In most cases, minor wounds can be easily treated with a home first aid product. The British Red Cross advises that a basic home first aid kit should include at least 20 plasters. Yet, it remains a fact that the bulk of sales of first aid products are distress purchases, bought only after the trauma has taken place or, in the worst case scenario for the NHS, after a wasted trip to A&E. That is why the Government’s current policy of emergency care reform promotes community pharmacy as a key stakeholder because of its ability to promote and support self care2.
Understanding wound healing
The key objective of any wound dressing is to protect the wound and to enable healing to proceed as smoothly and quickly as possible. The body’s own physiological response to a skin trauma is to form a protective scab, a firm crust of coagulated blood over the injured area, to protect it against external influences. However, several factors are known to compromise the body’s innate ability to heal wounds, among which are the type and amount of bacteria present in the wound, and the type and location of the wound.
Abrasions, for example, are often associated with contamination, whereas large contusions or lacerations will need professional medical attention to improve the healing prognosis. Other important factors are increasing age, underlying diseases eg reduced vascular supply and diabetes mellitus, or drug treatments eg steroids. In these situations clinical intervention will be appropriate to support the healing process. An additional consideration for the clinician involved in woundcare is the increasing body of research supporting the theory that modern woundcare technology can actually improve the body’s own healing processes3.
Dressings based around the traditional ‘dry wound healing’ technology essentially mimic the body’s own response to a skin trauma, by covering and protecting a wound, absorbing excess exudates and keeping the wound dry.
Dry wound healing
However, since the early 1960s scientists have considered that alternative models of woundcare may offer superior benefits. Chief among these is the theory of moist wound healing, which shows that cell growth can be optimised in moist conditions, which in turn optimises the formation of new tissue. In moist wound healing, wound exudate is allowed to serve as a transport medium for a variety of bioactive molecules such as enzymes, growth factors and hormones, which can support the immune system’s ability to destroy invading pathogens (thus reducing the rate of infection). The moist environment is also known to prevent formation of a hard scab, allowing epithelial cells to spread horizontally outwards through the thin layer of wound exudate to rapidly close the wound.
Moist wound healing
In the decades since, the theory of moist wound healing has become widely accepted practice, and a moist environment is now considered an essential feature of any advanced dressing4.
For patients using this technology the benefits have been immense – faster healing, less scarring and better cosmetic effects. Latest research, in fact, now supports up to 40 per cent acceleration in the rate of wound repair in a moist environment5.
Sadly, for many patients, these benefits remain unrealised. Lindsay Key, Elastoplast brand manager, says: “Our research tells us that 76 per cent of parents still believe that it is not necessary to cover a minor cut with a plaster while all evidence points to the contrary. There is clearly an opportunity for pharmacy teams to help educate their customers.”
Since the emergence of methicillin-resistant Staphylococcus aureus (MRSA) and other resistant ‘super-bugs’ in UK hospitals, medical practitioners have prioritised new methods of managing infections. Open wounds are considered a key risk area, as they are susceptible to cross-infection. Dressings containing silver are now commonly used in secondary care as a means of reducing or preventing the spread of bacteria from such lesions and this technology has also now been made available in family first aid products6.
Mode of action
Silver ions are highly active and penetrate bacterial membranes rapidly. They interact with enzymes and other proteins in bacteria, causing cellular distortion and loss of viability. Furthermore, silver ions interact with the bacterial cell wall and bind to bacterial DNA and RNA inhibiting replication. Clinical studies clearly demonstrate that silver is effective against a wide range of bacteria.
Over the past few years, the home first aid market has seen considerable growth, from £112 million in 20067 to £120 million in 2008, thanks primarily to product development that has been focused on technological advance and consumer benefits. Market monitor, Mintel, describes ease of use and convenience as key purchase drivers, and in the plasters subsector of the market this is exemplified by the recent launch of a plaster containing healing cream in the wound pad, and invisible plasters (completely transparent including the wound pad). It is well known that in dermatology treatments, patient compliance is largely dependent on the cosmetic acceptability of the preparations concerned. The same is said in the field of woundcare, where, as well as maintaining a moist environment and maximum clinical effectiveness, an ideal dressing is comfortable and acceptable for the patient, and easy to apply and wear5.
The role of pharmacy
To see the best results, patients need to receive the most clinically effective and most acceptable product for their individual needs and preferences. Dr Sarah Cockbill, from the Welsh School of Pharmacy, is a teaching fellow and widely-published author in the field of woundcare, and she believes that most consumers haven’t got the knowledge to know that, “well-meaning advice to ‘leave the wound open to the air and let it dry’ is now completely obsolete”. To ensure patients get the best possible woundcare, Dr Cockbill believes that customers will need to be convinced of the cost effectiveness of products that necessarily carry a premium price tag. “OTC moist healing technology is not just a gimmick – it is based on scientific evidence derived from many years of monitoring improvements in patient experiences with wounds.”
To properly help patients, pharmacists and their staff need to get hands-on experience with the products and take all the training that is on offer, she says: “They need to actually open the packets, handle the products and see how they should be applied to appreciate the difference in pain control and accelerated healing which patients can obtain.”
Practice Guide: tips for advising customers on good wound healing Silver’s mode of action
- Wash hands before handling dressings.
- Ideally, wear disposable surgical gloves.
- Clean the wound carefully under cold running water, wiping away any dirt and grit.
- If anything is embedded under the skin, leave it alone, and refer patient to their GP or local A&E.
- If nothing is embedded apply pressure until the bleeding stops.
- Dry the skin around the wound carefully.
- Cover and protect with a moist healing plaster or dressing.
Refer the patient to their GP or local A&E department if:
- The wound is deep or bleeding cannot be stopped;
- The wound shows signs of infection such as redness, warmth, pain and swelling;
- There are embedded foreign objects;
- It is a result of an animal bites;
- The wound is in the facial area;
- There is insufficient tetanus vaccination.
1. The Older Person in the Accident & Emergency Department [online] at: www.bgs.org.uk/Publications/Compendium/compend_3-2.htm
2. Emergency Care reform document: Dealing with minor illness and injury [online] at: www.dh.gov.uk/en/Healthcare/ Emergencycare/Modernisingemergencycare/DH_40638
3. Beiersdorf medical information [online] at: http://int.elastoplast.net/ med-info/wound-care-beautiful-healing/moist-wound-healing.html
4. Flynn J (2009). Understanding Chronic Wound Management. The Pharmaceutical Journal; 283: 41
5. Medical News Today. Moist Wound Healing Reduces Scarring And Promotes Faster Healing [online] at: www.medicalnewstoday.com/articles/156938.php
6. Thomas S: MRSA and the use of silver dressings: overcoming bacterial resistance [online] at: www.worldwidewounds.com/2004/ november/Thomas/Introducing-Silver-Dressings.html
7. Mintel first aid report