Surgical wound care

a summary of care of the surgical wound

1. SURGICAL WOUND CARE NINNN BY NICKY MARIAH SAMBO MSC NURSING, BUK.

2. OUTLINE Definitions Classifications of surgical wound Risk factors for surgical wound complications Types of wound dressings & when to use Types of lotions use for wound dressing Steps to wound dressing Signs of infection References

3. DEFINITIONS A surgical wound is an incision or a cut in the skin that is made by a scalpel during surgery. A surgical wound can also be the result of a drain placed during surgery. Surgical wounds vary greatly in size. They are usually closed with sutures, but are sometimes left open to heal . (1) Luo K.E, and De Pietro M. (2017)

4. Surgical Wound Classifications Surgical wounds are classified by degree of contaminants present at time of the procedure. The classification allows for appropriate risk stratification for development of complications and guide with appropriate care and treatment. (2) Surgical wound 101 (2018)

5. Surgical Wound Classifications cont… Clean or Class I Clean-Contaminated or Class II Contaminated or Class III Dirty-Infected or Class IV (2) Surgical wound 101 (2018)

6. Risk Factors for Surgical Wound Complications Advanced surgical wound classification Malnutrition Altered states of perfusion Radiation therapy Unintentional weight loss Longer duration of surgical procedure (greater than two hours) 3,4 &5 Immunocompromised state Generalized debility Female sex Obesity Emergency procedure Pre-operative sepsis

7. Types of wound dressings & when to use (6&7) The process of   wound healing, is vital to ensure that healing is fast and effective , for this using the right dressing is crucial. The type of dressing used for dressing a wound depends on various factors, such as the type of injury, the size, location, and severity .

8. Hydrocolloid Dressing These are non-breathable dressings that are self-adhesive. They are flexible ,comfortable to wear and suitable for even sensitive skin types. T hese dressings work is by creating moist conditions that helps certain wounds The surface is coated with a substance which contains polysaccharides and other polymers which absorb water and form a gel, promote healing by keeping the wound clean and protecting it from infection.   Impermeable to bacteria,  long-lasting, biodegradable, and easy to apply Can be used on burns, wounds that are emitting liquid, necrotic wounds, pressure ulcers, and venous ulcers. 

9. Transparent Dressing Transparent dressings  are useful when the professionals want to monitor wound healing, as these dressings cover the wound with a clear film. These make identifying potential complications much easier, such as by making infections easier to spot at an earlier time. These kinds of dressings are often used on surgical incision sites, on burns and ulcers, and on IV sites .  They are also flexible, which makes them comfortable to wear.

10. Alginate Dressings These dressings Contain sodium and seaweed fibres , they are able to absorb high amounts of fluid create a gel that helps to heal the wound or burn more quickly and are biodegradable. These dressings require changing around every two days or more, due to the amount of liquid they absorb and nature of the wound. Changing them too often could cause dryness or exposure to bacteria. They are made for wounds that have high amounts of drainage, burns , venous ulcers, packing wounds, and higher state pressure ulcers.

11. Collagen dressings Collagen, which is produced by fibroblasts, is the most abundant protein in the human body. A natural structural protein, collagen is involved in all 3 phases of the wound-healing cascade. It stimulates cellular migration and contributes to new tissue development. (7)   It target chronic wounds pressure sores, surgical wounds, ulcers, burns, or injuries with a large surface area. It removes dead tissue, aid growth of new blood vessels,analgesic effects and helping to bring the wound edges together, effectively speeding up healing .( 6&7) Collagen dressings are formulated with bovine, avian, or porcine collagen. Oxidized regenerated cellulose, a plant-based material, has been combined with collagen to produce a dressing capable of binding to and protecting growth factors by binding and inactivating matrix metalloproteinases in the wound environment (7)

12. Hydrogel dressings Hydrogel dressings maximize patient comfort and reduce pain while helping to heal wounds or burns and fight infection. It has cooling gel like burn soothe   which makes them so effective at reducing pain and speeding up the healing process . Can be used for a range of wounds that are leaking little or no fluid, and are painful or necrotic, pressure ulcers or donor sites . Hydrogel can also be used for second-degree burns and infected wounds.

13. Composites dressings Composites or combination dressings may be used as the primary dressing or as a secondary dressing. Made from any combination of dressing types, but are merely a combination of a moisture retentive dressing and a gauze dressing. Use on: a wide variety of wounds, depending on the dressing type. Pros: widely available; simple for clinicians. Cons: may be more expensive and difficult to store; less flexible in indications for use.

14. Foam Dressing Foam dressing,   can work for varying injuries that exhibit odours. Foam dressings absorb exudates from the wound’s surface, creating an environment that promotes faster healing. These dressings allow water vapour to enter, keeping the area moist, promoting faster healing, but prevent bacteria from entering the affected area. These dressings come in various sizes and shapes, adhesive and non-adhesives.

15. Clothes Dressings Clothes dressings are the most commonly used dressings, often used to protect open wounds or areas of broken skin. They are suitable for minor injuries such as grazes, cuts or areas of delicate skin. These dressings come in all shapes and sizes, from small coverings for fingers to larger ones. As well as pre-cut dressings, these also come in a roll option that is made to be cut to size.

16. Gauze Dressings (8) Gauze dressings  are made of woven or non-woven materials and come in a wide variety of shapes and sizes. Use on:  wounds which require packing, wounds that are draining, wounds requiring very frequent dressing changes .( infected) Pros: readily available, cheaper than other dressing types, virtually used on any type of wound. Cons: needs changed frequently, which may add to overall cost; may adhere to the wound bed; must often be combined with another dressing type; often not effective for moist wound healing.

