How to prevent diarrhea from contaminating sacral wound dressings?

Preventing Diarrhea Contamination of Sacral Wound Dressings

Implementing strict infection control measures including use of gloves, gowns, and proper hand hygiene with soap and water is essential to prevent diarrhea from contaminating sacral wound dressings. 1

Primary Prevention Strategies

Barrier Methods

• Use specialized barrier dressings designed to protect wounds from moisture and fecal contamination:
  • Apply non-adherent dressings directly to the wound surface (such as Mepitel™ or Telfa™) 2
  • Consider hydrocolloid or foam dressings with adhesive borders that create a seal around the wound
  • Use transparent film dressings to create a waterproof barrier when appropriate

Fecal Management Systems

• For patients with liquid stool or frequent diarrhea:
  • Implement fecal collection devices (rectal tubes/pouches) to divert stool away from the wound
  • Consider fecal management systems that collect liquid stool into a collection bag
  • Position the patient to minimize contact between stool and the wound area

Wound Positioning and Care

• Position the patient to minimize pressure on the sacral area:
  • Use 30-degree lateral positioning rather than supine when possible
  • Implement a regular turning schedule (every 2 hours) to reduce pressure and contamination risk
  • Use specialized pressure-relieving surfaces that allow for drainage away from the wound

Management of Diarrhea

Medical Management

• Identify and treat the underlying cause of diarrhea:
  • Evaluate for infectious causes (C. difficile, other pathogens)
  • Review medications that may cause diarrhea
  • Consider anti-diarrheal medications when appropriate:
    • Loperamide 4 mg initially followed by 2 mg after each loose stool (maximum 16 mg/day) 3
    • Note: Use anti-diarrheals only after ruling out infectious causes that require specific treatment

Dietary Modifications

• Implement dietary changes to reduce diarrhea:
  • Low-residue diet during acute episodes
  • Avoid foods known to exacerbate diarrhea
  • Ensure adequate hydration and electrolyte replacement

Advanced Interventions

Surgical Options

• For severe cases with persistent contamination despite conservative measures:
  • Consider diverting colostomy in patients with intractable diarrhea and non-healing sacral wounds 1, 4
  • This approach has been shown to:
    • Reduce wound contamination
    • Decrease wound infection rates
    • Lower rates of wound dehiscence after closure 4
    • Promote better wound healing outcomes

Specialized Wound Therapy

• Consider negative pressure wound therapy with instillation and dwell time (NPWTi-d) for complex sacral wounds 5:
  • Helps irrigate the wound and remove debris
  • Promotes granulation tissue formation
  • May decrease number of operative debridements needed
  • Can serve as a "bridge to defined endpoint" (reconstruction, skin grafting, or stable wound)

Infection Control Practices

Hand Hygiene

• Perform hand hygiene meticulously 1:
  • After using the toilet
  • Before and after wound care
  • After handling soiled dressings or linens
  • Use soap and water rather than alcohol-based sanitizers when caring for patients with C. difficile or norovirus 1

Personal Protective Equipment

• Use appropriate PPE during wound care 1:
  • Gloves and gowns for all dressing changes
  • Change gloves between dirty and clean procedures
  • Dispose of contaminated materials properly

Wound Dressing Protocols

Dressing Change Frequency

• Increase dressing change frequency when contamination occurs
• Consider transparent dressings that allow for wound visualization without removal
• Maintain wound dressings for at least 48 hours unless leakage occurs 1

Cleaning Techniques

• When changing dressings:
  • Clean in a direction away from the wound (not toward it)
  • Use separate cleaning materials for perianal area and wound
  • Consider antimicrobial cleansers appropriate for periwound skin

Pitfalls and Caveats

• Avoid using the same gloves for perianal care and wound care
• Do not delay dressing changes when contamination is suspected
• Remember that visual inspection alone may be inadequate to detect early signs of wound complications 6
• Consider that pressure damage may start deep in the tissue before becoming visible at the skin surface 6
• Recognize that diarrhea in hospitalized patients can significantly increase medical costs and lead to complications such as volume depletion 7

By implementing these comprehensive strategies, healthcare providers can significantly reduce the risk of diarrhea contaminating sacral wound dressings and improve wound healing outcomes.