A unique active debriding product that can be used in all care settings by all practitioners4th April 2013
Debrisoft® from Activa Healthcare is a unique active debridement product that can be used by all clinicians in any setting to remove devitalised tissue and wound debris from wounds quickly and easy. This can significantly contribute to efficiency savings and improve patient experience, both of which are key in the current NHS.
Unlike any other non-specialist debridement product available, Debrisoft removes wound debris, necrotic material, haematoma and slough from wounds in minutes, rather than the days/weeks it can take to achieve the same results with dressings. It can also be used as part of a skin care routine, easily removing dry skin and long-standing hyperkeratotic tissue from patients with skin conditions associated with venous and lymphovenous disease of the lower limb.
Wound debridement, or the physical removal of non-viable/devitalised tissue, infected or foreign material from the wound bed and surrounding skin (Wounds UK, 2013), is widely recognised as an important part of wound bed preparation for a number of reasons. First, by removing these materials, the risk of infection is reduced and the chances of healing improved (Gray et al, 2011a); wounds that are infected will not heal in the normal expected timeframe and are more likely to develop complications as a result. Second, the presence of devitalised tissue or foreign material in the wound can provide a physical barrier to healing (Kubo et al, 2001), disrupting the processes such as extracellular matrix formation and epithelial resurfacing which are responsible for wound healing and closure (Weir et al, 2007). Third, removal of devitalised tissue allows any topical treatments such as antimicrobial dressings and analgesia to be more effective as their active ingredients are more able to access the wound bed (Weir et al, 2007).
Finally, debridement of a wound before a further assessment is carried out enables an accurate picture of the true condition of the wound to be obtained; a wound may be deeper than it first appears once devitalised tissue is removed or sinuses draining from a main wound may be hidden from sight. Being able to see the true clinical picture during wound assessment is key for the correct categorisation of certain wound types such as pressure ulcers and diabetic foot ulcers, and for the effective management and measurement of outcomes in all wounds.
Debridement allows the clinician to significantly improve patients’ wellbeing and quality of life, as well as contribute to optimal wound healing and use of healthcare resources (Gray et al, 2009).
Why use Debrisoft?
Although the benefits of debridement are well recognised in clinical practice and a number of debridement techniques exist, in reality choice may be narrowed by factors such as access to competent specialists and equipment. All non-surgical debridement techniques involve removing devitalised tissue and debris from the wound, without damaging the healthy tissue present, as quickly as possible. Studies indicate that if the debridement process is accelerated, healing will be achieved more quickly (Steed et al, 1996).
However, rapid removal of devitalised tissue usually requires specialist nurses or other clinicians trained in sharp debridement or the use of ultrasound/hydrosurgical equipment, to carry out the procedure. This is a problem in some areas since specialists and/or equipment may not be readily accessible or referral to these resources may result in an unacceptable delay in treatment.
The majority of wound care is carried out in the community in the UK, with practitioners most likely to perform autolytic debridement, using moist wound dressings. This technique uses wound dressings to speed up the body’s natural debridement process and is a relatively straightforward method that requires no specialist training. However, it can be a lengthy process, taking days and in some cases weeks to debride the wound effectively. The costs associated with the dressings and nursing time needed may also make this approach expensive (Gray et al, 2011a).
Debrisoft was developed in response to the need for an inexpensive, easy to use, quick and effective way to clean skin and debride wounds that can be used in all healthcare settings by all healthcare practitioners, and it appears to have been achieving these aims in clinical practice since its launch in the UK in 2011.
Debrisoft can either be used to replace an existing debridement method, e.g. autolytic debridement, or to complement other methods, e.g. to maintain the benefits of surgical or sharp debridment (Vowden and Vowden, 2011). It can be used on commonly encountered chronic wounds such as leg ulcers, pressure ulcers and diabetic foot ulcers and acute trauma and surgical wounds healing by secondary intention to mechanically debride superficial wounds that contain loose slough and debris, or to remove scale or hyperkeratosis from the skin.
Performance in clinical practice
The training required to use Debrisoft in clinical practice is minimal, with no specific instruction needed to debride successfully (Haemmerle et al, 2011; Gray et al, 2011b; Hawkins, 2012), making it a debridement option that does not need specialist training and which carries little potential for patient harm, unlike other methods such as sharp debridement. For these reasons, and drawing on their experience of the product, Johnson (2011) and Flinton (2011) concluded that Debrisoft was useful in a community setting.
Rosie Callaghan, Tissue Viability Specialist Nurse, Worcester Health and Care NHS Trust, shares this view believing that ‘Debrisoft enables quick and effective debridement in the home setting’.
