H.C.A TRAINING WOUND MANGEMENT

Sally Panto

Aug. 2006

AIM

• H.C.A will undertake training in management of a variety of simple wounds

OBJECTIVES

• To have awareness of stages of wound healing

• To demonstrate knowledge of factors affecting wound healing

• To develop knowledge in wound assessment

OBJECTIVES

• To accurately complete wound assessment chart and evaluations

• To demonstrate ability to select the ideal dressing

4 Stages of Wound Healing

• Haemostasis

• Inflammatory response

• Proliferative response

• Maturation

Diseases affecting wound healing

• Anaemia• Diabetes• Venous disease• Oxygen deficiency• Arterial insufficiency• Rheumatoid arthritis• Malignancy• Immunosuppression

OTHER FACTORSaffecting wound healing

• Wound specific slough/necrosis wound infection oedema Poor wound management traumatic cleaning/ dressing removal

Further Factors affecting Wound healing

• Too frequent dressing changes

• Inappropriate choice of dressing

• Systemic Factors

• Nutrition fluid intake

• Stress Drugs e.g. cytotoxic or steroids

• Radiotherapy

• immobility

• Smoking

• Incontinence

• Age

• Ischaemia

Wound assessment

• Allows for wound care to be evaluated

• Monitor progress

• Communication between team

• Documentary evidence

When to Assess

• Initial Visit

• Evaluation date

• Change in wound condition

• When healed

Wound Assessment

• Type of Wound• Useful and standard terminology - refer to laminate

sheet• Granulation tissue• Overgranulation• Epithelialisation• Necrosis• Eschar• Slough• Exudate• Odour

Wound Assessment

• Site of Wound

• Wound Measurement

• Wound bed

• Surrounding skin

• Skin edges

• Pain

Cavity woundsExample Pilonidal sinus

• This type of wound often requires daily dressing • Wound heals by secondary intention • Wound encouraged to heal from base & aim to

prevent premature closure of wound edges

Important to adequately but loosely insert packing into cavity

To remeasure at least weekly

Appropriate equipment in dressing these wounds

Infection Control& Safe Disposal of Waste

• Discuss Policy for the Management of Waste –Newark and Sherwood PCT(2003)

• Aprons• Gloves• Clinical Waste disposal in patients home

clinic setting

care home

When to arrange council clinical waste- yellow bag

Wound Assessment& Documentation

• Consulting nursing notes and care plans

• Completing wound assessment chart

• Evaluation sheet in Nursing notes• All notes to be recorded at time of visit• Any concerns to be promptly reported to nurse

in charge

Wound Photography

• Patient consent and explanations

• Consent form

• Best practice in taking photographs

• Is a photograph appropriate• Frequency

MRSA

• Carried on either skin or in nose of 30-50% of population (Colonisation)

• Good hand hygiene is essential for the prevention of transmission of MRSA

• Treat all patients as potentially infectious• How is MRSA spread• Educate patient on importance of hand washing and

discourage from touching broken skin or wounds• Use of alcohol hand rub• Ensure scissors are washed before each patient use

steri swabs if dressings need to be cut

MRSA

• Whenever possible visit infected patients at end of list of patients

• Principles of good infection control apply to all patients not just those with known infections

Ideal Dressing

• Moist environment• Manages exudate• Low or non adherence• Insulation• Protection• Acceptable• Cost effective• Treat symptoms