Betadine wash. Hydrogen Peroxide. These were staples in wound cleansing in my early days of nursing. The field of wound care has come a long way. Unfortunately, there are still some wound care myths out there that just refuse to die.
Myth #1: Wet-to-dry dressings are cheaper to use.
Not only is wet-to-dry substandard care, it's not even cost-effective.
Here's the math: The daily cost of care for a foam dressing is only $3.55. The daily cost of wet-to-dry is $12.26. Why the big difference? Wet-to-dry dressings require frequent changes. Think of healing a wound like baking a cake. If you open the oven door every 5 minutes to check the progress of your cake, it's going to ruin the end-product because it keeps dropping the temperature each time you open the door and it will take a lot longer to cook!
Every time you change a dressing and expose the tissue to the environment it causes a dramatic drop in the wound temperature. The cleansing solution is usually cold so further exacerbates this temperature drop. For a wound to heal, it should be close to normal body temperature. So if there is a 2_ C drop in temperature, this will slow or stop healing, and it can take up to four hours for that wound to re-acclimatise and resume wound healing processes. As we always say, "When the temperature drops, the healing stops."
Out of all the different dressings out there, foam keeps the wound bed the warmest, manages the exudate best to optimise the moisture content within the wound. And foam dressings can remain in place from 3 to 7 days, decreasing costs, labour, and drops in temperature. As always, with any dressing application, follow the manufacturer's instructions on proper usage.
Myth #2: Bleeding in a chronic wound is a sign of healing.
"Oh, it's bleeding! That's good!"
No, that's not normal or acceptable. Sanguineous (bloody) exudate serves as a clue to bedside clinicians that you need to go in and investigate what is causing the bleeding. Start by looking for:
¥ malignancy or trauma on the site
¥ high bioburden?
¥ a dressing that sticks to the wound and causes bleeding upon removal (mechanical debridement Ð nasty stuff and should be avoided!)
By putting on our detective hats and looking at the clues the wound is giving us, we can identify issues sooner rather than later.
Myth #3: Erythema is a sure sign of wound infection.
Erythema in the peri-wound is one of the classic signs of local infection, but it's not enough to label it as infected. You need to see at least three signs and symptoms. Here are some additional signs and symptoms to consider:
¥ Foul odour
¥ Increasing pain in the wound (studies have shown that PAIN is the best indicator of infection)
¥ Heat in the peri-wound
¥ Purulent drainage
If you see at least three of these signs, it means you have local infection and need to immediately treat the wound topically, before it moves into a systemic infection.
Myth #4: Oral or IV antibiotics are indicated for all infected wounds.
Administer oral or IV antibiotics only if infection extends beyond the wound margin, indicating a systemic infection. In other words, you need to see signs and symptoms such as fever, an elevated white blood cell count, or red streaks emanating from the wound.
Oral antibiotics are simply not the most effective treatment for local infections. Many chronic wounds have impaired blood flow, which can compromise the delivery of oral antibiotics to that wound. Meanwhile, the unnecessary use of antibiotics leads to the development of antibiotic-resistant strains of bacteria.
For patients with an arterial ulcer or diabetic ulcer keep in mind that even IV antibiotics will have a minimal effect due to the restricted blood supply. Topical antimicrobials are a better option in the case of diabetic or arterial ulcers generally.
Myth #5: Nurses are not responsible if a physician orders inappropriate treatment.
"I did it because the doctor ordered it."
We hear this excuse all the time! Would you administer improper heart medication to a patient if you knew it was wrong? You must think of wound care the same way. It's our responsibility to uphold the standards of care. If physicians are unaware of the guidelines and policies, we need to educate them.
Saying that the doctor wrote it and you merely followed orders is not going to protect you legally, and it's certainly not in the best interest of your patient. Always practice the current standard of care Ð no excuses!