Goodbye 2020 and hello 2021! As we all recall, 2020 was a proposed year of celebration, designated the International Year of the Nurse and Midwife. Instead, it became the year of the novel coronavirus 2019 (COVID-19) pandemic. Public health measures preserved the lives of people around the world and were the main focus in our own work settings and communities. In 2020, the world truly saw the continuing efforts that all healthcare and other essential workers contribute to our well-being.
Some good news. The World Health Organization has extended the International Year of the Nurse and Midwife to include 2021, and promising trials of several COVID-19 vaccines are concluding, although we still have many questions to be answered. How long will the immunity last? How will we transport those vaccines that need to be stored at −70° F (−57° C)? Will individuals adhere to the two-dose initial inoculation?
So much knowledge and new evidence support our public health practices including hand washing, physical distancing, and wearing masks. Without these measures, the spread and consequences of the virus can be dire. A recent study by Kasper et al1 documented an outbreak of COVID-19 on the USS Theodore Roosevelt with a crew of 4,779 personnel with an average age of 27 years. Social distancing on these vessels is difficult, and the closed air circulation is like that of large buildings. Within 5 weeks of the first positive test, 1,271 (26.6%) of the crew members were positive for COVID-19. Of these individuals, 76.9% had no initial symptoms, although this figure decreased to 45% at follow-up, and 60 other suspected illnesses met COVID-19 criteria despite a negative test! Twenty-three crew were hospitalized, and one person died.
Using a robust Institute for Health Metrics and Evaluation model,2 researchers in October 2020 estimated that universal mask wearing would have saved 130,000 lives in the US over the following 4 months. It is our hope that 2021 will see greater public acceptance of evidence-based preventive measures.
All that transpired in 2020 brought about rapid shifts in care goals and priorities. Within a short period of time, there was a new focus on preventing medical device-related pressure injuries. For example, Smart and colleagues3 provided data that using silicone foam dressings on providers’ faces conferred protection from skin damage from N-95 masks without compromising the fit test seal. Other projects and activities had to be put on hold as wound care professionals were reassigned to care for the bulging number of persons acutely ill with COVID-19.
As with COVID-19 treatment, resource utilization in wound care needs to be matched to realistic outcomes with the best possible patient outcomes. There are three different wound classifications related to outcomes: healable wounds, nonhealable wounds (those that will not close despite our best efforts), and maintenance wounds (in patients who do not adhere to treatment or in cases where there is a lack of healthcare system resources).
In this month’s CE/CME, an interprofessional team from South Africa and the Kingdom of Bahrain have completed an extensive systematic review of the literature to “appraise and synthesize” the literature on the management of nonhealable and maintenance wounds (scientific evidence) as applied to clinical practice (expert opinion). This is an important contribution to the care of persons with wounds that, because of systemic or patient factors, are not healing. The authors have outlined pathways for preventing wound deterioration. They identified three main themes for optimal care, including implementing the wound bed preparation model, patient-centered care, and timely intervention by an interprofessional team. It is their hope and ours that this model will have a positive outcome on the care of these patients.
Our new year wish for all our skin and wound care colleagues is for good health for you, your families, and your coworkers. We look forward to the day when we can all meet in person again; until then, please be safe, take good care of yourself, and maintain a good work/life balance.
Elizabeth A. Ayello, PhD, MS, BSN, RN, CWON, ETN, MAPWCA, FAAN
R. Gary Sibbald, MD, DSc (Hons), MEd, BSc, FRCPC (Med Derm), FAAD, MAPWCA, JM
1. Kasper MR, Geibe JR, Sears CL, et al. An outbreak of COVID-19 on an aircraft carrier [published online November 11, 2020]. N Engl J Med.
2. IHME COVID-19 Forecasting Team. Modeling COVID-19 scenarios for the United States [published online October 23, 2020]. Nat Med.
3. Smart H, Byron F, Darwich I, Elnawasany MA, Kodange C. Preventing facial pressure injury for health care providers adhering to COVID-19 personal protective equipment requirements. Adv Skin Wound Care 2020;33(8):418–27.