduated compression hosiery, there is the Jobst UlcerCare which is a great product. It is very easy to put on. It is a long stretch product. It has got a lower working pressure. It is best used when the wounds are in remission. It comprises of two component stockings. The white one goes on first providing 17 mmHg, and the outer garment with the zip is applied over the top and in combination that provides 30 to 40 mmHg, which as we said before, is what is recommended for slow healing wounds. It is very easy to don and doff by the patient or the carer, and it does not require any specialised training to use it.
I have just got a very brief case study here. Here you can see some pictures of a 78-year-old male who has got oedema and ulcers. You can see he has got proximal oedema in the lower leg and he has got some ulcers at the front there. There is no swelling in the foot. He had a Velcro wrap system applied for six weeks along with a super absorbent dressing. The super absorbent dressings are very compatible with the Velcro wrap systems. Six weeks later, you can see in the picture on the right that the oedema had resolved and the ulcers were seen to be in remission and healing.
When we are managing wounds again, as Margo said, it is really important to take a team approach and have a holistic view of the person. Just consider who else you have in your team or who else you feel you may need in your team and look to reach out to those. Wound CNCs are a great resource. Lymphedema therapists, dieticians, family members and also the wound garment company clinical specialists. They are a wealth of information and knowledge, and often know of other clinicians in local areas. Just bear that in mind. That is just a very brief overview on compression and what is available in the wound consumable scheme. Thank you.
Jayden Saunders
Thank you very much, Anita and Margo, for really insightful presentations. My name is Jayden everyone, and I work for ESSITY as well. I am going to get us into our Q&A section in a moment because there has been a lot of questions coming through. Before I do though, I just want to reiterate this is very much an introduction to the chronic wound consumables scheme. ESSITY, we are here to continue supporting the RACGP with whatever you need, and what that support looks like moving forward will be heavily determined by all of you. I would encourage you at the end of the webinar to complete the post webinar evaluation. Include in there any commentary about what resources you might require in the future, whether or not that is additional resources from us or maybe a wound management workshop in your local region.
I will just highlight one resource we have which is the Cutimed Wound Navigator app. It is a free app. You can download it now if you want to scan the QR code on the screen or you can go to your local app store on your smartphone. This app really just simplifies wound assessment and product selection in three quick steps, you measure the wound by taking a photo through the app, you select the relevant wound assessment criteria such as wound type, wound tissue, exudate level, that sort of thing, and then the app will generate a list of recommended products which are appropriate to manage that wound. Then you can jump on to the chronic wound consumable scheme portal and order those products. Taking the complexity out of wound assessment and management. Into our Q&A. Anita and Margo, I do not know if you want to switch on your cameras and join me.
Lots of questions coming through. We will try and get through as many as we can. I might just start. First of all, someone asked about how long will it take to deliver products to rural WA. I do not know how much you know about the scheme, but Independents Australia are the sole distributor. Initially, they will be distributing products out of their Victoria warehouse, but then as demand grows, they will start stocking products at their sites around the country. You are probably looking at two to three business days initially, but as the scheme progresses, I imagine that will take less time.
Next question we have got is someone asked about are enrolled nurses eligible to become prescribers. At the moment, it does just advise registered nurses and nurse practitioners, but as I said, things are constantly evolving. This may change in the future. Margo, the next one is for you. We had someone ask as a GP working in a private clinic, how can they provide dressings other than non-adhesive or gel and dressings when they are so expensive? You covered that a little bit with the purpose of the scheme. I do not know if you want to make any more comments.
Margo Asimus
I think importantly, if you are very limited in what you can supply to people outside of the scheme, tonight we have concentrated on what is going to be available and diabetic with a wound that is slow to heal. Happy days. You are going to have access to great products though. For me this is like a pilot to roll this out to more people, non-diabetic people with wounds. We have got to make this work and get the data on it so that our politicians can listen to hear that we need access to products just like my gentleman did not have access and what it cost.
I know that in GP practice that it is costing to put product on people. What I would recommend to you are those four things. Have a look at Sorbact. You do not need to have the expensive antimicrobials. You need to prepare your wound bed. Look at how you can clean that wound bed back. You can certainly use Betadine as the bioburden and the microbes are scrambling. Knock them out with some Betadine. Then you could use Sorbact, which is a really low-cost effective option. I would recommend that to you and maybe reach out to ESSITY to give you some information.
Jayden Saunders
Following on from that, we had another question come in saying about in the old days, chronic or slow to heal wounds, would often be soaked in antiseptic solutions and have we abandoned that or are we still doing that?
