20 PATIENT CLINICAL AND COST EFFICACY OBSERVATIONAL EVALUATION: EXUDATE MANAGEMENT
PERFORMANCE OF A NEW CMC GELLING FIBRE DRESSING IN CLINICAL COMMUNITY SETTINGS WITHIN THE UK
Professor and Consultant Nurse in Tissue Viability, Worcestershire Health & Care NHS Trust and Birmingham City University
Tissue Viability Nurse, Worcestershire Health & Care NHS Trust [email protected], CLAIRE STEPHENS
Independent Consultant Nurse. Complex Wound Manager, WC4Heroes.
In 2014, the annual cost of wound care was approximately £2,165
million and this figure has been predicted to rise by £212 million
to £2,377 million by 2019 (DowseW et al. 2014). In community
seYngs, nurses commonly treat wounds including pressure ulcers
which vary in exudate volume and this can be an expensive
process (Morgan, 2015). There are many challenges that
community nurses face when managing the levels of exudate
such as selecZng the right dressings to control this level whilst
ensuring the paZents are comfortable with this selecZon
(Morgan, 2014). Unit cost, dressing, dressing efficacy, wear Zme,
ease of use, ease of training are all significant factors influencing
any change in pracZce. One dressing range widely used as a
contact dressing for its efficacy in exudate management and nont
r a umaZc int e r a c Z o n w i t h t h e wound be d i s
Carboxymethycellulose (CMC). Considering unit price alone this is
a more costly dressing choice deeming clinical outcome and
extension of dressing life a more favorable cost consideraZon
measure. A new CMC potenZally offering significant unit cost
savings has been evaluated to assess its clinical efficacy and
Clinical Governance approval to undertake this 20 paZent
evaluaZon of a CMC dressing over a 4-week period was granted.
Consent to partake in the evaluaZon and use photography for
publicaZon was obtained. Eligible for inclusion and parZcipaZon
in this evaluaZon are paZents: Over the age of 18 years, Capacity
to understand the nature of the evaluaZon and provide consent,
Deemed as suitable for inclusion under evaluators clinical
judgment, Has received previous CMC dressing treatment or be
deemed suitable to receive CMC dressing treatment. Not eligible
for parZcipaZon or to be excluded from this evaluaZon are
paZents: Below the age of 18 years, Without capacity to
understand the nature of the evaluaZon or provide consent,
Deemed as unsuitable for inclusion for any other reason under
evaluators clinical judgment, Wound type unsuitable for CMC
20 paZents were recruited male (n8) and female n(12) of ages
ranging from 34-97 years (n8) had received other hydrofibre or
gelling fibre dressings for >2weeks prior to the evaluaZon.
include pressure ulcers (n9), leg ulcers (n4),
diabeZc foot ulcer (n1), fungaZng (n2), burn (n1), bursa (n1) and
traumaZc, post-surgical and lymphaZc compromised wounds (n2).
Wound age varied dramaZcally from 2 weeks to being present for
several years and (n2) wounds were recorded to be recurrent
episodes. Wounds were located in a variety of anatomical areas
. Tissue types recorded as healthy granulaZon (n5),
unhealthy granulaZon (n6), sloughy (n6), fungaZng (n2) and (n1)
documented as full limb maceraZon.
were reported to be: Copious (n3), Heavy
(n5) and Moderate (n12). Exudate type reported to vary from thin
watery serous to thick fibrous in viscosity. (n5) subjects were
reported to have thick fibrous exudate throughout the 4 week
duraZon of the evaluaZon.
Dressing wear Zme compared to previous dressing: same number
of days (n14), Increased number of wear days (n5) and decreased
number of wear days (n1). Dressing wear Zme was reported to be
62% three day wear
. A total number of 80 dressing changes
were recorded during this evaluaZon. Dressing leakage was
documented in 2 cases; wear was 3 days and exudate levels heavy.
Wear Zme was reduced to more appropriate frequency of 2 days
in one case and daily in another resulZng in no further leakage.
InteresZngly zero leakage was seen in the subjects with copious
levels of exudate at 3 days wear. Overall dressing wear Zme
increased n(6), remained the same n(13) and reduced n(1).
