Chronic wounds such as diabetic foot ulcers and bed sores in elderly lead to longer hospital stays, adds strain on resources

A five-year study in Singapore has highlighted that chronic wounds among patients with diabetic foot ulcers and bed sores led to longer hospital stays.

Alleviating the Social and Economic Burden of Wound Care

On 14 April 2021, a Memorandum of Understanding (MoU) was signed between Tan Tock Seng Hospital (TTSH) Centre For Asian Nursing Studies (CANS) and the Skin Research Institute of Singapore (SRIS), a tripartite1 hosted by the Agency for Science, Technology and Research (A*STAR). It aims to further research collaboration between the parties for improved chronic wound care outcomes. (chronic wounds i.e. pressure injury (bed sore), diabetic foot ulcer, venous leg ulcer, surgical site infections.)

The Importance of Wound Care Innovation in the Tropics

In collaboration with SRIS’ Wound Care Innovation for the Tropics (WCIT) programme2 , a five-year study (2013 to 2017) has highlighted that chronic wounds among patients with diabetic foot ulcers and bed sores led to longer hospital stays3 . The paper gathered data on chronic wounds among elderly patients at Tan Tock Seng Hospital (TTSH) via an e-Wounds4 system.

On a whole, the average length of stay for each wound episode was 17.7 days, which is 2.4 times that of the average length of stay within TTSH5 . This increases economic burden on healthcare resources, with significant reduction in quality of life for affected patients.

The journal paper, titled ‘Clinical and economic burden of wound care in the tropics: a 5-year institutional population health review’, was published by the International Wound Journal and authored by clinicians and nurses from institutions within Healthcity Novena – TTSH, Nanyang Technological University Lee Kong Chian School of Medicine, SRIS, A*STAR and the Health Services and Outcomes Research from the National Health Group.

It is the first paper from the Tropics to comprehensively evaluate the clinical and economic burden of various wounds types at hospital level. Chronic wounds are often under-reported, as they are considered complications of other diseases. This is further compounded by the lack of data from this part of the world.

The study recorded a total of 56,583 wound-related inpatient admissions for 41,461 patients, with a 95.1% increase in wound episodes from 2013 to 2017. 51.9% were moderately or severely frail6 . This is because as seniors age, they may eat less, lose muscle, and become more prone to illness. 41.3% had two or more wound-related admission episodes.

The wounds were broadly classified into diabetic foot ulcers (neuro-ischaemic ulcers ), slow-healing leg sores due to poor blood circulation in the leg (venous leg ulcers ), bed sores (pressure injuries ), and infection that occurs after surgery (surgical site infections ), as tracked by the eWounds system.

Compared to the national average of 29% for inpatients above 65 years in Singapore, TTSH has double of that with 53%. In view of an ageing population where one in four Singaporeans is expected to be 65 and above in 2030, the burden of wounds will continue to be a significant and increasing in Singapore.

As such, a multi-disciplinary and collaborative strategy must be adopted to tackle this issue, such that benefits for patients, clinicians, and healthcare systems, may be achieved.

How the MoU between TTSH’s Centre For Asian Nursing Studies (CANS)7 and SRIS, via the Wound Care Innovation for the Tropics (WCIT) programme, can lead to further collaborations between the public healthcare, research and education partners

The partnership will enable continued collaboration in the areas of: 

