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ASEPSIS AND INFECTION CONTROL 2

WOUND DRESSING
Wound, any break in the external or internal
surfaces of the body involving a separation
of tissue, and caused by external injury or
force. Wounds are classified as incised, or
cut, if they are produced by a sharp
instrument or object; puncture, if the
instrument is pointed and narrow; lacerated,
if accompanied by a tearing of the tissue;
contused, if a substantial amount of tissue is
bruised; penetrating, if the wound passes
completely through a part of the body; and
subcutaneous, if it involves deep destruction
of tissue with a relatively small opening, or
none at all, in the surface. Septic, or
infected, wounds are those in which the area
is contaminated by bacteria, which can
cause suppuration or shedding of tissue.
WOUND
CLASSIFICATION OF WOUNDS
1.Mechanism of injury
a) Incision- open wound;
painful;deep;shallow
b) Contusion-closed wound, skin appears
ecchymotic (bruised).
c) Abrasion-open wound involving the
skin; painful
d) Puncture-open wound which
penetrates the skin and underlying
tissues.
e) laceration-made by object that tears
tissues
f) Penetrating wounds-open wound that
penetrates the skin and the underlying
tissues.
2. According to depth
a) Partial thickness- confined to the skin
b) Full-thickness- involving the dermis,
epidermis, subcutaneous tissues and
possibly muscle and bone.
Decubitus ulcer
Gunshot wound
Stab wound
Lacerating wound

3. Degree of contamination
a) Clean-an aseptically made wound, that
does
not enter the alimentary, respiratory or
genito-urinary tracts.
b) Clean contaminated-are surgical wounds
in which the alimentary, respiratory and
genitals or urinary tract has been entered.
c) Contaminated- wounds exposed to
excessive amounts of bacteria
d) Dirty or infected-wounds containing
dead tissues and with evidence of clinical
infection (purulent discharged).
TYPES OF WOUND DRAINAGE
1. Serous-clean, watery
2. Purulent- thick, yellow, green, tan or
brown.
3. Serosanguineous-pale, red, watery
mixture of serous and sanguineous.
4. Sanguineous- bright red, indicative of
active bleeding.
PHASES OF WOUND HEALING
1. INFLAMMATORY PHASE-starts
immediately after injury and lasts 3-6 days or
4-6 days.
2 major processes occur during this phase
HEMOSTATIS AND PHAGOCYTOSIS
Hemostatis- blood vessels constrict, platelets
aggregates and bleeding stops, scabs forms,
preventing entry of infectious organisms.
Inflammation-increase blood flow, to wound
resulting localized redness and edema,
attracts WBC and wound growth factors.
WBC arrive-clear debris from wound.
2. PROLIFERATIVE PHASE-extends from
day 3 to about day 21 post injury.
collagen synthesis establishment of new
capillaries creation of granulation tissue
wound contraction epitheliazation.
3. REMODELLING OR MATURATION
PHASE
-final healing stage may continue for I year
or more.
Remodeling of scar tissue to provide wound
strength.

TYPES OF WOUND HEALING


FIRST INTENTION HEALING-partial thickness
wounds.
- a clean incision is made with primary
closure, minimal scarring.
-expected when the edges of clean surgical
incisions are sutured together, tissue loss is
minimal or absent if the wound is not
contaminated with microorganism.
-e.g.-abrasion or skin tear.
SECOND INTENTION HEALING-granulation
-accompanies traumatic open wounds with
tissues loss or wounds with a high
microorganisms count.
-go though a process involving scar tissue
formation a heal slowly because of the
volume of tissue needed to fill the defect.
-e.g.-contaminated surgical wound, pressure
ulcer.
FACTORS AFFECTING WOUND HEALING
Developmental considerations (healthy
children and adults)
Nutrition
Lifestyle
Medications
Contamination and infection

COMPLICATIONS OF WOUND HEALING


1. HEMORRRHAGE
-risk of hemorrhage is greatest during the ist
48 hours after surgery.
-emergency -N@- should apply pressure
dressing to the wound and monitor vital
signs.
2. INFECTION
-surgical infection is apparently 2-11 days
post operatively.
N@- watched for presence of changed in
wound color, pain or drainage-culturing of
the wound.
3. DEHISCENCE WITH POSSIBLE
EVISCERATION
-may occur 4-5 days postoperatively.
-involves an abdominal wound in which the
layers below the skin separates.

