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Carers' Corner

Wound Care

A. Introduction

A wound means damage to the surface of the skin resulting in loss of its protective function. All wounds may be complicated by infection as germs enter the body. It is therefore important for us to acquire the skill of proper wound care in order to reduce the risk of wound infection.

B. Four principles of wound care

1) Prevention of infection: - comply with the rule of ¡§aseptic technique¡¨ during wound dressing (see below).
2) Cleaning of wound: - always wipe from inside to outside and not vice versa.
- change the dressing regularly and when there are discharge and oozing from the wound.
3) Minimize further damage: - secure the dressing with a bandage only tight enough to sustain the pressure but not to impair the circulation.
- apply non-allergenic sterile gauze.
4) Promote healing: - maintain a well-balanced diet.

C. Classification and management of wounds

1) Abrasion (Graze) - e.g. superficial abrasion result from a fall in the park.
- If the wound is dirty, rinse it with soap and water.
- Cover the wound with swab and sterile gauze.
- In case of large wound, seek medical treatment immediately.
2) Incision - e.g. a cut by a sharp object such as knife.
- Firstly, remove any foreign bodies (e.g. glass) and rinse the wound with water.
- Do not attempt to remove objects that are firmly embedded in the wound, this may worsen bleeding.
- Control bleeding by applying direct pressure over the wound for at least 5-15 minutes by covering it with a gauze.
- Seek medical treatment if bleeding continues.
3) Contusion - e.g. bruises from knocking against furniture
- Contusion of skin by hard object with bruise appearing afterwards.
- Minor injuries can be treated with heparinoid ointment.
- Extensive contusion especially involving the head and limbs may be associated with severe damage and fractures, medical attention is therefore advised.
4) Burn and scald - e.g. scald wound from hot water in the bath.
- rinse the wound under cold running water for at least 10 minutes.
- Carefully remove any clothing or jewelleries before the affected area becomes inflamed and swollen.
- Remove any clothing that is soaked with hot water.
- Cover the burn and the surrounding tissue with sterile dressing or cling film.
- Do not rub the wound with ice, this may cause further damage to the skin.
- Keep the wound clean, do not apply any lotion, ointment or butter to the scald wound.
- Leave all blisters intact to prevent infection.
- Severe cases should be treated in hospital.
5) Pressure sores - e.g. back sores found in a bedridden patient.
- Change dressing every day if possible or whenever the dressing is soaked through.
- Use aseptic techniques
- Turn the patient regularly to promote healing of wound and to prevent contractures.

Anti-Tetanus Toxoid injection (ATT)

Patients who do not have immunization before or have immunization more than ten years ago should receive Tetanus immunization for any wound that is dirty and covered by soil or rust. A full course of ATT comprises of 3 injections and offers 10 years of protection.

Proper techniques in Wound Management

Information for carers at home

Carers should follow advice from doctor and bring the elder to a nearby clinic for regular wound dressing. Frail elders or elders with mobility problem could apply for the Community Nursing Services through doctor¡¦s referral during follow up. Observe for signs and symptoms of infection (please refer to details on next page) and consult doctor if necessary.

Information for carers in elderly home

Staff are advised to follow guidelines of aseptic technique when performing wound dressing. Details are as follow:

Preparation for wound dressing

1) Keep the area clean and tidy with good lighting.
2) Dressing materials: use disposable set for dressing ( usually include sterile towels, disposable forceps, gallipots, cotton wool balls and gauge), lotion ( according to doctor¡¦s prescriptions ),mask and gloves ( if needed ), disposable bag for soiled dressing, bandages, adhesive strapping and scissors.
3) Keep the patient warm and comfortable. Ensure adequate privacy during the procedure.
4) Wash hands thoroughly with soap and water.

Procedures of Aseptic Techniques

1) Open the package of sterile dressing. Lay the instruments on the sterile towel provided.
2) Pour the antiseptic lotion into the gallipot. Remove the soiled dressing with a pair of forceps. If the dressing is stuck to the wound, soak the dressing with normal saline. Dispose forceps and soiled dressing in a plastic bag.
3) Reserve the other two pairs of forceps for handling the clean dressing and the wound.
4) Use forceps to dip the cotton ball into antiseptic lotion and wipe the wound from inside to outside. Repeat the procedure using a new cotton ball each time until the wound is clean.
5) Dry the wound with sterile gauze.
6) Cover the wound with clean dressing and apply adhesive strapping to secure it.

Aftercare

1) Put everything in a plastic bag and tie it up tightly before disposal.
2) Wash hands again.

D. Signs and symptoms of wound infection

- Wound pain
- Oozing
- Redness, hot to touch
- Foul smelling wound with blood stained discharge or pus
- Change in general condition: fever, chills, increase in respiratory rate and pulse, headache, nausea and vomiting
If there are signs of wound infection or delayed healing , seek medical advice at once!

E. First aid box should contain the following items:

- Antiseptic lotion and alcohol
- Cotton wool and gauze
- Adhesive strapping and bandages
- Triangular bandage and scissors
- Disposable gloves

 

Related Topics

Elderly Safety

Burn and Scald


 
   
 
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2006 copyright logo | Important notices Last Revision Date : 1 October 2006