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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