Wound care

Supplementary materials

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PP 100009758 Supported by an unrestricted educational
grant from Nexcare™ Brand
ACTION kit supplementary materials
Wound care
May 2016
Project Manager
Rhyan Stanley
Layout
Rebecca Jones
Author
Jill Malek
Reviewers
Samantha Kourtis
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PHARMACEUTICAL SOCIETY OF
AUSTRALIA LTD. ABN 49 008 532 072
PO Box 42, Deakin West ACT 2600
P: 1800 303 270 or 1300 369 772
E: selfcare@psa.org.au
www.psa.org.au

This publication is supplied as part of the Self Care program,

Pharmaceutical Society of Australia. The views expressed by
the authors of this ACTION kit are their own and not necessarily
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review panel and must not be quoted as such.
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© Pharmaceutical Society of Australia Ltd., 2016

Disclaimer
The Pharmaceutical Society of Australia Ltd. has made
every effort to ensure that, at the date of publication,
the document is free from errors and that advice and
information drawn upon have been provided in good faith.
Neither the Pharmaceutical Society of Australia Ltd. nor any
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PSA5045

be inferred from, the document.

Contents
Wound management 4

Clinical background 5
Types of wounds 5
Wound healing 7
Wound assessment 10
Wound dressings 11
Safe disposal of waste 14
Health promotion 16

Appendix 1: Pharmacy first aid protocol for

treating wounds 17

Appendix 2: Wound assessment and treatment tool 18

Appendix 3: Wound dressing selection tool 20

Appendix 4: Summary of dressings based on

wound type chart 20

Appendix 5: Wound management plan tool 21

Appendix 6: Reducing the risk of acute wounds 22

Appendix 7: Pharmacy staff and consumer resources 23

References 23

Please refer to PSA companion publication Manual for delivering professional services
for more information about service delivery, and for templates for screening, care
plan, referral and other forms.
PSA thanks Nexcare™ Brand from 3M for their generous
support of this Wound care ACTION kit. Nexcare™ Brand
is a range of wound care products including strips, acute
wound care, tapes, bandages and sports tapes.
 Wound management
Wound management aims to minimise scar formation and to accelerate healing
time. Inappropriate management of wounds can lead to delayed healing, infection,
deterioration of wounds and wound breakdown. Evidence-based wound management
must always be applied.1,2
To successfully manage a wound, the healing process
of the wound must be understood and an appropriate
management process applied. Managing wounds in the
pharmacy would usually include wound assessment,
wound treatment such as cleaning wounds, and
application of wound dressings as well as providing
consumer wound self-care information.
The principles of wound management basically involve
the following2:
1. Determining the cause of the wound – either local
(wound-related factors) or systemic (patient-related
factors).
2. Treating both the wound and the cause.
3. Selecting and apply suitable dressings, if required.
4. Creating a management plan for wound care.
When managing a wound, the person with the wound
must be involved in the process. The preferences of
the person and their carer and their accompanying
lifestyle must be carefully considered and discussed
before appropriate wound management is commenced.
This is essential to achieve a good wound management
outcome and possibly prevent future wound
development.1–3
4 ACTION kit – Wound care: supplementary materials I © Pharmaceutical Society of Australia Ltd.
Collaborating with the wider healthcare team is also a
vital component of wound management. Referral for
further medical review may be needed if the wound
cannot be adequately managed in the pharmacy or by
the person with the wound. Establish good working
relationships with local doctors, community nurses and
hospital services to ensure the person with the wound is
receiving the best possible care.1
To facilitate a wound care service, ensure a range of
resources are always available in the pharmacy. This may
include wound dressings and bandages, associated
wound care products, devices and consumer wound
care information. All pharmacy staff involved in the
wound care management service should receive regular
training in the use of wound care products.1 Liaise with
suppliers of wound care products to ensure the most
appropriate and current products are supplied and
available for use in your practice.
This wound management ACTION kit is designed for the
management of wounds in the pharmacy.
Clinical background
Types of wounds
A wound is defined as a physical injury to the body where the skin or mucous membrane
becomes damaged, lacerated or broken. Wounds are defined as either acute or chronic.2,4

