Wound care - Pharmaceutical Society of · PDF fileCreating a management plan for wound care. When managing a wound, the person with the wound ... Burn Ultraviolet rays (sunburn), fire,

Wound careSupplementary materials

PRINT POST APPROVED PP 100009758 Supported by an unrestricted educational

grant from Nexcare™ Brand

ACTION kit supplementary materials Wound care May 2016

Project Manager Rhyan Stanley

Layout Rebecca Jones

Author Jill Malek

Reviewers Samantha Kourtis

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PHARMACEUTICAL SOCIETY OF AUSTRALIA LTD. ABN 49 008 532 072

PO Box 42, Deakin West ACT 2600P: 1800 303 270 or 1300 369 772 E: [email protected] www.psa.org.au

This publication is supplied as part of the Self Care program, Pharmaceutical Society of Australia. The views expressed by the authors of this ACTION kit are their own and not necessarily those of the publisher which is PSA, nor the editorial staff and review panel and must not be quoted as such.

This publication contains material that has been provided by the Pharmaceutical Society of Australia (PSA), and may contain material provided by the Commonwealth and third parties. Copyright in material provided by the Commonwealth or third parties belong to them. PSA owns the copyright in the publication as a whole and all material in the publication that has been developed by PSA. In relation to PSA owned material, no part may be reproduced by any process except in accordance with the provisions of the Copyright Act 1968 (Cth), or the written permission of PSA. Requests and inquiries regarding permission to use PSA material should be addressed to: Pharmaceutical Society of Australia, PO Box 42, Deakin West ACT 2600. Where you would like to use material that has been provided by the Commonwealth or third parties, contact them directly

© Pharmaceutical Society of Australia Ltd., 2016

DisclaimerThe Pharmaceutical Society of Australia Ltd. has made every effort to ensure that, at the date of publication, the document is free from errors and that advice and information drawn upon have been provided in good faith. Neither the Pharmaceutical Society of Australia Ltd. nor any person or organisation associated with the preparation of this document accepts liability for any loss which a user of this document may suffer as a result of reliance on the document and in particular for:

• Use of the document for a purpose for which it was not intended;

• Any errors or omissions in the document;• Any inaccuracy in the information or data on which

the document is based or which are contained in the document; or

• Any interpretations or opinions stated in, or which may be inferred from, the document.

PSA

5045

Contents

Wound management 4

Clinical background 5

Types of wounds 5

Wound healing 7

Wound assessment 10

Wound dressings 11

Safe disposal of waste 14

Health promotion 16

Appendix 1: Pharmacy first aid protocol for treating wounds 17

Appendix 2: Wound assessment and treatment tool 18

Appendix 3: Wound dressing selection tool 20

Appendix 4: Summary of dressings based on wound type chart 20

Appendix 5: Wound management plan tool 21

Appendix 6: Reducing the risk of acute wounds 22

Appendix 7: Pharmacy staff and consumer resources 23

References 23

Please refer to PSA companion publication Manual for delivering professional services for more information about service delivery, and for templates for screening, care plan, referral and other forms.

PSA thanks Nexcare™ Brand from 3M for their generous support of this Wound care ACTION kit. Nexcare™ Brand is a range of wound care products including strips, acute wound care, tapes, bandages and sports tapes.

4 ACTION kit – Wound care: supplementary materials I © Pharmaceutical Society of Australia Ltd.

Wound managementWound management aims to minimise scar formation and to accelerate healing time. Inappropriate management of wounds can lead to delayed healing, infection, deterioration of wounds and wound breakdown. Evidence-based wound management must always be applied.1,2

To successfully manage a wound, the healing process of the wound must be understood and an appropriate management process applied. Managing wounds in the pharmacy would usually include wound assessment, wound treatment such as cleaning wounds, and application of wound dressings as well as providing consumer wound self-care information.

The principles of wound management basically involve the following2:

1. Determining the cause of the wound – either local (wound-related factors) or systemic (patient-related factors).

2. Treating both the wound and the cause. 3. Selecting and apply suitable dressings, if required. 4. Creating a management plan for wound care.

When managing a wound, the person with the wound must be involved in the process. The preferences of the person and their carer and their accompanying lifestyle must be carefully considered and discussed before appropriate wound management is commenced. This is essential to achieve a good wound management outcome and possibly prevent future wound development.1–3

Collaborating with the wider healthcare team is also a vital component of wound management. Referral for further medical review may be needed if the wound cannot be adequately managed in the pharmacy or by the person with the wound. Establish good working relationships with local doctors, community nurses and hospital services to ensure the person with the wound is receiving the best possible care.1

To facilitate a wound care service, ensure a range of resources are always available in the pharmacy. This may include wound dressings and bandages, associated wound care products, devices and consumer wound care information. All pharmacy staff involved in the wound care management service should receive regular training in the use of wound care products.1 Liaise with suppliers of wound care products to ensure the most appropriate and current products are supplied and available for use in your practice.

This wound management ACTION kit is designed for the management of wounds in the pharmacy.

5ACTION kit – Wound care: supplementary materials I © Pharmaceutical Society of Australia Ltd.

Clinical background

Types of wounds

A wound is defined as a physical injury to the body where the skin or mucous membrane becomes damaged, lacerated or broken. Wounds are defined as either acute or chronic.2,4

Acute woundsWounds commonly seen in the pharmacy are acute and include abrasions, cuts and skin tears, burns (usually thermal burns such as sunburn). Acute wounds usually heal quite easily in an orderly progression without complication.4 Acute wounds can be painful and pain relief should be considered when treating these wounds. An acute wound can develop into a chronic wound if there is a failure to progress through the stages of wound repair within 3 months.2 For examples of acute wounds, see Table 1.

Before administering first aid in response to any wound, always wash hands thoroughly with soap and water for 15 seconds and dry them on a clean towel. An antibacterial hand gel can be used if hands are not visibly dirty.5 See Appendix 1: Pharmacy first aid protocol for treating wounds.

Table 1. Types, causes and descriptions of acute wounds4,5

TYPE CAUSE DESCRIPTION

Abrasion Sheering or rubbing against hard surfaces commonly seen on thin-skinned areas, e.g. hands, knees, elbows, shins, ankles

• Epidermis is broken• May contain dirt • Usually minimal bleeding as the abrasion may

only affect the epidermis

Incision/post operative wound

Sharp, pointed objects, e.g glass, scalpel

• Can be of varying depths• Bleeding is dependent on the depth of the

wound and if a blood vessel has been cut• Object may be lodged in the wound

Laceration/ skin tear

Sharp or blunt-edged object • Varied appearance and size• Jagged tears or cuts• Gaping wound or skin flaps• Bleeding is dependent on the depth of the

wound and if a blood vessel has been cut

Puncture Sharp object has pierced the skin making a hole, e.g. splinters, nails, glass, bites

• Size and depth of the wound is dependent on the size of the object

Burn Ultraviolet rays (sunburn), fire, steam, hot liquids, chemicals, electricity

• May affect the surface of the skin (superficial) or may be deep causing damage to many or all layers of the skin (partial- or full-thickness)

• Superficial – pain, red, moist • Partial-thickness – pain, red, moist, blisters• Full-thickness – skin is white or charred, dry,

no pain (nerves destroyed), no blistering


Chronic woundsA chronic skin wound has failed to orderly progress through the stages of healing. Functional integrity of the skin has not been achieved within 3 months.2

Factors that contribute to a wound becoming chronic include underlying disease, certain medicines, and reduced peripheral circulation caused by even moderate smoking. Chronic wounds include leg ulcers, pressure wounds, post-operative wounds, cancer and chronically infected wounds.2

The difficulty in managing any chronic wound in a pharmacy setting is treating the underlying cause (e.g. infection, diabetes). However, these contributing factors must be addressed to facilitate the healing process. See Table 2.

