Wound Hygiene has gained its own identity and is now a term in and of itself. A consensus document on Wound Hygiene published by a medical panel in March 2020 concludes that all wounds, particularly non-healing ulcers, greatly benefit from wound hygiene. Ideally, wound hygiene is initiated at the first referral following a full holistic assessment to identify the wound etiology and comorbidities. Thus, wound care specialists and podiatrists need an understanding of wound hygiene and its role in wound care.

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Wound Hygiene in Chronic Wounds

Many patients with chronic wounds have comorbidities such as diabetes, hypertension, and nutritional problems that interfere with wound healing. Non-healing wounds potentially cause long-term morbidity and reduced quality of life. They also incur a huge health economic burden for healthcare services. Caring for such wounds should then reduce the risk of infection by practicing wound hygiene, hand hygiene, and patient education.

Hand Hygiene

Steps like washing your hands before tending to a wound and highly disinfecting reusable equipment such as bandages go a long way in stopping infection. Alcohol hand-rub should be readily accessible throughout the wound care process. That can be implemented by placing an alcohol rub close to the bed or point of care in the room when performing wound care. Personnel should not touch the resident care environment while performing wound care as this contaminates gloves or the environment.

Patient Education

Running water is better for wounds, so a shower is recommended instead of bath water. Patients should pat the wounds dry with a towel to dry the wounds. The towel should be clean and dry. Patients should be encouraged to inspect their wounds regularly and look for symptoms such as redness, pus, or more fluid leaking from the wound or an unpleasant smell.

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Wound Hygiene Protocol for Proper Wound Care

Wound Hygiene is a 4-step protocol of care designed to clean a wound and prepare it for proper healing. It's crucial for healthcare professionals, wound care specialists, and podiatrists to understand the steps of wound hygiene to manage and treat wounds effectively and ultimately improve patient outcomes.

Cleanse

Bacteria commonly colonize chronic wounds such as leg ulcers and pressure ulcers, and the best method for wound hygiene would be a cleanse technique rather than an aseptic technique. First, the wound should be cleaned to remove devitalized tissue, biofilm, and debris. We then cleanse the periwound skin to remove dead skin scales and callus and to decontaminate it.

Periwound is concentrated approximately 4 to 8 inches from the wound edges or in the area covered by the dressing. Cleansing should be done at each dressing change using either a PH balanced solution or surfactant-containing antiseptic. Perform the cleansing process with as much physical force as the patient can tolerate and use different cleansing cloths for the wound and periwound.

Debride

Wound debridement involves the removal of necrotic tissue, debris, slough, and biofilm at every dressing change. Example methods for debriding include mechanical, sharp, ultrasonic, or biological; choice often depends on the specialist's wound setting and skill level. Full thickness wounds have biofilm active at the wound edges preventing epithelialization. Such wounds will require mechanical debridement of the wound edges to pinpoint bleeding. Caution should be exercised when mechanically debriding lower extremity wounds in patients with constricted blood flow, bleeding disorders, or who are on anticoagulation therapy.

Refashion

Refashioning involves removing necrotic, crusty, or overhanging wound edges that may be harboring biofilm. The skin edges should align with the wound bed to facilitate epithelial growth and contraction. This step also involves removing callus from the periwound. Wound bed fragility is rarely common, and thus refashioning aims at removing devitalized tissue from the wound edges resulting in healthy tissue.

Dress

Finally, dress the wound with antimicrobial dressings to tackle any residual biofilm and prevent contamination and recolonization, which can cause biofilm reformation. It's imperative to use appropriate dressing, taking into account the condition of the bed to manage exudate, thereby promoting healing. Lightly exuding wounds are often protected with a vapor permeable dressing.

Highly absorbent wound dressings such as Hydrofiber and hydrocolloid are suitable for wounds with heavy exudate. Occlusive wound dressings can potentially exacerbate moisture-associated skin damage and resulting maceration. Therefore, they should be avoided. Wounds should be assessed every 2 to 4 weeks to determine whether it's necessary to step down to a non-microbial dressing or another type of dressing.

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Importance of Wound Hygiene in Wound Care

The basis of wound care is to identify, treat, and practice wound hygiene to encourage healing and reduce the risk of complications.

Preventing Infections

Continual attention to the wound dressings reduces the risk of infection and other complications. Healthcare specialists should make medically-informed decisions by changing the dressings regularly, assessing the wound's progress, and making observations of discharge, temperature, bleeding, and smell.

Speeds Up Healing

A common myth is that uncovered wounds heal faster. That's not true. Covering the wound provides additional protection against infection and hastens the healing process.

Minimize Scarring

Keeping the wound soft minimizes scarring and limits the formation of hard scabs. Prescribing antibiotic ointments or any other treatment option during the early stages of healing keeps the skin around the wound soft and pliable.

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Bottom Line

Wound hygiene provides an optimal healing environment for hard-to-heal wounds, as long as all underlying etiological factors have been addressed. A comprehensive assessment is crucial in identifying and treating potential wound etiologies and patient comorbidities. Wound hygiene should begin at the first referral and continue until full healing. For proper wound care, it is important that all healthcare professionals implement and use wound hygiene.

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