Specialist commentator comments
Two specialist commentators were concerned about the length of time it takes for the Woundchek Protease Status test to give results. At 15 minutes this is longer than the 10 minute appointment time that practice nurses have to see patients. It was also noted that precision is needed in timing the tests to avoid false positive results, and that this precision is not always feasible in a clinic setting.
One specialist said that this test could be beneficial to wound care nurses who have the expertise to assess wounds and use the results of the elevated protease activity (EPA) test to develop a care plan. Two of the specialist commentators had been asked to do evaluations of the Woundchek protease status kit. One had concluded that the test was too costly because each wound care nurse would need to have the test kit and control kit, at a total cost of £45, although it should be noted that the control kit would be used for local quality control purposes and would not need to be used at each Woundchek test. The other specialist tried the test on around 20 patients, but found the kit complex to use and the need for precise timings made it impractical. One commentator noted that multiple matrix metalloproteases (MMPs) are involved in wound healing and it is unclear if the test is specific to certain MMPs or a broader range.
It was noted by one specialist that protease modulating dressings may still be used in the event of a negative EPA result, because some of these dressings tend to be highly absorbent. They felt that further guidance would be needed around which patients should be tested and whether testing should be repeated for non-healing wounds.
One specialist concluded that experienced wound care nurses use their clinical knowledge and experience to assess wounds and provide the best dressings, and that in their experience, most wounds heal regardless of EPA testing. They noted that many chronic wounds are seen by general nurses in primary care, who might not understand the role of proteases in chronic wounds so may still prescribe inappropriate dressings regardless of this test.