Cleaning & Dressing

Clean & Covered

For a wound to heal it needs to be clean (free from debris and infection) and covered (protected from the environment)

Cleansing

The wound is cleansed whenever a dressing is changed

• Sterile saline

• Sterile water

• Tap water

Don’t put anything in clean wound you wouldn’t put in your eye

Debridement

• Debris is anything in a wound that shouldn’t be there (ex. Sutures, gauze fibers, dog hair, dead tissue)

• Removing debris & dead tissue (necrotic tissue) is called debridement

• Remember: Healing (proliferative phase) won’t start until debris is cleared

4 kinds of debridement

• Sharp debridement

• Autolytic debridement

• Enzymatic debridement

• Mechanical debridement

Sharp Debridement

Removing necrotic tissue with a sharp instrument

• Usually MDs do this

Autolytic Debridement

• Occurs when the body breaks down necrotic tissue on its own - “keep it natural”

• Wound dressings that form a barrier to keep the wound moist trap the body’s natural enzymes

• Transparent film, hydrogel, hydrocolloid encourage autolytic debridement

Enzymatic Debridement

• Uses topical enzymes to break down slough and eschar (two kinds of dead tissue)

• We apply ointments/medications with enzymes to break down necrotic tissue

Mechanical debridement

Physically removing dead tissue

• Whirlpool (hydrotherapy)

Transparent Film

Provides a barrier

Hydrogel

Pain relief

Hydrocolloid

Absorbs the stuff from the wound and the dressing will smell bad

Alginate

Absorbent, anti-microbial, used for heavy exudate