Table 2. Types, causes and descriptions of chronic wounds2,4,6

TYPE CAUSES DESCRIPTION

Leg ulcers • Poor blood supply (may be due to smoking, high cholesterol, high blood pressure, diabetes and vascular disease, valve damage)

• Nerve damage (may be due to underlying conditions such as diabetes)

• Significant trauma• After a deep vein thrombosis

• Loss of the full thickness of the skin on the leg or foot

• Swelling, redness, oozing• Acute: heal in <4 weeks• Chronic: difficult to heal;

persists >4 weeks

Pressure wounds and ulcers

• Direct pressure on a bony prominence decreasing blood supply

• Friction from rubbing, wearing away top layers of skin (e.g. blisters)

• Shearing: skin sticks to a surface (e.g. bed linen or chair) while the underlying tissue slides down

• Lack of feeling in a part of the body and damage occurring without noticing

• Immobility• Excessive moisture (e.g. sweating, incontinence) • Malnutrition

• Also known as bedsores• Injuries to the skin and/

or underlying tissue often over a bone (particularly one that is protruding)

Post-operative wounds

• Due to a surgical procedure • Vulnerable to infection due to the invasive nature of surgery

• Often take longer to heal especially in patients who smoke

• Depending on the nature of the surgery, wound healing can be a major part of the overall recovery process

Chronically infected wounds

• A wound with a deeply established infection.

• Staphylococcus aureus commonly found in chronic wounds

• Very difficult to treat either with topical antibiotics or systemic antibiotics


Wound healing

Process of wound healingWound healing occurs as the wound closes and the skin’s integrity is restored.2,4 The body begins repairing a wound immediately and the process may continue for days, weeks, months or even years, depending on the injury. Underlying tissue may still be healing even though the surface of a wound appears to be healed.4

The healing process of a skin wound follows a predictable and recognisable pattern and time frame. A wound may fail to heal if one or more of the four healing stages are interrupted.6

There are four overlapping phases in the wound healing process4,6,7:

1. Haemostasis – occurs immediately after a wound is sustained. Bleeding will occur at first then blood vessels at the site will contract to prevent blood loss, and a clot will develop.

2. Inflammation (0–3 days) – the clot and surrounding tissue release inflammatory mediators (e.g. cytokines, growth factors). Once bleeding has been controlled, inflammatory cells migrate towards the wound promoting the inflammatory phase during which the wound is cleansed of debris. The inflammatory phase is characterised by erythema, heat and oedema.

3. Proliferation (2–24 days) – granulation tissue (layers of collagen and extracellular matrix) develops using a network of newly formed capillaries which supplies the area with oxygen and nutrients, the wound contracts and epithelial cells grow under the dried scab.

4. Maturation (24 days–1 year) – wound becomes less vascular and is strengthened by the re-arrangement of collagen fibres. Strengthening of the tissue below the skin surface continues for many months after the skin surface of the wound has healed.

Factors affecting wound healingCertain factors affect the rate at which a wound heals. These factors need to be considered before deciding on the method(s) used to treat a wound. Factors that affect wound healing can include local factors and systemic factors.2

Local factorsLocal (wound-related) factors such as wound hydration, and the presence of chemicals (e.g. antiseptics), foreign bodies and bacteria as well as pressure, friction and shearing, location, size, temperature of the wound and blood supply to the wound can all impact on the time it takes for a wound to heal.2,4 See Table 3.

Systemic factorsSystemic (patient-related) factors such as age, medical conditions, hydration, body type (e.g. emaciated, obese) and the nutritional status of the person all impact on the speed of wound healing (see Table 4).

Table 3. Local factors affecting wound healing4–6,8

LOCAL FACTOR DESCRIPTION ACTION

Chemical stress • Can be caused by wound antiseptics and cleansing agents (e.g. povidone-iodine, hydrogen peroxide, cetrimide, chlorhexidine gluconate, alcohols, sodium hypochlorite, acetic acid)

• Cetrimide, hydrogen peroxide, povidone-iodine can inhibit wound healing as they are toxic to keratinocytes, fibroblasts and leucocytes

• Avoid the prolonged use of antiseptics on a healing wound

• Use antiseptics for disinfecting acute, contaminated traumatic wounds and bites

• If antiseptics used, wash off after 3–4 minutes

Mechanical stress • Pressure, friction and shearing can damage newly formed blood vessels in a wound

• Do not change wound dressings too often to avoid unnecessarily damaging the wound surface

• Only change a dressing when it is wet, soiled or soaked with wound drainage

Temperature • Optimum temperature for human cell growth is 37 ºC• A drop in body temperature can decrease blood flow to and

through the wound, reducing the rate of healing

• Keep the body warm• Avoid unnecessary dressing changes and washing

of the wound with solutions that could lower the wound’s temperature

Oxygenation • Exposing a wound to the air (hypoxia) reduces the surface temperature of the wound lowering the blood flow to the wound

• Delays healing

• Cover the wound with a dressing keeping the wound moist

Foreign bodies • Debris of any type, whether produced by the wound or by the dressings used on the wound, will slow wound healing

• Debris will prolong the inflammatory phase, as well as increase the chance of infection

• Remove any necrotic (dead) tissue • Use non-shedding material to clean wounds and

apply non-shedding dressings


Table 4. Systemic factors affecting wound healing2,4,6,8

SYSTEMIC FACTOR DESCRIPTION ACTION

Increasing age • Skin becomes weaker, drier, less elastic, and thinner with age due to decreased subcutaneous fat, collagen, elastin deposits and secretion of sebum

• Increase risk of skin injury with age due to loss of some of feeling, flexibility, and elasticity

• Polypharmacy and nutritional deficiencies can contribute to lower skin healing rates

• Use skin moisturisers to hydrate the skin • Avoid washing the skin with agents that will

irritate the skin• Maintain a healthy diet• Use sun protection• Put padding on sharp furniture edges to

reduce chance of skin injury• Suggest wearing long sleeves, pants and

gloves when possible• Apply non-adhesive dressings and bandages

Medical conditions • Certain medical conditions including coronary artery disease, peripheral vascular disease, cancer, diabetes can: - slow the rate a wound heals - reduce blood flow to a wound - damage one or more peripheral nerves, causing

numbness, weakness and loss of sensation, e.g. diabetes - increase risk of infection

• Regularly examine feet, e.g. patients with diabetes

• Regularly examine wounds for signs of infection

• Encourage healthy eating and exercise• Promote smoking cessation

Medicines • Some medicines can delay wound healing • Impact of the medicine depends on the dose and

mechanism of action• Examples include anticoagulants, anti-inflammatories,

colchicine, glucocorticosteroids, immunosuppressants and antineoplastic drugs

• Obtain a medical history of a patient with a chronic wound

• Advise patients who are taking medicines that may delay healing to monitor any wounds.

