Chapter 4. Wound Care
Wound healing is a complex process. To ensure optimal wound healing, it is essential to identify and control underlying issues that may prevent a wound from healing. Controlling blood sugar levels, limiting smoking, and observing proper nutrition all have a significant impact on the healing process. It is important to educate patients on these modifiable risk factors to promote wound healing. Understanding the process of wound healing, the use of a comprehensive assessment, and the appropriate selection of wound care products can maximize the wound healing process.
- Wound care requires a complete assessment prior to initiating wound treatment. Always compare assessments with previous findings to assess whether wound is healing and if wound treatment is effective.
- Treat the patient (modifiable external and internal factors) and the wound to optimize the healing process.
- Select the appropriate wound treatment based on the wound characteristics, type of wound.
- Understand the differences between types of wounds and causes, and follow procedures for best practice in the acute and clinical setting.
Suggested Online Resources
- Canadian Association of Wound Care (CAWC): Education. This website offers an education section for health care professionals using various methods to provide flexible, interprofessional education that supports the learning needs and professional career growth in the areas of skin health, wound prevention, and management.
- Connecting Learners with Knowledge (CLWK). This website started as a pilot project in 2010 and was created by nurses to explore innovative ways to meet their education needs. Membership grew considerably, and it soon became a permanent, living resource. In February 2014 it merged with QExchange.ca, which was home to communities for British Columbia health care providers. CLWK is now a growing group of communities that support health care providers as they network and improve care.
- Connecting Learners with Knowledge (CLWK): Skin & wound care. These interactive e-learning modules cover skin and wound care and each take about 25 to 30 minutes to complete.
- Provincial Infection Control Network of British Columbia (PICNET). This is the website for PICNET, a program of the Provincial Health Services Authority. Its mission is to reduce health care-associated infections by improving infection prevention control practices.
- Vancouver Coastal Health: How wounds heal. This 30-minute video is designed for health care professionals who wish to improve their understanding of wound and skin care. Information includes the definition of a wound, the three classifications of wound healing or closure, the trajectory of wound healing, and reasons for delayed wound healing.
- Vancouver Coastal Health: Wound assessment. This 30-minute video is designed for health care professionals who wish to improve their understanding of wound and skin care. Information includes basic wound etiology, wound location, and wound assessment parameters.
Agency for Clinical Innovation. (n.d.). Pigtail drain with thread formation of pigtail shape [Photo]. Retrieved from https://www.aci.health.nsw.gov.au/resources/respiratory/pleural-drains/pleural-drains-in-adults/section-1-pre-insertion/tube-selection.
Alavi, A., Archibald, G., Botros, M., Brassard, A., Coutts, P. M., Cross, K., … Woo, K. (2015). Summary of An Overview of Advanced Therapies in the Management of Diabetic Neuropathic Foot Ulcers. Wound Care Canada, 13(2), 10-17. Retrieved from https://www.woundscanada.ca/docman/public/wound-care-canada-magazine/2015-vol-13-no-2/546-wcc-fall-2015-v13n2-advanced-therapies/file.
British Columbia College of Nursing Professionals. (2019). RN scope of practice standards | Autonomous scope and client-specific orders. Retrieved from https://crnbc.ca/Standards/Lists/StandardResources/804ScopeStandards.pdf.
British Columbia Institute of Technology (BCIT). (2010a). Simple dressing change. Skills checklists.
British Columbia Institute of Technology (BCIT). (2010b). Drain removal. Skills checklists.
British Columbia Institute of Technology (BCIT). (2010c). Removal of sutures and staples. Skills checklists.
British Columbia Provincial Nursing Skin and Wound Committee. (2011). Guideline: Assessment and treatment of surgical wounds healing by primary and secondary intention in adults & children. Retrieved from https://www.clwk.ca/buddydrive/file/guideline-surgical-wounds-primary-secondary-intention/.
British Columbia Provincial Nursing Skin and Wound Committee. (2014). Guidelines: Braden scale for predicting pressure ulcer risks in adults and children/infants. Retrieved from https://www.clwk.ca/buddydrive/file/guideline-braden-risk-assessment/.
British Columbia Provincial Nursing Skin and Wound Committee. (2017). Procedure: Wound packing. Retrieved from https://www.clwk.ca/buddydrive/file/procedure-wound-packing/.
Gallagher-Camden, S. (2012). Skin care needs of the obese patient. In R. A. Bryant & D. P. Nix (Eds.), Acute and chronic wounds: Current management concepts (4th ed.). St. Louis, MO: Mosby.
