Dressing an open wound

Nursing Practice: Principles of Open Wound Care

Wound care is an essential function in clinical nursing practice. Certain principles (such as asepsis) are applicable to all types of open wounds, but other aspects of proper wound care vary depending on the type of wound being dressed. Because of the potentially serious consequences of infection at the wound site, open wounds must be protected using techniques and material most conducive to optimal healing. Moreover, chronic wounds require different materials and additional techniques to maintain asepsis without simultaneously damaging healthy tissue. Already infected wounds, particularly those involving deep tissue layers, require a systematic approach to caring appropriately for tissues in fundamentally different states of health.

General Open Wound Care:

For the general care of superficial open wounds in the epidermis, the area should first be examined visually, preferably under a magnifying lens to rule out any foreign materials that could be more difficult to see after irrigation. Sterile gloves should be worn throughout and changed after irrigation and before disinfecting the wound. The wound should be irrigated with sterile saline solution if it resulted in circumstances that introduced foreign matter into the wound.

Ideally, irrigation with sterile 0.9% sodium chloride is the preferred method of disinfection in those cases (Taylor, Lillis, & LeMone, 2005; 1068). Otherwise, hydrogen peroxide is preferable to isopropyl alcohol because it causes less discomfort and because the bubbling of oxidation benefits the disinfection process. Wounds limited to the epidermis can also be treated with topical antibiotic ointments applied by sterile Q-tip before the application of the dressing. Adhesive dressings are appropriate for small wounds but can be associated with skin irritation.

Paper, plastic, or acetate-backed bandages are preferable because they are hypoallergenic and better tolerated in terms of comfort.

Chronic Wound Care:

For chronic wound care, the process is substantially the same except that padding should be applied to the external surface of the dressing as necessary to protect the area from pressure. Instead of paper, plastic, or acetate-backed bandages, chronic wound require material that is moisture absorbent, such as sterile gauze. Gauze is also preferable because it breathes and therefore inhibits the growth of anaerobic bacteria that are a potential risk of prolonged use of non-porous bandages (Taylor, Lillis, & LeMone, 2005;

Open chronic wounds should be more thoroughly irrigated with sterile 0.9%

sodium chloride being careful to allow the solution to drain from the top of the wound to the bottom and into an appropriate receptacle and/or absorbent material placed on the bed immediately before irrigation. Care must be taken to change sterile gloves after removing old bandages prior to handling the new bandage. A Penrose drain may be inserted where drainage is necessary ((Taylor, Lillis, & LeMone, 2005; 1071).

Infected Wound Care:

Open, infected wounds, particularly those involving deep tissue layers require more attention to sterile procedure. A gown and mask should be worn and care taken not to breathe into the wound. Additional care must be taken not to contaminate healthy tissue with infected or necrotic tissue (Taylor, Lillis, & LeMone, 2005; 1076). Great care should be taken to change sterile gloves in-between removal of the old bandage and cleaning the wound. Red tissue is healthy must be protected from contamination by yellow tissue that is infected or by black necrotic tissue during its removal during wound debridement (Taylor, Lillis, & LeMone, 2005; 1076).