Currently, there are 278 million annual wound dressing changes in UK primary care. Most dressing changes include the use of wound cleaning solutions and dressings, which for infected wounds frequently contain chemical antimicrobials such as e.g. polyaminopropyl biguanide aka polyhexamethylene biguanide aka PHMB aka polyhexanide aka polihexanide, chlorhexidine, octenidine, Dialkylcarbomoyl chloride (DACC). The dressings are made of synthetic, non-biodegradable components such as foam, silicones, polymers and hydrogels as well as outer plastic coverings and adhesives. The average weight of a dressing change is 60 g, which amounts to at least 16,680 tonnes of waste annually. This does neither include the more advanced dressings nor the use of vacuum pumps which involve a number of consumables, e.g. tubes, foams, canisters, dressings and in some cases batteries.
There is consequently substantial waste being produced, which contains plastics, silicones, antimicrobials and an array of other chemical compounds. In community care, where the majority of wounds are treated, the waste is typically disposed of as household waste. Studies have shown that antimicrobials released into the environment are highly stable (Lucas 2012) and affect the ecology of rivers and streams (e.g. Lawrence et al. 2008) in addition to their implications for antimicrobial resistance (AMR). The pollution by plastics is well known. This pollution needs to be viewed in the context of the limited effects on wound healing achieved as concluded by the FDA and NICE.
MPPT reduces the number of dressing changes. It only contains natural non-polluting ingredients. Its use does not involve any chemicals or antimicrobials. Its release into the household waste does therefore not pose a risk to the environment. All its packaging is recyclable. Changing to MPPT will therefore reduce the amount of waste and the release of plastics, chemicals and antimicrobials into the environment.
References
Bilyayeva O, Neshta VV, Golub A, Sams-Dodd F. Effects of SertaSil on wound healing in the rat. J Wound Care. 2014 Aug;23(8):410, 412-4, 415-6. doi: 10.12968/jowc.2014.23.8.410.
Bilyayeva OO, Neshta VV, Golub AA, Sams-Dodd F. Comparative Clinical Study of the Wound Healing Effects of a Novel Micropore Particle Technology: Effects on Wounds, Venous Leg Ulcers, and Diabetic Foot Ulcers. Wounds. 2017 Aug;29(8):1-9. Epub 2017 May 25.
FDA. FDA Executive Summary, Classification of Wound Dressings Combined with Drugs. Prepared for the Meeting of the General and Plastic Surgery Devices Advisory Panel. 2016; September 20-21, Page 38-39.
Guest JF, Fuller GW, Vowden P. Venous leg ulcer management in clinical practice in the UK: costs and outcomes. Int Wound J. 2018 Feb;15(1):29-37. doi: 10.1111/iwj.12814.
Guest JF, Fuller GW, Vowden P. Diabetic foot ulcer management in clinical practice in the UK: costs and outcomes. Int Wound J. 2018 Feb;15(1):43-52. doi: 10.1111/iwj.12816.
Guest JF, Fuller GW, Vowden P, Vowden KR. Cohort study evaluating pressure ulcer management in clinical practice in the UK following initial presentation in the community: costs and outcomes. BMJ Open. 2018 Jul 25;8(7):e021769. doi: 10.1136/bmjopen-2018-021769.
Guest JF, Fuller GW, Vowden P. Costs and outcomes in evaluating management of unhealed surgical wounds in the community in clinical practice in the UK: a cohort study. BMJ Open. 2018 Dec 14;8(12):e022591. doi: 10.1136/bmjopen-2018-022591.
Guest JF, Vowden K, Vowden P. The health economic burden that acute and chronic wounds impose on an average clinical commissioning group/health board in the UK. J Wound Care. 2017 Jun 2;26(6):292-303. doi: 10.12968/jowc.2017.26.6.292.
Guest JF, Ayoub N, McIlwraith T, Uchegbu I, Gerrish A, Weidlich D, Vowden K, Vowden P. Health economic burden that wounds impose on the National Health Service in the UK. BMJ Open. 2015 Dec 7;5(12):e009283. doi: 10.1136/bmjopen-2015-009283.
Guest JF, Ayoub N, McIlwraith T, Uchegbu I, Gerrish A, Weidlich D, Vowden K, Vowden P. Health economic burden that different wound types impose on the UK’s National Health Service. Int Wound J. 2017 Apr;14(2):322-330. doi: 10.1111/iwj.12603.
Lawrence JR, Zhu B, Swerhone GD, Topp E, Roy J, Wassenaar LI, Rema T, Korber DR. Community-level assessment of the effects of the broad-spectrum antimicrobial chlorhexidine on the outcome of river microbial biofilm development. Appl Environ Microbiol. 2008 Jun;74(11):3541-50. doi: 10.1128/AEM.02879-07. Epub 2008 Mar 31.
Lovgren M-L, Wernham A, James M, Martin-Clavijo A. Pyoderma gangrenosum ulcers treated with novel micropore particle technology. Br.J.Dermatol. 2018; 179 (Suppl. 1):BI22, p. 152.
Lucas AD. Environmental fate of polyhexamethylene biguanide. Bull Environ Contam Toxicol. 2012 Mar;88(3):322-5. doi: 10.1007/s00128-011-0436-3. Epub 2011 Oct 29.
NICE (2016) Chronic wounds: advanced wound dressings and antimicrobial dressings. NICE Guidelines
Ryan E. The use of a micropore particle technology in the treatment of acute wounds. J Wound Care. 2017 Jul 2;26(7):404-413. doi: 10.12968/jowc.2017.26.7.404.
Sams-Dodd J, Sams-Dodd F. Time to Abandon Antimicrobial Approaches in Wound Healing: A Paradigm Shift. Wounds. 2018; 30(11):345-352.
Sams-Dodd J, Sams-Dodd F. MPPT induces tissue regeneration, whereas PHMB causes degeneration, in patient. Wounds. 2019, submitted.
Wounds-UK (2018) https://www.wounds-uk.com/news/details/new-research-finds-uk-nurses-carry-out-180-wound-dressing-changes-a-year-on-each-chronic-wound-patient-