Acute wounds
Wounds commonly seen in the pharmacy are acute and Before administering first aid in response to any
include abrasions, cuts and skin tears, burns (usually wound, always wash hands thoroughly with soap and
thermal burns such as sunburn). Acute wounds usually water for 15 seconds and dry them on a clean towel.
heal quite easily in an orderly progression without An antibacterial hand gel can be used if hands are
complication.4 Acute wounds can be painful and not visibly dirty.5 See Appendix 1: Pharmacy first aid
pain relief should be considered when treating these protocol for treating wounds.
wounds. An acute wound can develop into a chronic
wound if there is a failure to progress through the stages
of wound repair within 3 months.2 For examples of acute
wounds, see Table 1.

Table 1. Types, causes and descriptions of acute wounds4,5

TYPE CAUSE DESCRIPTION
Abrasion Sheering or rubbing against • Epidermis is broken
hard surfaces commonly seen • May contain dirt
on thin-skinned areas, e.g. • Usually minimal bleeding as the abrasion may
hands, knees, elbows, shins, only affect the epidermis
ankles

Incision/post Sharp, pointed objects, • Can be of varying depths

operative e.g glass, scalpel • Bleeding is dependent on the depth of the
wound wound and if a blood vessel has been cut
• Object may be lodged in the wound

Laceration/ Sharp or blunt-edged object • Varied appearance and size

skin tear • Jagged tears or cuts
• Gaping wound or skin flaps
• Bleeding is dependent on the depth of the
wound and if a blood vessel has been cut

Puncture Sharp object has pierced • Size and depth of the wound is dependent on
the skin making a hole, e.g. the size of the object
splinters, nails, glass, bites

Burn Ultraviolet rays (sunburn), fire,
steam, hot liquids, chemicals,
electricity
• May affect the surface of the skin (superficial)
or may be deep causing damage to many or
all layers of the skin (partial- or full-thickness)
• Superficial – pain, red, moist
• Partial-thickness – pain, red, moist, blisters
• Full-thickness – skin is white or charred, dry,
no pain (nerves destroyed), no blistering

ACTION kit – Wound care: supplementary materials I © Pharmaceutical Society of Australia Ltd. 5
 Chronic wounds
A chronic skin wound has failed to orderly progress The difficulty in managing any chronic wound in a
through the stages of healing. Functional integrity pharmacy setting is treating the underlying cause (e.g.
of the skin has not been achieved within 3 months.2 infection, diabetes). However, these contributing factors
Factors that contribute to a wound becoming chronic must be addressed to facilitate the healing process. See
include underlying disease, certain medicines, and Table 2.
reduced peripheral circulation caused by even moderate
smoking. Chronic wounds include leg ulcers, pressure
wounds, post-operative wounds, cancer and chronically
infected wounds.2

Table 2. Types, causes and descriptions of chronic wounds2,4,6

TYPE CAUSES
Leg ulcers • Poor blood supply (may be due to smoking,
high cholesterol, high blood pressure,
diabetes and vascular disease, valve damage)
• Nerve damage (may be due to underlying
conditions such as diabetes)
• Significant trauma
• After a deep vein thrombosis
DESCRIPTION
• Loss of the full thickness of
the skin on the leg or foot
• Swelling, redness, oozing
• Acute: heal in <4 weeks
• Chronic: difficult to heal;
persists >4 weeks

Pressure wounds • Direct pressure on a bony prominence • Also known as bedsores

and ulcers decreasing blood supply • Injuries to the skin and/
• Friction from rubbing, wearing away top or underlying tissue often
layers of skin (e.g. blisters) over a bone (particularly
• Shearing: skin sticks to a surface (e.g. bed one that is protruding)
linen or chair) while the underlying tissue
slides down
• Lack of feeling in a part of the body and
damage occurring without noticing
• Immobility
• Excessive moisture (e.g. sweating, incontinence)
• Malnutrition
Post-operative • Due to a surgical procedure • Vulnerable to infection
wounds due to the invasive nature
of surgery
• Often take longer to heal
especially in patients who
smoke
• Depending on the nature
of the surgery, wound
healing can be a major
part of the overall recovery
process

