The technology

Prontosan (B Braun) is available as:

  • Prontosan Wound Irrigation Solution

  • Prontosan Wound Gel

  • Prontosan Wound Gel X.

It is indicated for cleansing, decontaminating and moistening acute and chronic wounds and to prevent and remove biofilms. The solution and gels contain 2 active ingredients, an antimicrobial polyhexanide (polyhexamethylene biguanide [PHMB]), and a betaine surfactant (undecylenamidopropyl betaine). The company claims that PHMB and betaine disrupt and remove the biofilm from the wound bed, and cleanse and remove slough, devitalised tissue and other wound debris. Prontosan solution can be used for irrigation, or applied to gauze as a soak. The gels are applied to the wound bed during dressing changes after cleansing.

Innovations

The company says that Prontosan is the only wound cleansing solution or gel that contains the active ingredients polyhexamethylene biguanide and undecylenamidopropyl betaine. It claims that Prontosan removes and prevents a biofilm forming, and provides active wound cleansing, removing barriers to wound healing.

Current care pathway

Several indications can result in acutely infected or chronic non-healing wounds, such as surgical site infections, diabetic foot problems and pressure ulcers.

Care of acutely infected or chronic non-healing wounds aims to promote healing and minimise the risk of further complications. Saline or water are usually used to cleanse wounds. If the wound is suspected of being infected, a microbiological sample is usually taken and an antibiotic prescribed to treat the organism causing the infection. The wound is treated with regular cleansing and debridement, and then a dressing is applied. Care staff choose a dressing that promotes healing and manages exudate on a case-by-case basis. Chronic non-healing wounds typically need more advanced dressings.

The following publications have been identified as relevant to this care pathway: NICE's guidelines on surgical site infections, diabetic foot problems and pressure ulcers.

Population, setting and intended user

Prontosan is for anyone with an acute or chronic wound.

It is applied by healthcare professionals in community and acute care settings, such as outpatient clinics, hospital inpatient care, GP surgeries, post-operative care and at the patient's home. Some basic training may be needed to use the technology.

Costs

Technology costs

The technology is available in several forms and quantities. The company has provided drug tariff prices for February 2020:

  • Prontosan Wound Irrigation Solution: £4.96 for a 350-ml bottle (cost per dressing change £0.28 to £0.56); £14.72 for twenty-four 40-ml pods (61p each, single use).

  • Prontosan Wound Gel X: £12.12 for a 50-g tube (cost per dressing change £1.21 to £3.03); £32.45 for a 250-g tube (cost per dressing change £1.30 to £3.25).

  • Prontosan Wound Gel: £6.62 for a 30-ml bottle (cost per dressing change £1.66 to £3.31).

All Prontosan products except the single-use pods have an 8-week shelf life. The company notes that if an opened bottle or tube of Prontosan is used for subsequent dressing changes in the same patient it has the potential to reduce costs. The range in cost per dressing change is based on a range of volume use per wound dressing, depending on the size of wound. For each dressing change there are also costs for nurse time, basic dressings and a dressing pack (see the costs of standard care section for details).

Costs of standard care

The company says that the costs for treating uncomplicated chronic wounds with standard care per dressing change are:

  • saline 25p per 20 ml

  • 15 minutes of nursing time £6.50

  • basic dressing 44p

  • dressing pack 60p.

Chronic wound treatment is not a single treatment, it is a treatment process over a period of time. Wound care costs for 12 months range from £698 to £3,998 per person for a healed wound, to £1,719 to £5,976 per person for an unhealed wound (Guest et al. 2016; Andriessen and Eberlein 2008).

Unit costs and 12‑month costs will vary depending on the wound, the extent of the intervention and the costs of the local provider.

The costs of standard care for treating acute wounds are uncertain and variable.

Resource consequences

The company says that Prontosan is used in around 60% of NHS trusts, and that usage varies between them, depending on local policy. Prontosan is often reserved for complex wounds.

According to the company, the technology costs more than standard care, however, it is expected that using this technology will release resources because acute and chronic wounds are likely to heal more quickly.

Prontosan will be used instead of saline or water to cleanse wounds. This is unlikely to cause a substantial change in care facilities and infrastructure. Prontosan will need to be made available during dressing change. The company says that brief training may be needed for some staff but will probably be unnecessary in staff who are already trained in cleansing with saline or water.