Setting up evidence-based cost-effective and clinically efficacious wound care service in a tertiary hospital in New Zealand: lessons learned

Mr Eric Tan1,2, Dr Wei Lun  Wong1,2, Mr Terrence Creagh1,2

1Department of Plastic Surgery, Christchurch Hospital, Christchurch , New Zealand, 2University of Otago, Christchurch, New Zealand


Introduction:Commonly used antimicrobial dressing (AD) are not robustly tested and have been adopted into clinical practice from a combination of marketing efforts from distributors, individual clinician’s preference and traditional departmental practice.
We would like to evaluate the level of EB practice at our workplace and its’ consequential health economics.

Methods: A standardised survey was sent to different medical and nursing staff involved in wound care in Christchurch Hospital.
A Pubmed/Medline systematic review was conducted using keywords “antimicrobials”, “silver dressing”, “acetic acid” and “wound”.

Results: 100/101 staff who completed the survey use silver based dressing for most wounds in general without correlation to previous and/or concurrent international consensus (Chi squared test p<0.00001). 95 out of 101 are unfamiliar with alternative AD like acetic acid (Chi squared test p<0.00001).
46 papers were included in systematic review. There are no randomised clinical trial comparing silver based dressing with other antimicrobial dressing in clinical practice. 2 Cochrane review groups found no evidence that silver based dressing improves healing rate.
In vitro studies suggest cytotoxic properties identified in silver based dressing and 1% acetic acid being to be non-cytotoxic but retain antimicrobial properties at 0.16% concentration.
A cost analysis based on 10 patients with 10% burn admission and 200 minor burn service in 6 months found that a predominantly acetic acid based dressing service reduces the estimated expenditure of NZD48,000 to NZD42.

Conclusion: A carefully design standardised treatment pathway will reduce cost but also ensure patients continue to receive the best concurrently recommended treatment.


Mr Eric Tan is a current fellow in the department of plastic surgery in Christchurch hospital. He has a special interest in evidence based burn practice and has produced educational curriculum for emergency department and junior doctors in UK on burns. He has also chaired sessions on burns in European Burns Association meetings with a special interest in chemical burns.

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