Chronically • A wound with a deeply established • Staphylococcus aureus

infected infection. commonly found in
wounds chronic wounds
• Very difficult to treat either
with topical antibiotics or
systemic antibiotics

6 ACTION kit – Wound care: supplementary materials I © Pharmaceutical Society of Australia Ltd.
Wound healing
Process of wound healing 4. Maturation (24 days–1 year) – wound becomes less
vascular and is strengthened by the re-arrangement
Wound healing occurs as the wound closes and the
of collagen fibres. Strengthening of the tissue below
skin’s integrity is restored.2,4 The body begins repairing
the skin surface continues for many months after the
a wound immediately and the process may continue
skin surface of the wound has healed.
for days, weeks, months or even years, depending on
the injury. Underlying tissue may still be healing even Factors affecting wound healing
though the surface of a wound appears to be healed.4
Certain factors affect the rate at which a wound heals.
The healing process of a skin wound follows a These factors need to be considered before deciding on
predictable and recognisable pattern and time frame. the method(s) used to treat a wound. Factors that affect
A wound may fail to heal if one or more of the four wound healing can include local factors and systemic
healing stages are interrupted.6 factors.2
There are four overlapping phases in the wound healing Local factors
process4,6,7:
Local (wound-related) factors such as wound hydration,
1. Haemostasis – occurs immediately after a wound
and the presence of chemicals (e.g. antiseptics), foreign
is sustained. Bleeding will occur at first then blood
bodies and bacteria as well as pressure, friction and
vessels at the site will contract to prevent blood loss,
shearing, location, size, temperature of the wound and
and a clot will develop.
blood supply to the wound can all impact on the time it
2. Inflammation (0–3 days) – the clot and surrounding takes for a wound to heal.2,4 See Table 3.
tissue release inflammatory mediators (e.g. cytokines,
growth factors). Once bleeding has been controlled, Systemic factors
inflammatory cells migrate towards the wound Systemic (patient-related) factors such as age, medical
promoting the inflammatory phase during which the conditions, hydration, body type (e.g. emaciated, obese)
wound is cleansed of debris. The inflammatory phase and the nutritional status of the person all impact on
is characterised by erythema, heat and oedema. the speed of wound healing (see Table 4).
3. Proliferation (2–24 days) – granulation tissue (layers
of collagen and extracellular matrix) develops
using a network of newly formed capillaries which
supplies the area with oxygen and nutrients, the
wound contracts and epithelial cells grow under the
dried scab.

Table 3. Local factors affecting wound healing4–6,8

LOCAL FACTOR DESCRIPTION
Chemical stress • Can be caused by wound antiseptics and cleansing agents
(e.g. povidone-iodine, hydrogen peroxide, cetrimide,
chlorhexidine gluconate, alcohols, sodium hypochlorite,
acetic acid)
• Cetrimide, hydrogen peroxide, povidone-iodine can
inhibit wound healing as they are toxic to keratinocytes,
fibroblasts and leucocytes
Mechanical stress • Pressure, friction and shearing can damage newly formed
blood vessels in a wound
Temperature • Optimum temperature for human cell growth is 37 ºC
• A drop in body temperature can decrease blood flow to and
through the wound, reducing the rate of healing
Oxygenation • Exposing a wound to the air (hypoxia) reduces the surface
temperature of the wound lowering the blood flow to the
wound
• Delays healing
Foreign bodies • Debris of any type, whether produced by the wound or by
the dressings used on the wound, will slow wound healing
• Debris will prolong the inflammatory phase, as well as
increase the chance of infection
ACTION
• Avoid the prolonged use of antiseptics on a
healing wound
• Use antiseptics for disinfecting acute,
contaminated traumatic wounds and bites
• If antiseptics used, wash off after 3–4 minutes
• Do not change wound dressings too often to
avoid unnecessarily damaging the wound surface
• Only change a dressing when it is wet, soiled or
soaked with wound drainage
• Keep the body warm
• Avoid unnecessary dressing changes and washing
of the wound with solutions that could lower the
wound’s temperature
• Cover the wound with a dressing keeping the
wound moist
• Remove any necrotic (dead) tissue
• Use non-shedding material to clean wounds and
apply non-shedding dressings

