# Aseptic Wound Care

## Overview

This module describes how to provide aseptic wound care.

## Indications

1. Any wound may require a dressing

## Contraindications

1. Some dressings have specific contraindications

## Patient information and consent

### How do I explain this procedure?

“I am going to put on a dressing to close this wound so that it can heal more quickly.”

### What can my patient expect?

“I will clean the wound with gauze swabs soaked in disinfectant, then cover it with pads and bandages. This may be uncomfortable, especially if your wound is very painful.”

### What is my patient’s role?

“Tell me if you have any allergies. Stay still while I put on the dressing and do not touch the wound area. You will need to come back to remove/change the dressing in x days.”

## Preparation

Prepare a trolley with equipment.

For some painful wounds, provide the patient with analgesia about 20-30 minutes prior to dressing the wound.

### Documentation

1. Patient notes
2. Wound care chart if available

### Equipment

## Site & Positioning

The patient should be positioned with the wound within easy reach. Make sure the curtains are drawn and there is minimal air movement around the patient — no bed making or open windows.

## Procedure

Follow medical asepsis with non-sterile and sterile gloves.

## Troubleshooting

The wound is a simple cut.

Small cuts may be left open or dressed. Larger cuts, especially those requiring sutures, should be dressed. A good choice is petroleum impregnated gauze, with a secondary dressing of dry gauze, secured with crepe or a transparent film. These dressings need to be changed every two days, so send the patient for a wound check in two days.

The wound is a burn.

Remember to

scrub

scrub

Provide analgesia first, especially to children.

burns first to remove devitalised tissue and to assess the extent of the burn. In the first few hours after the burn, apply a sterile hydrogel dressing. This can be replaced with flamazine on sterile gauze and secured with crepe the next day or with the appropriate dressing at the burns unit if the patient is being transferred. These dressings need to be changed daily.

The wound is black and necrotic.

The aim of treatment is debridement. Use hydrogels, enzymatic dressings, hydrocolloids, or moisture retentive dressings. However, do not debride wounds where the vascular status is compromised.

The wound has excessive slough.

Use enzymatic dressings, hydrogels, hydrocolloids, or moisture retentive dressings to deslough the wound.

The wound is granulating and healthy.

Use moisture retentive dressings, hydrocolloids, hydrofibers, foams, and negative pressure wound therapy to protect the wound, absorb exudate, and provide a moist healing environment.

The wound is epithelialising.

Use hydrocolloids and film dressings to protect the wound and provide a moist healing environment.

The wound is overgranulating.

Refer these wounds to the wound care team. Use non moisture retentive dressings, non-adhesive foams, and anti-inflammatory dressings such as silver to reverse overgranulation.

The wound is acutely infected.

Take a wound swab and initiate antimicrobial therapy. Use non-occlusive dressings and change them daily.

The wound is chronically infected.

Do a wound swab and initiate antimicrobial therapy. Use antimicrobial dressings.

The wound is large and gaping.

A vacuum dressing may be needed. Consult a senior/wound practitioner.

The wound is a stage I or II pressure ulcer.

Use a transparent film dressing and ensure the patient is being turned regularly. Consider pressure alleviating aids such as pillows, ring cushions, foam pads.

The patient is unable to return frequently for dressing changes.

Refer the patient to home based care, if applicable in the community where the patient lives, specifying the nature and size of the wound and instructions regarding the type and frequency of dressing changes in a referral letter. Also add any complications or changes they are to look out for and when to refer the patient back to the facility. The carers will collect the dressings at their nearest institution and do the dressing changes at the patient’s home.

There are maggots in the wound.

Remove the maggots and proceed as usual.

## Risks

1. Maceration of surrounding tissues
2. Wound infection
3. Poor wound healing
4. Allergic or irritant reaction to dressings
5. Tissue loss due to inappropriately tight bandaging

## References

1. Jones V, Grey JE, Harding KG. Wound dressings. BMJ. 2006;332(7544):777-780. doi:10.1136/bmj.332.7544.777