• Advise them if they have a wound that is not healing, to seek medical attention

Dehydration • Loss of water interferes with circulation and the amount of oxygen and nutrients getting the wound

• Skin becomes fragile and can breakdown

• Encourage drinking of water particularly in people who are elderly

• Use moisturising cream to hydrate the skin• Avoid alkaline soaps and washes, which can

desiccate the wound bed

Body type • Both obese and very thin people can have delayed wound healing which is related to poor nutrition

• Encourage healthy eating and exercise• Participation in weight loss programs for

people who are overweight• Refer to dietitian

Nutrition • Poor nutrition or lack of specific nutrients can affect wound healing

• Proteins, carbohydrates, fats, vitamins, trace elements and fluids all play a vital role in wound repair

• Vitamins A and C, zinc and protein are important

• Review the nutritional needs of people with chronic wounds and the elderly

• Encourage healthy eating

Smoking • Chemicals associated with smoking can affect healing (e.g. nicotine, carbon monoxide) by reducing blood flow and oxygen supply to the wound

• Increases the risk of wound infection

• Encourage patients to cease smoking• Suggest the participation in smoking

cessation programs at the pharmacy

LOCAL FACTOR DESCRIPTION ACTION

Hydration • If a wound dries and a scab forms, healing is either delayed, or will stop

• Exposed, dry wounds are more inflamed, painful, and itchy during the early stages of healing, and have more scab material during the early stages of wound healing

• Ensure the wound dressing provides an optimally moist environment so to prevent a scab forming

Maceration • Softening of the wound can occur if there is excessive moisture or wetness at the wound site

• May be due to incontinence, perspiration or excessive exudation from the wound

• Will cause the destruction of tissue and slow the healing process

• Maintain an optimally moist environment without excessive wetness

Infection • Signs of infection include redness of the skin, discharge, fever, pain and sometimes odour

• Some wounds can have a high bacterial count, but show no signs of infection

• Healing will be delayed in infected wounds and hospitalisation may be needed

• Antibiotics need to be considered• Consider referral to doctor • Note: some antibiotics can interfere with wound

healing. If there are no obvious signs of infection, avoid use of antibiotics

Table 3. Local factors affecting wound healing4–6,8 (continued)


Always read the instructions and use strictly as directed.© 3M 2016. All rights reserved. 3M and Nexcare are trademarks of 3M.

3M Australia Pty Limited. Building A, 1 Rivett Road, North Ryde NSW 2113.Contact Ph: 1300 363 797

Bringing you a range of first aid and wound care products developed from the 3M Health Care line; trusted by

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Moist wound healingThe moisture level of a wound has a significant effect on healing. Autolytic debridement (i.e. removal of necrotic material and slough), formation of granulation tissue and epithelialisation all occur optimally when the wound surface is kept moist (not wet). A wound will heal more quickly when kept moist, a scab is less likely to form (a physical barrier to healing) and there is less chance of scarring.4 Wound healing will also be adversely affected if the wound is too wet.2

The level of moisture can be controlled by the choice of dressing (see Tables 5, 6, and 7) and how often the dressing is changed. If the wound is too dry, a moisture-promoting dressing (e.g. hydrogel, hydrocolloid) may be appropriate. If it is too moist, a dressing that absorbs exudate (e.g. foam, alginate) would be suitable. If the dressing is changed too regularly, the wound may dry out. Depending on how much exudate is produced by the wound, some dressings can be left on the wound for extended periods of time to keep the wound moist.4 Other dressings need to be changed when they become wet, soiled or soaked with wound exudate.5

Wound temperatureThe temperature of the wound is important for optimal wound healing. The surface of the wound should be keep at a constant temperature. Cooling the wound by exposing the wound to the air and applying products that lower the wound’s temperature should be avoided. Changing a dressing too often can also lower the wound’s surface temperature impeding healing.1,4

The person with the wound should be counselled how to avoid raising or lowering the intact skin temperature by not overheating the body with clothing, bedding or use of heating devices. Use of plastic bed coverings and plastic-lined clothes should be avoided. The person with the wound should remain hydrated. The temperature of their surrounding environment should also be maintained stable and comfortable.1

Maintaining pHWound healing is optimised when the pH of the wound is neutral or slightly acidic. This can be achieved by avoiding the use of alkaline soaps, cleansers and other agents. A wound bed that has been allowed to dry out will have a higher pH and healing will be delayed.1

Wound assessmentBefore recommending a wound treatment, thoroughly assess the wound. Thorough wound assessment includes wound classification, colour, depth, shape, amount of exudate, wound location and the environment in which the wound will be cared. The wound and treatment will need to be re-assessed as the characteristics of the wound change (see Appendix 2: Wound assessment tool).9

Assess the wound by reviewing4,9,10:

Colour: A pink wound is in the final stages of healing. New epithelium is covering the wound. A red wound is granulating and is well vascularised. A yellow wound contains slough and a green wound often indicates infection. A black wound shows that the wound contains necrotic tissue and a layer of eschar (see Table 8).

Size/shape/depth: The wound depth may be superficial, partial-thickness, deep or a cavity. The depth, location and shape of the wound will determine the type of dressing and treatment options as well if the person needs to be referred for further medical assessment.

Exudate: Most wounds contain some exudate. Infected wounds often produce heavy exudate, which can be toxic to the surrounding skin. The dressing choice is determined by the level of exudate.

Wound edges: The edges of a wound may show if the wound is healing. Wound edges that are coming together and contracting are signs of healing. Wound edges that

are raised (may indicate pressure, trauma, or malignant changes) or rolled (may indicate wound stagnation or a chronic wound), are a sign that the wound may not be healing. If there is increased pain or lack of feeling at the edges of the wound, this may be another sign of non-optimal healing such as infection and referral for further medical review may be required.

Pain: A person with a wound may underestimate pain associated with wounds, especially if they have reduced peripheral feeling. Pain may also be a sign of infection. Accurately assessing pain is essential when choosing the most appropriate dressing. Always assess the level of the patient’s pain before, during and after changing a dressing as this may provide information about how the wound is healing and further wound management. If unsure, use a pain assessment chart to determine the person’s level of pain (see Wong Baker FACES Pain rating scale at: www.health.gov.au). See Appendix 2: Wound assessment tool.

Other factors: Assess if the person with the wound, and/or their carer, has the physical and mental capacity to manage the wound including changing the dressing. Review their lifestyle, health status, healing environment and assess the risk of further wounding. Reduced circulation, compromised nutrition and polypharmacy may all affect the rate of healing and should be assessed. Also consider the cost of the dressings (see Appendix 2: Wound assessment tool).


Wound dressingsDressings can be used as primary and/or secondary dressings depending on the wound. Primary dressings are placed directly onto the wound. Secondary dressings are placed over a primary dressing.4 The choice of dressing depends on the type of wound, where the wound is located on the body, the amount of exudate and patient characteristics.2,4

Before choosing a dressing, the patient must be assessed (see Appendix 2: Wound assessment tool). Any underlying disease that will impact on wound healing needs to be identified. Also, any patient concerns should be identified, considered and addressed.10

Dressings that create the most suitable environment at the wound-dressing interface will4:

• absorb excess exudate from the wound while keeping the wound optimally moist

• allow gas (i.e. oxygen, water vapour, carbon dioxide) and fluid to pass in and out

• not adhere to the wound minimising trauma to granulating tissue when removed

• be comfortable and conform to the wound shape

• keep the wound at a stable 37 oC

• protect the wound from mechanical and bacterial injury so to minimise particulate and toxic contamination

• not require frequent changes (unless infected)

• be non-toxic, non-allergenic and non-sensitising

• absorb wound odour.

Wound dressings can be classified into inert (passive) and interactive/bioactive (see Tables 5, 6, and 7).4

Inert (passive) dressings Inert dressings provide a protective covering over a wound. They can be used in dressing minor cuts and abrasions, as well as cleaning shallow wounds and minor burns (see Table 5).4

Active dressingsActive dressings can be classed as either interactive or bioactive. They help to control the wound healing environment promoting normal healing, by either4:

• combining with the exudate to form a gel

• controlling the flow of exudate from the wound into the dressing (e.g. films, hydrogels, foam dressings)

• delivering substances that actively assist in wound healing (e.g. hydrocolloids, alginates).