ACTION kit – Wound care: supplementary materials I © Pharmaceutical Society of Australia Ltd. 7
 Table 3. Local factors affecting wound healing4–6,8 (continued)
LOCAL FACTOR DESCRIPTION
Hydration • If a wound dries and a scab forms, healing is either delayed,
or will stop
• Exposed, dry wounds are more inflamed, painful, and itchy
during the early stages of healing, and have more scab
material during the early stages of wound healing
Maceration • Softening of the wound can occur if there is excessive
moisture or wetness at the wound site
• May be due to incontinence, perspiration or excessive
exudation from the wound
• Will cause the destruction of tissue and slow the healing
process
Infection • Signs of infection include redness of the skin, discharge,
fever, pain and sometimes odour
• Some wounds can have a high bacterial count, but show
no signs of infection
• Healing will be delayed in infected wounds and
hospitalisation may be needed
Table 4. Systemic factors affecting wound healing2,4,6,8
SYSTEMIC FACTOR DESCRIPTION
Increasing age • Skin becomes weaker, drier, less elastic, and thinner with
age due to decreased subcutaneous fat, collagen, elastin
deposits and secretion of sebum
• Increase risk of skin injury with age due to loss of some of
feeling, flexibility, and elasticity
• Polypharmacy and nutritional deficiencies can contribute
to lower skin healing rates
Medical conditions • Certain medical conditions including coronary artery
disease, peripheral vascular disease, cancer, diabetes can:
-- slow the rate a wound heals
-- reduce blood flow to a wound
-- damage one or more peripheral nerves, causing
numbness, weakness and loss of sensation, e.g. diabetes
-- increase risk of infection
Medicines • Some medicines can delay wound healing
• Impact of the medicine depends on the dose and
mechanism of action
• Examples include anticoagulants, anti-inflammatories,
colchicine, glucocorticosteroids, immunosuppressants and
antineoplastic drugs
Dehydration • Loss of water interferes with circulation and the amount of
oxygen and nutrients getting the wound
• Skin becomes fragile and can breakdown
Body type • Both obese and very thin people can have delayed wound
healing which is related to poor nutrition
Nutrition • Poor nutrition or lack of specific nutrients can affect
wound healing
• Proteins, carbohydrates, fats, vitamins, trace elements and
fluids all play a vital role in wound repair
• Vitamins A and C, zinc and protein are important
Smoking • Chemicals associated with smoking can affect healing (e.g.
nicotine, carbon monoxide) by reducing blood flow and
oxygen supply to the wound
• Increases the risk of wound infection
8 ACTION kit – Wound care: supplementary materials I © Pharmaceutical Society of Australia Ltd.
ACTION
• Ensure the wound dressing provides an optimally
moist environment so to prevent a scab forming
• Maintain an optimally moist environment without
excessive wetness
• Antibiotics need to be considered
• Consider referral to doctor
• Note: some antibiotics can interfere with wound
healing. If there are no obvious signs of infection,
avoid use of antibiotics
ACTION
• Use skin moisturisers to hydrate the skin
• Avoid washing the skin with agents that will
irritate the skin
• Maintain a healthy diet
• Use sun protection
• Put padding on sharp furniture edges to
reduce chance of skin injury
• Suggest wearing long sleeves, pants and
gloves when possible
• Apply non-adhesive dressings and bandages
• Regularly examine feet, e.g. patients with
diabetes
• Regularly examine wounds for signs of
infection
• Encourage healthy eating and exercise
• Promote smoking cessation
• Obtain a medical history of a patient with a
chronic wound
• Advise patients who are taking medicines
that may delay healing to monitor any
wounds.
• Advise them if they have a wound that is not
healing, to seek medical attention
• Encourage drinking of water particularly in
people who are elderly
• Use moisturising cream to hydrate the skin
• Avoid alkaline soaps and washes, which can
desiccate the wound bed
• Encourage healthy eating and exercise
• Participation in weight loss programs for
people who are overweight
• Refer to dietitian
• Review the nutritional needs of people with
chronic wounds and the elderly
• Encourage healthy eating
• Encourage patients to cease smoking
• Suggest the participation in smoking
cessation programs at the pharmacy
 Hospital heritage.
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developed from the 3M Health Care line; trusted by
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© 3M 2016. All rights reserved. 3M and Nexcare are trademarks of 3M.
3M Australia Pty Limited. Building A, 1 Rivett Road, North Ryde NSW 2113.
Contact Ph: 1300 363 797

