Specialist wound care to rebuild the lives of physically injured ex-service men and women

WoundTec HTC: an overview article

The NIHR Wound Prevention and Treatment Healthcare Technology Co-operative (WoundTec HTC) is a national organisation funded by the National Institute for Health Research (NIHR) dedicated to identifying areas of unmet needs and improving the lives of patients who suffer with wounds by delivering new medical devices, healthcare technologies and technology-dependent interventions.

The HTC is led by Lt Col Professor Steven Jeffery, a military plastic surgeon and is supported by a strategic partnership between wound care experts in Bradford Teaching Hospitals, King’s College London, Queen Elizabeth II Hospital Birmingham, and the universities of Leeds, Bradford, Southampton and Wolverhampton. 

Over the past three years, the HTC has worked with numerous innovative technologies and engaged an extensive national network of companies, NHS Trusts, universities, charities and patient groups.  The HTC has a special focus on understanding unmet needs from the perspective of medical device users – not only from the viewpoint of clinician, but importantly, also from the view of patients and carers, who are often neglected during the development process. 

Increasing economic pressures on healthcare systems mean that innovations need to deliver value and satisfy the requirements of wider stakeholders.  The HTC is well positioned to understand the problems encountered in both the hospital and community settings and identifying the potential barriers to uptake of wound care devices within the NHS. 

Raising the profile of wound care

Wound care has been described as a ‘silent epidemic’, posing a serious burden for patients and healthcare providers worldwide, yet receives little media attention.
The HTC recently published a major study in the BMJ Open and International Wound Journal, examining the burden of wounds to the NHS. The ground-breaking ‘real world’ research found that an estimated 2.2 million wounds are managed by the NHS annually at an estimated cost of £5 billion – well above previous estimates and comparable to the cost of managing obesity. The costs associated with unhealed wounds were more than twice the cost of healed wounds.  

Worryingly, the study showed that some patients are receiving a lack of evidence based care; nearly a third (30%) of all patients did not have a differential diagnosis for their wound.  The ratio of arm and ankle systolic pressure, known as ankle brachial pressure index (ABPI), is used to define the level of compression applicable to patients with venous leg ulceration and forms part of the regular foot assessment process of diabetic patients. Despite national guidance requiring an ABPI measurement in the management of all lower limb wounds and diabetic foot ulcers, only 16% of patients were documented as receiving this intervention.  This has significant implications for care pathways as without a correct diagnosis, appropriate treatment regimens and management plans cannot be administered. 

The HTC has presented the findings to the Nursing Directorate of NHS England.  The concern generated by the study has resulted in a significant work programme by NHS England to tackle unwarranted variation and inequalities in wound care.

Facilitating the development of new technologies

A significant part of the HTC’s work is identification, development and introduction of new wound care technologies for the benefit of patients.  Whilst many of the technologies are at the early stages of development, some examples of exciting emerging technologies are shown below:

Eggshell membrane dressings

Dressings containing collagen, often derived from animals (e.g. fish, pig and horse tissue), have been shown to increase healing rates for patients with chronic wounds. The collagen mimics the role of the extracellular matrix (the tissue that forms the bulk of skin) to augment the wound healing process.  The process of extracting collagen from animals make them prohibitively expensive for general use and offered by the NHS only to patients with only the most severe chronic wounds.

The HTC have been working with Biovotec, a small Norwegian company, to develop an innovative dressing using the membrane of domestic eggs. The idea was inspired by an old Chinese remedy for healing wounds, where the eggshell membrane is traditionally used to help accelerate the wound healing process. Scientific studies have shown eggshell membrane has a similar structure to the extracellular matrix of human skin, demonstrating encouraging results in small studies.
The dressings will recycle eggshells discarded by companies which use eggs as a manufacturing ingredient (such as mayonnaise and cake-mix manufacturers), processing the waste eggshell into wound care dressings.  The cost of these dressings to the NHS is expected to be considerably less than similar products on the market today, and has the potential to be offered to all patients with chronic wounds. 

The first clinical trials of the dressing are planned for early 2017. Biovotec hopes to obtain a ‘CE mark’ for European market approval by 2018. The research is co-funded by the Horizon 2020 Programme of the European Union.

A camera that can visualise bacteria in real time

NIHR WoundTec HTC has been working with a small Canadian company, Moleculight, who have invented a ground-breaking camera that can help visualise high bacterial burden in real time at the point of care.  The HTC hosted the first European showcase of the camera to a multidisciplinary audience of clinicians, academics, industry representatives and commissioners.  

The camera, currently undergoing the CE marking process, but will soon be available on market. The device has a number of potential benefits including:
  • Providing a real time objective assessment of likelihood of wound infection
  • Providing a real time view of bacteria for targeted swabbing (it is often difficult to know which areas are appropriate to swab in a wound as the bacteria cannot be visualised by the naked eye)
  • Improving surgical debridement of wounds as bacterial burden can be assessed during the debridement process.  
  • Improving wound healing rates due to reduction in infection
  • Reducing inappropriate antibiotics/antimicrobial prescribing

Professor Lt Col Steven Jeffery, Clinical Director of NIHR WoundTec HTC, is one of the first clinicians in the Europe to evaluate the camera. Case studies are in the process of being developed to assess its usability for patients with burns and trauma wounds.  Further studies are also in the planning to assess the effectiveness of the camera. 

Veterans after care

A recent study commissioned by the Help for Heroes, highlighted that over 750, 000 people served as Regulars in the British Armed Forces between 1991 and 2014.  Whilst thankfully the vast majority of those are re-integrated into civilian live without any long-term issues, sadly, an estimated 1 in 11 of may suffer from physical health or mental health issues at some point.  However post discharge, veterans report a lack of support and inadequate post-discharge preparation.  Veterans often report being ‘lost in the system’ since the healthcare systems is not designed around their needs. 

Working with our partners, Woundcare4heroes and Kings College London, the HTC has provided seed-funding to conduct some feasibility work and to understand the problems faced by veterans, which technology may be able to address.  It is hoped that this will help to progress the project to a stage where external funding can be secured to address this important unmet need.

The future

Whilst much progress has been made in increasing the profile of wound care, and accelerating innovations, there are many more challenges and opportunities ahead.  WoundTec HTC will continue to extend its impact and influence further through new collaboration partnerships.  If you are interested in working with WoundTec HTC, please contact Hussein Dharma (hussein.dharma@bthft.nhs.uk)
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