5.0 Infection control Listen

Whether a patient’s wound is managed in their own home or in an acute hospital, an aseptic non-touch technique should be carried out according to local guidelines.

Wound cleansing
Wounds should only be cleaned if indicated. The wound area should be cleansed using a process of irrigation to avoid trauma to the healing tissues on the wound bed. Irrigating the wound with sterile saline or a wound irrigation detergent is the best practice in order not to damage any newly formed tissue in the wound bed. For the cleansing of leg ulcers it is more appropriate to use tap water. Leg ulcers are chronic wounds and can be extensive in size. The benefit of using tap water is more to clean the rest of the leg of debris and skin build-up rather than the actual ulcer itself.  Washing the leg with an emollient in a bowl or bucket of warm tap water helps to keep the rest of the skin to the leg hydrated.

Moisture control
Moist wound healing is important because if facilitates autolysis of devitalised tissue and promotes the formation of new tissue. Moist conditions provide a wound surface that is rich in blood vessels providing a good supply of oxygen. Moist conditions should be created when caring for chronic wounds. Dressings that dry out the wound should not be used on the wound. Whilst the wound should be kept moist, it should not be kept too wet that skin maceration occurs. The only wounds that should be kept dry are healed surgical wounds where the wound has completely knitted together. When there is necrosis and eschar present in a wound this may be kept moist or hydrated to facilitate autolysis. The decision to moisten necrosis or eschar should only be made following advice from a tissue viability nurse as some wounds such as diabietic foot wounds will actually deteriorate if they are kept moist.

Temperature and pH
The wound should have a pH below 5.5 and a temperature that is above 33˚C but below 42˚C. Evidence suggests a normothermic temperature and an acidic wound environment improves wound healing. The wound temperature should be maintained at an optimum temperature by covering the wound area quickly after a procedure. If the wound is to be cleansed, the saline used should be warm and not cold.