ACTION kit – Wound care: supplementary materials I © Pharmaceutical Society of Australia Ltd. 9
 Moist wound healing
The moisture level of a wound has a significant effect
on healing. Autolytic debridement (i.e. removal of
necrotic material and slough), formation of granulation
tissue and epithelialisation all occur optimally when
the wound surface is kept moist (not wet). A wound
will heal more quickly when kept moist, a scab is less
likely to form (a physical barrier to healing) and there
is less chance of scarring.4 Wound healing will also be
adversely affected if the wound is too wet.2
The level of moisture can be controlled by the choice
of dressing (see Tables 5, 6, and 7) and how often the
dressing is changed. If the wound is too dry, a moisture-
promoting dressing (e.g. hydrogel, hydrocolloid) may
be appropriate. If it is too moist, a dressing that absorbs
exudate (e.g. foam, alginate) would be suitable. If the
dressing is changed too regularly, the wound may dry
out. Depending on how much exudate is produced by
the wound, some dressings can be left on the wound
for extended periods of time to keep the wound moist.4
Other dressings need to be changed when they become
wet, soiled or soaked with wound exudate.5
Wound assessment
Before recommending a wound treatment, thoroughly
assess the wound. Thorough wound assessment includes
wound classification, colour, depth, shape, amount of
exudate, wound location and the environment in which
the wound will be cared. The wound and treatment
will need to be re-assessed as the characteristics of the
wound change (see Appendix 2: Wound assessment tool).9
Assess the wound by reviewing4,9,10:
Colour: A pink wound is in the final stages of healing.
New epithelium is covering the wound. A red wound
is granulating and is well vascularised. A yellow
wound contains slough and a green wound often
indicates infection. A black wound shows that the
wound contains necrotic tissue and a layer of eschar
(see Table 8).
Size/shape/depth: The wound depth may be superficial,
partial-thickness, deep or a cavity. The depth, location
and shape of the wound will determine the type of
dressing and treatment options as well if the person
needs to be referred for further medical assessment.
Exudate: Most wounds contain some exudate. Infected
wounds often produce heavy exudate, which can be
toxic to the surrounding skin. The dressing choice is
determined by the level of exudate.
Wound edges: The edges of a wound may show if the
wound is healing. Wound edges that are coming together
and contracting are signs of healing. Wound edges that
10 ACTION kit – Wound care: supplementary materials I © Pharmaceutical Society of Australia Ltd.
Wound temperature
The temperature of the wound is important for optimal
wound healing. The surface of the wound should be
keep at a constant temperature. Cooling the wound by
exposing the wound to the air and applying products
that lower the wound’s temperature should be avoided.
Changing a dressing too often can also lower the wound’s
surface temperature impeding healing.1,4
The person with the wound should be counselled how
to avoid raising or lowering the intact skin temperature
by not overheating the body with clothing, bedding or
use of heating devices. Use of plastic bed coverings and
plastic-lined clothes should be avoided. The person with
the wound should remain hydrated. The temperature of
their surrounding environment should also be maintained
stable and comfortable.1
Maintaining pH
Wound healing is optimised when the pH of the wound is
neutral or slightly acidic. This can be achieved by avoiding
the use of alkaline soaps, cleansers and other agents.
A wound bed that has been allowed to dry out will have a
higher pH and healing will be delayed.1
are raised (may indicate pressure, trauma, or malignant
changes) or rolled (may indicate wound stagnation or a
chronic wound), are a sign that the wound may not be
healing. If there is increased pain or lack of feeling at the
edges of the wound, this may be another sign of non-
optimal healing such as infection and referral for further
medical review may be required.
Pain: A person with a wound may underestimate pain
associated with wounds, especially if they have reduced
peripheral feeling. Pain may also be a sign of infection.
Accurately assessing pain is essential when choosing
the most appropriate dressing. Always assess the level
