Aim: The study aims to determine the cost of chronic wound management in a tertiary hospital in Singapore.

Background: Given the impact of chronic wound care on health care expenditure, wound prevention is a priority in public health initiatives. Holistic wound management can reduce the incidence of chronic wounds and will potentially reduce wound care costs.

Methodology: This is a retrospective analysis over a two-year period (1 January 2012 to 31 December 2013) in a tertiary institution specialising in wound care. Five common chronic wound categories were included, namely: diabetic, pressure, venous, ischaemic and unspecified chronic skin ulcers. Their diagnosis-related group (DRG) code served as an identifier for patients suffering from these conditions. The cost of hospitalisation of each patient was individually calculated. Total cost consisted of direct and indirect costs, and are represented in Singapore dollars (SGD).

Results: Four hundred and seventy patients were admitted in this study. The mean age was 68 years and mean length of stay was 13.2 days. The annual direct cost amounted to a gross sum of SGD 4.59 million and net payable sum was SGD 1.98 million after subsidies. Annual total indirect costs (for example, income loss due to hospitalisation stay and sick leave) amounted to SGD 0.86 million (mean of SGD 3,600 per patient). Of the patients, 23% had the primary diagnosis of ‘diabetes mellitus with foot ulcer due to multiple causes’, followed by 16.1% ‘pressure injuries unspecified’, and 13.4% ‘varicose veins of lower extremities with ulcer’. The direct gross cost per annum was highest for diabetic foot ulcers, followed by pressure injuries, and then ischaemic ulcers (SGD 1.68 million, SGD 0.63 million and SGD 0.43 million, respectively).

Conclusion: Chronic wounds present a substantial economic burden on society. We recommend early medical interventions through regular screening by specialised wound teams and evaluating the cost-effectiveness of these interventions in the local setting.

There is increasing evidence that people with diabetes-related foot ulcers (DRFU) can experience pain related to their wound. A cross-sectional pilot study was conducted to examine and compare the prevalence, intensity and nature of DRFU pain in people with neuropathic, neuroischaemic and ischaemic wound aetiologies. A questionnaire incorporating pain assessment tools, the Short-form McGill Pain Questionnaire and the Short-form Brief Pain Inventory was used to interview 15 patients with DRFU. Descriptive analyses were conducted. The mean age was 64 years, 60% had neuropathic ulcers and 40% had neuroischaemic ulcers. No ischaemic DRFU were observed in the study sample. Formal assessment tools had a higher reported pain prevalence (53%) compared with a single question asked by the researcher (33%). Low scores for pain intensity and effect of pain on health-related quality of life were reported for both aetiologies. This study indicates people with DRFU can experience wound pain, despite analgesia usage. It also highlights that clinical pain assessment and management techniques appear inadequate. A larger study is warranted to investigate characteristics of DRFU pain, to determine if statistical differences in pain experiences exist between wound aetiologies and to develop guidelines for assessment and management of wound pain.

Wound healing is a complex milieu that affects millions of people around the world every day. This descriptive correlational study investigated the impact of prolonged exposure through delays in dressing changes, on the biophysical wound bed parameters (wound temperature, transepidermal water loss (TEWL) and pH) and possible contamination of the wound. In addition, the effect delays have on patient pain, comfort and activities of daily living (ADLs), were investigated.

The results identified that the participants’ wounds were hypothermic as well as alkaline on dressing removal and throughout the period of exposure. The mean wound temperature increased throughout the total duration of the down time, which was contrary to expectation, although despite this, all wounds remained hypothermic and the wounds became more alkaline (p=0.0079). Agar plates placed in proximity to the exposed wounds grew pathogens, which could potentially contaminate the wound and participants were unable to perform some ADLs.

The impact of delayed wound dressing changes on the patient’s ADLs and pain are important in patient-centred care and the poor state of the wounds’ microenvironment immediately following removal of the dressing needs further investigation.

Background: This study aimed to evaluate the relationship between visual and objective periwound assessment and explore how these assessments relate to diabetes-related foot ulcer (DRFU) healing.

Methods: Seventeen people with DRFU were recruited from a foot clinic. The periwound of each participant’s DRFU was assessed at baseline and fortnightly for 6 weeks. Assessment included visual appraisal by podiatrists and objective evaluation using the SD202 skin-measuring device (C.K. Electronic). Wound healing measures included whether or not the wound healed, the number of days to healing and wound healing rates. Pearson’s correlation coefficients were obtained for relationships between: (i) clinician and SD202 device periwound assessments; (ii) clinician periwound assessment and wound healing measures; and (iii) SD202 device measures and wound healing measures.

Results: Relationships between clinician and SD202 hydration assessments were consistently strong and positive but only significant at baseline (r=0.565 p=0.035) and 2 weeks (r=0.611 p=0.035). No significant relationships between clinician and SD202 periwound erythema assessments were detected at any time point. Clinician-observed maceration (for example, baseline r=-0.901, p<.001) and SD202 appraised erythema (for example, baseline r=0.648, p=0.023) related significantly to wound healing.

Conclusions: This pilot study highlights that further research is required to establish valid and reliable periwound assessment approaches.

Incontinence-associated dermatitis (IAD) is a largely preventable skin injury that can occur following chronic skin exposure to urine and faeces as a result of incontinence. Limited data is available about the prevalence of IAD in the Australian acute care setting. In 2011, the facility combined the annual pressure injury (PI) prevalence survey with a survey to determine the prevalence of IAD. This paper examines the PI and IAD prevalence results from surveys before and after the introduction of the combined survey protocol. The surveys were conducted in a major acute care Australian hospital between 2009 and 2013, with PI only surveys conducted between 2009 and 2010, and the combined PI and IAD surveys undertaken from 2011 to 2013. Overall, PI point prevalence decreased from 12.8% (n = 500) in 2009 to 6.3% (n = 444) in 2013. IAD prevalence was first reported in the 2011 survey. IAD prevalence decreased from 10% (n = 376) in 2011, to 2.7% (n = 444) in 2013. Combining the PI and IAD survey protocols provided valuable and previously unknown IAD data. In addition, combining the surveys was accomplished without increased financial or staff resources, nor increased survey participation burden for patients. Key aspects of the combined protocol have subsequently been adopted by the facility as standard procedures for ongoing PI prevalence surveys.