Have you heard of Acapsil for treatment of pressure sores, and if not, why not?May 16, 2019
Having become paralysed nearly 26 years ago and having sustained my first pressure sore to both my heels within 12 hours of my paralysis, I am all too aware of the impact skin breakdown has on someone. This ranges from being able to access rehabilitation; inordinate amounts of time spent on bed rest; future complications; vulnerabilities around the scar tissue; and lastly the huge impact it has on your physical and emotional wellbeing.
This of course is just the impact a pressure sore has on the individual, let alone the impact it has on NHS resources and funding.
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.”
Picture of Acapsil medication (Source: http://acapsil.com/en-gb/)
Despite progress over the last few years, the management of pressure ulcers remain 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). This is against the backdrop that most pressure sores are avoidable and should not occur in the first instance and if they do occur, then should not reach the most severe grade with proper and effective treatment and management.
I was therefore cautiously intrigued when a fellow spinal cord injured colleague asked me if I’d heard of Acapsil 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 about what it can do, and perhaps most crucially, why my spinal injury unit were not the ones to inform me of this product.
What are pressure sores, why do they occur and what are the current options are for those who have an open wound?
Pressure sores can be known as bed sores or pressure ulcers. Essentially it is 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 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. It is for this reason that those with a spinal cord injury or the elderly are often the populations that 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 to pressure sores is to prevent the sore from occurring in the first instance. This is of course easier said than done.
People who sustain a spinal cord injury are taught to pressure relieve every 15 minutes and taught how to check their skin to spot the early signs such as a red mark which doesn’t disappear or blanche 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 and or if the sheets are creased which can then ‘mark’ your skin.
If the skin looks ‘angry’ the first and really only solution is to relieve the pressure and 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 and instead, simply break. If this happens, even if the area looks small and the size of a finger nail, it can still take 2-3 weeks for the skin to fully heal and be able to tolerate pressure again. The time spent on bed rest is even greater the more serious and 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 is not much if anything that can ‘treat’ the wound for it to heal quickly and effectively. There are a myriad of dressings which help prevent infection and promote healing of the skin tissue but given that not infrequently many people spend many months on bed rest, this will give you an indication as to how successful these dressings are at treating the sore successfully and efficiently. For sores that simply won’t heal, surgery is considered an option but this is still viewed by medical professionals as a last resort. This is in part because often infections occur when the skin breaks down and this can make surgery very complicated, if at all possible.
Therefore the treatment and management of wound therapy currently centres on prevention if possible and then 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.
However, there is another option, but sadly one not too many people know about. This is Acapsil.
What is Acapsil?
Acapsil is effectively a white, odourless natural powder that is placed on the wound and then covered with a light permeable dressing if needed. The frequency with which Acapsil needs to be applied will depend on the age of the wound when it is first treated with Acapsil and you should seek professional advice on this, at the point of using it.
The beauty of Acapsil 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 simply it can be used are available on Willingsford Healthcare’s website.
Although it is a powder, it is classed as a medical device and a treatment for wounds. It is available in a professional and an over-the-counter version, so individuals can buy the product themselves.
How does Acapsil work?
Acapsil works as a passive immunotherapy which removes wound infections and supports healing. It disrupts the weaponry used by infective bacteria and fungi against the immune system. This in turn 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.
Acapsil removes antibiotic resistant infections and will not cause resistance. Willingsford Healthcare state that in comparison, new data shows that antiseptics and disinfectants make bacteria resistant to a wide range of our antibiotics.
Speeding up wound healing
According to Willingsford Healthcare, comparative studies show that Acapsil removes wound infections 60% quicker than antibiotics and antiseptics.
In an evaluation of dehisced surgical wounds, Acapsil reached the same healing stage in 4-5 days which normally requires 3 weeks with NPWT (vacuum pump).
Is Acapsil just for pressure sores?
Acapsil can be used not just for pressure sores but also for leg ulcers, diabetic foot ulcers, trauma wounds or surgical wounds which just won’t heal.
However, not many healthcare professionals are aware of its existence, its potential to speed up wound closure, nor how to gain access to it for their patients.
Why are healthcare providers not talking about Acapsil more?
The short answer is that it is not clear why not. Some spinal rehabilitation consultants are aware of the product and have seen the benefits. Raising awareness responsibly is the next key step.
There is also the issue of funding. Getting funding for products to be used within the NHS is not a straightforward matter. It is a complex and can vary depending on the region of the UK. What will always be at the forefront of considerations is whether the cost of the product can deliver enough benefit and improve the QALY (essentially the quality of life of the person given the years left to live) as per NICE definitions.
However, to my mind this is something that will be driven by patients and quite simply results. The proof will be in the pudding. If the product works, speeds up wound healing, reduces time spent on bed rest as well as reduces the financial spend on numerous dressings, antibiotics, healthcare professional’s time and time spent in a hospital bed, then this will become a no brainer.
How do I access Acapsil?
Everyone is different and when someone has a complex condition such as a spinal cord injury it is vital that you consult your medical team before commencing with any treatment yourself just in case it is not suitable or contra indicated.
However, given the lack of awareness of this product amongst healthcare professionals, it may require you to take the lead by making contact with your lead physician to see if they have heard of Acapsil and if so, whether they would consider it 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 have 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 Acapsil, it very much surprised me that I was not told of this product when I had my most recent skin breakdown a few weeks ago.
Like many patients, I want to ensure any treatments or products that I use, is with the agreement, support and approval of my treating team.
I therefore contacted my consultant to ask his views and see whether this was something he was aware of. The response so far has been that some Tissue Viability Nurses (TVNs) have heard of it, but not all and there is less awareness amongst consultants. Those that have heard of Acapsil are not fully up to speed on how it works and or whether it could be of use to their patients.
Fortunately, my consultant was able to take a view and stated he would support the use should my skin breakdown in future. I therefore contacted Willingsford Healthcare who were able to provide me with a sample that I could use for when this might occur. If and when my skin breaks down in future, I will contact my local spinal injury to let them know, send photos and state that I will be trialling Acapsil. I have no idea if it will work on me, but from what I have read and seen, this is the most innovative product in recent years that actually tries to reduce the time spent waiting for a wound to heal and, crucially, has a track record of doing so.
Raquel Siganporia is head of the Spinal Injuries team and partner at Bolt Burdon Kemp. If you or a loved one have suffered a spinal injury as a result of result of an accident, someone else’s negligence or you are concerned about the treatment you have received contact Raquel in confidence on 020 7288 4844 or at firstname.lastname@example.org. Alternatively, complete this form and one of the solicitors from the Spinal Injury team will contact you. Find out more about the Spinal Injury team.