Persistent wounds 'a big issue' in Canada

Persistent wounds including diabetic foot ulcers and bedsores can lead to severe complications and are widespread in Canada, but some can be prevented, according to a new report.

CIHI says some 117,000 people yearly in acute-care hospitals had wounds that don't heal well

Mary Anne Kecskemethy had one foot amputated for diabetic ulcers and now has lesions on her legs and remaining foot. (CBC)

Persistent wounds including diabetic foot ulcers and bedsores can lead to severe complications and are widespread in Canada, but some can be prevented, according to a new report.

The Canadian Institute for Health Information (CIHI) report released Thursday looks at certain wounds that don't heal well.

Reduced blood flow is one of the reasons people with diabetes are more prone to foot ulcers (Lucy Nicholson/Reuters)

"We found that compromised wounds were a big issue," Kathleen Morris, CIHI's director of health system analysis in Toronto, said in an interview.

"It's an important aspect of health care because it's very painful and very distressing for patients, and it sometimes leads to significant health consequences."

Morris said compromised wounds don't heal well, perhaps because of a skin infection or chronic condition such as diabetes that can make healing more difficult. Another category is pressure ulcers or bed sores that are more likely in people with restricted mobility, for example, if they're in a wheelchair or confined to a bed.

No health-care sector was immune. Nationally, "compromised wounds" were reported in :

  • Almost four per cent of acute patients in hospital — the only sector for which data was available from all Canadian hospitals. In 2011-2012, more than 117,000 people in acute care had compromised wounds.
  • Almost seven per cent of home-care clients.
  • Almost 10 per cent of long-term-care clients.
  • Almost 30 per cent of hospital-based continuing care clients in some provinces. The hospitals treat people with chronic conditions such as those with diabetes of peripheral vascular disease.

To prevent compromised wounds, the report's authors suggest:

  • Turning bedridden patients frequently to prevent pressure ulcers.
  • Having people with diabetes undergo regular foot checkups.
  • Reducing surgical site infections.

People with diabetes are more likely to have wounds that don't heal properly because of their reduced foot blood flow and sensation. That's why it's important to inspect the skin regularly, to identify any cuts or blisters promptly to a health-care team, Morris suggested.  Keeping the feet in good condition by wearing well-fitting shoes with closed toes can also help.

Dr. Ron Linden, medical director of the Judy Dan Research & Treatment Centre in Toronto, uses hyperbaric medicine to try to treat diabetic ulcers.

Canada spends $1.5 billion a year on diabetic amputations, Linden said.

"The earlier you start treating these wounds, the easier it is to treat them. If the patients come late, where the wounds are already necrotic or the wounds are gangrenous, there's no other alternative than amputation," Linden said.

The object is to recognize that the wounds will occur and to treat them as soon as possible, he said.

Mary Anne Kecskemethy has Type 2 diabetes. She's had one foot amputated and came to Linden's clinic today to check how lesions on her remaining foot are healing.

"It's black," she said, her voice breaking on learning the bad news that her big toe became bruised without her realizing it. "Any kind of damage to my foot creates more problems."

Laura Teague is a registered nurse and nurse practitioner for the wound care program at St. Michael's Hospital in Toronto, where she focuses on pressure ulcers.

"We have a program that identifies risk of pressure ulcer, and when patients are identified as high risk we put certain measures in place," Teague said. "One of those measures is putting the patient on an appropriate patient redistribution mattress and we also put a turning schedule into place for patients."

Since many factors influence the onset and severity of pressure ulcers, Teague said not all of the wounds are preventable.

With files from CBC's Kim Bruhuber and Jill English