Clinical update

Chronic wounds dressing

Around 200,000 people have a chronic wound at any one time in the UK, at a cost to the NHS of £4 billion.

Essential facts

A chronic wound is usually defined as any wound that has not healed for six weeks or more. In the UK, around 200,000 people are experiencing a chronic wound at any one time, with an estimated annual cost to the NHS of around £4 billion.

According to the National Institute for Health and Care Excellence (NICE) the selection of dressings is hindered by the relative lack of clinical evidence, while the prescription of advanced dressing, such as hydrocolloids, alginates, hydrofibre and antimicrobial dressings, for chronic wounds account for about £110 million a year in primary care in England.

In March, NICE published advice on advanced wound and antimicrobial dressings for managing common chronic wounds, including diabetic foot ulcers, pressure ulcers, venous leg ulcers and infected wounds. It outlines the best available evidence and advises that when a specific type of dressing cannot be justified on clinical grounds, professionals should choose the least costly type for the wound and its stage of healing – taking into account size, adhesion, conformability and fluid handling properties. It also supports Wounds UK’s recommendation that multidisciplinary teams should develop wound dressings formularies, using a fair and impartial process.

Those at risk of developing chronic wounds include patients with chronic medical conditions such as diabetes, those with vascular disease, older people, those with a previous history of ulcers and patients with a weakened immune system.

Ulcers are the most common type of chronic wound and new pressure ulcers are expected to occur in 4-10% of patients admitted to hospital in the UK. Around one in ten people with diabetes will have a diabetic foot ulcer at some point, while chronic venous leg ulcers affect between one and three in every 1,000 people in the UK, rising to 20 in 1,000 for people aged over 80.

All practitioners involved in wound care should have training, knowledge and expertise, according to Wounds UK. A patient’s wound should be carefully and regularly assessed, alongside their clinical condition, comorbidities and personal circumstances. When choosing dressings, professionals should consider safety, efficacy and cost effectiveness. The frequency of changing dressings should also be appropriate for the wound and dressing type.

Expert comment

Una Adderley, lecturer in community nursing, University of Leeds

‘This new NICE advice is a balanced piece of work. It has gathered together the existing evidence in an accessible way for healthcare professionals involved in chronic wound care.

‘Alongside reviewing the available research it considers the debates about the issue, and the involvement of clinicians in the work is clear, as is the consideration to the individual needs of patients.

‘It also highlights the lack of an evidence base around dressings, with many studies being small, poorly designed or using out-of-date comparators. We need some good quality evidence about what works and what is acceptable for patients.’

Find out more

NICE guidance: Chronic wounds: advanced wound dressings and antimicrobial dressings (2016)

NICE guidance: Wound care products (2015)

BNF: Advanced wound dressings

Wounds UK: Best practice statements

World Union of Wound Healing Societies

Wound Care Alliance UK

Nursing Standard: Reducing avoidable pressure ulcers in the community (2014)

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