Anti-infective dressingsMicrobial contamination on the surface of a wound can slow the healing process (see Table 7). If a wound is infected, systemic antibiotics are usually required along with an anti-infective dressing4,9

Recommending dressingsTo recommend the most appropriate dressing for the wound:

• review the appearance of the wound

• match the absorbency of the dressing to the amount of exudate from the wound (see Appendix 4: Summary of dressings based on wound type chart)

• look at the skin surrounding the wound.


Table 5. Inert dressings4,11

TYPE DESCRIPTION USE SOME EXAMPLES

Wound dressing strip

• Island dressing with absorbent pad attached to a strip of adhesive tape (plastic or fabric)

• Plastic tape is water vapour impermeable causing possible maceration of the surrounding skin

• Minor superficial wound Nexcare Blue Strips OR Nexcare Waterproof Strips, Nexcare Active Waterproof Strips, Nexcare Blister Waterproof Strips, Nexcare Heavy Duty Fabric Strips, Nexcare Soft ‘n Flex Strips, Nexcare Blue StripsBandaid

Gauze • Sterilised cotton woven and non-woven cloth available as pads, folded swabs and ribbon gauze

• AbsorbentContraindications• Allows wound to dry out• Can shed fibres• Can stick to wound causing trauma on removal• Permeable to bacteria

• Cleaning wounds• Primary dressings• Wet dressings• Ribbon gauze is used for nasal

packing and in cavity wounds• Pressure dressing to stop bleeding• Absorbents in surgery• Non-woven

Woven: Gauze swabs and dressingsNon-woven: Handy swabs, Multisorb swabs

Non-adherent absorbent pad

• Absorbent • Non-stick inner film layer• Do not use on dry wounds• May be used with tapes/or bandages to adhere

to the skin

• Primary dressing for minor and low exudating superficial wound

• Secondary dressing for moderate-to-high exudating wounds

• Secondary dressing if attached to an adhesive secondary dressing (island dressing), e.g. used over lacerations and minor wounds; over a hydrogel on minor burns

Moderate absorbency: Nexcare non-stick pads, Cutilin, Melolin, TelfaHigh absorbency: Exudry, MesorbIsland dressing: Nexcare Tegaderm plus pad, Nexcare sensitive skin adhesive pad, Cutiplast steril, Mepore, Primapore, Telfa islandTapes: Nexcare Micropore, Nexcare Sensitive Skin Tape, Nexcare Absolute Waterproof Tape, Nexcare Flexible Clear tape, Nexcare Soft Cloth TapeBandages: Nexcare No Hurt Wrap, Nexcare Crepe Bandages

Tulle-gras dressings

• Gauze dressing impregnated with paraffin • Reduces adhesion to wound• Needs to be changed daily or more frequently• Permeable to bacteria• Provides a moist environment but may cause

maceration • Non-absorbent• Requires a secondary dressing

• Minor burns• Clean superficial wounds that are

healing by secondary intention

Jelonet, Paranet, Unitulle

• Impregnated with antiseptics or antibiotics and paraffin

• Requires a secondary dressing• May cause allergy to medicated ingredients• Continued exposure to antiseptics can be

detrimental to newly granulating tissue

• Burns • Contaminated orinfected wounds

Bactigras (contains chlorhexidine), Betadine Pads (contains povidone-iodine), Sofra-Tulle

• Non-paraffin modern tulle• Tightly meshed• Allows moisture to pass through• Less maceration that paraffin tulle• Does not adhere to wound or allow tissue

embedding • Requires secondary dressing

• Simple, clean abrasions and burns, excoriated peri-skin

• Initial dressing over skin grafts

Adaptic (contains petrolium emulsion), Atrauman, Cuticerin, Urgotul

• Non-fibre, non-paraffin tulle• Tightly meshed • Silicone coated • Can remain in place for 10–14 days

• Burns• Skin tears

Mepitel

Fixation sheets

• Porous polyester fabric with adhesive backing• Provides pain relief due to reduced air flow across

the wound• Permeable and washable • Soak in oil to remove• Can be left in place for 5–7 days

• Primary or secondary dressing for low exudating wounds, superficial grazes, and burns and wounds that do not need frequent review

• Do not use on infected wounds or it allergy to adhesive

Fixomull, Hypafix, Mefix

Film • Waterproof• Gas/vapour permeable • Adhesive • Flexible • Reduces pain• Barrier to external contamination• Protection to friction and microbes• Removal may cause trauma to wound or fragile skin• Replace if there is leakage or if the wound looks

infected

• Primary dressing over minor abrasions, lacerations, burns, scalds with low or no exudate, over sutures, after suture removal

• Prevention and treatment of superficial pressure areas

• Secondary dressing with an absorbent pad over gels, alginates and foams

• Remove slowly stretching away from and parallel to the wound

• Do not use on highly exudating wounds, deep burns, deep cavity wounds (primary dressing), fragile skin, or infected wounds

Nexcare Tegaderm, Elastoplast Aqua Protect Film, Hydrofilm, Mepore Film, Opsite Flexigrid,Island film dressing: Nexcare Tegaderm plus pad, Cutifilm Plus, Hydrofilm Plus, Opsite Post Op, Tegaderm


Table 6. Interactive and bioactive dressings4,9

TYPE DESCRIPTION USE EXAMPLE

INTERACTIVE DRESSING

Foam • Absorb exudate• Maintains a moist environment • Soft, non-adherent • Provides cushioning • Needs secondary dressing or

tape/bandage to hold in place• Protects against temperature

changes• Available as sheets or cavity-

filling shapes

• Wounds with medium-to-high amounts of exudate, e.g. ulcers and minor burns

• Superficial burns • Can be left in place for 2–3 days• Secondary dressing for hydrogel

dressings

Allevyn, Curafoam, Hydrasorb, Lyofoam

Hydrogels • Water-containing (up to 96%) • Maintains moist environment

to rehydrate a dry, sloughy wound

• Non-adherent, absorbent• Allows gases and water vapour

to pass through• Requires secondary dressing to

hold in place

• Dry, sloughy wounds to rehydrate and remove dead tissue

• Sunburn, simple scalds (amorphous hydrogels)

• Partial-thickness burns (sheet hydrogels)

• Do not use on highly exudating wounds

Amorphous:Aquaform gel, DuoDERM gel, Hydrosorb gel, Intrasite gel, Nu-Gel, SoloSite, SolugelSheet:AquaClear, Flexigel sheet, Intrasite Comfortable

BIOACTIVE DRESSINGS

Hydrocolloids • Absorbs wound exudate and forms a gel

• Provides a moist, warm environment that promotes debridement and healing

• Occlusive and some are semi-permeable

• Can be left in place for up to 7 days depending on amount of exudate and type of dressing

• Many different forms: adhesive, non-adhesive, paste, powder

• Sloughy wounds• Wounds with low-to-moderate

amounts of exudate• Leg, pressure ulcers

Not recommended for:• high exudate wounds• wounds that need frequent inspection• infected wounds

Nexcare Blister Strips, Comfeel Plus, CombiDERM, DuoDERM CGF, Hydrocoll, Replicare Ultra, Restore, Tegasorb

Hydroactive • Absorb large amounts of exudate and swell (do not form a gel)

• Maintain moist environment• Promote autolytic debridement• Waterproof, semi-permeable,

elastic

• Medium-to-high levels of exudate, e.g. cavity wounds such as leg ulcers, pressure wounds, minor burns

