H.C.A TRAINING WOUND MANGEMENT

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H.C.A TRAINING WOUND MANGEMENT

• Sally Panto
• Aug. 2006

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AIM

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

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OBJECTIVES

• To have awareness of stages of wound healing
• To demonstrate knowledge of factors affecting
  wound healing
• To develop knowledge in wound assessment

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OBJECTIVES

• To accurately complete wound assessment chart and
  evaluations
• To demonstrate ability to select the ideal
  dressing

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4 Stages of Wound Healing

• Haemostasis
• Inflammatory response
• Proliferative response
• Maturation

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Diseases affecting wound healing

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

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OTHER FACTORSaffecting wound healing

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

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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

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• Smoking
• Incontinence
• Age
• Ischaemia

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Wound assessment

• Allows for wound care to be evaluated
• Monitor progress
• Communication between team
• Documentary evidence

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When to Assess

• Initial Visit
• Evaluation date
• Change in wound condition
• When healed

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Wound Assessment

• Type of Wound
• Useful and standard terminology - refer to
  laminate sheet
• Granulation tissue
• Overgranulation
• Epithelialisation
• Necrosis
• Eschar
• Slough
• Exudate
• Odour

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Wound Assessment

• Site of Wound
• Wound Measurement
• Wound bed
• Surrounding skin
• Skin edges
• Pain

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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

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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

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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

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Wound Photography

• Patient consent and explanations
• Consent form
• Best practice in taking photographs
• Is a photograph appropriate
• Frequency

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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

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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

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Ideal Dressing

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