A cost effective alternative to collagenase for debridement in home care

Debridement of nonviable tissue is an essential part of wound management. There is a plethora of literature regarding the safety and efficacy of prescription collagenase ointment for enzymatic debridement. However, in home care, the cost of collagenase has proven to be a limitation for some patients due to out of pocket expense. Clinicians must be able to establish an alternative, safe and cost-effective treatment for patients. A surfactant wound gel was introduced to a home health agency purporting similar debridement efficacy to collagenase with lower patient costs. The gel is classified as hydrogel and therefore bundled within home health reimbursement.

Two male and four female patients, ages 60-75, were identified as having chronic wounds with 100% non-viable tissue.  Pertinent comorbidities included immobility r/t Parkinson's, arterial insufficiency, diabetes, and hypertension. Previous topical therapies ranged from wet-to-dry dressings to advanced wound care dressings over a 4-6 week period. Responses varied from a silver allergy, increased pain, cost issues, and overall failure to remove nonviable tissue.

The surfactant wound gel trial was initiated, and was applied per manufacturer recommendations. Dressings were changed two to three times weekly depending on wound characteristics and drainage. At four weeks, two of the six were hospitalized(not wound related) and lost to follow up. The remaining four tolerated treatment with surfactant gel well with 100% debridement of nonviable tissue at 45 days and without adverse effects such as burning, pain or stinging. Of note, two of the four individuals also had a decrease in overall wound dimensions.

Surfactant gel presents as a debridement option to home health patients with efficacy in removal of nonviable tissue without pain and eliminating patient cost. High quality studies comparing collagenase and surfactant gel are recommended measuring nonviable tissue removal, pain, costs to patients and agencies, and clinical outcomes.