Keep the patient and yourself from being infected!! Basic Wound Care Keep the patient and yourself from being infected!!

What is a Wound? A wound is the disruption of the Stratum Corneum skin barrier

Layers of the Skin Epidermis – the top layer of the skin Dermis – the next layer Subcutaneous – fat layer

Signs of Infection Tenderness Red Streaks leading from wound Redness Swollen Glands Swelling around Wound Throbbing Increase discharge from the wound Red Streaks leading from wound Fever Pus Continued or increasing redness beyond day four of wound healing

Universal Precautions for the Athletic Environment Take care against possible transmission of AIDS, HIV, & HBV ALWAYS take precautionary measures Glove Up! All open wounds or lesions MUST be covered with a fixed dressing before practice or competition. Athletes with active bleeding MUST be removed ASAP & return only when OK’d by medical staff.

Universal Precautions for the Athletic Environment Clothing saturated with blood MUST be changed before returning to room(game). Protective equipment MUST be used when there is potential for contact with blood borne pathogens. Infectious waste/Biohazard materials (gauze, dressings, tissues, towels, gloves, sharps, etc.) MUST be disposed of properly.

Components of a Safety for Blood Borne Pathogens Gloves Bandages Face shields Disposable towels Biohazard bags Antiseptics Disposable bags Hand towels Resuscitation mask Absorbency material Disinfectant spray/liquid Sharps container Others

Wound Care Products Antiseptics Antibiotics Cleansers Bandages Tapes Wraps Other covers including Hydrogels, Films, Liquid Bandages, and Foams Tissue Growth Promoters

Selection of Wound Care Products Do NOT put in your wound anything you would not put in your eye. Do not select products that stick to your wound, or if bandages stick, moisten with saline or water before removal. Do not select products that harm growing tissues. Select dressings that can be changed easily and do not cause irritation. Clean the wound in a very gentle manner in-between dressings. Wounds are not sterile and strict sterility is not a necessity, but CLEAN IS A MUST! Select dressings that will protect the wound.

Wound Dressing Evolution Cotton Linters Linters Non-woven swab Paper Fibers Sleeve dressing Feathers Cotton Gauze Adhesive Pads Dust Knitted Fibers Plaster/Strips 1960’s 1980’s 2000’s Non-wovens Urethane Films Active Agents Plastic Films Hydrocolloids Growth Factors Foams Cell/Gene Therapy Hydrogels/Alginates Smart Dressings

Care of a Wound Glove Up! Remove anything covering the wound. Manage open and closed wounds by applying direct or indirect pressure to control bleed. Elevate the wound area if there is excessive bleeding. Clean the wound from the inner portion to the outer portion. Use sterile equipment.

Care of a Wound Clean, debride, & protect the open wound. Soap & water or saline may be used along with a sterile gauze pad to clean the wound. Various cleansers Note: Hydrogen Peroxide (H2O2) is being phased out. Bubbles away blood clots & related debris. Flush the wound with lots of water, then dry with sterile gauze.

Wound Wash Saline & Topical Antibiotics

Various Bandages

Care of a Wound Use isopropyl rubbing alcohol to clean the skin adjacent to the wound site. DO NOT APPLY DIRECTLY OVER THE WOUND! Apply superficial closures. Apply antibiotic ointment if necessary. Note: Do not apply ointment directly on the wound from the ointment tube. You will cause contamination to the tube. Types of ointments: Neosporin, Bactroban, Garamycin, bacitracin, gentamicin, mupirocin, neomycin, silver sulfasalazine, chloramphenicol, and clindamycin

Care of a Wound Apply appropriate dressings. If dressing becomes soaked with blood. Add more. DO NOT REMOVE BLOOD-SOAKED DRESSINGS UNTIL BLEEDING HAS BEEN CONTROLLED! Properly remove gloves & other personal protective equipment. Properly dispose of biohazardous waste.

Care of a Wound Apply ice, compression & elevation of an acute sprain, strain, or contusion, if associated with wound. A tetanus shot may be required depending on the cause of the wound. Change dressing daily & look for signs of infection.

Hydrocolloid Wound Care You want to keep the wound moist so it can heal for the inside out. The “crust” that forms impedes the rapid re- epithelialization. 3 types of Occlusive Dressings Hydocolloids Semipermeable films Hydrogels Semipermeable film Hydrogel

Moist Wound Healing – How & Why Maintaining moisture allows the body to move cells into the entire area of injury. This reduces the scarring. The chance of infection is reduced Excessive drainage is absorbed by the bandages if present, but does not dry out the wound bed. Protection from bacteria and protection of the newly formed cell growth is maintained.

Biological Activity of Moist Wound Healing Re-epithelialization – Coverage with new skin is enhanced. Granulation – Growth of new collagen and blood vessels occurs more rapidly. Debridement – The wound is cleaned by the body more rapidly. Pain relief – The nerves are soothed. Angiogenesis – New blood vessels grow more rapidly in a low oxygen environment, oxygen comes from below the skin, not from the environment.

Occlusive Dressings Hydrocolloids: Made up of gelatin, pectin, &/or carboxymethylcellulose in a polyisobutylene adhesive base. Impermeable to H2O, O2, & bacteria Effective in absorbing minimal to moderate amount of exudate. Suitable for high friction areas. Not recommended for wounds with anaerobic infections.

Occlusive Dressings Semi-permeable Films: Made from transparent polyurethane membranes with H2O adhesives. Highly elastic, conforms well, provides visual site of wound. Semi-permeable to moisture vapor & O2, but occlusive to bacterial invasion. Can be used for superficial wounds, burns, post-op wounds, donor sites. Minimally absorbent, so they trap moisture & facilitate autolytic debridement.

Occlusive Dressings Hydrogels (semi-permeable) Contains approximately 96% H2O or glycerin Transparent, comfortable, moisture-retentive, & permeable to O2. Available in sheet or gel form. Used with acute & chronic, partial & full-thickness wounds with minimal to moderate amounts of exudate.

Hepatitis B Shots Series of 3 shots 1st shot 2nd shot given approx. 4 weeks after 1st shot 3rd shot given 6 months later Hepatitis B: Virus that affects the liver Occurs when blood or body fluids from an infected person enters the body of a person who is not immune.

And Finally… Always take precautionary measures! Glove up! Hepatitis B Shots Proper placement of contaminated material Education of various blood borne pathogens

The End