of the patient’s pain before, during and after changing
a dressing as this may provide information about how
the wound is healing and further wound management.
If unsure, use a pain assessment chart to determine the
person’s level of pain (see Wong Baker FACES Pain rating
scale at: www.health.gov.au). See Appendix 2: Wound
assessment tool.
Other factors: Assess if the person with the wound, and/
or their carer, has the physical and mental capacity to
manage the wound including changing the dressing.
Review their lifestyle, health status, healing environment
and assess the risk of further wounding. Reduced
circulation, compromised nutrition and polypharmacy
may all affect the rate of healing and should be assessed.
Also consider the cost of the dressings (see Appendix 2:
Wound assessment tool).
Wound dressings
Dressings can be used as primary and/or secondary
dressings depending on the wound. Primary dressings
are placed directly onto the wound. Secondary
dressings are placed over a primary dressing.4
The choice of dressing depends on the type of wound,
where the wound is located on the body, the amount of
exudate and patient characteristics.2,4
Before choosing a dressing, the patient must
be assessed (see Appendix 2: Wound assessment
tool). Any underlying disease that will impact on
wound healing needs to be identified. Also, any
patient concerns should be identified, considered
and addressed.10
Dressings that create the most suitable environment at
the wound-dressing interface will4:
• absorb excess exudate from the wound while keeping
the wound optimally moist
• allow gas (i.e. oxygen, water vapour, carbon dioxide)
and fluid to pass in and out
• not adhere to the wound minimising trauma to
granulating tissue when removed
• be comfortable and conform to the wound shape
• keep the wound at a stable 37 oC
• protect the wound from mechanical and bacterial
injury so to minimise particulate and toxic
contamination
• not require frequent changes (unless infected)
• be non-toxic, non-allergenic and non-sensitising
• absorb wound odour.
Wound dressings can be classified into inert (passive)
and interactive/bioactive (see Tables 5, 6, and 7).4
ACTION kit – Wound care: supplementary materials I © Pharmaceutical Society of Australia Ltd.
Inert (passive) dressings
Inert dressings provide a protective covering over a
wound. They can be used in dressing minor cuts and
abrasions, as well as cleaning shallow wounds and
minor burns (see Table 5).4
Active dressings
Active dressings can be classed as either interactive
or bioactive. They help to control the wound healing
environment promoting normal healing, by either4:
• combining with the exudate to form a gel
• controlling the flow of exudate from the wound into
the dressing (e.g. films, hydrogels, foam dressings)
• delivering substances that actively assist in wound
healing (e.g. hydrocolloids, alginates).
Anti-infective dressings
Microbial contamination on the surface of a wound
can slow the healing process (see Table 7). If a wound is
infected, systemic antibiotics are usually required along
with an anti-infective dressing4,9
Recommending dressings
To recommend the most appropriate dressing for
the wound:
• review the appearance of the wound
• match the absorbency of the dressing to the amount
of exudate from the wound (see Appendix 4: Summary
of dressings based on wound type chart)
• look at the skin surrounding the wound.
11
 Table 5. Inert dressings4,11
TYPE DESCRIPTION USE SOME EXAMPLES
Wound • Island dressing with absorbent pad attached to a • Minor superficial wound Nexcare Blue Strips OR Nexcare Waterproof
dressing strip of adhesive tape (plastic or fabric) Strips, Nexcare Active Waterproof Strips, Nexcare
strip • Plastic tape is water vapour impermeable causing Blister Waterproof Strips, Nexcare Heavy Duty
possible maceration of the surrounding skin Fabric Strips, Nexcare Soft ‘n Flex Strips, Nexcare
Blue Strips
Bandaid
Gauze • Sterilised cotton woven and non-woven cloth • Cleaning wounds Woven: Gauze swabs and dressings
available as pads, folded swabs and ribbon gauze • Primary dressings Non-woven: Handy swabs, Multisorb swabs
• Absorbent • Wet dressings
Contraindications • Ribbon gauze is used for nasal
• Allows wound to dry out packing and in cavity wounds
• Can shed fibres • Pressure dressing to stop bleeding
• Can stick to wound causing trauma on removal • Absorbents in surgery
• Permeable to bacteria • Non-woven

