Over the years, there has been a plethora of evidence-based literature on effective and ineffective wound management practices; however, some healthcare professionals continue to manage wounds using outmoded or ritualistic practices. The key areas are: frequency of dressing changes; maintenance of a moist environment to aid healing; when wounds should be cleansed; and which cleaning solutions to use. This article presents the evidence base in these key four areas and aims to dispel some of the myths and misconceptions to ensure that healthcare professionals can be confident that they are delivering upto- date, evidence-based wound care in accordance with the Code of Conduct (Nursing and Midwifery Council [NMC], 2015).
Almost one adult in 20 in the UK has a wound, while the NHS cares for 2.2 million people with wounds annually. Most of the people in the UK with a wound are managed in primary care by nurses (Guest et al, 2015). Some wounds, such as minor burns, cuts, abrasions and surgical wounds, heal quickly and with minimal intervention. However, over half of all wounds go on to become chronic, with approximately 39% of these failing to heal after 12 months (Vowden and Vowden, 2009). One of the basic tenets of evidence-based wound care is choosing the correct dressing. This article discusses the management of chronic wounds in the community and provides guidance for community nurses on choosing appropriate dressings.
Exudate management in chronic wounds and hard-to-heal wounds is a vital process and community nurses need to be aware of the best practice evidence as well as correct product choice. This is particularly important when attempting to provide the optimum moist healing environment and achieve a balance of moisture in the wound bed. Another important element in chronic wounds is the promotion of autolytic debridement, which helps to ensure that healing is not complicated by any devitalised tissue, which can harbour bacteria and impede new tissue growth. This article investigates best practice in the treatment of chronic wounds, with a focus on the management of moisture in the wound bed. The author also looks at one dressing in particular, Cutimed HydroControl® (BSN medical, an SCA company), which uses an osmotic effect and a high moisture vapour transmission rate (MVTR) to ensure that excessive wound exudate is drawn away from the wound bed, while also ensuring that fresh exudate is produced to promote autolytic debridement and maintain moisture levels in dry wounds. Cutimed HydroControl is able to avoid inappropriate dressing use by facilitating the needs of both exuding and dry wounds, thereby ensuring an optimum moist wound environment
The management of exudate in acute and chronic wounds is a common issue for community nurses, with too much exudate resulting in issues with infection and the breakdown of periwound skin; while too little moisture risks the wound bed becoming too dry. Nurses need to find the most cost-effective and clinically proven treatment regimen when treating wounds that produce different levels of exudate, minimising dressing changes and patient discomfort. While it can be difficult to make a choice about which dressing to use because of the vast array on offer, it is important to match the dressing to the wound and use the most appropriate dressing for the levels of exudate being produced. Similarly, using a more responsive approach to wound management — adapting treatment as the wound changes — will result in a more cost-effective approach. Advancis Medical have a range of wound management dressings that are suitable for different wound types and can handle varying levels of exudate. This allows nurses to use a step-up, step-down approach to the management of exudate as the most cost-effective dressing regimen.
Corinne Ball discusses the treatment of pretibial lacerations in the community.
Corinne Ball RGN, is a Practice Nurse, Rustington, West Sussex.
Article accepted for publication March 2002.