No adherence to the wound bed or painful removal was reported
in the data of n (18) subjects. Peri-wound skin reported: same as
or improved in all subjects with no deterioraZon reported and
barrier film use recorded in only (n6) subjects. Pain scores: (n12)
remained unchanged, (n4) reducZon in pain, (n2) Chronic Regional
Pain Syndrome (CRPS) and unable to scale and (n2) increased pain
which correlates with infecZon, bleeding within the data set.
DowseW, C., Bielby, A. and Searle, R. (2014) Reconciling increasing wound care demands with available resources.
Journal of Wound Care
, 23(11), pp. 552 – 62.
Morgan, T. (2014) Wound care in the community: infecZon, exudate and conformability.
Journal of Community
, 28(5), pp. 43 – 48.
Morgan, T. (2015) Are your wound management choices cosZng you money?
Journal of Community Nursing
pp. 17 – 20. Available at:
End of evaluaCon raCng
Ease of applicaZon rated mostly 10 (excellent) (n14) rated 10, (n1)
rated 9, (n4) rated 8 and (n1) rated 6.
Ease of removal rated mostly 10 (excellent) (n11) rated 10, (n1)
rated 9, (n6) rated 8, (n1) rated 7 and (n1) rated 6.
Exudate management and overall outcome (n12) rated 8-10
(superior/excellent) (n7) rated 5-7 (good) and (n1) rated at 3.
100% stated they would like to conZnue use of the new CMC (n1)
did not complete the field in the data.
KerraCel™ dressings effecZvely managed varied exudate volumes
and viscosiZes in a wide range of wound aeZologies. The secondary
dressing choice for each evaluaZon subject remained unchanged
and wear Zme was equal to if not beWer than. In 2 cases where
dressing leakage was seen it is highly probable that this would have
occurred with the usual CMC and possibly a result of dressing
failure involving primary and secondary dressings. It is also
important to note that n(12) of the 20 paZents were not receiving
treatment with CMC prior to inclusion into this evaluaZon therefore
the improvements noted are due to the introducZon of CMC rather
than a change in type of CMC dressing used. PosiZve wound
outcomes have been drawn from this data and the end of
evaluaZon feedback demonstrates acceptance from both paZents
Managing wounds remains a clinical challenge and managing
exudate is a key challenge. This 20 paZent single centre clinical
evaluaZon demonstrates clinical efficacy in exudate with
consideraZon to volume and viscosity. PosiZve paZent outcomes in
relaZon to applicaZon, removal, and wear Zme have been
demonstrated. The evaluaZon has demonstrated the ease of
implementaZon into pracZce when using a less expensive CMC
dressing material. KerraCel™ dressings were changed less
frequently, which has significant implicaZons for both paZent
convenience and cost of care. A conclusion is made that KerraCel™
is a promising new dressing that could offer significant advantages
to improve the clinical and financial outcomes and warrants a larger
– Wound Type
– Dressing Wear Days
– Exudate Level
76 year-old lady presented with an un-gradable
pressure ulcer to the sacrum. The wound is
sloughy with moderate levels of thin fibrous exudate
and peri-wound maceraZon is present on recruitment
to this evaluaZon.
Dressing changes were undertaken at 3 day intervals
and at dressing change 4 (12 days) wound bed is
dramaZcally improved with 90% healthy granulaZon
Zssue and a small amount ofslough remaining. Periwound
reversed (note no barrier film products were used).
The evaluaZon dressing did not leak during higher
exudaZng period and did not adhere to the wound
despite exudate levels dropping to low levels at the
end of evaluaZon.
97 year-old lady presented with a grade 3 pressure ulcer
to thigh. Moderate levels of watery serous exudate with
both peri-wound maceraZon and peri-wound
excoriaZon to the wound edge and wound margins.
skin protecZon has been used prior to
commencing evaluaZon dressing.
The wound bed on recruitment comprised of 70%
granulaZon Zssue with a 30% island of fibrous slough.
Dressing changes were performed at 3 day intervals and
at day 12 the wound showed significant improvement
with no signs of peri-wound maceraZon. The evaluaZon
dressing did not leak during higher exudaZng period and
did not adhere to the wound despite exudate levels
dropping to lower levels towards the end of the