What are the guidelines for proper wound care?

Guidelines for Proper Wound Care

Proper wound care requires a systematic approach including wound assessment, cleansing, appropriate dressing selection, infection management, and regular monitoring to optimize healing and prevent complications. 1

Wound Assessment

• Use a structured approach to evaluate wounds, including measurement of length, width, depth, and area 2
• Assess exudate (quantity and quality), wound bed appearance (tissue type), pain level, undermining, and condition of wound edges 2, 3
• Evaluate for signs of infection including erythema, swelling, increased pain, purulent drainage, and odor 1, 4
• Document wound characteristics regularly to monitor healing progression 5, 6
• For diabetic wounds, assess for arterial insufficiency, neuropathy, and biomechanical problems 4

Wound Cleansing

• Clean wounds with sterile normal saline (avoid iodine or antibiotic-containing solutions for routine cleansing) 1
• Remove superficial debris during cleansing 1
• Consider using warm cleaning solution to reduce pain during the procedure 1
• Avoid aggressive cleansing that could damage healthy tissue 1, 6

Debridement

• Debride necrotic tissue or surrounding callus to promote healing 1, 4
• Sharp debridement is generally preferred for non-viable tissue 4
• Consider surgical debridement for infections with deep abscess, extensive necrosis, or necrotizing fasciitis 1, 4
• Debridement techniques include: surgical, sharp/conservative-sharp, autolytic, mechanical, enzymatic, chemical/mechanical/surfactant, and biosurgical/larval methods 1

Dressing Selection

• Choose dressings based on wound characteristics including size, depth, and exudate level 1
• For dry or necrotic wounds: use continuously moistened saline gauze or hydrogels 1, 4
• For exudative wounds: use alginates, hydrocolloids, or foams 1, 4
• For occlusive or semi-occlusive coverage: use films to maintain moisture in dry wounds 1
• Secure dressings with gauze bandages or tubular bandages instead of tape when possible, especially in fragile skin 1
• Change dressings at appropriate intervals based on wound characteristics and dressing type 6

Infection Management

• Do not use topical antimicrobials for most clinically uninfected wounds 1, 4
• For infected wounds, prompt management with appropriate antibiotics and debridement is essential 1, 4
• Consider empiric antibiotic therapy targeted at Staphylococcus aureus and streptococci for mild infections 4
• For severe infections, hospitalization and broad-spectrum parenteral antibiotics may be required 4
• Monitor wounds closely for signs of infection progression or sepsis 1

Pressure Offloading

• For diabetic neuropathic plantar ulcers, use non-removable knee-high offloading devices 4
• For non-diabetic wounds, consider appropriate pressure offloading to minimize excessive pressure at the wound site 1
• Instruct patients to limit standing and walking when appropriate 4
• Consider elevation of injured body parts, especially if swollen, to accelerate healing 1

Special Considerations

• For bite wounds (animal or human), cleanse thoroughly, consider rabies prophylaxis, ensure tetanus status is current, and use appropriate antibiotics 1
• For surgical wounds, follow specific post-operative protocols including appropriate dressing changes and monitoring for complications 1
• For chronic limb-threatening ischemia with wounds, ensure adequate revascularization before expecting wound healing 1
• For diabetic foot wounds, use a multidisciplinary approach addressing vascular status, infection control, and pressure offloading 4

Adjunctive Therapies

• Consider negative pressure wound therapy (NPWT) for complex wounds after surgical debridement or when primary closure is not feasible 1
• Hyperbaric oxygen therapy may be considered for non-healing diabetic foot ulcers after revascularization 1
• For pediatric patients, involve parents in wound care and provide appropriate education 1

Monitoring and Follow-up

• Regularly reassess wounds to evaluate healing progress 5, 6
• Document changes in wound characteristics including size, appearance, and signs of infection 2
• Adjust treatment plan based on wound healing trajectory 6
• Provide early and careful follow-up to ensure treatment effectiveness 4

Common Pitfalls to Avoid

• Avoid using antibiotics for uninfected wounds as this may promote antimicrobial resistance 4
• Avoid closing infected wounds as this may lead to abscess formation 1
• Do not neglect vascular assessment in wounds with poor healing, especially in patients with diabetes or peripheral artery disease 1, 4
• Avoid aggressive debridement that could damage healthy tissue or enlarge the wound unnecessarily 1