Wound care management

• If there is broken skin, use a dressing. This will create the best environment for healing.
• Perform early wound debridement. A clean wound will have the best opportunity to heal.
• Screen for infection and intervene early, if present.
• Cleaning the wound bed in the shower is the simplest technique to clean a wound. Additional use of an antibacterial solution can assist with reducing biofilm formation and preventing infection.
• Remove pressure from the wound. Offloading is crucial to healing any wound.
• Packing causes pressure from within the wound and is not recommended. Packing can include gauze, alginates or foam with all dressing types inclusive of negative pressure wound therapy. Packing becomes hard nubile material, that increases pressure to the wound bed.
• Manage exudate, as this can macerate the wound edge. This may include the need to increase wound care frequency or dressing absorbency. Shear may also increase wound exudate and should be excluded.
• Keep it simple with wound care. Complex wound care products can increase:
  • issues with following care plans
  • risks with devices such as additional tubing
  • costs
  • expectancies that a complex dressing will have better outcomes than a simple dressing
• Prevent contamination from incontinence. Assess the feasibility of toileting and showering on a mobile shower commode. Consider an indwelling catheter, if needed.

Offload

• Removing pressure from the damaged skin will enable blood supply to the tissue to aid in recovery.
• The easiest method to check if the wound is offloaded is to place a hand over the wound in the desired position and feel for any contact with the wound and surface. The hand should move freely between the two contact points.
• For specific advice on how this can be managed, based on the location of the breakdown, visit the pressure injury location and management page.

Person-centred care

Support the person to take ownership of their skin management plan through open, collaborative discussions with the healthcare team.

This may include:

• Viewing the wound (in person or via photographs)
• Planning routines and lifestyle adjustments
• Agreeing on realistic offloading strategies
• Developing a tailored return-to-sitting plan