• Useful over joints, e.g. elbow, knee, fingers and toes as elastic and contract without causing constriction

• Not recommended for wounds with little or no exudate or infected wounds

Allevyn Plus, Cutinova Hydro, TenderWet, Tielle

Alginates • Contain alginic acids (obtained from seaweed)

• Forms a gel providing a moist environment

• Provides a moist environment• Highly absorbent (up to 15–20

times their weight)• May leave fibres that could

cause inflammation• Require secondary dressing• Available in sheets, packing

rope

• Moderate-to-heavy exudate wounds (e.g. leg ulcers, pressure wounds, cavity wounds)

• Used on skin graft sites, bleeding sites, exudating leg ulcers and cavities

• Must be changed daily• Not recommended for low exudating

or dry wounds

Soft sheet: Comfeel SeaSorb, SorbsanForm sheet: Algisite M, Algoderm, Restore CalciCare Tegagen HI and HGRope: Algoderm, Comfeel SeaSorb, Kaltostat, Restore CalciCare, Sorbsan, Tegagen HI

Hydrofibres • Consists of synthetic fibrous mat which is highly absorbent

• Absorb exudate forming a soft gel

• Available as sheet or ribbon dressings

• Wounds with heavy exudate (e.g. leg ulcers, pressure wounds, cavity wounds)

• Superficial burns

Aquacel


Table 7. Anti-infective dressings4

TYPE DESCRIPTION USE EXAMPLE

Honey • Sterilised honey

• Maintains a moist healing environment

• Eliminates odour

• Stimulates new tissue growth

• Aids debridement

• Most commonly used to treat infected wounds such as leg ulcers, pressure ulcers, diabetic foot ulcers, infected wounds as a result of injury or surgery, burns often when conventional therapy has failed

• First aid treatment of burns

Actilite, Activon, Algivon (alginate dressing impregnated with honey)

Iodine • Iodine acts as an antiseptic to reduce infection

• Cadexomer iodine: Iodine combined with a polymer which absorbs exudate and slowly releases iodine protecting the wound from bacteria, mycobacteria, fungi, protozoa, viruses over 72 hours

• Sloughy/infected wounds, diabetic wounds and wounds which are healing poorly, e.g. leg and pressure ulcers

• Avoid or use with caution if patient is sensitive to iodine, has thyroid disorders, significant renal disease, children and pregnant women

• Use with caution for long-term treatment of large wounds and before and after radio-iodine tests

Povidone-iodine: Inadine

Cadexomer iodine:

Iodosorb, Iodoflex

Polyhexanide • Contains non-cytotoxic (not deadly to cells) antiseptic

• Removal of wound debris and bacteria in acute and chronic skin wounds, superficial and partial-thickness burns

Prontosan

Silver • Contains silver

• Broad-spectrum antimicrobial

• Dressing may need to be activated by moistening with sterile water (not saline) before applying

• Cream used to treat burns and some wounds

• Use on slow-to-heal and critically colonised wounds

• Choice of silver dressing depends on the level of infection, size and depth of wound and amount of exudate

• Avoid if patient is allergic to silver

• Use with caution in renally impaired patients due to accumulate risk

Allevyn Ag, Silvercel, Acticoat

Safe disposal of wasteWaste will be generated through a wound management service. Used wound dressings, bandages, disposable gloves and other equipment may contain human blood and/or body fluids. These materials have the potential to cause injury, infection or offence.

Pharmacists have the responsibility of managing the disposal of this waste. Most of the waste will be non-reusable and/or non-recyclable and therefore must be managed in a manner that protects both the community and the environment. Some states and territories require the incineration of this type of waste.

State, territory and local council regulations have different requirements for the disposal of this type of waste. Before commencing a wound management service, contact the pharmacy’s local council for current local area advice on waste disposal. State and territory health departments and environmental protection agencies may also have advice on the correct disposal of this type of waste. Once waste disposal requirements have been determined, train the pharmacy staff on both minimising waste and ensuring that it is properly managed in the pharmacy.


Table 8. Wound assessment and dressing selection4,9

WOUND COLOUR

WOUND APPEARANCE DESCRIPTION DRESSING SELECTION

Pink • Wound in the final stages of healing

• Low exudate

Protect and insulate new tissue and maintain a moist environment, e.g. island dressings, non-adherent dressings, hydrocolloids, hydroactives, tulle, zinc paste

Red • Wounds looks granular and highly vascular (red) due to new blood vessels

• Low or high exudate

Absorb excess exudate, maintain a moist environment but not soggy, protect the wound and promote tissue growth

Low exudate: hydrocolloids, films, foams, sheet hydrogels

High exudate: foams, alginates, hydroactive dressings

Black • Wound with hard, black and leathery tissue due to local tissue death

• Low exudate

Rehydrate and loosen the hard tissue and remove infected and dead tissue, e.g. foams, alginates, hydroactive dressings

Yellow • Wound with a sloughy layer of non-viable tissue

• Low or high exudate

Maintain moist environment, remove slough, absorb exudate

Low exudate: hydrogels to rehydrate the slough, hydrocolloids, films and enzymes, cadexomer iodine, silver dressings

High exudate: hydrocolloid paste or powder, alginates, hydrogel, hydrofibres, cadexomer iodine, silver dressings

Green • Infected wound with large amount of exudate

• High exudate

Absorb infected exudate and avoid the breakdown of the surrounding skin, e.g. hypertonic saline, silver dressings, cadexomer iodine, interactive wet dressings, hydrofibres

Images reproduced with permission from G. Sussman and J. Jones.


Health promotionHealth promotion engages consumers and the community to promote health and wellbeing at a population or group level, and includes strategies such as health education, health counselling, provision of health information and skills development.

A health promotion campaign focused on wound care could raise consumer awareness of the importance of appropriate and timely management of wounds. Effective management of wounds can minimise healing time and scarring and reduce the chance of wounds becoming chronic.

Through a wound care health promotion, consumers can be encouraged to take immediate care of acute wounds. A catch phrase for the promotion such as Act now on wounds, can be used to highlight the need for immediate and effective wound care treatment. Chronic wounds are known to affect a person’s physical, social and psychological health as well as imparting a huge cost on the community.8,14 Through a wound care health promotion, consumers with chronic wounds may be identified and referred for further medical treatment as required.

A wound care health promotion campaign could also identify people at risk of wounds. Elderly people, for example, are at risk of skin tears. Their skin is fragile and easily damaged. It is drier, less elastic and often very thin. Bleeding and skin discolouration and bruising are common. Alert them to the risks of skin tears especially on the upper limbs and encourage them to come to the pharmacy for assessment and treatment if a wound occurs. This type of wound can be effectively and efficiently managed in the community pharmacy.8

Therefore, it is very important to be familiar with your local wound care network. Identify hospitals, outpatient clinics, general practitioner surgeries, dietitians, dermatologists, oncologists, and community nurses in your area who contribute to wound management. Contact them before hosting a wound care health promotion and discuss their roles in wound management. For example, if a patient with a chronic wound needs more specialised care, you will need to know how to access the most appropriate local wound care services such as community nursing. A wound management service must be community-wide, not limited to the pharmacy. It must involve all local area wound management services.

Through wound care demonstrations and training, consumers can be encouraged to take an active role in the management of their wounds. The risk factors for wounds can be highlighted and information provided on how to take preventive action to avoid injuries.

Pharmacies wanting to host a wound care promotion could partner with healthcare organisations, such as Wounds Australia as well as manufacturers of wound

care products. These organisations have resources and materials that can be used during the promotion period. A wound care health promotion could be coordinated with national awareness campaigns such as Wound Awareness Week. These campaigns often have accompanying posters and consumer brochures. Suppliers of wound products should also be contacted and an agreement established to ensure a regular supply of wound care products.

