Introduction

When it comes to wound care, many experts agree that hands-on education stands out as an effective teaching model.^1,2 "Hands-on opportunities provide a rounded experience that is more meaningful and longer lasting than in a pure lecture format," says Dr. Paul Kim. These workshops present an opportunity for clinicians not only to obtain CME credits but to acquire wound management skills that can be applied to their practice tomorrow. SAWC Fall saw a pre-conference workshop that used hands-on education. The following highlights faculty insights and experiences in hands-on clinical education as well as wound bed preparation.

Practical Wound Care Education in Action

Little over a year ago, WoundCon held its first hands-on, virtual workshop on “Biofilm-Based Wound Care." The workshop employed creative, inclusive methods so virtual attendees could follow along. They used household items such as pastries, yogurt, oranges, and squash.^3,4 Cathy Milne, co-presenter to Dr. Jayesh Shah, commented on the importance of attendee involvement:³

“We were showing what to do on a real patient and how to translate it to practice. You must have muscle memory to do that. We came up with really creative ideas to get those concepts across…”

For its ingenuity and contribution to wound care education, this workshop received international acclaim. The Journal of Wound Care’s World Union Wound Healing Societies (WUWHS) awarded Cathy Milne and Dr. Shah Gold in the Wound Hygiene Implementation category.³

Recent Hands-On Workshop Learning

As SAWC Fall saw a myriad of educational opportunities, the WoundSource team had the chance to interview several presenters for one Hands-on Workshop on Wound Bed Preparation. This pre-conference workshop featured practical as well as didactic instruction, with lectures, demonstrations, and, of course, hands-on activities. Joined by Dr. Shah on October 13th were experts Emily Greenstein, Elizabeth Faust, and Dr. Paul Kim.

Reports have estimated that chronic wounds affect 6.5 million patients in the United States alone.⁵ As wounds that do not heal within an expected rate, chronic wounds require the identification and addressal of healing barriers to create the optimal healing environment. "Wound bed preparation is seemingly a very basic thing," says Dr. Kim. "However, it is the foundation to everything else we do in wound care." Three of the presenters shared their thoughts on this workshop as well as the overall importance of wound bed preparation. In addition, these experts share practical wound bed preparation tips readers can implement in their clinical practice.

What inspired you to participate in the creation and presentation of this workshop?

Dr. Paul Kim emphasized the quality education hands-on workshops provide, sharing: “I think it is very important to be an active learner. I find hands-on workshops to be less formal than in a lecture hall. Thus, there is generally more open discussion with robust interaction. It is more interesting for the instructors because of the one-to-one interaction that occurs with the participants. I often feel like I learn more from the participants than they learn from me.”

Dr. Shah took a different approach. He identified the opportunity to share his 25 years of experience with those new to wound care, as he and Cathy Milne had during their workshop on biofilm, which saw over 6,200 participants.³ “As an educator in wound care, it gives me immense pleasure to teach basic skills to the new learners who can make a huge impact in their clinical practice, as they will be helping thousands of patients with chronic wounds,” he said. Dr. Shah points to a potential cascade of aid to the millions of patients who have chronic wounds.

Emily Greenstein emphasized the vast educational materials available: “Wound bed preparation is an essential part of wound care. There are many papers out there talking about the importance of good wound bed preparation and cleansing.” Each expert identified a separate, yet vital aspect of this workshop’s focus. The importance of hands-on learning, the education of those new to wound care, and, of course, wound bed preparation.

What do you feel are the leading innovations in the field regarding wound bed preparation?

Dr. Shah identified several standard, advanced, and adjunctive therapies available to wound care professionals for wound bed preparation: "Newer point of service testing can allow clinicians to detect biofilm and oxygenation and may help clinicians decide how to proceed with wound bed preparation at a point of service.

Many new technologies are available, such as in newer debridement techniques like ultrasound guided debridement. There are also newer wound cleansers that can decrease bacterial bioburden, newer dressings that can help decrease bacterial bioburden, negative pressure therapy, shock wave therapy, multiple cellular and tissue products, and hyperbaric oxygen therapy."

