Not only does it affect access to rehabilitation, but an inordinate amount of time is also spent on bed rest. It can cause future complications and vulnerabilities around the scar tissue – and lastly, it has a huge impact on your physical and emotional well-being.
That’s just the impact a pressure sore has on one individual. The impact it has on NHS resources and funding reaches significantly further.
The NICE 2014 Guidelines on the Prevention and Management of Pressure Ulcers state:
“The daily costs of treating a pressure ulcer are estimated to range from £43 to £374. For ulcers, without complications, the daily cost ranges from between £43 to £57 (Bennett, Dealey and Posnett, 2012). These costs assume that patients are cared for in a hospital or long-term care setting but are not admitted solely for the care of a pressure ulcer. These are the daily costs in addition to the costs of standard care. Resources required include nurse time, dressings, antibiotics, diagnostic tests and pressure redistributing devices.”
Despite progress over the last few years, managing pressure ulcers remains a significant healthcare problem, with up to 200,000 people developing a new pressure ulcer in 2017/18 (Guest et al 2017). Treating pressure ulcers costs the NHS more than £1.4 million every day (Guest et al 2017).
Most pressure sores are avoidable and should not occur in the first instance. If they do occur, effective treatment and management should prevent them from reaching the most severe grade.
I was cautiously intrigued when a fellow spinal cord injured colleague asked me if I’d heard of Amicapsil and whether I would like to know more. I was put in contact with the directors of Willingsford Healthcare who own the product and met them to find out more. Perhaps most crucially, I wanted to find out why my spinal injury unit didn’t inform me about this product.
What are pressure sores, why do they occur and what are the current options?
Pressure sores are also known as bedsores or pressure ulcers. Essentially, it’s when the skin breaks down – usually in a bony area or where there has been muscle wastage – due to some form of pressure. The pressure is often external, but it can also be caused by internal pressure.
People with some form of neurological injury which prevents them from either being able to feel the build-up of pressure or shift their position to relieve the pressure, are at high risk of developing pressure sores.
People with spinal cord injuries and the elderly tend to suffer from pressure sores the most – although they can occur in anyone whose mobility or sensation is compromised, even if just temporarily.
The key aspect of pressure sores is to prevent them from occurring in the first instance, but this is much easier said than done.
Spot the signs
People who sustain a spinal cord injury are taught to relieve pressure every 15 minutes and are shown how to check their skin to spot the early signs of pressure sores. A pressure sore can start as a red mark which doesn’t disappear (or blanch) when pressed.
Typically, people with a spinal cord injury will develop a pressure sore on their heels, around the backs of their legs or around their sacral area (usually from the pressure of sitting down against the wheelchair). They can also occur when lying in bed if you do not turn regularly, or if the sheets are creased.
If the skin looks angry, the first (and the only) solution is to relieve the pressure. This means bed rest with frequent turns. The length of time you have to spend on bed rest will depend on whether the skin is just red or whether the skin has started to break.
For those who have had pressure sores before, the skin can be very vulnerable and may not turn red – instead, it simply breaks. If this happens, even if the area looks smaller than the size of a fingernail, it can still take 2-3 weeks for the skin to fully heal and be able to tolerate pressure again.
Take the pressure off
The time spent on bed rest is even greater the more severe the skin breakdown. Some of the worst sores I have seen have required people to be bedridden for two to three years – which is horrendous, given that their life is effectively on hold for this period.
Simply lying on a bed, waiting for a wound to heal is not something many find acceptable in this day and age, given the huge impact it has on a person. But the reality is that once the skin has sustained a breakdown, there isn’t much that can treat the wound for it to heal quickly and effectively.
There are countless dressings which help prevent infection and promote healing of the skin tissue, but when you consider that many people can spend months on bed rest, you get an idea of how effective these dressings are. For sores that simply won’t heal, surgery is an option, although medical professionals still view it as a last resort. This is partly because infections often occur when the skin breaks down, making surgery very complicated, even impossible.
Therefore the treatment and management of wound therapy currently focus on prevention. After prevention comes to a mixture of dressings with varied properties, antibiotics, negative pressure wound therapy (which isn’t always tolerated by the patient) and bed rest with regular turns.
There is another option – but sadly, not too many people know about it. This is Amicapsil to treat pressure sores.
What is Amicapsil?
Amicapsil is a white, odourless, natural powder that is placed on the wound and, if needed, covered with a light-permeable dressing. The frequency with which Amicapsil needs to be applied will depend on the age of the wound when it is first treated. You should seek professional advice on this, at the point of using Amicapsil.
The beauty of Amicapsil is that it is simple to use and can be applied by a family member or relative if they have been shown how. Information about how to apply is available on Willingsford Healthcare’s website.
