Wound Cleaning and Dressing
A wound is defined as any disruption along the skin. As skin is the largest protection of the body from the environment, the skin is prone in various physical and chemical irritants. A break in the skin may predispose an individual to tetanus as well as other complications such as nerve damage.
A normal wound healing process can take place through three stages:
1. Reaction Phase – Upon the occurrence of injury, constriction of blood vessels occur in order to control the entrance of foreign bodies into the wound. Some tissues become edematous as a form of combating the injury to the skin. The neutrophils then surround the wound to eat the loosened tissues and fight the infection. Once the neutrophils have served its purpose they will die forming pus.
2. Regrowth Phase – After the debris has been taken out, a thin covering or film of tissue is outline on the wound. Collagen for instance gives strength to the scar. For pressure ulcers, granulation tissue covered the hollow area during this stage. The reaction phase and the regrowth phase may actually overlap.
3. Remodeling Phase – The new scar formation is strengthened through time. The average maturation of the scar may range from 6 months to 12 months depending on the intensity of the wounds and its damaged area.
Wound Cleaning & Dressing Procedure:
- Observe the whole body of the patient, survey the extent of injury.
- Prioritize the type of wounds to be cleaned from the worst to the minimal open wound.
- Check for nerve damage.
- Explain to the patient that you will start cleaning the wounds.
- Expose the needed area of the body to be cleaned. Preserve privacy as much as possible.
- Cleanse the wounds with normal saline solution or a combination of betadine solution.
- Drape the wound. Please observe sterility of the environment.
- Anesthetize the surrounding wound area with local anaesthetics such as Lidocaine or Benzocaine. Some of the local anaesthetics might be skin tested before induction.
- Provide a direct pressure using sterile gauze on the wound area afterwards to stop bleeding or minimal bleeding must be obtained. For wounds on the limb, elevate the area above the level of the heart in order to slow the bleeding process.
- Paint the wound area with betadine solution.
- Use surgical forceps for picking up debris on the wound if there are any.
- Irrigate the wound with normal saline from time to time.
- Once the bleeding has stopped as well as no debris or foreign materials are found in the wound. Close the wound using sterile gauze.
- Lacerations, abrasions and avulsions can be closed with butterfly tape to hold the wound areas.
- Instruct the patient about proper wound care as well as follow-up if there are stitches along the wound. Encourage them to eat foods rich in Vitamin C in order to promote a faster wound healing.