Treat

The philosophy behind AHS’ Formulary approach to wound care is that by providing suite of tools that includes a standard process for care, the best adjunctive technologies available, and consistently capturing outcomes for the wound care process - wound care can move from a treatment model to a healing model. And when applied correctly and consistently, that Formulary approach will significantly improve wound care outcomes.

In order for an adjunctive technology to become a recommended part of AHS’ Treatment Guideline it requires the following components: FDA Approval, clinical experience by AHS’ Formulary Committee, and the demonstration that the technology can either reduce time to heal, reduce cost to heal, or both.

Guidance associated with AHS Wound Care Formulary is based on the clinical experience of AHS’ Formulary Committee and the outcomes demonstrated as a result of Formulary application. Recommendations provided are intended to give an overview for assessing and treating wounds of multiple etiologies and severity, however the advice provided is not intended to supersede the evaluation or recommendations of the licensed practitioner that has had direct patient interaction.

Basic Assumptions:

All wounds should be seen and documented initially and at a minimum weekly thereafter under the supervision of a licensed medical practitioner.

Formulary Process: Wound Treatment Guidelines

Just like a recipe for cooking or baking, the ingredients alone are not enough to achieve the desired outcomes. By guiding Formulary users in the appropriate indications and applications for applying these tools, AHS’ Wound Care Formulary has driven thousands of successful wound outcomes across the nation.

AHS’ Wound Treatment Guideline recommends the following steps:

First – Determine wound etiology.

• Wound etiology may be on the patient’s record.
• If the wound etiology is not previously documented in the patient record, follow facility procedure for identifying the type of wound (etiology).
• There are also steps provided within this AHS' Wound Care Guideline that may help to determine wound etiology.
• A unit manager, facility wound champion, MDS Coordinator, Director of Nursing, or Medical Director [or primary care MD] may need to sign off on the wound etiology depending on facility policy.

Second – Assess the wound against the characteristics shown for wounds of that etiology.

• Characteristics are listed in order that they should be assessed to provide the best, most consistent care to the patient or resident.
• If the wound etiology is not previously documented in the patient record, follow facility procedure for identifying the type of wound (etiology).
Note: that the characteristics listed by wound etiology may vary; for example, the relevant characteristics to identify for a Venous wound are different than those of an Arterial wound, which are also different than those of a Diabetic wound or Pressure ulcer.

Third – Identify Formulary technologies recommended for wounds of that etiology regardless of the other wound characteristics

Fourth – Follow the treatment guidelines provided as part of AHS' Wound Care Formulary unless these guidelines are superseded by the orders of an attending physician or other licensed practitioner.

Formulary Technology: Pulsed Electromagnetic Frequency Therapy (PEMF)

PEMF means pulsed electromagnetic frequency therapy. It is a proprietary means of using a specific radio frequency signal to induce the proliferation of human fibroblasts cells.

Fibroblasts are connective tissue cells that secrete proteins, especially molecular collagen that form a fibrillar matrix in which all skin and muscle cells grow. Research has shown that fibroblast cells respond to varying doses of long wave electromagnetic energy by dividing and doubling themselves every 12 hours.

The specific dose of PEMF energy that is administered to the wound site was because it was found to have the greatest effect on the release of human growth factors that have been identified to be a part of the natural healing process.

A PEMF signal from a treatment coil travels 7-8 cm through intact wound dressings to penetrate all damaged tissue layers. In this way, PEMF is unlike any other wound therapy in that it can induce healing of tunneling and undermining below the surface of the wound, through necrotic even gangrenous tissue, and eschar.

• 48 to 72 hours –PEMF therapy produces robust, visible reduction of swelling in the wound and surrounding tissues usually within 48 to 72 hours of the first treatment.
• 2 – 3 weeks – New granulation tissue usually becomes visible within 2 – 3 weeks of the first treatment and wound seems to close from the bottom to the top.
• 3 – 4 weeks – Within 3 – 4 weeks new skin or epithelialization tissues become visible and wounds begin to heal from the outside to the center just like cuts normally do.

Clinical results, including randomized, placebo-controlled clinical trials, show that PEMF therapy can reduce wound healing time by 50%, even for wounds that have not previously responded to other treatments.

