Researchers: Louise Skerritt (PhD Candidate, SETU), Professor Martina Gooney, Dr Linda Sheahan (SETU Department of Nursing and Healthcare).
Challenge:
The prevalence and cost of wounds in Ireland has been derived from UK data where it has been estimated that approximately 159,640 individuals within the Irish population, require wound care. It is estimated that the management of these wounds cost €629,064,198 per annum, representing 5% of public health expenditure. In fact, this is similar to the cost to tackle obesity, however, there are campaigns and specific programmes for obesity, but wound care has no public profile or public health campaigns. Examining the actual delivery of wound care in Irish community healthcare settings highlights that wounds are being treated in isolation. This compartmentalisation of wound care is resulting in fragmented care for patients, resulting negatively on the overall healing outcomes, and an overuse of antimicrobials which places a huge burden on health services limited resources.
Impact Summary:
This study has impacted the public health nursing service, primary care services and acute hospital services by highlighting the current delivery of wound care in a community care setting. This research has attracted attention from regional healthcare leaders, resulting in meetings to develop regional wound care strategies. Collaborations with the HSE led to plans for clinical decision-support software to improve prescribing and referral processes. The study has fostered partnerships with academic institutions and nursing bodies, driving capacity-building and the development of wound care micro-credentials and masterclasses at SETU. Beneficiaries include health authorities, clinicians, academic partners, and patients, with ongoing dissemination planned through publications, conferences, and policy initiatives to implement improved wound management practices nationwide.
Redefining Wound Management in Ireland
This research has transformed wound management practices in Irish healthcare by quantifying the number and types of wounds managed by community nurses and mapping treatment pathways (previously estimated from UK data). As the first Irish study using client chart data rather than questionnaires, it offers an accurate understanding of wound prevalence, treatment patterns, and costs within the national context.
Key Findings and Patient Impact
The study identified fragmented care, poorly standardised management, inconsistent clinical documentation, delayed diagnoses, over-reliance on GPs and specialists, inappropriate antimicrobial use, and high resource pressures. These issues increase costs, contribute to antimicrobial resistance, and negatively affect healing outcomes. The research established a baseline for improving antibiotic stewardship, early infection detection, and delivery of care tailored to wound type. This data provides service managers, service planners and wound care providers with a broad range of baseline information for quality initiatives and continuous quality improvement in wound care. Regional leaders and healthcare practitioners have begun implementing recommendations that are benefiting patients through more holistic, timely, and appropriate wound care, leading to higher healing rates and greater confidence in the health service.
System-wide Improvements and Collaboration
Community nurses, GPs, and practice nurses gained detailed data on wound management, opportunities to highlight barriers, and access to improved protocols, referral pathways, and governance structures. Healthcare policymakers have been informed and empowered to implement quality improvement initiatives, optimise resource allocation, and enhance health outcomes. Engagement with HSE regional teams, digital leads, and the National Wound Care Lead has advanced clinical judgment software development, timely referrals, and antimicrobial stewardship. Louise co-organised a Pressure Ulcer Master Class in April 2024 and a Leg Ulcer Masterclass in April 2025 at SETU, which provided training on the prevention and management of leg ulcers to support healthcare professionals in improving patient healing rates, reducing recurrence, and alleviating the burden of chronic wounds such as pressure ulcers and lower leg ulcers. Over 110 healthcare professionals from across the South East attended both days, including clinicians from private and public sectors, colleagues from pharmacy, and health and social care professionals, reflecting a broad commitment to improving patient outcomes.
Collaboration between the HSE, academic institutions, professional nursing bodies, and SETU’s Department of Pharmacy has fostered capacity-building initiatives, micro-credentials in wound care, and digital health integration. National recognition from HSE and IHA managers confirms the study’s influence on both policy and clinical practice. Improvements are being driven at the highest policy levels, where findings are informing strategic decision-making, governance, and resource planning, while simultaneously being embedded from the bottom up through masterclasses, frontline training, and the development of wound care modules for healthcare professionals. This dual approach is ensuring that systemic policy change is reinforced by enhanced clinical capability on the ground.