Further information about health promotion activities in pharmacies is available in the PSA Self Care Manual for delivering professional services, Professional Practice Standards Standard 13: Health promotion, and Professional Practice Standards Appendix 3: The Health promotion planning cycle.

Wound management serviceA wound management service is an advanced level of practice focusing on wound assessment, treatment and timely referral to other members of the healthcare team, if required. This service offers consumers easier access to enhanced wound management, support and advice. Pharmacists offering this service will commonly treat acute wounds such as abrasions, cuts, burns and skin tears, often in a first aid situation. However, as many chronic wounds are now being managed in the community,14 pharmacists may also be involved in the care of chronic wounds.

To establish a pharmacy wound management service:

• Develop a pharmacy first aid protocol (see Appendix 1: Pharmacy first aid protocol for treating wounds)

• Ensure all pharmacy staff involved in the wound management service have current first aid certificates (see PSA at: www.psa.org.au)

• Assess the wound to determine the optimal management required (see Appendix 2: Wound assessment tool)

• Select the most appropriate wound care products and dressings (see Appendix 3: Wound dressing selection tool and Appendix 4: Summary of dressings based on wound type chart)

• Provide the person with the wound a wound care management plan (see Appendix 5: Wound management plan)

• Identify those people at risk of wounding and provide information about how to prevent wounds (see Appendix 2: Wound assessment tool and Appendix 6: Reducing the risk of acute wounds)

• Identify when referral for further medical review is needed (see Appendix 2: Wound assessment tool)

• Establish relationships with local healthcare providers and suppliers of wound care products

• Distribute patient counselling material and wound care information (see Appendix 5: Wound management plan tool, Appendix 6: Reducing the risk of acute wounds and Appendix 7: Pharmacist and consumer resources)

• Provide ongoing wound care education for all pharmacy staff (see Appendix 7: Pharmacist and consumer resources).


Appendix 1: Pharmacy first aid protocol for treating woundsA first aid protocol is designed to prevent the spread of infection between the patient and the pharmacy member treating the wound, between patients and between the pharmacy staff and the patient. High standards of hygiene must be adhered to at all times.

SEQUENCE EXPLANATION

1 Appoint a first aid officer

Appoint a member of staff as the pharmacy’s first aid officer who will be responsible for:• maintaining a current first aid qualification • maintaining the wound assessment and treatment area• ensuring stock levels of wound dressings and associated wound care products are adequate• cleaning, disinfecting and sterilising the treatment area and non-disposable items after use• safe collection, storage and disposal of contaminated waste• contacting an ambulance in an emergency situation• sourcing and maintaining wound care supplies and educational material for people with wounds and pharmacy staff

members

2 Establish a treatment area

• Establish a designated area within the pharmacy for patient triage to assess, treat and review wounds• Treatment area must contain chairs, treatment tables, access to a water supply, sealed contaminated waste disposal,

dressings and associated wound care products, disposable treatment items such as gloves, masks, swabs

3 Ensure infection control

• Before examining a wound, wash hands with soap and water for 15 seconds and dry on a clean towel. An antibacterial hand gel can be used if your hands are not visibly dirty

• Use gloves, masks and other protective equipment, if necessary, before examining the wound especially when there is risk of contamination. Also ensure washing of hands before touching any surfaces or after the dressing is completed.

• Ensure the correct disposal of contaminated waste in a sealed disposal container• Ensure all wound care products and materials are stored according to the manufacturer’s instructions

4 First aid treatment of a wound

Abrasion (graze)5

• Stop the bleeding by applying pressure to the wound• Gently clean the wound under running water with a non-fibre shedding material or sterile gauze to remove dirt and

debris • Don’t scrub at embedded dirt, as this can further traumatise the site • Cover the cleaned wound with an appropriate non-stick sterile dressing• Change the dressing according to the manufacturer’s instructions (some may be left in place for several days to

a week) • Do not use any product on the wound that will dry or traumatise the wound • Offer appropriate pain management

Laceration (cut)4,12

• Stop the bleeding of a small laceration by applying firm pressure to the wound with a towel for 5–10 minutes. A haemostatic dressing (e.g. alginate) may also be applied initially to stop the bleeding. If the laceration is large, continue applying pressure for at least 10 minutes. If possible, raise the wound area to try to stop the bleeding.

• If blood is squirting from the laceration, or bleeding cannot be stopped, ring Triple Zero (000). Apply a tourniquet 5 cm above the wound and tie tightly to reduce the blood flow to the area

• Clean a small laceration as for an abrasion• Apply wound closure strips across a deep cut to close the wound• Dress with a simple permeable dressing either waterproof or not• Wrap in a lightweight cohesive bandage over the dressing to further inhibit bleeding if necessary

Burn13

• Place the burnt area under running tap water for at least 20 minutes (thermal burn) or at least 1 hour for a chemical burn

• Do not apply ice, creams, lotions, or butter to the burnt area• Remove any jewellery that is near the burn if not stuck to the skin• Apply a non-stick dressing to the wound area, e.g. hydrogel, hydrocolloid and change according to

manufacturer’s instructions• If the burn covers a large area or is deep, refer immediately to hospital• For further information see Australian and New Zealand Burn Association, Wounds Australia, The Royal Children’s Hospital

Melbourne Clinical Practice Guidelines (Burns/management of burn wounds)

Skin tears8,16

• If bleeding, place a clean towel on the wound and apply gentle pressure until bleeding stops• Clean a minor skin tear using clean water, normal saline or non-toxic surfactant wash. If wound starts bleeding,

re-apply pressure and very carefully pat dry• If there is a skin flap, gently replace it over the wound (a moist cotton bud can be used) but do not pull it into place.• Use a silicone dressing that has silicone over its entire wound contact surface as this will secure the flap. Only use

elasticised skin fasteners if silicone dressings are not available or the flap has a complex shape. Take care to allow for wound drainage.

• Cover the wound with a non-adhesive dressing and hold in place with a paper tape or cloth bandage to reduce further trauma to the skin

• If the skin flap is partially or totally missing, or is very deep, refer for further medical advice • For further information, see STAR Skin Tear Classification System, CWC Skin tears assessment and management

5 Safe disposal of clinical waste

Safely dispose of any waste generated through the service according to local council, state and territory waste disposal requirements


Appendix 2: Wound assessment and treatment tool

Use a wound assessment and treatment tool when reviewing the wound and recording patient details and determining treatment*

Date of presentation: .....................................................................

Patient name: ................................................................................... Date of birth: .............................................................................................

Address: ......................................................................................................................................................................................................................

Phone: ................................................................................................. Email: ...........................................................................................................

Current medicines: .................................................................................................................................................................................................

.......................................................................................................................................................................................................................................

.......................................................................................................................................................................................................................................

Reason for presentation: ......................................................................................................................................................................................

.......................................................................................................................................................................................................................................

.......................................................................................................................................................................................................................................

Duration of wound: ........................................................................

Pain assessment: 1 2 3 4 5 6 7 8 9 10 Mild Moderate Severe

Related health issues:

Diabetes Smoking Pain Malodorous Arthritis Psycho-social

Nutritional status: ..................................... Body mass index (BMI): ....................................... Other: ......................................

Tetanus status: .................................................................................

Previous wound history and outcome: ...........................................................................................................................................................

.......................................................................................................................................................................................................................................

