NICE recommendation for efficient wound debridement using Debrisoft®22nd July 2014
The National Institute for Health and Care Excellence (NICE, 2014) has recently recommended the use of Debrisoft® (Activa Healthcare), a monofilament debridement pad, in the community for the management of acute and chronic wounds in adults and children. When compared with existing alternatives for wound debridement, such as autolytic debridement using dressings, or wound irrigation with saline or cleansing with gauze, NICE found that Debrisoft offers patient benefits and savings to the NHS.
In the current community nursing climate of increasing caseloads, declining workforce, lack of training and budget cuts, a wound care product that is recognised by NICE, the independent body responsible for driving improvement in health care, as saving both time and money is too pertinent for any healthcare team to ignore.
So, what is Debrisoft?
As with many of the best ideas, the principle behind Debrisoft is a simple yet effective one. It is a single-use, soft, polyester fibre pad that is moistened with tap water, sterile water or saline and gently wiped across the wound or skin, where more than 18 million flexible monofilament fibres remove and retain exudate (Wiegand et al, 2013), dead cells and wound debris. Using Debrisoft, debridement can take an average of 2–4 minutes, compared with the days or even weeks taken using dressings to promote autolytic debridement, making it a time-efficient method of debriding many wounds encountered in the community nurse’s daily caseload, including leg ulcers, pressure ulcers, diabetic foot ulcers, trauma wounds and postoperative wounds, and the build up of dead skin cells or hyperkeratosis that frequently surrounds some of these wound types. It really is that simple; no specialist training is required, giving any clinician the ability to perform quick and easy skin cleansing and wound debridement.
A clinical game-changer
As well as obtaining evidence from clinical experts on the clinical and cost-efficacy of Debrisoft, 15 multiple-patient case-series reports (five peer-reviewed papers and 10 posters) were reviewed, some of which included retrospective comparators.
One study excerpt concluded:
‘Clinicians reported that the Debrisoft pad removed debris, slough, dried exudate and crusts efficiently, without damaging the fragile skin surrounding the wound. Photographic analysis confirmed this.’ (Bahr et al, 2011).
Following a review of all the evidence, NICE (2014) concluded that:
- Debrisoft is more effective at debridement than the current practice of using hydrogel or other autolytic dressings and irrigating wounds with saline or gentle cleansing with gauze
- Debrisoft provides quicker debridement, allowing earlier visibility of the wound bed and therefore better management of the wound
- Debrisoft can reduce pain associated with debridement
- Debrisoft enables faster treatment, resulting in less frequent and fewer overall care visits
- Debrisoft reduces risk of trauma to healthy tissue and reduces bleeding as well as cutting the overall number of wound dressings used
- Debrisoft contributes to overall cost-savings compared with current practices.
NICE also highlighted the cost-effectiveness of Debrisoft, citing its own cost calculator, which estimates that using Debrisoft within the community can save the NHS up to £484 per patient for complete debridement of a wound, compared to current standard management.
Why use Debrisoft?
By removing dead tissue in some wounds in a matter of minutes using Debrisoft, the wound bioburden is reduced, and with it the risk of infection.
Debrisoft offers clinicians a quick and efficient way to gently debride the wound bed, which in turn aids wound assessment. By effectively removing dead tissue and wound debris that may obscure the state of the wound, the true condition of the wound bed and surrounding skin can be revealed, enabling rapid assessment and timely management decisions to be made (Callaghan and Stephen-Haynes, 2012; Stephen-Haynes and Callaghan, 2012). Another recent study showed that when nurses used Debrisoft as part of the assessment process, it helped them to more accurately categorise pressure ulcers (Swan and Orig, 2013).
Generalist or less experienced clinicians may become confused when a superficial pressure ulcer contains light slough or yellow material and categorise as a 3 when in fact it may be a category 2.This inevitably has implications for the patient’s treatment, as it may be more intensive for a category 3 than a category 2 ulcer; and for the health service itself, which will incur the costs of treating a higher category ulcer (Swan and Orig, 2013). Category 3 pressure ulcers may also necessitate investigation by senior nurses, which can be time-consuming. In addition, once classified you cannot change the category from a 3 to a 2.
Swan and Orig (2013), for example, retrospectively de-escalated 60% of the pressure ulcers in their study just by ‘debrisofting’, and, as a result, no route cause analysis was needed for those patients, which, in turn, saved significant NHS resources and demonstrated more accurate trust/organisation performance in pressure ulcer care. If generalist nurses are able to more accurately assess and classify pressure damage, the implications for healthcare resources and patient wellbeing are obvious.
Trudie Young, Director of Education and Training at the Welsh Wound Innovation Center and a member of the expert panel working with NICE said: ‘The NICE guidance provides evidence that Debrisoft is a cost-effective method of wound management, it is also convenient and easy to use.’
With regards to the speed of Debrisoft in completely debriding wounds, Young commented that, ‘quicker debridement may give earlier visibility of the wound bed and therefore enable better management of the wound. Debrisoft is particularly effective on chronic, sloughy wounds with exudate and hyperkeratotic skin’.
Young also stressed the importance of the patient’s experience: ‘Dead tissue and offensive smelling wounds are very distressing to patients. So for me as a nurse, it is extremely rewarding to remove both quickly and painlessly with Debrisoft.’
Simon Barrett, tissue viability specialist, highlighted the unique nature of Debrisoft. ‘Over time products evolve and improve on existing technology,’ he said. ‘It’s not often that something comes along which revolutionises practice like Debrisoft. It gives the practitioner the opportunity to provide optimum care by improving how we treat the wound bed and care for skin.’
Changing the clinical landscape
A growing body of evidence highlighted in the NICE recommendations for the use of Debrisoft to manage acute and chronic wounds shows that it can help to make wound care assessment an easier and more accurate process. It is easy, quick and convenient to use, debriding appropriate wounds more quickly, with fewer nurse visits, than other debridement methods. This brings huge benefits for patients, as well as cost-savings for the NHS. In today’s time- and cash-strapped health service, what is there not to like about that?
Bahr S, Mustafi N, Hattig P, et al (2011) Clinical efficacy of a new monofilament fibre-containing wound debridement product. J Wound Care 205(5): 242–48
Callaghan R, Stephen-Haynes J (2012) Changing the face of debridement in pressure ulcers. Poster presentation. EPUAP conference, Cardiff, UK
National Institute for Health and Care Excellence (2014) The Debrisoft monofilament debridement pad for use in acute and chronic wounds (MTG17). NICE, London. Available online: http://www.nice.org.uk/MTG17
Swan J, Orig R (2013) Debridement using a monofilament fibre pad to aid in the accurate categorisation of pressure ulcers. Poster presentation. EPUAP conference, Vienna
Stephen-Haynes J, Callaghan R (2012) The role of an active debridement system in assisting the experienced clinician to undertake an assessment and determine appropriate wound management objectives. Poster presentation, EWMA, Vienna
Wiegand C, Reddersen K, Abel M, Ruth P, Hipler U-C (2013) Determination of the fluid holding capacity (FHC) of a new debrider compared to conventional cotton gauze. Poster presentation, Wounds UK, Harrogate, 11–13 November, 2013