Rosie and her colleague Jackie Stephen-Haynes, Consultant Nurse and Senior Lecturer at the trust, coordinated an evaluation of Debrisoft to see if it would help a team of 40 experienced tissue viability link nurses working in the community to improve wound assessment and thus wound management decisions. She admitted that when presented with Debrisoft to carry out wound debridement, both clinicians and patients were skeptical.
However, Debrisoft’s soft, fleecy wound contact layer is in fact made up of soft polyester fibres (a 10cmx10cm pad contains more than 18 million fibres), designed specifically to mechanically remove slough and devitalised cells when dampened and wiped gently over the wound bed. Although the fibres look and feel soft to touch, they are mechanically strong and are made to a specified length, thickness and density, with angled tips. These features, in addition to extreme flexibility, enable Debrisoft to loosen necrotic tissue, keratoses and adherent exudate from all areas of the wound bed in a variety of wound types (Bahr et al, 2011; Collarte et al (2011; Gray et al, 2011; Haemmerle et al, 2011) and effectively remove hyperkeratosis from the peri-wound skin (Gray et al, 2011; Shepherd, 2011; Whitaker, 2011) without disturbing or damaging healthy new tissue (Haemmerle et al, 2011).
Scanning electron microscopic analysis of Debrisoft pre- and post-debridement showed that removed debris is attached into the texture of the debrider, or fibres are fixed together like adhesive tapes by the removed material (Bahr et al, 2011).
Back in Worcester, following the 12-week clinical evaluation of Debrisoft on a range of wound types, results showed it was mainly used to carry out debridement, and the removal of hyperkeratosis, with the majority describing its performance at these tasks as ‘very good’ or ‘good’. A Debrisoft session took on average between 2–10 minutes, in keeping with times reported in the literature (Bahr et al, 2010; Flinton, 2011; Gray et al, 2011; Johnson, 2011).
Almost every clinician using it found it achieved instant results of greatly improved skin condition and rapidly improved visibility of the wound/skin for assessment, enabling better classification of pressure ulceration, and management decisions, findings that were also noted in another study by Callaghan and Stephen Haynes (2012). The time taken to carry out debridement was reduced, in addition to the number of patient visits usually needed to obtain the same results. One clinician who participated in the evaluation said “[Debrisoft] exposed a wound bed which normally takes weeks or a hospital admission’, while another commented, ‘The debridement system when used to remove a haematoma gently peeled away the skin layer over the haematoma, exposing it, then it lifted out. This would take a week with other products’.
This mirrors the experience of Gray et al (2011b) who removed haematoma and soft haematoma debris from the wound beds of three patients in five minutes or under using just one Debrisoft pad per patient.
The evaluation also revealed that debridement with Debrisoft was pain free for patients. Rosie described one patient who had previously been unable to tolerate the nurse touching his wound due to pain, who was then able to successfully and painlessly debride his own wound using Debrisoft, with instruction from his nurse.
Similarly, Dr Ingo Stoffels, Department of Dermatology, Venereology and Allergology, University Hospital Essen, Germany, described how one of his patients with second and third degree scald burns to her face was able to painlessly self-debride using Debrisoft without analgesia, and concluded that ‘Pain is a major problem for patients with wounds…Debrisoft presents, particularly in patients with painful acute wounds, a new, safe and painless therapy option’.
Many other clinicians have reported similar pain free debridement using Debrisoft (Bahr et al, 2011; Collarte et al, 2011; Flinton, 2011; Gray et al, 2011b; Green, 2011; Haemmerle et al, 2011; Johnson, 2011; Sharpe and Concannon et al, 2011; Simon, 2011; Whitaker, 2011).
In addition to the demand for delivery of positive patient-centred care (NHS Operating Framework 2012/13) and for quality outcomes to drive all care delivery in the NHS, ‘Clinicians need to be mindful of efficiency targets everyday’
commented Sian Fumarola, Senior Clinical Nurse Specialist, University Hospital of North Staffordshire. Sian found that in her Trust, the ability to quickly and easily carry out rapid debridement using Debrisoft in an Accident and Emergency setting resulted in cost savings by ensuring patients were accurately assessed at the outset. She continued ‘it is ‘really important to get assessment right in the beginning so that the right management plan is implemented’ by placing the patient on the correct care pathway from the outset, the impact of wounds on acute bed capacity can be lessened, helping the patients to progress through the organisation in a seamless and timely fashion.
Jackie Stephen-Haynes agrees: 'The use of debrisoft in our trust has resulted in more accurate wound assessment, particularly in pressure ulcer grading, enabling well informed, appropriate and efficient management decisions to be made. It has reduced time spent on debridement, and because its quick to use and pain-free, has resulted in an improved debridement experience for many’.