17.   Lotions is used for wound cleaning Normal Saline : Saline is the preferred cleanser for most wounds because it is physiologic and will always be safe. It will not clean well in dirty, necrotic wounds. Studies have shown that bacterial growth in saline may be present within 24 hours of opening the container

18. Lotions is used for wound cleaning (9) cont… Silver dressings  are topical wound care products derived from ionic silver. These products release a steady amount of silver to the wound and provide antimicrobial or antibacterial action. The silver is activated from the dressing to the wound's surface based on the amount of exudate and bacteria in the wound . Silver dressings may be used as primary or secondary dressings to manage minimal, moderate, or heavy exudate in acute and chronic wounds e.g diabetic foot ulcers, pressure ulcers, and leg ulcers May cause staining on wound and intact skin May cause stinging or sensitization

19. Lotions is used for wound cleaning (10) cont… Antiseptic solutions, such as C hlorhexidine , P ovidone -iodine , and Hydrogen peroxide A re some of the lotions use in clean infected or newly contaminated wounds . Be aware that antiseptic solutions may damage healthy tissue and delay wound healing.

20. Process of wound dressing (11) When applying or changing dressings, an aseptic technique is used in order to avoid introducing infections into a wound . Even if a wound is already infected, an aseptic technique is important that no further infection is introduced. This technique should be used when the patient has a surgical or non-surgical wound 

21. What you will need A stainless steel trolley. Big enough for the dressing pack to be opened on A sterile dressing/procedure pack Access to hand washing sink or alcohol hand wash Non-sterile gloves to remove old dressing Apron Appropriate dressings Appropriate solution for cleaning the wound, if needed.

22. Preparation Introduce yourself to the patient and explain the procedure. P rovide privacy. Position the patient and ensure surrounding area is clean and tidy before starting. Update yourself on any changes in the patient's condition and ensure dressing is due to be change from patients notes. Wash hands and put on an apron. Disinfectant the trolley . From top of the trolley and work down to the bottom legs of the trolley using single strokes with damp cloth. Place the sterile dressing/procedure pack on the top shelf of the trolley. Open the sterile dressing pack on top. Open any other sterile items needed onto the sterile field without touching them.

23. Removing an old dressing Wash your hands and put on non-sterile gloves (to protect yourself) before removing an old dressing. Dispose of this dressing in a separate dirty clinical waste bag. Complete a wound assessment ; a visual check and comparing and evaluating the smell, amount of blood or ooze and their colour , and the size of the wound. If the site has not improved as expected, then the treating physician or senior charge nurse must be informed so they too can evaluate it and consider changing the care plan.

24. Cleaning and dressing the wound Select the correct dressing type and size as per the care plan. Wash hands and put on sterile gloves. Start from the clean area and then move out to the dirty area . Be very careful when doing this as the tissue or skin may be tender and there may also be sutures in place. Clean the area without causing further damage or distress Make sure you do not re-introduce dirt or ooze by ensuring that cleaning materials are not over-used. Change them regularly (use once only if possible ) Make sure that you have selected the correct dressing type and materials needed to provide full and appropriate coverage for the type, size and location of the wound, according to the care plan. Dress the wound as per instructions

25. After the procedure Fold up the dressing/procedure pack and place all contaminated material in a clinical waste bag A ll sharps are removed and disposed of in a sharps container. Remove gloves and place in waste bag. Wash hands. Clean the trolley with disinfectant solution as before. Record /document on the patient's chart your wound assessment, the dressing change and the care given . Provide the patient with some dressing management education and answer any questions. Report any changes to a senior nurse or doctor.

26. Signs of infection A yellow or green discharge that is increasing. A change in the odor of the discharge. Redness or hardening of the surrounding area. Fever. A change in the size of the incision . The incision is hot to the touch . Increasing or unusual pain. Excessive bleeding that has soaked through the dressing.

27. REFERENCES 1.Luo K.E, and   De Pietro M. (2017) surgical wound 2.Surgical wound 101 (2018) wound source accelerators blog 3. Centers for Disease Control and Prevention (CDC). Surgical site infection (SSI) event: procedure-associated module. 2016. 4. Canadian Agency for Drugs and Technologies in Health .( 2014.) Antibacterial sutures for wound closure after surgery: a review of clinical and cost-effectiveness and guidelines for use. 5.Wiseman JT, Fernandez-Taylor S, Barnes M, et al. (2015)Predictors of surgical site infection after hospital discharge in patients undergoing major vascular surgery . 6. CLH Healthcare (2017) .7 Types Of Wound Dressings & When To Use Each

28. REFERENCES 7. Fleck , C. A., & Simman , R. (2011). Modern collagen wound dressings: function and purpose.  The journal of the American College of Certified Wound Specialists . 8.  Laurie Swezey RN (2011). Wound Dressing Selection: Types and Usage.wound source. 9. Hess, Cathy Thomas RN , (2003) Advances in Skin & Wound Care: silver dressing

29. REFERENCES 10. Basic wound cleaning step by step, Nursing Made Incredibly Easy!:2008 - Volume 6 - Issue 5 - p 30-31 11. Pickering, D., & Marsden, J. (2015). Techniques for aseptic dressing and procedures.  Community eye health ,  28 (89), 17.

30. THANK YOU FOR YOUR TIME