By the WoundSource Editors Wound care professionals are feeling the challenges of caring for patients with wounds during the COVID-19 pandemic. Coming together during this time is paramount for developing the best strategy for delivering quality of care across the continuum. Providers should implement wound management protocols for their specific health care setting to be most efficient. The word “essential” is being used a lot these days, and there is some debate about what constitutes essential care. Wound care is “essential” for vulnerable wound care patients who often have various comorbidities such as diabetes, hypertension, chronic lung disease, and obesity, as well as advanced age. Older adults especially are at higher risk for non-healing wounds and infection. Providers should utilize current technologies and platforms now available to them under Health Insurance Portability and Accountability Act (HIPAA) restriction loosening to continue patient engagement for care. The COVID-19 pandemic has created a need for health care providers to find ways to create a stronger platform for care in patients with chronic wounds. Patients need to avoid frequent emergency department visits and hospital stays, where the possibility of infection is increased. The Wound Healing Society has developed helpful guidelines for various health care settings.¹ Because of the limited supply of personal protective equipment (PPE) throughout the country, the recommendations have been adjusted for the current situation. As your area opens to normal business, you will need to make necessary adjustments according to your infection control policy and procedures per facility. There will be many uncertainties until a vaccine is developed; therefore, implementing a plan is critical.^1,2

Wound Clinic

Providers should evaluate each patient for “essential” and “non-essential” appointments and follow-ups. Those patients who are at higher risk for wound infection, require serial sharp debridement or surgical debridement, have inconsistent wound care at home, have cellular and/or tissue-based product application or treatments, and are undergoing compression therapy with high exudate amounts should be considered “essential.”

Screen wound clinic visit patients for temperature, and ask questions regarding respiratory symptoms on entering the clinic. Provide a face mask as appropriate. The provider should decide whether the patient should be seen weekly, every two weeks, or every four to six weeks. Patients who are provided wound care in their home by a visiting nurse can be scheduled to return in two to three weeks to the wound clinic. The home health care nurse, family, and patient are encouraged to call the provider with any changes or problems. Do what you can to reduce the need for frequent dressing changes in between visits, such as utilizing absorbent dressings on low-exudating wounds to extend wear time and appointment visits. Educate patients, family, and caregivers on how to change wound care dressings, on COVID-19 prevention measures, and on hand hygiene. The American College of Surgeons Wound Management Home Skills program is a helpful resource suggested by the Wound Healing Society.^1,3

Skilled Nursing Facilities and Long-Term Care

Patients in nursing homes, skilled or non-skilled, can be scheduled every four to six weeks for the wound center if the wound is stable. Wound care provider groups that visit facilities will decide whether to continue in-person visits at their own discretion. If they decide against in-person visits, they will set up telehealth visits.⁴ Those wound care providers working in nursing facilities and long-term care centers should familiarize themselves with telehealth procedures and technologies so they can help facilitate these visits because residents will likely require assistance. Infection control policy and procedures for disinfecting surfaces should be closely followed and implemented within these facilities, with special attention paid to stainless steel. Also, follow PPE policy per facility.¹

Telemedicine

Telemedicine or Telehealth visits can be utilized in patients with healed wounds or no open wounds or for extended follow-ups in very stable patients. These visits can be coordinated with the patient, family, caregiver, and/or visiting nurse. Telemedicine is real-time, audio-video communication connecting the provider and patient in two separate locations. The provider or nurse should ask questions that coincide with how the wound assessment is normally performed, such as asking about drainage, odor, pain, etc. Photographs or live video per HIPAA compliance can be performed as well, although high quality of the photo and video is imperative for providing accurate assessment. Encourage additional lighting as indicated and without washing out the color of the wound and periwound area. All data and images can be transmitted and interpreted later.^1–3Telemedicine Wound Assessment When performing a wound assessment via telehealth, have the patient describe the following for you as they examine their wound, and always encourage patients or caregivers to wear clean gloves as they perform the assessment.

• Wound bed colors (pink, red, yellow, black)
• Undermining or tunneling? Provide instruction on how to check for this.
• Amount of exudate. Ask when the dressing was changed last.
• Color of exudate
• Odor after wound cleansing
• Fever, chills, new or increased pain?
• Redness, firmness, or edema?
• Recent blood glucose levels

Hospital

A team approach is necessary to review patients in need of inpatient or outpatient wound care. Communication with the primary team, surgeon, home care, and skilled nursing facility is critical to close any gaps in care. Utilize telemedicine as applicable to maximize patient engagement as needed. Elective procedures should be canceled for patients with a vital or functional prognosis that will not be remarkably worse after a two-month delay in treatment. Such procedures include those used to treat slow-growing skin cancers and non-healing wounds in patients with flap reconstruction.^1,3Staff Education Education provided to all health care staff should include wearing PPE, cleaning all surfaces—especially stainless steel—with antiviral wipes or cleanser per facility policy. Good hand washing hygiene should be encouraged as a skill in fighting and preventing the spread of COVID-19 and flu-like illnesses.^1,3

Conclusion

We are in this pandemic together. Utilizing telehealth technologies will help with patient engagement and monitoring care. Education for health care professionals will help bolster providing and delivering continuity of care. Our goal is to keep our patients as healthy as possible by utilizing the technologies available for monitoring those in quarantine, those at low and high risk, and patients confirmed positive for COVID-19.

References 1. Wound Healing Society. COVID-19 guidelines. 2020. https://woundheal.org/COVID-guidelines.cgi. Accessed May 18, 2020. 2. American Medical Association. AMA quick guide to telemedicine in practice. 2020. https://www.ama-assn.org/practice-management/digital/ama-quick-guide-te…. Accessed May 18, 2020. 3. American College of Surgeons. Wound management home skills program. https://www.facs.org/education/patient-education/skills-programs/wound-…. Accessed May 18, 2020. 4. Swift Medical. Groundbreaking coalition of industry leaders bring telehealth to wound care at no cost during coronavirus pandemic. PR Newswire. 2020. https://www.prnewswire.com/news-releases/groundbreaking-coalition-of-in…. Accessed May 18, 2020.