In light of recent technologies available to wound care professionals, Dr. Kim underscored the importance of educating wound care teams on how these different tools are used. He illustrated this with discussion of antiseptics and diagnostic technologies: “Most antiseptics require more than 10 minutes of contact time to impact the widest range of pathogens. I have often observed these products being used as irrigants with minimal contact time. So proper education/training is needed to fully maximize their effectiveness. There has been a shifting focus on diagnostics.

The utility of devices that can monitor size, bacterial bioburden, inflammation, and perfusion has improved. Although these types of devices have been available in the past, their adoption has been slow due to the difficulty of use (reliability, size, interpretation, integration into EMRs, etc). As the technology has improved, so has its utility.”

Emily Greenstein recognized recent focus on cleansing and debridement and pointed toward new developments in wound care: “One aspect which interests me is the current research looking at managing the wound pH levels to help control infection.”

What one thing do you feel clinicians can do tomorrow to improve their wound bed preparation practices?

Dr. Shah recommended the evaluation of risk factors that may impede healing, demonstrating that wound bed preparation is a multi-faceted approach.

Expanding on this approach, Dr. Kim asserts that “the wound is always changing” and clinicians must be “nimble:” “We must respond to the needs of the wound rather than try to fit the wound into our preconceived ideas on how the wound should behave. We should always be open to learning new methods/techniques and be keen observers of the dynamic nature of the wound environment. We should also treat the patient as a whole and not focus solely on the wound. External factors, including social determinants of care, often are the driving force for or against healing."

Emily Greenstein provided a more practical recommendation to readers: “Clinicians should make sure that they are cleansing both the wound bed and the periwound skin. Oftentimes patients and clinicians are afraid to wash or get the wound wet. We have learned keeping a wound dry and covered in the shower is an old wives' tale.”

What do you hope readers/clinicians will take away from this workshop?

“Readers and clinicians will learn how to use some basic and some advanced techniques to help with wound bed preparation,” Dr. Shah related. In addition, the speakers are hopeful that this workshop will impact the quality of care delivered to patients.

“Wound bed preparation is seemingly a very basic thing,” added Dr. Kim.

“However, it is the foundation to everything else we do in wound care, and I have observed that not everyone does it well. Without mastering the basic principles, the probability of healing goes down, and the use of more advanced wound products becomes futile; thus increasing overall health care costs and delaying ultimate healing. There are innovative products and techniques that can assist use in maximizing the potential for healing. My hope is that workshop participants learn something new or fine tune their current understanding and practice.”

Emily Greenstein identified those particular techniques and tools available to clinicians for wound bed preparation that Dr. Kim alludes to. “We talk a lot about sharp debridement, but not everyone, due to their licensing and state’s practice acts, can perform sharp debridement,” she says. “That doesn't mean they can't still perform good wound bed cleansing with the technique of mechanical debridement and the use of antiseptic agents.”

Conclusion

The “Hands-On Pre-Conference Workshop: Wound Bed Preparation,” along with those of the future, will surely provide wound care professionals with the “muscle memory” so integral to practice.

References

1. Carver C. How to Make Staff Education Fun with a Wound Care Carnival. WoundSource; 2021 https://www.woundsource.com/blog/how-make-staff-education-fun-wound-car…
2. Hoven H. Taking a Hands-On Approach to Wound Care Education. WoundSource; 2017 https://www.woundsource.com/blog/taking-hands-approach-wound-care-educa…
3. Bowden J. Wound Care Faculty Earn International Acclaim for Hands-on Workshop. HMP Global; 2022 https://hmpglobal.com/blog/wound-care-faculty-earn-international-acclai…
4. Industry News. First-of-Its-Kind Virtual Workshop to Offer Hands-on Skills Practice in Its Live Coverage of Wound Hygiene Principles. WoundSource; 2021 https://www.woundsource.com/blog/first-its-kind-virtual-workshop-offer-…
5. Sen CK, Gordillo GM, Roy S, Kirsner R, Lambert L, Hunt TK, Gottrup F, Gurtner GC, Longaker MT. Human skin wounds: a major and snowballing threat to public health and the economy. Wound Repair Regen. 2009 Nov-Dec;17(6):763-71. doi: 10.1111/j.1524-475X.2009.00543.x. PMID: 19903300; PMCID: PMC2810192.

