Basic Wound Care

1
Basic Wound Care

• Keep the Patient Yourself from Being Infected!

2
What is a Wound?

• A Wound Is disruption Of the Stratum Corneum Skin
  Barrier

3
Layers Of The Skin

• Epidermis- The Top Layer Of the Skin
• Dermis- The next layer
• Subcutaneous/ Fat Layer

4
Signs Of Infection

• Tenderness
• Redness
• Swollen Glands
• Swelling Around The Wound
• Throbbing
• Increasing Discharge From The Wound

• Red Streaks Leading From The Wound
• Fever
• Pus
• Continued Or Increasing Redness Beyond Four Day
  After Wounding

5
Universal Precautions for the Athletic
Environment

• Take care against possible transmission of AIDS,
  HIV, HBV.
• Always take precautionary measures.
• Glove up!
• All open wounds or lesions MUST be covered with a
  fixed dressing before practice or competition.
• Athletes with active bleeding MUST be removed
  ASAP return only when OKd by medical staff.

6
Universal Precautions for the Athletic
Environment

• Uniforms saturated with blood MUST be changed
  before returning to participation.
• Protective equipment MUST be used when there is a
  potential for contact with blood borne pathogens.
• Infectious waste/Biohazard material (gauze,
  dressings, tissues, towels, gloves, sharps, etc.)
  MUST be disposed of properly.

7
Components of a Safety Kit for Blood Borne
Pathogens

• Gloves
• Bandages
• Face shields
• Disposable towels
• Biohazard bags
• Antiseptics
• Disposable bags

• Hand towels
• Resuscitation mask
• Absorbency material
• Disinfectant spray/liquid
• Sharps container
• Others

8
Wound Care Products

• Antiseptics
• Antibiotics
• Cleansers
• Bandages
• Tapes
• Wraps

• Other Covers Including Hydrogels, Films, Liquid
  Bandages, Foams
• Tissue Growth Promoters

9
Selection Of Wound Care Products

• Do NOT put in your wound anything you would not
  put in your eye
• Do not select products that stick to your wound,
  or if bandages stick, moisten with saline or
  water before removal
• Do not select products that harm growing tissues
• Select dressings that can be changed easily and
  do not cause irritation
• Clean the wound in a very gentle manner
  in-between dressings
• Wounds are not sterile and strict sterility is
  not a necessity, but CLEAN IS A MUST!
• Select dressings that sill protect the wound

10
Wound Dressing Evolution
11
Wound Dressing Evolution Function
12
Care of a Wound

• Glove up!
• Remove anything covering the wound.
• Manage open closed wounds by applying direct or
  indirect pressure to control bleed.
• Elevate the wound area if there is excessive
  bleeding.
• Clean the wound from the inner portion to the
  outer portion.
• Use sterile equipment.

13
Care of a Wound

• Clean, debride protect the open wound.
• Soap water or saline may be used along with a
  sterile gauze pad, to clean the wound.
• If after practice, make sure the person takes a
  shower.
• Various cleansers
• http//search.woundsource.com/client/wound/bg1/sea
  rch.asp
• http//www.medicaledu.com/prodindx.htm
• Note Hydrogen Peroxide (H2O2) is being phased
  out.
• Bubbles away blood clots related debris. Flush
  the wound with lots of water, then dry with
  sterile gauze pad.

14
Wound Wash Saline Topical Antibiotics
15
Various Bandages
16
Care of a Wound

• Use isopropyl rubbing alcohol to clean the skin
  adjacent to the wound site. DO NOT APPLY
  DIRECTLY OVER THE WOUND!
• Apply superficial skin closures. Apply
  antibiotic ointment if necessary. Note Do not
  apply ointment directly on the wound from the
  ointment tube. You will cause contamination to
  the tube.
• Types of ointments Neosporin, Bactroban,
  Garamycin, bacitracin, gentamicin, mupirocin,
  neomycin, silver sulfasalazine, chloramphenicol,
  and clindamycin.

17
Care of a Wound

• Apply appropriate dressings. If dressing becomes
  soaked with blood, add more. DO NOT REMOVE
  BLOOD-SOAKED DRESSINGS UNTIL BLEEDING HAS BEEN
  CONTROLLED!
• Properly remove gloves other personal
  protective equipment. Properly dispose of
  biohazardous waste.

18
Care of a Wound

• Apply ice, compression elevation of an acute
  sprain, strain, or contusion, if associated with
  wound.
• A tetanus shot may be required depending on the
  cause of the wound.
• Change dressing daily look for signs of
  infection.

19
Wound Care

• You want to keep the wound moist so it can heal
  from the inside out.
• The crust that forms impedes the rapid
  re-epithelialization.
• 3 types of Occlusive Dressings
• Hydrocolloids
• Semipermeable films
• Hydrogels

20
Moist Wound Healing How Why

• Maintaining moisture allows the body to move
  cells into the entire area of injury
• This reduces the scarring
• The chance for infection is reduced
• Excessive drainage is absorbed by the bandages if
  present, but does not dry out the wound bed
• Protection from bacteria and protection of the
  newly formed cell growth is maintained

21
Biological Activity of Moist Wound Healing

• Re-epithelialization- Coverage with new skin is
  enhanced
• Granulation- Growth of new collagen and blood
  vessels occurs more rapidly
• Debridement- The wound is cleaned by the body
  more rapidly
• Pain Relief- The nerves are soothed
• Angiogenesis- New blood vessels grow more rapidly
  in a low oxygen environment, oxygen comes from
  below the skin, not from the environment

22
Occlusive Dressings

• Hydrocolloids
• Made up of gelatin, pectin, /or
  carboxymethylcellulose in a polyisobutylene
  adhesive base
• Impermeable to H2O, O2, bacteria
• Effective in absorbing minimal to moderate amount
  of exudate
• Suitable for high friction areas
• Not recommended for wounds with anaerobic
  infections

23
Types of Hydrocolloid Dressings

• Duoderm (R)
• J J Ulcer Dressing (R)
• Comfeel (R)
• Ultec (R)
• Restore (R)
• Intact (R)
• Intrasite (R)
• Hydrapad (R)
• Tegasorb (R)
• ConvaTec

• http//www.worldwidewounds.com/1998/april/Hydrocol
  loid-FAQ/hydrocolloid-questions-1.0.htmlmeaning

24
Occlusive Dressings

• Semi-permeable Films
• Made from transparent polyurethane membranes with
  H2O adhesives
• Highly elastic, conforms well, provides visual
  site of wound
• Semi-permeable to moisture vapor O2, but
  occlusive to bacterial invasion
• Can be used for superficial wounds, burns,
  post-op wounds, donor sites
• Minimally absorbent, so they trap moisture
  facilitate autolytic debridement

25
Semi-Permeable Films

• 3M Tegaderm
• Polymem
• Bioclusive (JJ)
• OpSite

26
Occlusive Dressings

• Hydrogels (semi-permeable)
• Contains approximately 96 H2O or glycerin
• Transparent, conformable, moisture-retentive,
  permeable to O2
• Available in sheet or gel form
• Used with acute chronic, partial
  full-thickness wounds with minimal to moderate
  amounts of exudate

27
Hydrogel Sheets
28
Hepatitis B Shots

• Series of 3 shots
• 1st shot
• 2nd shot given approx. 4 weeks after 1st
• 3rd shot given 6 months later
• Hepatitis B virus that affects the liver
• Occurs when blood or body fluids from an infected
  person enters the body of a person who is not
  immune

29
The Final Curtain

• Always take precautionary measures!
• Glove up!
• Hepatitis B shots
• Proper placement of contaminated material
• Education of various blood borne pathogens