Häggström, M. (2010). Phases of wound healing. Limits vary within faded intervals, mainly by wound severity [Infographic]. Wikimedia Commons. Retrieved from https://commons.wikimedia.org/wiki/File:Wound_healing_phases.svg.
Harris, C., Kuhnke, J., Haley, J., Cross, K., Somayaji, R., Dubois, J., … Lewis, K. (2018). Best practice recommendations for the prevention and management of surgical wound complications. Canadian Association of Wound Care. Retrieved from https://www.woundscanada.ca/docman/public/health-care-professional/bpr-workshop/555-bpr-prevention-and-management-of-surgical-wound-complications-v2/file.
Healthwise Staff. (2017, May 16). Incision care after surgery. Retrieved from Government of British Columbia, HealthLinkBC website: https://www.healthlinkbc.ca/health-topics/tc4128spec.
Interior Health. (2016). Infection prevention and control manual. Retrieved from https://www.interiorhealth.ca/AboutUs/QualityCare/IPCManual/Entire%20Infection%20Control%20Manual.pdf.
International Wound Infection Institute (IWII). (2016). Wound infection in clinical practice. Wounds International. Retrieved from http://www.woundinfection-institute.com/wp-content/uploads/2017/07/IWII-Consensus_Final-2017.pdf.
Jones, S. (2007). 5 stitches on the finger [Photo]. Wikimedia Commons. Retrieved from https://commons.wikimedia.org/wiki/File:Stitches_2.jpg.
Kerr, J. R., Wood, M., Astle, B., & Duggleby, W. (2014). Canadian fundamentals of nursing (5th ed.). Toronto, ON: Elsevier.
Munteanu, A., Florescu, I., Nitescu, C. (2016). A modern method of treatment: The role of silver dressings in promoting healing and preventing pathological scarring in patients with burn wounds. Journal of Medicine and Life, 9(3). Pp 306-315. PMID: 27974941
Norton, L., Parslow, N., Johnston, D., Ho, C., Afalavi, A., Mark, M., … Moffat, S. (2018). Best practice recommendations for the prevention and management of pressure injuries. Canadian Association of Wound Care. Retrieved from https://www.woundscanada.ca/docman/public/health-care-professional/bpr-workshop/172-bpr-prevention-and-management-of-pressure-injuries-2/file.
Perry, A., Potter, P., & Ostendorf, W. (2014). Clinical skills and nursing techniques (8th ed.). St. Louis, MO: Elsevier-Mosby.
Perry, A., Potter, P., & Ostendorf, W. (2018). Clinical skills and nursing techniques (9th ed.). St. Louis: Elsevier-Mosby.
Radiology Society of North America (RSNA). (2018). Percutaneous abscess drainage. Information for patients. Retrieved from https://www.radiologyinfo.org/en/info.cfm?pg=percabscessdrn.
Saskatoon Health Region. (2013). Drains: Emptying, shortening and removal. Policies and procedures. Retrieved from https://www.saskatoonhealthregion.ca/about/NursingManual/1100.pdf.
Spiliotis, J., Tsiveriotis, K., Datsis, A. D., Vaxevanidou, A., Zacharis, G., Giafis, K., … Rogdakis, A. (2009). Wound dehiscence: Is still a problem in the 21st century: A retrospective study. Retrieved from http://www.wjes.org/content/4/1/12.
Stotts, N. A. (2012). Nutritional assessment and support. In R. A. Bryant & D. P. Nix (Eds.), Acute and chronic wounds: Current management concepts (4th ed.). St. Louis, MO: Mosby.
Vancouver Coastal Health Authority. (2009). Wound assessment course. Retrieved from http://ccrs.vch.ca/onlinecourses/wound_management/woundassessment_v4/index.html.
Wellmann, K.-H. (2013). Surgical staples after totel hip replacement (right thigh), 13th day after surgery [Photo]. Wikimedia Commons. Retrieved from https://commons.wikimedia.org/wiki/File:Hip_replacement,_surgical_staples_01.JPG.
Wiegand, C., Tittelbach, J., Hipler, U., & Elsner, P. (2015). Clinical efficacy of dressings for treatment of heavily exuding chronic wounds. Chronic Wound Care Management and Research, (2), 101-111. https://doi.org/10.2147/CWCMR.S60315.
World Health Organization. (2009). Glove use information leaflet. Retrieved from http://www.who.int/gpsc/5may/Glove_Use_Information_Leaflet.pdf.
World Health Organization. (n.d.). Practical suture techniques. Retrieved from http://www.who.int/surgery/publications/s16383e.pdf.