H.C.A TRAINING WOUND MANGEMENT Sally Panto Aug. 2006

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

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

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

4 Stages of Wound Healing Haemostasis Inflammatory response Proliferative response Maturation

Diseases affecting wound healing Anaemia Diabetes Venous disease Oxygen deficiency Arterial insufficiency Rheumatoid arthritis Malignancy Immunosuppression

OTHER FACTORS affecting wound healing Wound specific slough/necrosis wound infection oedema Poor wound management traumatic cleaning/ dressing removal

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

Smoking Incontinence Age Ischaemia

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

When to Assess Initial Visit Evaluation date Change in wound condition When healed

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

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

Cavity wounds Example 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

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

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

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

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

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

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