Although it’s a powder, it is classed as a medical device and a treatment for wounds. It is available in a professional and over-the-counter versions, so individuals can buy the product themselves.
How does Amicapsil Work?
Amicapsil works as a passive immunotherapy which removes wound infections and supports healing. It disrupts the processes that infective bacteria and fungi use against the immune system. This allows the immune cells to regain their ability to fight the infection. It does not involve any antimicrobial actions but supports the skin microbiome and the immune system.
Amicapsil removes antibiotic-resistant infections and will not further contribute to antibiotic resistance. Willingsford Healthcare states that in comparison, new data show that antiseptics and disinfectants make bacteria resistant to a wide range of antibiotics.
Speeding up wound healing
According to Willingsford Healthcare, comparative studies show that Amicapsil removes wound infections 60% quicker than antibiotics and antiseptics.
In an evaluation of dehisced surgical wounds, Amicapsil reached the same healing stage in 4-5 days that negative pressure wound therapy would normally reach in 3 weeks.
Is Amicapsil just for pressure sores?
Amicapsil has several applications: it can be used for leg ulcers, diabetic foot ulcers, trauma wounds or surgical wounds which just won’t heal. However, many healthcare professionals are still unaware of its existence, let alone how to gain access to it for their patients.
Why aren’t healthcare providers talking about Amicapsil?
It’s not clear why Amicapsil is still so obscure. Some spinal rehabilitation consultants are aware of the product and have seen the benefits, but in my personal experience, it is not something raised as an option by healthcare professionals. It is more so something you need to know about yourself. Therefore, raising awareness responsibly is the next key step.
There’s also the issue of funding. Getting NHS funding for products is not a straightforward matter – it’s complex and can vary depending on the region of the UK. At the forefront of considerations is whether the cost of the product can deliver enough benefit and improve the QALY (the quality of life of the person given the years left to live), as per NICE definitions.
In my mind, this is an issue that will be driven by patients and results. The proof will be in the pudding: if the product works, speeds up wound healing, reduces time spent on bed rest and reduces the financial spend and time spent in a hospital bed, then Amicapsil will become a no-brainer.
How do I access Amicapsil to treat pressure sores?
Everyone is different – and when someone has a complex condition such as a spinal cord injury, you must consult your medical team before commencing with any treatment yourself.
However, given the lack of awareness of this product amongst healthcare professionals, you might need to take the lead. Contact your lead physician to see if they have heard of Amicapsil and if so, whether they would consider it as an option for you.
As someone who has had to wrestle with skin breakdown, anything that helps minimise the amount of time my skin takes to heal is something I want to know about. I’ve had various conversations with my spinal injury unit over the years about how skin breakdown can either be prevented in future or treated better when it inevitably breaks.
Having met with the directors at Willingsford Healthcare and read up on Amicapsil, I was surprised that I was not told of this product when I had my most recent skin breakdown a few weeks prior.
Like many patients, I want to ensure any treatments or products that I use are with the agreement, support and approval of my treating team. So, I contacted my consultant to ask his views and see whether this was something he was aware of. The response so far has been that only some Tissue Viability Nurses (TVNs) have heard of it – and there’s even less awareness among consultants. Those that have heard of Amicapsil are not fully up to speed on how it works or whether it could be used by their patients.
Fortunately, my consultant was able to take a view and stated he would support the use should my skin break down in future. I contacted Willingsford Healthcare who were able to provide me with a sample that I could use for when this might occur. Sure enough, my skin has broken down since – and I was able to use Amicapsil to treat it.
I contacted my local spinal injury clinic to let them know, sent photos and stated that I would be trialling Amicapsil. I then communicated regularly with Willingsford Healthcare throughout my skin breakdown. The last step is crucial and anyone thinking of using it should consult with Willingsford Healthcare before using it.
I have no doubt that the use of Amicapsil sped up my recovery and substantially reduced the amount of time I had to spend on bed rest compared to how long it has taken for other skin breakdowns in the past.
I know of several people who have trialled Amicapsil and from what I have read and seen, this is the most innovative product in recent years – one that tries to reduce the time spent waiting for a wound to heal and crucially, has a track record of doing so.
To me, keeping a bottle in the fridge ready for if and when a skin breakdown occurs is in the same category as keeping painkillers and plasters in the medicine cabinet. You don’t know when you’ll need it, but you’re prepared for when you do.
Talk to Aspire Law
Raquel Siganporia is a Senior Solicitor and Director of Business Development at Aspire Law. If you or a loved one feel you may have suffered a spinal injury as a result of an accident or someone else’s negligence, or you are concerned about the treatment you have received, contact Raquel free of charge and in confidence on 0800 030 20 40 or at Raquel.Siganporia@aspirelaw.co.uk. Alternatively, complete this form and one of our Spinal Injury specialists will contact you.