PEMF induces the release of the body’s own growth factors and the proliferation of fibroblast cells critical to an active, normal wound healing process even in individuals whose health is compromised by disease or who are aged and frail. PEMF treatment has been found in several studies to completely heal chronic wounds in half of the time expected when compared with traditional wound treatment.

Is PEMF similar to other wound healing devices?

No, PEMF is significantly different from other devices commonly used for wound healing. In example:

• Electrical stimulation involves the transfer of electric current through electrodes applied to the surface of the skin. This process must be done by a skilled therapist and may be painful to the patient. Electrodes placed in the wound bed or on the skin a distance away.
• Vacuum assisted devices assist wound closure by applying continuous localized negative pressure or suction, through a specialized dressing, to draw the edges of the wound to the center and to help remove excess drainage. This process also needs to be started, monitored and stopped by a specially trained nurse or therapist. It may also be painful for the patient.
• Ultrasound devices are used to increase blood flow to tissues even below the surface of the wound. Some research indicates that ultrasound may enhance wound healing by killing infection causing microbes.

In contrast, PEMF therapy is non-invasive, uses no surface electrodes, specialized dressings or transducers, and is automatically dosage controlled. Although a doctor’s prescription is required, patients may be taught to treat themselves at home until a wound has completely closed.

Formulary Technology: AgX Catalytic Silver ™

There more than 80 regulated types silver products in the USA. All are based on colloidal silver.

These products have become much more frequently used in medicine because many bacteria have evolved to resist antibiotics– they have become “superbugs”.

Further, although viruses are not affected by antibiotics, anti-viral medications are chemicals that work in much the same way that antibiotics do, which means that viral DNA can become resistant too.

Silver can neutralize both bacterial and viral pathogens rapidly through electrolysis. But not all silver products are equally effective.

AHS AgX Catalytic Silver Spray Gel is a revolutionary silver-based drug free antimicrobial and wound treatment spray that is 200% to 300% more effective than other silver-based products due to nanotechnology, its unique composition and manufacture.

AHS AgX Catalytic silver is patented three ways: method of manufacture; method of action; and is patented for use against bacteria, viruses and fungi in vitro including MRSA, HIV and Hepatitis B.

AHS AgX Catalytic silver is also the smallest nano-silver particle in the world. Because of that, each particle has more surface area and therefore has 100 -1000 x fewer particles than medical Colloid silvers, yet it can kill more pathogens faster.

Finally, its unique molecular structure makes it non-toxic.

AHS AgX Catalytic silver is a completely new, patented silver technology. United States Patent No. 6,939,568. It is comprised of three parts:

AgX Catalytic Silver™ is unique among all silver products as follows:

• Is regulated by the FDA as a supplement
• Is the only patented silver world-wide
• Contains the lowest parts per million
• Is completely non-toxic
• Is patented to kill hundreds of bacterial, viral and fungal pathogens including the following:
  Candida albicans (yeast), Haemophilusinfluenzae, Hepatitis B, MRSA, Osteomyelitis, Pseudomonas, Salmonella, Tuberculosis

Formulary Technology: Dermafill – Bio-cellulose Based-Dressing

Dermafill is a non-prescription, semi permeable occlusive wound dressing produced from a pure biosynthetic cellulose. It is approximately .05 millimeters in thickness and when dry has the consistency of a very thin tissue paper, but upon wetting acquires significant strength to both sheer and tear. It is indicated for a variety of chronic and acute wounds where it can produce homeostasis at the wound site.

Dermafill works because its cellulose content resembles the body’s own collagen. In the context of wound healing, the body creates collagen to heal the wound. Specifically, microbial cellulose acts as a scaffold covering the wound’s granulation tissue and will attract fibroblasts to the wound base. These fibroblasts then lay down new collagen and growth factors enhancing the healing processes.

Because Dermafill is self-adhesive and occlusive the wound’s exposure to air is minimized. This reduction of exposure reduces pain and also reduces the likelihood of exposure to harmful pathogens.

A final benefit is that Dermafill is typically only applied to the wound one time. Wounds heal with a single application and therefore the dressing does not have to be removed periodically from the time that it is applied until it naturally falls away with the wound scab.