Simple tool to ensure effective enzymatic debridement

In today’s rapidly changing healthcare arena, ensuring evidence based, efficacious practice can be challenging. Miniscule print on lengthy package inserts compounds this issue. Currently, there is only one enzymatic debriding agent (Clostridium collagenase ointment) available which, if used appropriately, can be effective in removing necrotic tissue from wounds.  However, there are many product interactions including wound cleansers and commonly used topical treatments which can render the Clostridium collagenase debriding agent partially to completely inactive. For example, both the floor stocked wound cleanser and antimicrobial roll gauze used in our academic medical center located in the Southeast negate the enzymatic activity by one hundred percent and were frequently noted to be used in conjunction with this product. In addition to rendering the product useless, this practice was fiscally irresponsible as the Clostridium collagenase is quite expensive at nearly $200 per 30 gram tube. 

Based on a research study published in 2012, a one page visual reference guide was created to help guide clinician practice in selecting appropriate topical management when using Clostridium collagenase ointment (Jovanovic, et al, 2012). Our product formulary was reviewed in relation to the published research on product interactions and using a one page stop light type visual guide, products with no interaction were denoted using green. Products with 0-10% negative impact on product effectiveness were denoted using yellow. Those products noted to negate enzymatic activity by 10-25% were highlighted in a light orange and any products which impacted effectiveness by greater than 25% were highlighted in red. This guide was shared with colleagues, posted on unit bulletin boards and included in our intranet wound resources for staff reference. This simple tool has been useful in translating research into practice, thereby promoting better patient outcomes and avoiding wasteful, ineffective product utilization.