  • Better understanding of pressing needs in chronic wound care. This will facilitate care that follows an elderly patient from an acute hospital care setting to a community or home setting, and improve the quality of life for patients with chronic wounds. This will be further supported by a robust access to network of care partners in the community (i.e. Nursing Homes, Agencies that coordinate care for patients with chronic wounds)
  • Training opportunities for local nurses. i.e. Initiative Chronische Wunden (ICW), endorsed by the European Wound Management Alliance (EWMA)
  • Driving innovation for products that can aid wound healing.
    1. Example: Disposable Pressure Sensor for Compression Therapy in Venous Leg Ulcers. A disposable pressure sensor made of thin multilayer film consisting of an array of micron-sized chambers (imagine a microscopic “bubble wrap”), each filled with a dye solution. Upon compression, the micro-chambers will rupture and release a dye to provide an indication that sufficient pressure is achieved.
    2. This “micro-bubble wrap” is developed locally (by SRIS and A*STAR’s Institute of Materials Research and Engineering (IMRE), as well as TTSH) for purpose of wound care and training tool for nurses, to ensure that the right pressure is delivered in the compressing bandages to treat venous leg ulcer.
    3. This innovation serves to guide nurses on the level of pressure delivered upon application and improves the effectiveness of compression therapy by eliminating the uncertainty of the required pressure during application. It could also potentially reduce the burden of specialist nurses caring for patients with chronic wounds, as this Pressure Sensor Tool can help to widen the pool of nurses with the required skills to handle chronic wounds. At present, and also as reflected in the research paper, most of the follow-up care for VLUs takes place at the specialist outpatient and primary care setting.

Interviews with relevant spokespersons for the projects listed above are available upon request.

For media enquiries:

Ms Charlene Tan
Senior Executive, Communications
Tan Tock Seng Hospital
Tel: 6357 8414 | 9634 3443
Email: [email protected]

Ms Yip Min-Ting
Assistant Head, Corporate Communications
Agency for Science, Technology and Research (A*STAR)
Tel: 65171977
Email: [email protected]


1 SRIS is a tripartite partnership between the Agency for Science, Technology and Research (A*STAR), the National Healthcare Group (NHG) and Nanyang Technological University (NTU).
2 The Wound Care Innovation for the Tropics (WCIT) programme is a first-of-its-kind research programme in the world that focuses on wound care in tropical climates. It aims to transform the care of hard-to-heal chronic wounds and reduce its corresponding economic and social burden.
3 15.8 days for patients with diabetic foot ulcers, and 18.6 days for patients with bed sores.
4 The e-Wounds system is an electronic wound documentation system that not only tracks types of wounds seen in patients at TTSH, but also guides nurses based on an algorithm, on what could be done to manage wounds.
5 7.3 days for an average acute admission
6 Frailty is characterised by ageing-related weight loss, reduced muscle strength and a slower walking pace.
7 In 2019, CANS became the first in Asia to offer an advanced Wound Care programme, with an Initiative Chronische Wunden (ICW) certification for healthcare professionals across the country and region. This was achieved with the support of the Wound Care Innovation for the Tropics (WCIT) Programme in SRIS.


About the Centre For Asian Nursing Studies (CANS)

Centre For Asian Nursing Studies (CANS) was established in 2016 to generate nursing thought-leadership that is uniquely Asian focused. CANS is a member of the CHI Co-learning network. CANS supports the projects run by these 5 Clinical Care Streams, as aligned with the foci of Singapore's healthcare system:

• Wound
• Diabetes Mellitus
• Population Health
• Infectious Diseases
• Frailty Care Stream.

These Clinical Care Streams seek to improve and implement innovative and pioneering solutions to inevitable problems of the future.

With Research, Innovation and Education Faculties and Advisory Council, comprising local and overseas partners, the goal is to grow our sustainable network. This network enables members to Co-Learn, Co-Create, and Co-Lead with partners, sharing knowledge and resources, creating and implementing advanced solutions to local and global challenges.

Through building connections, communities of practice, and coalitions of change, we will all lead in charting the growth of Asian nursing together.

More info here:

About the Wound Care Innovation for the Tropics (WCIT) programme by the Skin Research Institute of Singapore (SRIS)

Chronic Wounds pose a significant burden to healthcare systems, accounting for up to 10% of healthcare expenditure in developed nations. Furthermore, predicting wound healing is challenging for wound care professionals. The Wound Care Innovation for the Tropics (WCIT) programme is a first-of-its-kind research programme in the world that focuses on wound care in tropical 6 climates. It aims to transform the care of hard-to-heal chronic wounds and reduce the economic and social burden created by this silent epidemic. The programme brings together leading researchers, industry partners and clinicians to develop technologies and therapies for better wound care. WCIT focuses on accelerating the development of novel wound care therapies and practices, to transform how chronic wounds are detected, managed and monitored to accelerate the healing process. This will be achieved via:

