ghp July 2015 | 17 public health implementation of guidelines for leg ulcers (more information available at www.ewma.org ). EWMA also collaborates with other societies, such as the Interna- tional Working Group on the Diabetic Foot (IWGDF) and the European Pressure Ulcer Advisory Panel (EPUAP) to actively support large scale implementa- tion of the available European guidelines. Focus on prevention – a patient safety issue Pressure ulcers are a preventable, yet common prob- lem. Internationally, prevalence rates vary from 8.8% to 53.2 %, while incidence rates from 7 % to 71.6 % (14). Thus the prevention of pressure ulcers does constitute an important patient safety issue and po- tentially, significant resource savings if the appropri- ate prevention measures are effectively implemented. Another area with the potential for great improve- ments for the patients, as well as resource savings is nosocomial infections. Even though the focus on patient safety has increased in recent years, owing to, among other things, the focus on this topic in the EU Commission 1 (15), there is still a long way to go with regards to prevention of pressure ulcers. Insufficient prevention measures relate back to the lacking adop- tion of evidence based guidelines, including appropri- ate risk assessment tools. To enhance the recognition of pressure ulcers as a significant patient safety issue, and thereby promote the adoption of evidence based guidelines for pressure ulcer management, EWMA in- itiated a series of activities promoting pressure ulcers to be mentioned as a specific focus area within the communications of the EU Commission 2 (15). Challenges related to the prevention and manage- ment of nosocomial infections are further covered in the next section. Supporting appropriate use of antimicrobials in wound management Wounds are predisposed to infection, as the expo- sure of subcutaneous tissue following a loss of skin integrity provides a moist, warm, and nutrient-rich environment that is conducive to microbial colonisa- tion and proliferation. Consequently, the use of anti- microbial agents is important in wound management. Inappropriate use of antimicrobials, however, creates an environment for resistance against the currently available antimicrobial products. This may have supported cases of non-use, where antimicrobials could have supported more efficient treatment of the infection and decreased the risk of complications and death. On the opposite side, over-use of antimicrobial agents is a well-known general problem contributing to the development of antimicrobial resistance, as well as an ineffective use of health care resources (16). At present, there is a lack of a consistent approach to defining, evaluating, and measuring the appropriate and adequate use of antimicrobials locally/topically in wound management. This represents a challenge with regards to ensuring effective wound management. These problems are outlined in a recently published document by the European Wound Management Association (EWMA): Antimicrobials and Non-healing Wounds (17). To further support the antimicrobial re- sistance agenda at implementation level, EWMA is cur- rently launching a European Antimicrobial Stewardship Programme which aims to reduce inappropriate use of antimicrobials by promoting, facilitating and teaching good antimicrobial practice in wound management. Conclusion Non-healing wounds are one of the most frequent problems in health care across Europe, concerning a large number of medical specialties and professions. The consequent implementation of existing treatment guidelines by an interdisciplinary and multidisciplinary team would help to reduce the suffering of those af- flicted with such a wound, as well as reduce the eco- nomical burden that non-healing wounds represent. 1 The European Commission within the Public Health Programme co-funded and supported the establishment of The European Union Network for Patient Safety and Quality of Care, PaSQ Joint Action, http://www.pasq.eu/ 2 http://ewma.org/english/ewma-activities/advocacy-activi- ties.html (Visited June 2015) References 1. Dale, J.J., et al., Chronic ulcers of the leg: a study of prevalence in a Scottish community. Health Bull (Ed- inb), 1983. 41(6): p. 310-4. 2. Posnett, J., et al., The resource impact of wounds on health-care providers in Europe. J Wound Care, 2009. 18(4): p. 154-161. 3. Hjort, A. and F. Gottrup, Cost of wound treatment to increase significantly in Denmark over the next decade. 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