About the Presenters

About Emily Greenstein

Emily Greenstein, APRN, CNP, CWON-AP, FACCWS is a Certified Nurse Practitioner at Sanford Health in Fargo, ND. She received her BSN from Jamestown College and her MSN from Maryville University. She is certified as an Adult-Gerontology Nurse Practitioner through the American Academy of Nurse Practitioners. She has been certified in wound and ostomy care through the WOCNCB for the past 12 years. At Sanford she oversees the outpatient wound care and is co-director for the limb preservation program. She currently serves as the President elect for the North Central Region Wound, Ostomy, and Continence Society. Emily has served as an expert reviewer for the WOCN Society and the Journal for WOCN. Her main career focus is on the advancement of wound care through evidence-based research.

Emily Greenstein's Disclosures: Coloplast- World Panel Member; 3M- Consultant; Urgo Medical- Consultant; Smith and Nephew- Consultant

About Jayesh Shah

Jayesh Shah MD, UHM(ABPM), CWSP, FAPWCA, FCCWS, FUHM, FACP, FACHM is an award-winning wound care and hyperbaric physician in active clinical practice. He is Columbia-trained and certified in Wound Management, Board Certified in Undersea and Hyperbaric Medicine and Internal Medicine. He is a Fellow of Undersea and Hyperbaric Medicine, American College of Physicians and American College of Clinical Wound Specialist.

He is a superb educator with extensive speaking experience. He is the President of South Texas Wound Associates, where he provides clinical wound care services in San Antonio since past 22 years. He is the President of TIMEO2 Healing Concepts, LLC, which provides consulting and education services in wound care and hyperbaric medicine; Medical Director of Wound Healing Center at Northeast Baptist Hospital and Mission Trail Baptist Wound Healing Center in San Antonio, Texas; Past President of the American College of Hyperbaric Medicine; Past President American Association of Physicians of Indian Origin; Past President of Bexar County Medical Society; Current Board of Trustees Member of Texas Medical Association, Current AMA Delegate from Texas; Current Board Member and Regional Director of International Skin Tear Advisory Panel.

Dr. Shah's Disclosures: Consultant/Advisory Board - Medline, V Tail, M3, Integra lifesciences

About Paul Kim

Paul J. Kim is the Medical Director of the Wound Program at University of Texas Southwestern, Dallas, Texas. He has the rank of Professor in the Departments of Plastic Surgery and Orthopedic Surgery. He is also a Fellow of the American College of Foot and Ankle Surgeons. Dr. Kim received his Bachelor of Arts degree, Magna Cum Laude, in Psychology and Biology from the University of Colorado at Boulder in 1995 and his Doctor of Podiatric Medicine degree from the Ohio College of Podiatric Medicine in 2002 with multiple honors. Dr. Kim completed a surgical foot and ankle residency program in 2005 from Inova Fairfax Hospital in Falls Church, Virginia. He also received a Master of Science Degree in Clinical Research Management from Arizona State University in 2012.

Dr. Kim has received both intramural and extramural research grants in the areas of wound care, Diabetic limb salvage, and tendon pathology. He has chaired multiple committees related to research and Evidence Based Medicine and the Diabetic limb for various national and international organizations. Dr. Kim is also a national and international speaker with over 300 invited lectures and has authored over 200 basic science, clinical manuscripts, and book chapters on various topics in foot and ankle medicine and surgery with a specific interest in the Diabetic Limb.

Dr. Kim's Disclosures: 3M, UrgoMed, Integra Lifesciences