Wound Dressing & Wound Care at Inline Health Chiropractic

NDIS Wound Dressing & Wound care plan management

Wounds may be acute or chronic as well as closed (under the skin’s surface such as with hematomas) or open due to trauma or surgery.

Wounds may also be classified due to cleanliness:

• Class 1 wounds (clean): Uninfected, with no inflammation, and primarily closed. Respiratory, genital, or urinary tracts are not affected.
• Class 2 wounds (clean-contaminated): Lack of unusual contamination. Affects the respiratory, genital, or urinary tracts in controlled conditions.
• Class 3 wounds (contaminated): Fresh, open wounds from poor sterile techniques or leakage. Incisions result in acute or lack of purulent inflammation.
• Class 4 wounds (dirty-infected): Result from poor interventions for traumatic wounds. Most commonly result from microorganisms present in perforated surgical sites.

Wound infection occurs when bacteria enter damaged skin and begin to proliferate. When the microorganism can penetrate the host’s defense mechanism (skin) and overwhelm the immune system and defense cells, infection occurs.

Poor aseptic technique and contamination cause wound infection. Pre-existing client conditions like diabetes mellitus or compromised immune systems may put the client at risk. Typically, an infection develops in 3 to 6 days following a skin injury.

Staphylococcus aureus (the most common skin flora), methicillin-resistant staphylococcus aureus (MRSA), and pseudomonas aeruginosa are the most common bacteria strains found in patients with infected wounds.

Symptoms of Infection

Symptoms of an infected wound include:

Tissue integrity restoration (wound healing) immediately takes place after skin injury. Any delay or disruption in the wound healing process can lead to infection. Wound healing has 4 main phases:

1. Hemostasis: Cessation of bleeding (coagulation, platelet aggregation, and activation of intrinsic and extrinsic coagulation pathways)
2. Inflammation: Immune system (neutrophils and macrophages) attempts to control the formation of infection in the wound
3. Proliferation: Scar tissue development (granulation tissue fills the wound bed and epithelial cells cover the wound)
4. Maturation: Collagen synthesis (collagen I replaces collagen III to close the wound)

Your Wound Nurse Will Do an Assessment

1. Assess the wound with each dressing change. Assess the size, color, depth, and presence of drainage or tunneling to determine whether treatment is effective or not.
2. Classify the type of wound. Identifying the type of wound is necessary for successful wound repair. Wounds can be categorized into five groups: avulsion, abrasion, puncture, laceration, and incisions. It can also be categorized according to duration (acute or chronic), skin damage (open or closed), or cleanliness and condition (from clean to infected).
3. Use a risk assessment tool. An evaluation of risks can be done by taking a patient’s medical history, performing physical exams, and running lab tests. Alcohol, smoking, and comorbidities (such as diabetes and hypertension) are common risk factors for poor wound healing.
4. Obtain a wound culture. Wounds can be swabbed to monitor for the presence of bacteria such as MRSA which can guide treatment.

Intervention

1. Disinfect the site with antiseptic. Use antiseptic wound cleansers to clean the wound. Refrain from using alcohol or harsh chemicals on the skin.
2. Decontaminate the skin injury. Remove any foreign objects to decontaminate the wound. Complete in a timely and consistent manner to revascularize and remove any necrotic tissue, which may lead to infections.
3. Remove any dying tissue. Debridement will ensure that the wound is kept free of necrotic tissue, which could be a source of pathogenic infections.
4. Apply appropriate wound dressings. Non-adherent saline wraps (saline-soaked gauze) and absorbent material are effective to prevent wound infection and promote tissue re-epithelialization. Secure the dressing with soft gauze tape. Asepsis in wound care will prevent further contamination of wounds.
5. Manage the wound based on the stages of healing. At various phases of healing, a wound will require changes to the wound care treatment such as changes in cleansers, ointments, or dressings.
6. Keep the wound moist. For some wounds, a moist environment speeds up the healing of a wound by maintaining hydration, boosting angiogenesis (bloody supply) and collagen formation, and accelerating the breakdown of dead tissue and fibrin. It also alleviates the pain and enhances the appearance of the wound.
7. Apply topical antibiotics and antiseptics as recommended. Topical antibiotics eliminate bacteria, whereas topical antiseptics stop the spread of microbes (such as chlorhexidine and iodine solutions). These treatments are covered by a secondary dressing suitable for use in infected wounds. Use carefully as directed by the doctor or wound care specialist.
8. Remove sutures for surgical wounds. Sutures or adhesive strips should be removed 10-14 days after their application (or 3-5 days if the wound is on the head) once the skin begins to approximate. Adhesive glue will naturally peel off after 1-2 weeks.
9. Refer to a wound care specialist. Refer to a wound care professional if the wound has not begun to heal after two weeks or has not fully healed after six. The care and treatment of acute, chronic, and non-healing wounds require the expertise of a wound specialist.

Wound Dressing & Wound Care Essendon serving Southbank, South Yarra, and Melbourne | (03) 9379 5425