Acute wound

Abrassion

Incision

Laceration

Puncture

Burn

Skin tear

Chronic wound

Leg ulcer

Pressure wound

Post-operative wound

Cancer-related wound

Chronically infected wound

Other: .............................................................................................


Description of wound

Colour:

Pink Red Yellow Black Green

Amount of exudate:

Nil Low High

Wound edge:

Level Raised Rolled

Shape and size:

Infection: ............................................................................................

Pain: .....................................................................................................

Assessment of individual’s healing environment

Lifestyle factors: ...............................................................................

Hygiene status: ................................................................................

Risk of contamination: ..................................................................

Storage of wound products: .......................................................

Appropriate disposal of used wound products:

...............................................................................................................

Other: ..................................................................................................

Treatment

Cleaning: ............................................................................................

Dressing type: ..................................................................................

Analgaesia: ........................................................................................

Frequency of review: .....................................................................

Referral: ..............................................................................................

Patient counselling:........................................................................

Outcome: ...........................................................................................

Risk assessment

Falls: .............................................................................................................................................................................................................................

Skin integrity: ...........................................................................................................................................................................................................

Other: ..........................................................................................................................................................................................................................

*Adapted from www.awma.com.au/publications/2011_standards_for_wound_management_v2.pdf and www.rch.org.au/uploadedFiles/Main/Content/rchcpg/Wound_assesment_and_Treatment_Plan_version_7__2_.pdf

Size of wound:

...............................................................................................................

Underlying nerve, tissue, tendon damage:

...............................................................................................................

Assess movement:

...............................................................................................................

Assess tissue damage or loss:

...............................................................................................................

Location


Appendix 3: Wound dressing selection tool Before recommending a wound dressing, thoroughly assess the wound, and review and consider the patient’s needs. Use the wound dressing selection tool to ensure the most appropriate dressing has been selected.

Wound dressing selection tool*

CONSIDERATIONS YES/NO

Match the dressing absorbency with the level of wound exudate

Identify wound bed tissue type – epithelialising, granulating, infected, necrotic, or sloughy (see Appendix 3)

Inspect the condition of the surrounding skin

Identify a method of holding the dressing onto the body to provide protection and not cause additional trauma to the wound (e.g. tape, film, bandage)

Minimise pain and trauma i.e. silicone-based or non-adherent contact layers minimise trauma when the dressing is changed; moisture-retentive dressings and moist wound healing environments usually reduce pain

Estimate the size of the wound and use an appropriately sized dressing

Determine how long the dressing will be worn and when the dressing will need to be replaced

Consider the wound management requirements e.g. frequency of review, application of antibiotic, compression bandaging, etc.

Know the correct application and removal method of the dressing or secondary dressing

Know any precautions or contraindications for dressing use e.g. suitability on infected wounds

Aware and respectful of the patient’s needs and quality of life

Appendix 4: Summary of dressings based on wound type chartSummary of dressings based on wound type chart*

TYPE OF WOUND AIM OF DRESSING LOW EXUDATE HIGH EXUDATE DEEP WOUNDS

Epithelialising Keep moist and warm

Protection

Low or non-adherent dressing or

hydrocolloid

Alginate or hydrofibres with secondary absorbent dressing

Not applicable

Granulating Keep moist and protected

Manage exudate

Low or non-adherent dressing

Hydrocolloid


Alginate with a secondary absorbent dressing

Infected Reduce colonisation

Manage exudate

Alginate with secondary absorbent dressing and antimicrobial dressing (e.g. silver, iodine, honey)

Alginate with secondary absorbent dressing and systemic antibiotics

Alginate with secondary absorbent dressing and systemic antibiotics

Necrotic Rehydrate, debride, and manage exudates (note vascular status if lower limbs affected)

Hydrogel and semi-permeable film dressing or hydrocolloid


Hydrogel and semi-permeable dressing

Sloughy Remove slough,

debride and

absorb exudates

Hydrogel and semipermeable film dressing or hydrocolloid or surgical debridement

Alginate or hydrofibres with a secondary absorbent dressing

Alginate with a secondary absorbent dressing

*Adapted from Pharmaceutical Society of Australia. Wound care in practice. Canberra: PSA; 2013. p. 38.

*Adapted from Clinical pharmacist 2010;2:363–6. At: www.pharmaceutical-journal.com/files/rps-pjonline/pdf/cp201011_practice_tools-363.pdf


Appendix 5: Wound management plan toolAn acute wound care management plan is a general plan for caring for a wound. Although every wound is different, requiring different treatment and management strategies, a basic acute wound management plan can be useful in the pharmacy as well as given to the patient/carer to take home. This is particularly helpful for treating and managing acute wounds such as abrasions, minor cuts and burns.

1 Wash hands Before cleaning or dressing a wound, always thoroughly wash your hands with soap and water for 15 seconds. Dry them on a clean towel. An antibacterial hand gel can be used if your hands are not visibly dirty (also wash hands after cleaning or dressing wounds or if touching any surface)

2 Stop the bleeding

If the wound is bleeding, use a clean, dry towel and apply gentle pressure to stop the bleeding. If the wound is large or bleeding a lot, elevate the wound to help stop the bleeding. If bleeding won’t stop after 10 minutes or is squirting from the wound, call an ambulance immediately

3 Clean the wound

Use running tap water to wash the wound. Remove any dirt or debris from the wound with a clean towel. Do not use cotton wool balls. If the wound starts to bleed, apply gentle pressure. Avoid putting soap onto the wound. Antiseptics are not recommended. If soap or antiseptics have been used on the wound, flush or wash the wound with running tap water 3–4 minutes

4 Look for foreign bodies

Examine the wound to see if there are any foreign bodies embedded in the wound. If unsure, go to the emergency department at the hospital for investigation

5 Apply a primary dressing

Apply a dressing directly to the wound that is non-stick and able to absorb any wound fluid (exudate)

6 Apply a secondary dressing

Apply a dressing , tape or bandage that will hold the first dressing in place and fix to the body. Consider the patient’s age, skin type and activity levels, e.g. a cohesive bandage that does not stick to the skin or cause skin tears when removed would be appropriate for fragile skin, a water-resistant bandage should be considered if the wound was on a part of the body that was to be regularly wet such as the hands

7 Wound protection

Protect the wound if necessary with a firm covering such as a finger stall

8 Keep it moist Wounds heal more quickly with less chance of scaring if kept moist. Only change the dressing when it becomes soaked with wound fluid, dirty or soiled. Exposing the wound to the air will dry it and a scab will form slowing healing

9 Changing dressings

Dressings usually need to be changed when they become soaked with wound fluid, dirty or soiled. Always change dressings in a clean area and wash your hands before changing the dressing

Carefully and slowly remove the old dressing starting at the corners. Support the skin around the dressing to avoid damaging the skin and causing pain. If some of the old dressing is stuck to the wound, soak it off with clean water

• Discard the used dressing in the bin

• Avoid touching the wound as much as possible and look for signs of infection

• Clean the wound with a non-fibre shedding towel dampened with a mild cleanser. Pat dry

• Apply the new dressing recommended by a pharmacist or doctor. Avoid touching the part of the dressing that will go onto to the wound. If the dressing is not adhesive, secure it with tape or a bandage

10 Signs of infection

Observe around the wound for signs of infection such as increased pain, swelling, heat, redness, or discoloured and thick wound fluid (pus). Also if you feel unwell or develop a temperature. See your pharmacist or doctor

11 Pain relief Some wounds are painful and you may need a pain relief medicine such as paracetamol. Always ask a pharmacist or doctor before taking any medicine

12 Wounds that don’t heal

If the wound does not heal in four weeks or if it becomes larger, go to a pharmacist or doctor for advice

13 To assist wound healing

• Stop or reduce smoking• Drink plenty of fluid (but avoid too much caffeine or alcohol)• Eat foods rich in protein (including meat, fish, nuts, low fat dairy products, legumes)• Avoid removing dressings or treatments applied by a health practitioner unless you are instructed to

do so• Avoid exposing your wound to the air• Avoid bathing your wound in the sea


Appendix 6: Reducing the risk of acute woundsSome wounds can be avoided by taking preventive measures. This information could be provided to consumers and used as a teaching tool for pharmacy staff.