Non- • Absorbent • Primary dressing for minor and low Moderate absorbency: Nexcare non-stick pads,
adherent • Non-stick inner film layer exudating superficial wound Cutilin, Melolin, Telfa
absorbent • Do not use on dry wounds • Secondary dressing for moderate- High absorbency: Exudry, Mesorb
pad • May be used with tapes/or bandages to adhere to-high exudating wounds Island dressing: Nexcare Tegaderm plus pad,
to the skin • Secondary dressing if attached to Nexcare sensitive skin adhesive pad, Cutiplast
an adhesive secondary dressing steril, Mepore, Primapore, Telfa island
(island dressing), e.g. used over Tapes: Nexcare Micropore, Nexcare Sensitive Skin
lacerations and minor wounds; over Tape, Nexcare Absolute Waterproof Tape, Nexcare
a hydrogel on minor burns Flexible Clear tape, Nexcare Soft Cloth Tape
Bandages: Nexcare No Hurt Wrap, Nexcare Crepe
Bandages
Tulle-gras • Gauze dressing impregnated with paraffin • Minor burns Jelonet, Paranet, Unitulle
dressings • Reduces adhesion to wound • Clean superficial wounds that are
• Needs to be changed daily or more frequently healing by secondary intention
• Permeable to bacteria
• Provides a moist environment but may cause
maceration
• Non-absorbent
• Requires a secondary dressing
• Impregnated with antiseptics or antibiotics and • Burns Bactigras (contains chlorhexidine), Betadine Pads (contains
paraffin • Contaminated orinfected wounds povidone-iodine), Sofra-Tulle
• Requires a secondary dressing
• May cause allergy to medicated ingredients
• Continued exposure to antiseptics can be
detrimental to newly granulating tissue
• Non-paraffin modern tulle • Simple, clean abrasions and burns, Adaptic (contains petrolium emulsion), Atrauman, Cuticerin,
• Tightly meshed excoriated peri-skin Urgotul
• Allows moisture to pass through • Initial dressing over skin grafts
• Less maceration that paraffin tulle
• Does not adhere to wound or allow tissue
embedding
• Requires secondary dressing
• Non-fibre, non-paraffin tulle • Burns Mepitel
• Tightly meshed • Skin tears
• Silicone coated
• Can remain in place for 10–14 days
Fixation • Porous polyester fabric with adhesive backing • Primary or secondary dressing for Fixomull, Hypafix, Mefix
sheets • Provides pain relief due to reduced air flow across low exudating wounds, superficial
the wound grazes, and burns and wounds that
• Permeable and washable do not need frequent review
• Soak in oil to remove • Do not use on infected wounds or it
• Can be left in place for 5–7 days allergy to adhesive