N@- an increase in flow of serosanguinous


drainage into the dressing can indicate
impending dehiscence.
- If occurs N@ should be quickly
supported by sterile dressing soaked
in sterile normal saline.
-position? Client in bed with knees
bentwhy? To decrease pull on the incision.
and? Notify physician
Wound evisceration from stab wound
Wound dehiscence
Infected wound dehiscence
WOUND ASSESSMENT PARAMETERS
Etiology
Location of the wound
Stage of wound/extent of tissue loss
Phase of healing
Wound size
Presence of undermining, sinus tracts
or tunnels
Condition of the wound bed
Volume of exudates
Condition of periwound skin
Presence of pain
WOUND MANAGEMENT
1. DRESSINGS - material applied to
wound with or without medication, to
give protection and assist in healing.
-what are the purposes?
a) To protect the wound from mechanical
injury
b) Splint or immobilized the wound.
c) Absorbs dressing
d) Prevent contamination from bloody
discharges
e.) Promote homeostasis,(pressure dressing)
f.) Debride the wound
g.) to kill or inhibit microorganism
h.) provide a physiologic environment
conducive to healing
i.) provide mental and physical comfort for
the patient.
Pressure dressing
What are the types of dressings?
a. DRY TO DRY DRESSINGS

-used primarily for wounds closing by


primary intention.
>adv-offers good protection, absorption &
provide pressure
>dadv-they adhere to the wound surface
when drainage dries.
- when remove can cause pain and
disruption of granulation tissue.
b. WET TO DRY DRESSINGS
-used for untidy or infected wounds that
must be debrided and closed by secondary
intention.
>how can it be done?
-gauze saturated with sterile saline or
antimicrobial soln. is packed into the wound,
the wet dressing are then covered by dry
dressings
>when to changed?
-when it becomes dry
b. WET TO WET DRESSINGS
-used on clean open wounds or on
granulating surfaces.
>adv-provide a more physiologic
environment (warmth moisture) which can
enhance the local healing processes and
assure greater patient comfort.
>dadv-surrounding tissues can become
ulcerated. high risk for infection.
2. DRAINS- device or a tube used to
draw fluids from an internal body
cavity to the surface.
-what are the purposes?
a) placed in the wounds only when
abdominal fluid collections are
present.
b) placed near the incision site
> wound drainage-drains placed within the
wounds are attached to a portable suction
with a collection container.
e.g. hemovac, jackson-pratt, penrose drain.
3. BINDERS AND BANDAGES
-what are the purposes?
a) Creates pressure over the body parts
b) Immobilize body parts
c) Reduce or prevent edema
d) Secure a splints
e) Secure dressing

UNEXPECTED OUTCOMES & RELATED


INTERVENTIONS
1. Inflamed and tender wounds which
evidence of drainage and foul odor.
N@ a. Monitor clients for signs of infection
(fever, increase in WBC count).
b. notify physician
c. obtain wound culture as ordered.
2. Increase wound drainage
N@
a. changed dressing frequently
b. notify physician
3. Wound bleeds during dressing change
PAPER AND PENCIL TEST
PART 1
1. Based on your readings, dressings
may be used for what 6 reasons?
2. During dressings changes, wounds
and surrounding tissues must be
inspected for?
3. What will be the assessment data you
must collect prior to any dressing?
4. Describe on how to set-up, prepare
materials needed for dressing thus,
maintaining sterility. Draw a picture to
help explain your answer.
PART 2
Explain what should be done in each of the
following situations to avoid contamination
during wound dressing.
1. You are in the middle of a sterile
dressing change with the wound
exposed and realize that you need
more dressings from the CSR.
2. You begin to sneeze prior to beginning
a sterile procedure.
3. A patient with abdominal wound is
walking in the hall when his dressing
falls onto the floor.
4. When removing the cap from any
sterile solution bottle, be sure the cap
is placed with the inner side up. Why
is this critically important?
THANK YOU!