Nursing Teaching on Precautions to be Observed with Infected & Contaminated Wounds

Nurse educated the patient and caregiver upon precautions to be observed with infected & contaminated wounds as follows:

1. Always perform hand hygiene liberally & as recommended using alcohol-based hand rub and don gloves immediately before accessing the wound for wound care. Good hand hygiene practice plays a significant role in prevention of wound infection and infection transmission. If hands are clearly soiled with wound drainage or body fluids, performing hand hygiene using soap and water is recommended.
2. Infected and contaminated wounds stand the risk of developing serious complications, such as, gas gangrene and tetanus. Gas gangrene is caused by infection of the wound with a bacterium called Clostridium perfringens. Infection with this bacterium causes the release of certain toxins, which result in production of harmful gases inside the wound, causing cell death & gangrene. Tetanus is caused by infection of the wound with a bacterium called Clostridium tetani. Infection with this bacterium can cause release of toxins that affect the nerves and result in painful muscle contractions, especially in the jaw and neck area, thus compromising an individual’s ability to breathe normally, trouble swallowing, and stiffness all over the body. Avoid completely closing wounds infected with bacteria, especially belonging to the clostridium family. These bacteria are anaerobic in nature, which means, they do not require oxygen for growth. These bacteria thrive in environments with poor or no oxygen availability and availability of oxygen can be detrimental to their growth. Closing the infected and contaminated wounds off completely can seriously reduce the oxygen availability to the wound and establish a favorable medium for these infections to develop & thrive. These wounds must be left open and cleansed regularly, until the wound is completely clean, before attempting to close the wound. On every wound dressing, check for any necrotic tissue developed, which should be periodically debrided to allow growth of healthy granulation tissue. This can quicken wound healing. While closing these wounds, packing these wounds loosely with clean gauze and cover the packed wound site with a dry dressing. Change the packing and dressing every day.
3. Donning a mask, protective eye wear, and wearing a disposable gown covering the arms & clothing can be of extra help, especially during debridement and irrigation of wounds that are heavily draining and involve risk for splattering the wound drainage.
4. Any reusable equipment, such as, scissors, forceps, flashlight, that stand the risk of exposure to the patient’s blood and body fluids must be appropriately disinfected before using for next patient during your home health visits. Since high-level disinfection between your visits on a workday could be impractical, encourage the patient and family to arrange for dedicated wound care equipment & supplies. Each piece of dedicated wound care equipment could be disinfected after each use, using alcohol or hydrogen peroxide and safely discarded once the wound is healed & the patient no longer requires wound care.
5. Healthy blood flow to the wound site is needed for quicker wound healing, as it brings in oxygen and nutrients to the healing wound tissue. Ample blood flow also brings in white blood cells into the wound tissue, which can help fight wound infection, if any, thus contributing to improved healing. Excessive edema with fluid accumulation involving the wound site can increase the local pressure at the wound site. Undue amount of pressure could be built into the wound tissue in individuals with foot ulcers wearing tight compression stockings and in individuals with torso wounds wearing tight corsets. This locally increased pressure can disrupt blood flow to the wound site. Disrupted blood flow to the wound site can result in reduced delivery of oxygen and nutrients to the healing wound tissue, contributing to increased cell death, development of necrotic tissue, which can lead to delayed wound healing. Compromised blood flow to the wound site can also lead to reduced flow of white blood cells into the wound site, which can increase the risk for infection in the wound site and contribute to delayed healing.
6. Starting an individual with complicated wounds early on antibiotic prophylaxis can help significantly to counter development of any infection. Complicated wounds include wounds that are contaminated, penetrating deep wounds, wounds contaminated with soil & dust, burns, wounds with lot of necrotic tissue, and wounds involving body parts in individuals with reduced blood flow.
7. Complicated wounds should be treated with regular wound cleansing and debridement of devitalized tissue. Wash the open wounds with warm water & soap and cleanse the wound with normal saline. Wounds with increased risk for infection could be cleansed using antiseptic wound wash, such as, Betadine, Povidone iodine, or Chlorhexidine. Wound care products containing alcohol or hydrogen peroxide can causing damage to the growing healthy granulation tissue, thus delaying healing. So, while picking your wound wash, make sure they are free of alcohol and hydrogen peroxide. Consider applying bacitracin ointment or a triple antibiotic ointment on these wounds, as per your doctor’s recommendation. Remove any dirt & soil particles, if any. Surgically debride the dead tissue in the wound site, as presence of dead tissue can compromise growth and healthy granulation tissue and delay wound healing.
8. Wounds can be tetanus prone, especially when the open wounds are deep, have significant amount of necrotic tissue, contaminated with soil, or have turned septic with swelling, purulent drainage, & foul odor. Wounds sustained due to extremes of temperature, such as, burn injuries and frostbite, are also considered high risk for tetanus. Individuals having wounds with increased risk for tetanus should consider the protocol for tetanus prophylaxis, by receiving Tetanus Toxoid (TT) and/or Tetanus Immunoglobulin (TIG). Check with your physician in this regard and observe compliance with the recommendation made.