key: cord-0752411-x9axoi9w
authors: Mufti, Asfandyar; Sachdeva, Muskaan; Maliyar, Khalad; Sibbald, R. Gary
title: COVID-19 and Wound Care – A Canadian Perspective
date: 2020-06-05
journal: JAAD international
DOI: 10.1016/j.jdin.2020.05.003
sha: cc2c15beccf450888db76267abf93c872b0bcfd4
doc_id: 752411
cord_uid: x9axoi9w

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Delivering acute and chronic wound care with physical distancing measures is a major challenge during the COVID-19 pandemic. The average age of chronic wound patients is over 70 years, putting this population at increased risk. 1 Health care providers should continue to focus on reducing exposure risk in this subgroup of patients, while adapting to the new normal. We recommend a multifaceted approach including virtual wound care, patient education and interprofessional collaboration to optimize care (Figure 1 ).

Currently, many wound care appointments are being postponed or moved to a telephone consult. 2 These regular appointments are often essential for optimizing care and preventing unscheduled emergency department visits for complications including infections. Tele-wound care can be as effective as in-person visits and are conducted through either store and forward technologies (SAF), live telephone or videoconferencing. SAF allows patients to send wound photographs and information to the dermatologist, while videoconferencing or telephone communication allows real-time interaction between patients and providers. Newer cellphone photographs often have better photo resolution than most video transmissions. Provincial governments in some areas also compensate for telephone appointments as an emergency response.

To limit exposure, the Wound Healing Society has recommended a decrease in the frequency of wound dressing changes at the clinics and has encouraged caregivers and patients to do interim dressing applications. 2 This may pose a challenge with the need to educate patients on a detailed dressing change approach. A self-education tool by Wounds Canada can be downloaded and given to patients as handouts during visits since online videos may be difficult for older patients. 3

Due to the cancellation of many educational events, there is a reduced opportunity for dermatologists, primary care clinicians and other professionals to exchange knowledge and discuss the appropriate management of wound care patients. With re-assignment of some healthcare providers to COVID-19 emergency duties, there is a greater wound care responsibility on community dermatologists. One way to mitigate this concern is through Project ECHO (Extension for Community Health Outcomes). 4 Project ECHO Ontario Skin and Wound Care -"moving knowledge, not patients" A virtual hub of interprofessional teams exists in the province of Ontario, Canada for improving skin and wound care. During the two-hour weekly sessions, care providers present anonymous patient cases facilitated by Zoom technology. The virtual forum allows for attendees to collectively generate management plans that are generalizable to other similar patients. Over 30 organizations with 100+ care providers attend weekly sessions provided free of charge by the Ontario Ministry of Health and Long-term Care. These efforts have led to increased interprofessional and coordinated wound care expertise. A positive impact on professional satisfaction and effectiveness was documented with 83% of respondents indicating that they would implement changes to their practices. 5 The COVID-19 pandemic has drastically affected wound care delivery for the foreseeable future.

Without timely adjustments to optimize care, the health care burden of wound care will continue to rise. We hope that this three-pronged approach will help alleviate some of the challenges faced during this pandemic.

Epidemiology of chronic wounds treated in primary health care in Portugal. Revista portuguesa de cirurgia cardio-toracica e vascular: orgao oficial da Sociedade Portuguesa de Cirurgia Cardio-Toracica e Vascular

Additional Best Practice Resources -Wounds Canada

Faculty of Health Sciences | Queen's University