CHAPTER ONE
INTRODUCTION
- Background of the Study
Wounds have a variety of causes; some arise from surgical intervention, some are the result of injury, and others are a consequence of extrinsic factors, such as pressure or shear, or underlying conditions such as diabetes or vascular disease. They are often classified as a result of their underlying cause into acute wounds, such as surgical wounds and burns, and chronic wounds, such as leg ulcers, diabetic foot ulcers (DFUs) and pressure ulcers. Whatever the cause, wounds have a substantial but often unrecognised impact on those who suffer from them, on their careers and on the health care system. Infact, the phenomenon of wounds has been called the Silent Epidemic (Eming et al. 2011). Living with a wound can have a profound effect on quality of life. The human cost of wounds manifests itself in, among other things, pain, distress, social isolation, anxiety, extended hospital stay, chronic morbidity or even mortality. Many of these issues are preventable. Furthermore, because of underlying factors such as the age of the patient and the presence of underlying chronic comorbidities, some wounds do not follow the normal healing process. These ‘hard-to-heal’ wounds defined as wounds that fail to heal with ‘standard therapy’ in an orderly and timely manner cause further deterioration in quality of life and increase the burden on the health care system over a prolonged period. Sometimes, it is thought that the financial cost of wound management is just the cost of the materials used, such as dressings, bandages or topical antiseptics. This is not the case; most of the cost relates to the use of health care professionals’ time and the cost of staying in hospital, as we will see later. The choice of materials and treatments, however, can have a major influence on the total cost (Carmeliet, 2013).
Literally millions of traumatic wounds are treated each year in emergency departments in Nigeria. Wound management is an area of still ongoing research, much of which supports traditionally performed techniques, but some of which also is still trying to resolve controversial topics. The basic principles of wound care are simple, as long as one keeps in mind what the intent of the care being rendered is. First of all, one must remember that the wound heals itself. If the patient is not mortally wounded, then the wound will heal all by itself. The physician who believes that he made the wound heal is deluding himself and does not understand wound healing. So, what is the big deal and what are the doctors good for if the wound is going to heal no matter what? In essence, the objective is to restore tissue integrity, and function, while avoiding infection and morbidity, and minimizing scarring. To achieve this outcome, a thorough understanding of wounds is necessary (Isaac, 2010).
Clinicians who treat patients with wounds need access to the resources that will enable them to deliver the best and most appropriate treatments. With economic constraints on healthcare budgets, in addition to challenges to prove efficacy, budget holders and payers are increasingly asking for financial justification for the provision of treatment. They therefore need to know how to provide such justification to ensure continued provision of appropriate wound management services, including the implementation of service improvements and new technologies.