The research team has also been speaking and presenting to the senior regional executive team, which included the REO as well as other policy and programme developers. These stakeholders have begun incorporating the findings into practice and policy recommendations. This combined top-down and bottom-up strategy is expected to drive further improvements at both practical and policy levels, leading to lasting change across Irish wound care, improving patient outcomes, strengthening clinical decision-making, and enhancing health service efficiency, and positioning SETU as a leader in evidence-based, patient-focused wound care research.
This research represents phase one of a larger mixed-method study, comprising a quantitative, multisite retrospective chart review of consenting clients receiving wound care between 1 October 2020 and 30 September 2021. Data were collected directly from client charts rather than providers to prevent bias, across 11 health centres in a large Irish community healthcare area serving 135,507 people. Over 300,000 data points were analysed, offering a comprehensive picture of wound prevalence, assessment practices, and resource use. Several findings were compared with a smaller prevalence study conducted in the same area ten years prior, highlighting trends and systemic gaps.
Key findings revealed that 89% of community-managed wounds are chronic, yet holistic assessment was frequently lacking. Over a third of lower leg ulcers had incomplete or absent clinical documentation, 34% of lower leg ulcer patients were not referred for a wound diagnosis, and 55% of clients with diabetic foot ulcers were not referred to specialised foot care teams. These gaps indicate patients were often denied appropriate, timely care, leading to prolonged wound duration, advanced tissue damage, and increased healthcare resource use.
The study also highlighted the overuse of antibiotics, with nearly 80% of clients receiving prescriptions, often without documented infection, raising serious concerns for antimicrobial stewardship. Nurses spent 67% of their wound management time on wounds, despite these comprising just 16% of active caseloads, revealing significant resource inefficiencies.
The research has had substantial national and international impact, informing policymakers, healthcare managers, and clinicians about systemic shortcomings in wound care. Its findings have sparked high-profile discussions with HSE regional teams and influenced professional practice, while publication in a high-impact journal and recognition through the UHW Research Award and the EU-CONEXUS competition have amplified its reach.
By quantifying the scale, complexity, and systemic failings of community wound care, this research underlines the need for early, holistic assessment protocols, standardised referral pathways, and targeted educational initiatives. It provides evidence to improve patient outcomes, reduce unnecessary antibiotic use, and optimise nursing resources, laying the groundwork for a more coordinated, efficient, and sustainable wound care system in Ireland.
Testimonials
“This is exactly the type of educational initiative we need to keep leg ulcer care on the health care agenda.” Wound Care Masterclass 2025 Participant
“The sessions were expertly delivered and the workshops integrated the morning sessions in a practical way”. Wound Care Masterclass 2025 Participant
“This is a great piece of work that needs to be highlighted at a regional level”. IHA manager.
“Your paper was very well written, and I have been referring to it for all of our national documents on wound care and antibiotic use”. National Wound Care Lead
Media
PhD candidate Louise Skerritt wins prestigious Simon Cross Research Prize
Department of Nursing and Healthcare - Leg Ulcer Masterclass
Publications
Skerritt, L. and Moore, Z., 2014. The prevalence, aetiology and management of wounds in a community care area in Ireland. British journal of community nursing, 19(Sup6), pp.S11-S17. https://doi.org/10.12968/bjcn.2014.19.Sup6.S11
Skerritt, L., Gooney, M. and Sheahan, L., 2025. The provision of wound care and management in a community healthcare setting: an exploratory study. Journal of Wound Care, 34(1), pp.74-87. https://doi.org/10.12968/jowc.2024.0108
Mental Health Ireland, Mental Health Services in Wexford, Mental Health Services Executive for the South East Region, Local Sports Partnership (Sports Active Wexford).
This PhD research was self-funded in year one and year two. Year three, four and five have been funded (annual fees only) by the SETU Department of Nursing and Health Care.