TYPE OF WOUND ADVICE5,12,13,15

Abrasion/graze • Protect your limbs by wearing long sleeves and pants

• Wear protective clothing when riding bicycles, skateboards, scooters or motorcycles such as helmets, knee and elbow pads, clothing made of thick tear-proof material such as leather

• Keep skin in good condition and hydrated by using a good quality moisturiser and drinking adequate fluid (i.e. water)

Laceration/cut • Take extreme care when using any sharp items such as knives, utensils, tools and razors

• Wear protective clothing when using sharp utensils and tools such as gloves, shoes, face protectors, leather aprons

• Wear shoes with thick soles to avoid cuts to your feet. Do not walk around barefoot

Burn • Use extreme care when using heating devises such as kettles, stovetops, ovens, microwave ovens, hot water tap, radiators

• Install a mixer tap in bathrooms to avoid scalds

• Do not handle caustic chemicals

• Do not touch electrical work unless you are trained to do so

• Do not add petrol or other flammable liquids to a fire

• Do not smoke around flammable liquids

• Apply sunscreen generously 20 minutes before going outside and re-apply every 2 hours

• Wear sun protective clothing when outside such as broad-brimmed hats, long sleeves and pants, sunglasses

• Regularly have your skin checked for any changes such as new spots, or changes to existing freckles or moles

Skin tear • Regularly apply a good quality moisturising cream

• Drink adequate amount of fluids such as water not caffeine or alcohol

• Eat a nourishing diet

• Ensure there is adequate lighting

• Protect limbs by wearing long sleeves, pants and gloves.

• Specialised limb protectors are available from some medical suppliers for persons at high risk of skin tears

• Use a walking aids such as a walking frame or stick to avoid falling

• Use foam or other cushioning and padding materials on corners and sharp edges of household furniture

• Use non-adherent dressings to avoid ripping the skin

• Use cohesive bandages to hold dressings in place

• If tape is required to hold dressings in place, use paper or cloth tape that can be easily removed or falls off

• Take extreme care when removing adhesive dressings always supporting the skin. Use an adhesive dissolvent if necessary

• Use soft, moisturising soaps when washing such as sorbolene cream. Do not use alkaline soaps for washing

• Educate family members and carers about preventing skin tears


Appendix 7: Pharmacy staff and consumer resources

Pharmacist• PSA Self Care InPHARMation April 2016: Facts behind the fact cards – Wound care in pharmacy

• PSA First Aid training. At: www.psa.org.au

• Wounds Australia. Standards for wound management. 2nd edn. 2010; At: www.awma.com.au/publications/2011_standards_for_wound_management_v2.pdf

• Training:

- Monash University: Graduate certificate, Graduate diploma and Masters of wound care. At: www.monash.edu.au/pharm/

- Wounds Australia: Wound management courses. At: www.awma.com.au/pages/courses.php

- Smith and Nephew: Wound management education. At: www.smith-nephew.com/professional/training-and-education/wound-management

Pharmacy assistant• PSA Self Care InPHARMation April 2016: Counter connection – Wound care in pharmacy

• PSA Self Care Fact Cards First aid in the home and Sense in the sun.

Consumer• PSA Self Care Fact Cards First aid in the home and Sense in the sun.

• Better Health Channel. Wounds – how to care for them. 2014. At: www.betterhealth.vic.gov.au/health/conditionsandtreatments/wounds-how-to-care-for-them

• Better Health Channel. Skin cuts and abrasions. 2016. www.betterhealth.vic.gov.au/health/conditionsandtreatments/skin-cuts-and-abrasions

• healthdirect. Wounds, cuts and grazes. 2015. At: www.healthdirect.gov.au/wounds-cuts-and-grazes

• Department of Health & Human Services, State Government of Victoria. Emergency department fact sheet. Care of open wounds, cuts and grazes. 2010; At: www.health.vic.gov.au/edfactsheets/downloads/care-of-open-wounds-cuts-and-grazes.pdf

References1. Australian Wound Management Association.

Standards for wound management. 2nd edn. 2010; At: www.awma.com.au/publications/2011_standards_for_wound_management_v2.pdf

2. Wound management. In: Sansom LN, ed. Australian pharmaceutical formulary and handbook. 23rd edn. Canberra: Pharmaceutical Society of Australia; 2015. p. 211–26.

3. Corbett LQ, Ennis WJ. What do patients want? Patient preference in wound care. Adv Wound Care (New Rochelle) 2014;3(8):537–43. At: www.ncbi.nlm.nih.gov/pmc/articles/PMC4121048/

4. Pharmaceutical Society of Australia. Wound care in practice. Canberra: PSA; 2013.

5. Australian Wound Management Association. Abrasions; 2014. At: www.awma.com.au/2015/awma-sa-Abrasions-2015-04-23.pdf

6. Guo S, DiPietro LA. Factors affecting wound healing. J Dent Res 2010;89(3):219–29. At: www.ncbi.nlm.nih.gov/pmc/articles/PMC2903966/

7. Mercandetti M. Wound healing and repair. In: Medscape. 2015. At: http://emedicine.medscape.com/article/1298129-overview#a5

8. Sussman G, Golding M. Skin tears: should the emphasis be only their management? Wound practice and research 2011;19(2):67–71. At: www.awma.com.au/journal/1902_03.pdf

9. Weller C, Sussman G. Wound dressings update. Journal of Pharmacy Practice and Research 2006;36(4):318–24. At: http://jppr.shpa.org.au/lib/pdf/gt/GT0612.pdf

10. The Royal Children’s Hospital Melbourne. Clinical guidelines (nursing). Wound care. 2013. At: www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Wound_care/

11. The Royal Children’s Hospital Melbourne. Clinical guidelines (nursing). Wound dressings - acute traumatic wounds. At: www.rch.org.au/clinicalguide/guideline_index/Wound_dressings_acute_traumatic_wounds/

12. Australian Wound Management Association. Lacerations; 2014. At: www.awma.com.au/2015/awma-sa-Lacerations-2015-04-23.pdf

13. Australian Wound Management Association. Minor burns and scalds; 2014. At: www.awma.com.au/2015/awma-sa-Burns-2015-04-23.pdf

14. Australian Wound Management Association. Background briefing paper: wound management in Australia - improving wound care, saving money. 2012; At: www.awma.com.au/publications/2012_wounds_and_politicians_kb.pdf

15. SunSmart Victoria. How to apply sunscreen. 2016. At: www.sunsmart.com.au/uv-sun-protection/slop-on-sunscreen

16. Connected Wound Care. Skin tears assessment and management: a health care guide for nursing staff; 2012. At: www.grhc.org.au/document-library/doc_download/282-cwc-skin-tears-and-assessment-print-version


Infants

Elderly

Sensitive Body AreasSkin with hair

Chronic Skin Conditions

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• Moisture resistant adhesive.

Documents

Wound care - Pharmaceutical Society of · PDF fileCreating a management plan for wound care. When managing a wound, the person with the wound ... Burn Ultraviolet rays (sunburn), fire,