Smartwound-plasma

This project addresses two major healthcare and societal challenges of the early 21st century: those of the rise of antimicrobial resistance (AMR) and of the growing epidemic, in developed and developing nations of chronic (non-healing) wounds.

The recent report of Lord Jim O'Neil (TACKLING DRUG-RESISTANT INFECTIONS GLOBALLY, 2016) highlights the scale of the problem we now face as micro-organisms develop resistance to antibiotic therapies that have served us extraordinarily well for now over sixty years. In his report he draws attention to a world in 2050 where AMR is a 'devastating problem' unless we find new alternative strategies to effectively destroying invading pathogens. Whilst in 2016 it was estimated that AMR gave rise to an "already large" 700,000 deaths every year, this number will increase to an "extremely disturbing" 10 million every year, which is in fact more than the number of people that currently die from cancer every year. O'Neil also makes clear, in addition to the 'tragic human costs' the economic penalty of not tackling the rise in in AMR would grow by 2050 to 'an enormous' 100 trillion USD if we do not take action.

Whilst new drug therapies will no doubt play a role in combating the rise in AMR, there is a significant role for engineering solutions. In this project plasma technology is used to generate (from ambient air) agents such as hydrogen peroxide (H2O2) that are extremely effective at killing pathogens. Because plasma delivers several agents at one time, unlike antibiotics there is no evidence to date that microbes can develop resistance to plasma.

One of major complications of chronic wounds is infection, arising from opportunistic micro-organisms. Wound infections, like any other type of infection are showing AMR. Therefore the ability to (i) detect the first signs infection and (ii) neutralise the responsible organisms immediately would provide healthcare professionals a significant new weapon.

Finally the combined technologies that will be developed can be applied to problems beyond wound infection, for example bacterial colonisation of other medical devices including urinary catheters.

Infections are a major complication in non-healing wounds. In developed / developing countries these wounds present a growing problem of epidemic proportion. Chronic wounds which include venous leg ulcers, pressure ulcers and foot ulcers totalled 575,000 cases in 2002 at a cost to the NHS estimated at between £2.3 bn - £3.1 bn. Major underlying causes include obesity and the diabetes (over 7 million people in the UK are now pre-diabetic. Wounds being "open" are more susceptible to advantageous infection and AMR presents a significant threat.

(i) Patients with open, non-healing wounds. These are likely to be either venous leg ulcers or diabetic wounds, but hospital acquired surgical infections account for nearly 24% of all hospital acquired infections. Elderly and medically compromised (e.g. diabetics) patients can live for months, or years with open wounds. Failure of these wound to heal leads to a high probability of infection (50% of diabetic foot ulcers become infected) greatly increasing the risk of subsequent amputation. Around 20% of diabetic patients with infected foot wounds end up with some type of lower extremity amputation. In addition, minor trauma injuries can lead rapidly to diabetic foot infections for much the same reason. Burns and scolds are particularly vulnerable to infections and patients with extensive burns are most at risk.
(ii) Healthcare professionals. The increased incidence of chronic wounds presents a significant and growing burden on healthcare providers. In the case of possible infections, healthcare givers are conservative and are liable to prescribe antibiotics.
(iii) Healthcare systems. Estimates as to the cost of chronic wound management, to the NHS for example vary, but none are below £2bn pa, with agreement that this cost will grow at a rate outstripping funding. The more complicated wounds cost more to manage. This includes infected wounds. Infections are treated by antibiotics and there is evidence that there is a significant over use of antibiotics.
(iv) Manufacturers. The wound care industry is important in the UK. There is a considerable threat to manufacturers of dressing materials, as the industry rapidly moves from comparatively low technology dressings to "smart" dressings.

Beneficiaries could benefit in the following manner:
Patients. For patients with chronic wounds, technologies that provide an early signal of infection, below the critical colonisation threshold CCT, and afford immediate, effective and safe treatment offer: better wound management outcomes; potentially a reduction in the administration of antibiotics and prevent potential later (severe) complications leading to amputation. For burns patients, silver dressings are used prophylactically, but there are concerns about effectiveness and safety.
(i) Healthcare providers. New detection/treatment modalities offer healthcare professionals alternatives to prescribing antibiotics. They will benefit from a substantial reduction in the volume of patients and from reduced time per patient. Early, successful interventions will prevent more radical interventions (e.g. amputations).
(ii) Healthcare systems. We believe that the smart dressing-plasma offers a route to manage costs, whilst ensuring good patient outcomes. A clear priority is to reduce the use of antibiotics, reserving these for the "worst" indications.
(iii) Manufacturers. One of the attractive elements of the Smartwound-plasma technology is that it value adds to existing wound care materials. Smartwound-plasma technology can be built into existing hydrogel dressings, impacting little if at all on manufacturing costs, but adding (potentially) very significant value to the final product.