Principles of Wound Care

1. Principles of Wound Care Professor Claire Hale

2. What is a Wound? Any break in the continuity of body tissue Examples: grazes, burns, surgical incisions, stabs, leg ulcers, decubitus ulcers ( pressure sores)

3. Stages of Wound Healing • Stage 1 - traumatic inflammation ( 0-3 days)- redness, heat, swelling • Stage 2 -destructive phase ( 2-5 days)- polymorphs and macrophages clear the wound of debris and stimulate new growth • Stage 3- the proliferative phase( 3-24 days increased collagen formation • Stage 4- maturation phase ( 24 days-1 year) scar tissue decreases granulating tissue gets stronger and changes from reddish to pale

4. Closure of Surgical Wounds • Primary closure - first intention ( direct suture- if no tissue loss • Delayed primary closure- usually when a drain is left in situ. • Secondary intention - wound closes by a process of contraction and epithelialisation e.g ulcers and pressure sores

5. Factors Influencing Wound Healing • Good blood supply: ( oxygen, nutrients) • Good nutrition: • Rest: skin cells multiply more rapidly during sleep • Lack of stress: increased levels of adrenaline and steriods delay healing • Lack of infection: • Age : children heal more rapidly than older people • Site of wound: face and neck heal more rapidly

6. General factors poor diet anaemia pulmonary disease cardiac insufficiency arteriosclerosis diabetes mellitus smoking Jaundice malignant disease high blood urea stress lack of sleep drug therapy e.g. steroids and cytotoxic radiotherapy Factors Delaying Wound Healing

7. Local to patient/wound skin edges not lined up dead tissue in wound foreign bodies in wound tension on wound infection irritant material for suturing too tight suturing Factors Delaying Wound Healing

8. Complications of wounds • Haemorrhage ( surgical wounds) • Infection • non union • rupture ( dehiscence) • pressure and strain ( coughing vomiting) • over granulation of scar tissue • contractures

9. Caring for Wounds Assess for: • type of wound • location of wound • size of wound • shape of wound • level of exudate • condition of wound bed • condition of surrounding skin

10. Caring for Wounds Recognising inflammation • redness over area and surrounding tissue • swelling • heat • pain/ tenderness • loss of function

11. Caring for Wounds • cleansing wounds • should it be done? • what should be used? • how should it be done/ • types of dressing • who makes the decision

12. Cleansing wounds: an area where ritualistic practice predominates Key questions: 1. Does the wound really need cleaning? 2. What is the safest method that causes no ill effects and maintains the wound temperature? 3. What is acceptable to the patient? Wounds that are clean and healthy do not require cleaning and should be left alone

13. Cleansing wounds: Main reasons • Excess exudate and signs of infection • Foreign body contamination ( eg. grit in a graze) • Presence of devitalised tissue ( slough or necrotic tissue) • To assess the wound • psychological reasons

14. Types of Cleansing Fluids • Antiseptics: generally discouraged now- can be toxic to tissue healing • Saline solutions: normal saline sachets commonly used • Tap water: Why not!! tip: cleansing fluids should be at body temperature

15. Methods of Cleansing • Swabbing: not particularly effective, mainly redistributes organisms • Bathing: useful for chronic wounds such as leg ulcers. Take care with equipment to avoid cross contamination • Irrigation: shower head, waterjug, syringes - don’t be overzealous

16. Choice of Dressing The concept of moist wound healing Modern dressingtechnology is basedon the principle that the wound /dressing interface should be moist rather than dry. In other words scabs are bad!

17. Capable of maintaining high humidity at wound site free of particles and contaminants] non toxic / non allergenic capable of protecting the wound from further trauma Impermeable to bacteria thermally insulating capable of allowing gaseous exchange] able to withstand infrequent changes cost effective long lasting Common characteristics of wound dressings

18. Patient Factors Influencing the choice of dressing: • Age • Lifestyle • Medical History • Care environment • Ability to maintain /change own dressing • Competence and willingness of potential carers

19. Types of Dressings • Low adherent dressings-Tullegras,Tegapore • Semi permeable films- Opsite, Tegaderm • Hydrocolloids - Comfeel plus, Granuflex • Hydrogels- Intrasite, Sterigel • Alginates- Sorbisan, Kaltostat • Foam dressings- Cavicare, Lyofoam extra • Antimicrobial dressings- Actisorb plus, Inadine

20. Minimising Cross Infection • Dressing and cleansing wounds is at the very minimum a Clean Procedure and is often an Aseptic Procedures • Thorough hand-washing and use of gloves are the most effective methods of preventing contamination of the wound • If wounds are infected then care must be taken to prevent cross contamination