Proper Wound Care Begins with Evidence, Not Tradition

By Nancy Kennedy

Amber Young, CRNP, is in the right specialty area. She loves everything about wound care. Correction: everything about proper wound care.

“Proper wound care can positively impact quality of life for my patients,” she said. “Inappropriate wound management based on tradition, rather than evidence, can result in impaired wound healing, increase pain, further the emotional distress/anxiety for patients and increase the total cost of treatment.”

Probably the biggest tradition associated with wound care is something that almost everyone has heard from their parents: take the bandage off and let the air get to it. Turns out the science doesn’t agree.

“It was once believed that wounds would heal faster if allowed to dry out,” said Young. “Evidence now shows that dry wounds have an increased risk of infection, heal slower than moist wounds and can become stuck in the inflammatory stage with repeated dressing removal. I am always reminding my family to leave the wound covered and keep that band-aid on!”

There are many factors to consider when evaluating and treating a patient’s wounds. Everything from what caused the wound to how big it is, if it is infected, to whether there is good circulation for the wound and surrounding tissue.

Medical professionals refer to the cause of the wound as the “mechanism of onset,” which indicates if the wound is due to surgical intervention, traumatic in nature, or is the result of an underlying pathology.

Young says this becomes important because surgical wounds heal faster than traumatic ones and wounds due to underlying pathology often become chronic due to comorbidities, which occurs when two or more diseases or conditions are present in a patient.

Other factors that determine how quickly healing can occur include the size, shape, and depth of the wound. It seems obvious that in most cases larger wounds will heal more slowly than smaller or superficial ones, but circular wounds close more slowly than square or rectangular ones.

Infection and the presence of foreign bodies in the wound can also impede wound healing, but Young says another tradition that can be dispensed with are antiseptics…one in particular.

“Don’t use hydrogen peroxide,” she says. “It impedes wound healing by damaging new tissue. Antiseptics are very harsh and are best used for cleaning intact skin.”

Additionally, the presence of other diseases, particularly diseases that affect circulation, tissue perfusion and oxygenation, or result in incontinence, can negatively impact wound healing. Also, a patient’s age, nutrition, hydration, medications, and behavioral risk taking are all taken into account.

“For chronic wounds, there is more of a trial-and-error process to wound care,” Young said. “Wound care can be a puzzle and you have to look at the whole person.”

For more information about the Washington Health System Wound and Skin Healing Center, located at 228 Wellness Way in Washington, PA, visit whs.org/woundandskin or call 724-223-6903