This article details a literature search that aimed to find evidence for best practice in treating heel pressure injury. The article gives some background to the aetiology and presentation of heel injury, as well as detailing some of the evidence and literature that was found in the search. The results show that more good quality studies are necessary to arrive at a definition of best practice in heel pressure ulcer treatment to guide nurses. For example, there should be clear indications about how to treat the different categories of pressure damage, the surgical intervention required to repair wounds without putting patients at risk of major amputation, and more focus on the benefits of a through vascular assessment before stating any debridement.
Meningococcal disease is a contagious bacterial condition that can result in life-threatening sepsis as well as the development of extensive blistering and lesions. This article presents the topical management regimen for one young patient’s wound care in conjunction with the community and outpatient paediatric teams. Practical tips on how to manage complex wounds in children will be outlined to demonstrate that such cases can be managed effectively by nursing teams in a relaxed home environment and outpatient setting, preventing readmission and supporting the emotional recovery of the child and parents. The success of this case study and the reintegration of the child back into daily life and school was attributed to the joint working and collaboration between parents and child, and tissue viability, paediatric and community nursing teams.
Wound debridement can be challenging for community nurses, who need to be able to quickly identify a wound’s status in order to proceed with treatment. This article looks at some of the basic factors that nurses should consider when debriding and cleaning a wound, paying particular attention to assessment and ‘seeing’ the wound, and how clinicians can better remove potentially damaging material such as slough and necrosis. The article also investigates how clinicians caring for patients with leg ulceration can treat the ‘whole leg’. Finally, the authors consider the benefits of a new product, the UCS® debridement cloth (medi UK), and its ability to help community nurses gently debride and clean wounds of all types, as well as reducing the burden of using buckets of water to clean patients’ lower limbs. This has important implications for many community nurses, particularly concerning strain to the back during lower limb cleansing and the infection risk of transporting, cleaning and storing buckets in patients’ homes. There is also a time factor, as debridement cloths mean that visiting nurses can reduce the time associated with filling and emptying buckets in both clinic and home environments.
The government's policy of moving care closer to home means that not only will community nurses continue to see patients with chronic wounds such as leg ulcers, pressure ulcers and diabetic foot ulcers, they may also start to see an increase in the numbers of patients who have been discharged from hospital with surgical wounds, who might previously have stayed in secondary care for a longer period. It is imperative that community nurses tasked with visiting a range of patients in their own homes have an understanding of the fundamentals of wound development and management to provide basic evidence-based wound care. This article looks at some of those fundamentals, including debridement, dressing application and removal, wound cleansing, infection, and the effects of comorbidities on the wound.
In chronic wound management the potential for healing increases following effective debridement. Indeed, it has been suggested that debridement’s effect on chronic wound healing is similar in impact to the relief of pressure in preventing pressure ulceration. Debridement can be performed using a number of methods, but larval debridement has recognised benefits, including the breakdown of necrotic tissue; removal of microbes; wound cleansing; and breakdown of biofilm. The reduction of malodour in the wound can also help increase patients’ self-esteem and overall wellbeing. This article looks at the use of larval therapy in a community setting, which can be particularly cost-effective as rapid debridement swiftly reduces the bacterial load, helping to lessen the potential for hospital admission.
Throughout history, it has been observed that wounds tended to heal more quickly with fewer complications when larvae found their way onto open wounds. Larval therapy (LT) is used for the debridement of chronic wounds and to create a wound bed conductive to effective healing. The aim of this article is to discuss the effectiveness of larval therapy for the debridement of chronic wounds through a critical analysis of the relevant literature.
Laura Wood, BA (Nursing). Previously Staff Nurse, AMU, Heartlands Hospital, Birmingham
Mark Hughes RGN, DN, HV, BSc (Hons), MSc, PGCE, Lecturer, University of Birmingham
Article accepted for publication: December 2012
Mark O'Brien describes several methods of wound debridement and discusses the clinical considerations which must be taken into account before wound debridement is undertaken.
Mark O'Brien RGN, CNS Tissue Viability, Great Ormond Street Hospital, London.
Article accepted for publication: September 2003
Sylvie Hampton explores the definition of slough and the biofilms of bacteria that inhabit it and will review methods of successfully debriding a wound of necrotic tissue and slough.
Sylvie Hampton MA BSc (Hons) DpSN RGN. Article accepted for publication: March 2005
Juli Kirby presents a case study which focuses on the wound management of a patient with a highly exudating leg ulcer.
Juli Kirby RN, EN, Dip N, DN, is a District Nurse and Wound Link Nurse, Carmarthenshire, Wales. Article accepted for publication: January 2005
Jacky Edwards gives an overview of burn wound management using maggots for wound debridement.Jacky Edwards, BSc (Hons) PGDE, DSPN, RGN is a Clinical Nurse Specialist, South Manchester University Hospitals Trust.
Article accepted for publication: May 2006
