RN Cathy HammondSpecialist Wound Management Service at Nurse

Maude

Christchurch

16:30 - 17:00 How to Prevent an Acute Wound Becoming Chronic

How to Prevent Chronic Wound Becoming Chronic

Catherine Hammond CNS/CNE2016

Acute wound Healing

Underlying

problem

Inflammatory

cytokines

↑MMPs

↓ TIMPs

Tissue

degradation

Inflammation

History of the wound

• How did it occur

• Duration

• Initial and on-going treatment

• Previous wounds and healing

• Pain

• Movement

• Other wounds or injuries

Manage factors affecting healing

Assess the wound using time

T – tissue

Assess the wound using TIME

• I – Inflammation and infection

Biofilm development

Assess the wound using TIME

M – Moisture

Assess the wound using TIME

E – Epithelializing edge

Assess the surrounding tissue

Interpretation of assessment findings

Determine the goals of care and outcome measures

What are the aims of wound treatment

• Debridement

• Control of infection

• Absorb exudate

• Donate moisture

• Protection

Prioritization

•Diabetic foot ulcers

• Ischaemia

•Gross leg oedema

• Immunosuppression

• Infection

Treat the cause

Manage factors affecting healing

Cleansing the wound and surrounding tissue

Treatment of a biofilm

Broad spectrum antimicrobial

• Iodine

• Silver

• Honey

• PHMB

• Super oxidised solution

• Chlorhexidine

Choose appropriate wound dressing

• Moist, warm environment

• Comfortable

• Free from toxic substances

• Dose not lint into wound

• Cost effective

• Does not cause trauma

• Allows gaseous exchange

• Control bacterial load

• Wick away moisture as needed

Products Made Simple

Antimicrobials

Silver dressings PHMB

Cadexomer iodine SOS

Iodine

Honey

Donate Moisture

Hydrogels

Hydrocolloids

Absorb Moisture

Alginates

Hydrofibre

Foams

Absorbent pads

Protection

Films

Foams

Silicone

Fine woven tulle

TIME

Prevention is better than cure

References

Gottrup, F. Apelquist, J. Bjanshott, T et al (2013). Antimicrobials and non-healing wounds. Evidence, controversies and suggestions. Journal of Wound Care, 22(5), S1

Hubner, N & Kramer, A. (2010). Review on the efficacy, safety and clinical applications of polihexanide, a modern wound antiseptic. Skin Pharmacol Physiol 23, suppl 1, 17-27

European Wound Management Association (EWMA). (2008). Position document. Hard to heal wounds: a holistic approach. MEPLtd.

Pieper, B. (2009). Honey-based dressing and and wound care. Journal of wound ostomy and continence nursing. 36(10), 45-51

Principals of Best Practice: Wound Infection in Clinical Practice. An International Consensus. London: MEP Ltd. 2008.

Wilson, J. & Clarke, J. (2003). Obesity: Impediment to wound healing. Critical Care Nursing 26(2), 119-132