• Better stratification of wounds
• Effective discrimination between healthily colonised and infected wounds
• Stimulation of healing, leading to a shorter time to wound closure

The integrated research activities in the WCIT Programme encompass the spectrum from quality improvement to disruptive technologies - this will enable product, service, process, system and social innovation in the wound healing space. Harnessing the best in science, technology and clinical understanding, the WCIT programme uniquely positions Singapore as the go-to Research and Innovation hub for chronic wound healing. More importantly, the programme charts a path to change the paradigm of wound care and healing, in Singapore and beyond.

More info here:

About the Skin Research Institute of Singapore (SRIS)

Established in 2013, SRIS is a collaboration between the Agency for Science, Technology and Research (A*STAR), the National Healthcare Group (NHG), and Nanyang Technological University, Singapore (NTU). Building on the strengths of each partner, this tripartite collaboration harnesses the expertise of scientists, clinicians and engineers to conduct high impact, interdisciplinary skin research that can be translated into improved patient care. In July 2018, SRIS formally became an A*STAR Research Institute and in May 2019, transitioned from being a virtual institute by establishing a physical presence in the Novena campus with headquarter laboratories running multi-disciplinary collaborative research programs.

Our research programmes bring together expertise in clinical dermatology, epidemiology, imaging, cell and molecular biology, bioinformatics, immunology, biomaterials, biomedical engineering, health economics and health services 7 research to address key clinical questions and to ensure that we have the best chance of success in translating our research to improve patient care.

Our technology platforms accelerate scientific discoveries and provide support to translate these into therapeutics. We partner with several technology and instrument providers, enabling researchers and industry to have the best and most up-to-date technology at their disposal. SRIS is also expanding its research and innovation efforts in the area of advanced skin imaging, image analysis and artificial intelligence, with the goal of transforming the paradigm of skin care through the introduction of digital dermatology and Health approaches.

About Tan Tock Seng Hospital

Tan Tock Seng Hospital (TTSH) is the flagship hospital of the National Healthcare Group and part of Singapore’s Public Healthcare System. As a pioneering hospital with strong roots in the community for over 175 years, TTSH is recognised as the People’s Hospital, serving a resident population of 1.4 Million living in Central Singapore.

Together, with 70 community partners and 80 community health posts, it brings care beyond the hospital into the community as an integrated care organisation – Central Health. As one of the largest multi-disciplinary hospitals in Singapore, TTSH operates more than 1700 beds with centres of excellence including the National Centre for Infectious Diseases (NCID), Institute for Geriatrics & Active Ageing (IGA), NHG Eye Institute (NHGEI), TTSH Rehabilitation Centre, and Ang Mo Kio Specialist Centre (AMKSC).

TTSH’s 600-bed Integrated Care Hub will be ready in 2022 to provide for subacute care and rehabilitation. As a healthcare leader in population health, systems innovation, health technologies and workforce transformation, TTSH hosts Singapore’s largest purpose-built innovation centre for healthcare – the Ng Teng Fong Centre for Healthcare Innovation (CHI) and its Co-Learning Network of 37 local and international partners.

About the Agency for Science, Technology and Research (A*STAR)

The Agency for Science, Technology and Research (A*STAR) is Singapore's lead public sector R&D agency, spearheading economic-oriented research to advance scientific discovery and develop innovative technology. Through open innovation, we collaborate with our partners in both the public and private sectors to benefit society.

As a Science and Technology Organisation, A*STAR bridges the gap between academia and industry. Our research creates economic growth and jobs for Singapore, and enhances lives by contributing to societal benefits such as improving outcomes in healthcare, urban living, and sustainability.

We play a key role in nurturing and developing a diversity of talent and leaders in our Agency and research entities, the wider research community and industry. A*STAR’s R&D activities span biomedical sciences and physical sciences and engineering, with research entities primarily located in Biopolis and Fusionopolis.

Published: 15 Apr 2021

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