April Wound Blog – A Protocol for Wound Management
Happy April everyone, the months are flying by. I hope you are all finding value from my Wound Blog Series. I have had lots of positive feedback so far, so thank you, and please do let me know if there are any topics you want me to cover.
This month I wanted to encourage your practice to incorporate a Wound Management Protocol.
Many practices miss doing this, but it is extremely important, especially with the numbers of increasing wounds appearing, every member of the team must follow a correct set of procedures.
Speaking to practices regularly, I hear many have not yet placed a protocol in place for managing wounds. Now, I know what you're saying right now; how can you set a protocol for us to follow when every injury is different? My response is you'll see significant positive results by simply following these four guiding principles.
ONE
It's hugely important to assess a patient's wound and treat in an aseptic/clean room in practice. Having either a dedicated wound room or a separate clean room at all times, will help prevent further contamination/infection. Ideally also being planned for wound procedures, so having a wound set up box is ideal in this room. This room can then be disinfected down appropriately after, especially if a case is confirmed with zoonotic bacteria!
TWO
Every wound should be clipped free of hair, whether it's an abscess, scab or a tear/break in the sin. Removing the hair gives accurate visualisation of what you're dealing with, not to mention helping prevent contamination with bacteria that covers this hair. I do recommend a clip as far back as the owners will let you. Hair grows quick, less the better! Clippers must be clean on this note, with clean clipper blades and check no teeth are missing! Ideally, a separate pair within the wound room is preferred, and the blades should be sterile.
THREE
Lavaging wounds – big topic! The goal of irrigation is to clean the wound, while further avoiding any direct trauma to the wound bed and driving debris into the wound bed. This is the simplest but most important aspect of open wound management! Manual removal of any gross debris, followed by a correct lavage technique, will remove additional microscopic contaminants remaining within the wound bed.
Studies are suggested that the pressure should ideally be between 8-12 psi, which is strong enough to overcome the forces of bacteria. A 35ml syringe and an 18g/19g needle or catheter for irrigation is ideal. I would also suggest patients be given either analgesia or sedated/anaesthetised, prior to irrigation on larger wounds as this procedure can be painful. (Types of irrigation I will cover on a separate blog.)
The key principle is to use large volumes when lavaging, so any bacteria and contaminants are removed or diluted if they are not completely removed.
Clean incontinence pads should be placed under the patients wound prior to wound lavage. This limits the patient from becoming soaked, thus getting cold, as well as keeping all water off the patient as much as possible. With the pulp within good quality liners, this will hold the liquid away from the patient.
FOUR
Correct PPE! Clean PPE should be worn when assessing/treating wounds by ALL parties involved. This includes everyone washing hands prior, wearing gloves, apron/gown and goggles. I can't tell you the number of times pictures are sent to me with no one wearing gloves. NOT wearing gloves is a considerable infection control risk, and I want to stress how critical it is!
Some wounds contain bacteria, and yes, this can transfer to humans (Zoonotic), so full PPE should be worn, including staff handling the patient and the wound.
Final thoughts
On my last note, if deciding a swab for wound culture and sensitivity, take this as soon as the patient arrives before clipping and lavaging. Some practices have placed this into their protocol to take on every wound case, which doesn't mean you have to send it, but at least you have it!
If anyone would like to discuss any of these areas further or would like some more information on lavaging wounds, please contact me directly, and I would be happy to assist.