Margo Asimus
Thank you for that question. Everything is guided by consensus or position documents. I would urge you to download or we could even send the link out if that is possible, the Wound Infection Institute 2022 document. It lists all the antiseptics and what the drawbacks are on using some of those. I am talking Condy's crystals, looking at resistant pseudomonas. When you have nothing else and you cannot use systemic, Condy's crystals has a place in the toolbox, but it is not going to be used on something that is a healing wound. I think that is the difference. Years ago, we just used a strategy of one size fits all. Now, we think about do we need to put an antiseptic on this wound? The best antiseptic is still the oldest antiseptic, and that is the iodine. Most certainly have a look at that evidence, and it supports that practice of using it in a wound that is heavily laden with biofilm.
Jayden Saunders
Yeah, definitely. The next few questions, I will combine a few questions into one because they are kind of all on the similar topic, but it is kind of a lot about wound cleansing. People are worried about removing potentially healthy tissue and damaging the wound further. How do you know what sort of wound cleanser to choose? I know you mentioned Microdacyn and then someone even asking about maggots, for example, and if there is ever any evidence for that.
Margo Asimus
Okay. A couple of things in that. Again, I urge you to go to the document. There is a new document out just last month. We will include a link to this one as well. It is just purely talking about wound hygiene and how to clean wounds and what to clean wounds with. It was so supportive of the super oxidising solutions. How they work? It is a low dose hydrochloric acid to the level that your stomach makes. We are using these in cleaning gut wounds out in surgery for debridement. Very safe to go in cavities where you do not know where it goes to. More so than irrigating with a Betadine. You could not do that in a cavity where you do not know where it goes to, but certainly the super oxidising solution.
I hope that answers. It is safe to use on good tissue. Secondly, your question around maggot therapy. Wild maggot therapy. I mainly write about how to remove maggots out of wounds. When they are the feral type, those that are grown for debridement, works very well. Problem we have is getting them in time, especially in the rural and remote areas. They are grown in Westmead in New South Wales and so that can be quite difficult to have that as an option for debridement. If you live near the city and you can handle the yuck factor of maggots, well yes, there is great supporting evidence in its use.
Jayden Saunders
Perfect. We have got time for one or two more quick ones. Someone has asked if a patient is eligible, how much does it cost for the patient? The great thing about the scheme is that there is no cost to the patient potentially for these dressings. Margo, you could probably speak a bit more to what it was like previously.
Margo Asimus
I was quite interested in this. I am also a stomal therapist and I thought it would mirror the stomal therapy scheme where what happens there? This may happen into the future. What happens for stoma patients will be that they pay a membership fee per year, and that is around $30 and they pay their delivery fee. The delivery fee may range from $6 to $12 and they may order once a quarter. That is the cost for a stomal therapy patient. At the moment, there is no cost. Into the future, if this is rolled out to service more people non-diabetic with wounds failing to progress, it may mirror the stomal therapy scheme.
Jayden Saunders
Okay. I might leave it there for the Q&A. There are additional questions that have come through. I have tried to get through as many as we can, but I know Meghann just has to wrap things up as well from her end. We will endeavour to get any additional questions answered by Margo and Anita. Keep submitting those and we will get those sent through and distribute as a bit of follow up for you all.
Margo Asimus
Also, Jayden, if we can just include those links to the evidence that I have spoken about tonight as well with answering those questions, not a problem.
Jayden Saunders
Definitely. Great. Thanks, Meghann, over to you.
Meghann Price
Thank you very much, Margo and Anita, for that informative webinar. Thank you, Jayden and Andrew for helping out as well. A reminder to please complete the evaluation that will pop up in a minute when the webinar session closes, it takes no more than a couple of minutes to complete. Certificates of attendance will become available on your CPD statements within the next few days, but for any non RACGP members who would like a certificate of attendance, please just email rural@racgp.org.au.
Lastly, I would just like to invite you all to join us for our next free webinar next month. The How and Why of Becoming a Supervisor in Your Rural Practice. Join Dr Gerard Ingham and Dr Rod Omond as they explore the role of a supervisor, the positive impact you can have and a clear roadmap to getting started. You will learn about the importance of the supervisor role, how it contributes to the development of the rural GP workforce and why it is such a fulfilling and vital position in our rural communities. If you have not yet registered for this free webinar, I will pop it in the chat in a second. For everyone else, on that note, thank you and good night.