Institutions | About Us | Help | Gaeilge
rian logo

Go Back
National best practice and evidence based guidelines for wound management
Health Service Executive (HSE) Office of the Nursing Services Director
Approximately 1.5% of the population will have a wound of some type at any one point in time. Fortunately, many of these are minor or acute and will heal without incident. The remaining wounds, the majority of which are chronic ulcers are a significant source of patient morbidity and in some cases mortality. Chronic wounds affect the individual’s quality of life and reduce their ability to optimise their contribution to society. The management of wounds is also very costly to the health service with the largest portion of that cost being nursing time. The protracted course of treatment, potential for infection, together with the knowledge and skills required for optimal management supports the need for national guidelines to promote evidence based practice. The approach to optimal wound management centers on a comprehensive assessment of the patient and the wound. This should be completed by a person trained in such assessment. The aetiology of the wound should be determined with referral to appropriate members of the multi-disciplinary team when further investigation or intervention is required. All aspects of care from initial presentation through to treatment and evaluation should be documented. Following assessment, treatment goals should be agreed with the patient and a time frame for their achievement set. Underlying factors which could influence the potential for wound healing should be addressed. As wound healing is a complex multifactorial process, the input of several members of the multi-disciplinary team may be required to achieve the objectives. Evaluation is an on-going process. Each clinician involved in the provision of care must work within their Scope of Practice and is accountable for their practice. When cleansing the wound, potable tap water is suited for chronic wounds and in adults with lacerations. An aseptic technique is required when the individual is immuno-compromised and/or the wound enters a sterile body cavity. All dressings used in wound management should be used in accordance with manufacturer’s instructions and the integrity of such products must be ensured through proper storage and use. The choice of dressing is influenced by the type of wound, the amount of exudate, location of wound, skin condition, presence or absence of infection, condition of the wound bed, the characteristics of dressings available and treatment goals. Surgical wound dressings should be left dry and untouched for a minimum of 48 hours post-operatively to allow for re-establishment of the natural bacteria-proof barrier, unless otherwise clinically indicated. Patients presenting with lower limb ulceration should have assessment and investigation undertaken by health care professionals trained in leg ulcer management. All such patients should be screened for evidence of arterial disease by measurement of ABPI by a person trained in such measurement. ABPI should be conducted when: an ulcer is deteriorating, is not fully healed by 12 weeks, is recurrent, prior to commencing compression therapy, when there is sudden increase in wound size, sudden increase in wound pain, change in colour and/or temperature of the foot or as part of on-going assessment. Graduated compression therapy with adequate padding, capable of sustaining compression for at least one week should be the first line of treatment for uncomplicated venous leg ulcers. This should be applied by a practitioner trained in its application. Removal of devitalised tissue will promote wound healing. However, in arterial ulcers with dry gangrene or eschar, debridement should not be performed until arterial flow has been established. Routine use of antibiotics is unnecessary unless there are signs of infection.
Publication Date:
Type: Report
Peer-Reviewed: Unknown
Language(s): English
Institution: Lenus
Publisher(s): Health Service Executive (HSE)
First Indexed: 2014-04-02 05:58:15 Last Updated: 2017-04-22 21:50:15