4.4 Wound Management

The science of wound management has grown tremendously in recent years. As our understanding of wound healing has grown, so has the number of products used to manage wounds. For purposes of this textbook, brief discussions of different types of dressings are included. The reader is encouraged to further their understanding of wound healing through other sources and to seek the skills of wound care experts in practice.

Purposes of a dressing (Kerr et al, 2014):

• Protects from microorganisms entering the body
• Protects fragile wound bed
• Aids in hemostasis
• Absorbs drainage, and assists autolytic debridement
• Supports the wound and site (i.e., pressure dressing)
• Provides thermal insulation of the wound surface
• Provides wound bed with a moist environment

Wound management occurs on a continuum from what many nurses refer to as simple dressing changes (such as a surgical wound) to complex wound management involving things like wound irrigation, vacuum assisted closure, and use of manufactured products designed for specific wound needs. The bottom line is that dressings have different purposes, and the dressing chosen should be appropriate to the wound’s needs.

Wound management follows the nursing process in terms of:

•  Assessment and reassessment: Assess the whole patient not just the “hole in the patient.” Assessment must include patient and other factors that are influencing wound healing. This often includes a multidisciplinary approach with the patient at the centre. Continual reassessment of the patient and the wound are essential
• Setting goals: Ideally the patient and healthcare team cooperate to determine and identify goals that take into account the patient’s values and beliefs and a realistic vision of the wound’s capabilities. For example, some wounds will not heal, in which case quality of life and symptom control might be the most reasonable expectations.
• Intervention and implementation: These are the strategies used to promote wound healing. Multiple strategies might be necessary including optimizing nutrition, oxygenation, and the appropriate selection and use of particular wound care products.
• Evaluation: Links back to assessment. Did the interventions work? If not, why? Review and reconsider interventions and implementation.

Terms that sometimes confuse people:

Aseptic technique: The purposeful prevention of the transfer of microorganisms from one person to another by keeping the microbe count to a minimum, and for assuring that cross-contamination does not occur. The technique chosen is based on dressing procedure, client setting, and agency policy. Principles of asepsis apply to all of them. There are three different applications of aseptic technique for the nurse to consider (British Columbia Provincial Nursing Skin & Wound Committee, 2011):

• Sterile technique: The use of sterile gloves, field, tray, instruments solutions, and dressings. This is similar to no touch technique, but you use sterile gloved hands to manipulate your equipment. Appropriate for surgical wounds, drain sites, wound irrigation, and wound packing.
• No touch technique: The use of clean gloves and sterile field, tray, instruments, solutions; sterile instruments are used for direct contact with the wound; dressings are to be sterile. This is the same as sterile technique, but you use instruments to manipulate your equipment.
• Clean technique: The use of sterile solutions, clean gloves, and clean dressings. Appropriate for chronic wounds (e.g., diabetic foot ulcers, pressure ulcers).