Exploring The Impact of WoundComplications Upon the Lives

of Patients

Wound Infection

Wound Infection

• What are the implications for the NHS?

• What are the human costs involved?

• Can we do more?

The physical appearance of wound infection

The physical appearance of wound infection

Taken from Patients Association website

• My local hospital is only five years old. It is deeply in debt. It pays very little attention to MRSA prevention - in my opinion. I was in hospital (Intensive care) for many months early this year. I had bed sores for which I had no treatment - then I caught MRSA. I was moved from ward to ward with the bug, sometimes I was in isolation and sometimes I was in a general ward. I also got really bad stomach bugs. I could not walk because of the MRSA so I could not return home to live on my own. I tried several residential homes but they would not have me because of the MRSA and eventually I had to move into a very expensive home for some months - which I paid for myself. I have now had to move into a residential home at vast expense. I would like to sue the hospital -- any comments anyone? Any advice?

Exudate / Wound Fluid

Achieving Moisture Balance

Potential causes of excess exudate

• Wound site eg. gravitational exudate in leg ulceration

• Wound type• Wound size (although not always relevant)• Bacterial burden• Sinus • Fistula • Often in chronic wounds there is a combination

of factors

The impact of excessive exudate;On the wound

• Excess exudate can cause maceration of the wound and surrounding skin

• The surrounding skin can become white due to the moisture content in the cells

• Proteases can cause breakdown of the new extracellular matrix (ECM)

• Bacteria such as Pseudomonas may proliferate • Odour may be apparent• Wound healing will be affected

The impact of excessive exudate:On the Patient

• Soggy wet heavy dressings will impact on lifestyle

• Discomfort Odour can cause embarrassment and impact on

social situations • Prolongs healing time and increases anxiety• Increased dressing changes/nursing visits• Impacts on relationships

Exudate/Wound Fluid

Excess Exudate

Excess Exudate/ Maceration

• Cells in the surrounding skin swell due to moisture

• The tissue at the wound edge becomes non viable

• Wound dressings and good wound care can assist in preventing this damage

Peri-Wound, Maceration

Wound Trauma and Pain

Pain: Individual experience which must be dealt with on an individual basis

• Pain is an individual ‘feeling’ and as such is often multi-factorial in nature

• Wound pain may occur at dressing changes, may be present at all times or both

• We must explore the full context in which the pain presents

Consider the impact of the wound aetiology on the pain

Concurrent pathology which can complicate pain

• Peripheral Vascular Disease

• Diabetic neuropathy• Malignancy• Arthritis• Dermatological

conditions• Vasculitis

The multidimensional impact of pain

• Socio cultural dimension: • Long standing pain will affect the patients family • Personal relationships can be affected• Relationships with staff can be affected• The patient may not be inclined to get involved

in social situations• Consider the impact of spiritual, social and

cultural factors in perception of pain.

What does wound pain mean for patients?

• Mood changes• Poor sleep patterns• Inability to

concentrate• Anxiety• Fear of procedures• Socioeconomic

factors

Trauma and Pain

Peri-wound , Trauma

Dealing with pain at dressing changes

• The use of warm cleansing solutions • Careful removal of dressings and their residue or

encouraging patients to remove their own dressings

• The use of 'time out‘ when experiencing pain • The use of atraumatic dressings • Correct application of dressings and bandages • Changing/reducing the frequency of dressing

changes.

Wound Malodour

Malodour

• Odour tends to occur in chronic wounds such as leg ulcers, pressure ulcers, malignancy, wet wounds, necrotic wounds and ischaemic wounds.

• The presence of odour in wounds is linked to bacteria, particularly in necrotic tissue.

• These bacteria are normally anaerobic in nature

The impact of odour

• Odour impacts on all aspects of the patients life.• There is an impact on relatives and a sense of

stigma and embarrassment• May induce nausea and vomiting• Can impact on sexual expression• May add to feelings of anxiety and depression• Patient may feel dirty or unclean• May affect employment

Summary

Conclusion

• Wound complications can have a major impact upon the lives of patients and their relatives .

• It is not always possible to eradicate these complications but it is always possible to develop a plan of management to minimise their impact .