Wound Centers and COVID 19

From: SerenaGroup® Executive Team

Date: March 18. 2020

Re: Wound Centers and COVID 19

Recently, the CMS/ HHS and others have encouraged health care delivery systems to consider reducing, delaying, canceling or closing departments that provide non-emergent care.   As your partner in providing advanced wound care, we would like to share our perspective during the COVID19 crises.  SerenaGroup® is strongly encouraging our partner hospitals and clinics to continue wound care services. SerenaGroup CEO, Dr. Thomas Serena stresses that caring for patients suffering from acute and chronic wounds is urgent and essential. This population is at high risk for infectious complications related to their wounds. Left untreated these patients will return to the emergency room septic requiring intensive care services including mechanical ventilation. Closing the wound clinic is more likely to exacerbate the problems we all face in dealing with COVID19. We suggest that the wound clinic staff take every precaution in caring for patients including calling the patients prior to their appointment to ask about COVID19 symptoms, adjusting the schedule to prevent patients from waiting together in the waiting room, and of course handwashing and wearing protective clothing.  Below are FAQ’s to consider,

Is outpatient wound care emergent?

Answer: It is urgent and prevents exacerbation of the current crises.  Patients return to the advanced wound care center weekly. A robust body of literature has shown that this decreases complications such as amputation, infection, sepsis and death. Changing the dressings, cleansing the wound with antiseptics, debriding and applying an antimicrobial dressing dramatically reduces the risk of infectious complications. When patient do not return to the clinic weekly their risk of infection with septic complications rises sharply. The average wound clinic patient has 10 co-morbidities. An infectious complication in this group of patients rapidly leads to sepsis and admission to the ICU. Closing the wound clinic is likely to increase the utilization of ICU beds and ventilators.

Are the patients considered stable or maintenance care?

Answer: No.   Wound care patients have multiple co-morbid conditions (diabetes, lymphedema, infection, congestive heart failure, renal insufficiency, malnutrition and immunosuppression).   Closing or reducing access to care will increase the risk of infectious complications and the need for intensive care.

Should on-going care be delayed?

Answer: This patient population typically has procedures that are time limiting throughout their course of care.  They may have a Total Contact Cast (TCC), Multi-layered Compression (MLC), Cultured Tissue Products (CTP), Negative Pressure Wound Therapy (NPWT), all of which need to be removed at least weekly; some more frequently.

What would happen if the above care was delayed?

Answer: The TCC is designed to be replaced weekly.  If not replaced, progress of the Diabetic Foot Ulcer cannot be managed and there is the potential that the cast would decrease its ability to protect the off-loaded wound and the friction against the skin may create another wound.

Answer- The MLC is designed to reduce edema in the extremity and wick fluid away from the venous leg ulcer.  Periodic replacement allows for reducing edema and removing the exudate from the ulcer.  

What about Hyperbaric Oxygen Therapy (HBOT)?

Answer: This patient population needs to receive HBOT daily.  HBOT is comparable to Radiation Therapy for the Cancer patients:  each day of treatment builds from the previous day’s treatment to promote healing.  Delaying or cancelling this could have a negative impact on the patient and increase the risk of complications.

3D WOUND ASSESSMENT SOLUTION

3D WOUND ASSESSMENT SOLUTION

3D WOUND ASSESSMENT SOLUTIONCambridge, MA. SerenaGroup™, the premier Wound Care management and Research Organization in the US, and eKare, Inc. announces inSight™ 3D Wound Assessment Solution to be introduced in SerenaGroup’s clinic worldwide. With the goal of transforming wound care using advanced analytics and sensor technology, eKare, Inc., a spin off enterprise from The Children’s National Health System in Washington, DC, introduces their new inSight™ 3D Wound Assessment Solution. inSight™ provides accurate and convenient 3D wound measurement and documentation at the point-of-care for pressure ulcers, diabetic foot ulcers, venous ulcers and other hard to heal chronic wounds. Built on an Apple iPad, inSight™ delivers an intuitive solution that enables clinicians to obtain a full set of 3D measurements by simply snapping a photo of the wound without direct patient contact. eKare co-founder and Chief Medical Officer, Kyle Wu, MD, states, “inSight™’s 3D sensing delivers objective metrics such as wound depth, area, and volume, as well as estimates of wound bed composition by appearance while reducing risk of nosocomial complications. And all this is accomplished right at your fingertips using inSight™ directly on an iPadtablet.” In addressing the question of clinical flow, eKare CEO, Patrick Cheng, commented, “our HIPPA-compliant cloud platform allows clinicians and providers to securely access, analyze and share the images and informatics generated from the eKare sensors. Clinicians can access the information when and where they need it, allowing for more effective remote monitoring and tele-collaboration,” Cheng said. With increasing emphasis on data transparency and quality improvement by the CMS, inSight™ will be integral to provider accreditation. Dr. Wu commented that “ inSight™ is positioned to facilitate compliance in meeting the skin and wound assessment requirements for the providers and become the ‘gold-standard’ for wound measurement and documentation” in meeting their reporting mandate. “The current methodology for measuring wounds in the wound clinic is inaccurate and not reproducible. It is essential that we incorporate advanced imaging techniques in assessing healing in our patients. It will allow us to identify patients in need of advanced potentially limb salvaging procedures earlier on in the course of their treatment,” said Thomas Serena, MD, FACS,CEO and Medical Director of SerenaGroup™ SerenaGroup™ is a global health care management company with the mission of developing the world’s leading Centers of Excellence in wound and hyperbaric medicine. SG has placed a special emphasis on clinical performance, outcomes, and serious clinical research in the Wound Care space.