Other clinicians who have used Debrisoft (Bahr et al, 2011; Collarte et al, 2011; Flinton; 2011; Gray et al, 2011b; Haemmerle et al, 2011; Johnson, 2011; Vowden and Vowden, 2011), also concluded it is a quick, effective and safe method of debridement, which could have clinical and economic benefits by shortening the time and resources required to debride wounds, improving wound assessment and management decisions and reducing the time to healing.
If you would like to access latest best practice documents on debridement and clinical evaluations and case studies on the use of Debrisoft in a variety of wound types, visit http://www.activahealthcare.co.uk/debrisoft/, and to learn more and test your knowledge on wound assessment, debridement and Debrisoft, go to Activa's e-learning zone: http://www.activahealthcare.co.uk/learning/.
To watch Debrisoft in action and hear Rosie, Sian and Ingo discussing it in detail, click below.
Bahr S, Mustafi N, Hattig P et al (2011) Clinical efficacy of a new monofilament fibre-containing wound debridement product. J Wound Care 20(5): 244–50
Benbow M (2011) Using Debrisoft for wound debridement. J Comm Nurs 25(5): 17–18
Callaghan R, Stephen-Haynes J (2012) Changing the face of debridement in pressure ulcers. EPUAP Poster, 2012
Collarte A, Lara L, Alberto A (2011) Evaluation of a new debridement method for sloughy wounds and hyperkeratotic skin for a non-specialist setting. Poster Presentation, European Wound Management Association Conference, 25–27 May, Brussels, Belgium
Flinton R (2011) A new solution to an old problem — an innovative active debridement system. Poster Presentation, Wounds UK, 11–14 November, Harrogate
Gray, D, White R, Cooper P, et al (2009) An introduction to Applied Wound Management and its use in the assessment of wounds. In: Applied Wounds Management: Part 3: Use in practice. Wounds UK (suppl) 5(4): 4–5. Available at: http://www. wounds-uk.com/applied-wound-management
Gray D, Acton C, Chadwick P et al (2011a) Consensus guide for the use of debridement techniques in the UK. Wounds UK 7(1): 77–84
Gray D, Cooper P, Russell F, Stringfellow S (2011b) Assessing the clinical performance of a new selective mechanical wound debridement product. Wounds UK 7(3): 42–6
Green M (2011) Case study 3: Mrs K. In: Debrisoft: Revolutionizing Debridement. Activa Supplement BJN/BJCN: 10–11
Haemmerle G, Duelli H, Abel M, Strohal R (2011) The wound debrider: a new monofilament fibre technology. Br J Nurs (Tissue Viability Supplement) 20(6): S35–42
Hawkins K (2012) Achieving vascular outcomes by smart debridement. Poster
Johnson S (2011) A 10 patient evaluation of a new active debridement system. Poster
Presentation, Wounds UK, 11–14 November, Harrogate
NHS Operating Framework 2012/13: Available online at: https://www.gov.uk/government/publications/the-operating-framework-for-the-nhs-in-england-2012-13
Sharpe A, Concannon M (2011) Case study 2: Mrs V. In: Debrisoft: Revolutionizing Debridement. Activa Supplement BJN/BJCN: 7–9
Shepherd J (2011) Case study 5: Mrs W. In: Debrisoft: Revolutionizing Debridement. Activa Supplement BJN/BJCN: 14–15
Simon D (2011) Case study 1: Mrs B. In: Debrisoft: Revolutionizing Debridement. Activa Supplement BJN/BJCN: 5–6
Steed DL, Donohoe D, Webster MW, et al (1996) Effect of extensive debridement and treatment on the healing of diabetic foot ulcers. Diabetic Ulcer Study Group. J Am Coll Surg 183(1): 61–4
Vowden P, Vowden K (2011) Introduction to Debrisoft. In: Debrisoft: Revolutionizing Debridement. Activa Supplement BJN/BJCN: 3
Weir D, Scarborough P, Niezgoda JA (2007) Wound debridement. In: Krasner DL (ed). Chronic Wound Care: A Clinical Source Book for Healthcare Professionals (4th edn). HMP Communications, Malvern: 35; 343–55
Whitaker J (2011) Case study 4: Mr J. In: Debrisoft: Revolutionizing Debridement. Activa Supplement BJN/BJCN: 12–13
Kubo M, Van der Water L, Plantefaber LC, et al (2001) Fibrinogen and fibrin are anti-adhesive for keratinocytes: a mechanism for fibrin eschar and slough during wound repair. J Invest Dermatol 117(6): 1369–81, erratum in 118(5): 910
Wounds UK (2013) Effective debridement in a changing NHS: a UK consensus. London: Wounds UK, 2013. Available online at: http://www.wounds-uk.com/supplements/effective-debridement-in-a-changing-nhs-a-uk-consensus
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