Film • Waterproof • Primary dressing over minor Nexcare Tegaderm, Elastoplast Aqua Protect
• Gas/vapour permeable abrasions, lacerations, burns, scalds Film, Hydrofilm, Mepore Film, Opsite Flexigrid,
• Adhesive with low or no exudate, over Island film dressing: Nexcare Tegaderm plus
• Flexible sutures, after suture removal pad, Cutifilm Plus, Hydrofilm Plus,
• Reduces pain • Prevention and treatment of Opsite Post Op, Tegaderm
• Barrier to external contamination superficial pressure areas
• Protection to friction and microbes • Secondary dressing with an absorbent
• Removal may cause trauma to wound or fragile skin pad over gels, alginates and foams
• Replace if there is leakage or if the wound looks • Remove slowly stretching away
infected from and parallel to the wound
• Do not use on highly exudating
wounds, deep burns, deep cavity
wounds (primary dressing), fragile
skin, or infected wounds

12 ACTION kit – Wound care: supplementary materials I © Pharmaceutical Society of Australia Ltd.
Table 6. Interactive and bioactive dressings4,9
TYPE DESCRIPTION
INTERACTIVE DRESSING
Foam • Absorb exudate
• Maintains a moist environment
• Soft, non-adherent
• Provides cushioning
• Needs secondary dressing or
tape/bandage to hold in place
• Protects against temperature
changes
• Available as sheets or cavity-
filling shapes
Hydrogels • Water-containing (up to 96%)
• Maintains moist environment
to rehydrate a dry, sloughy
wound
• Non-adherent, absorbent
• Allows gases and water vapour
to pass through
• Requires secondary dressing to
hold in place
BIOACTIVE DRESSINGS
Hydrocolloids • Absorbs wound exudate and
forms a gel
• Provides a moist, warm
environment that promotes
debridement and healing
• Occlusive and some are semi-
permeable
• Can be left in place for up to
7 days depending on amount
of exudate and type of dressing
• Many different forms: adhesive,
non-adhesive, paste, powder
Hydroactive • Absorb large amounts of
exudate and swell (do not form
a gel)
• Maintain moist environment
• Promote autolytic debridement
• Waterproof, semi-permeable,
elastic
Alginates • Contain alginic acids (obtained
from seaweed)
• Forms a gel providing a moist
environment
• Provides a moist environment
• Highly absorbent (up to 15–20
times their weight)
• May leave fibres that could
cause inflammation
• Require secondary dressing
• Available in sheets, packing
rope
Hydrofibres • Consists of synthetic fibrous
mat which is highly absorbent
• Absorb exudate forming a
soft gel
• Available as sheet or ribbon
dressings
USE EXAMPLE
• Wounds with medium-to-high Allevyn, Curafoam, Hydrasorb, Lyofoam
amounts of exudate, e.g. ulcers and
minor burns
• Superficial burns
• Can be left in place for 2–3 days
• Secondary dressing for hydrogel
dressings
• Dry, sloughy wounds to rehydrate and Amorphous:
remove dead tissue Aquaform gel, DuoDERM gel, Hydrosorb gel,
• Sunburn, simple scalds (amorphous Intrasite gel, Nu-Gel, SoloSite, Solugel
hydrogels) Sheet:
• Partial-thickness burns (sheet AquaClear, Flexigel sheet, Intrasite
hydrogels) Comfortable
• Do not use on highly exudating
wounds
• Sloughy wounds Nexcare Blister Strips, Comfeel
• Wounds with low-to-moderate Plus, CombiDERM, DuoDERM
amounts of exudate CGF, Hydrocoll, Replicare Ultra,
• Leg, pressure ulcers Restore, Tegasorb
Not recommended for:
• high exudate wounds
• wounds that need frequent inspection
• infected wounds
• Medium-to-high levels of exudate, Allevyn Plus, Cutinova Hydro, TenderWet,
e.g. cavity wounds such as leg ulcers, Tielle
pressure wounds, minor burns
• Useful over joints, e.g. elbow, knee,
fingers and toes as elastic and
contract without causing constriction
• Not recommended for wounds
with little or no exudate or infected
wounds
• Moderate-to-heavy exudate Soft sheet: Comfeel SeaSorb, Sorbsan
wounds (e.g. leg ulcers, pressure Form sheet: Algisite M, Algoderm, Restore
wounds, cavity wounds) CalciCare Tegagen HI and HG
• Used on skin graft sites, bleeding sites, Rope: Algoderm, Comfeel SeaSorb, Kaltostat,
exudating leg ulcers and cavities Restore CalciCare, Sorbsan, Tegagen HI
• Must be changed daily
• Not recommended for low exudating
or dry wounds
• Wounds with heavy exudate (e.g. Aquacel
leg ulcers, pressure wounds, cavity
wounds)
• Superficial burns
ACTION kit – Wound care: supplementary materials I © Pharmaceutical Society of Australia Ltd. 13
 Table 7. Anti-infective dressings4
TYPE DESCRIPTION
Honey • Sterilised honey
• Maintains a moist healing
environment
• Eliminates odour
• Stimulates new tissue growth
• Aids debridement
Iodine • Iodine acts as an antiseptic to
reduce infection
• Cadexomer iodine: Iodine
combined with a polymer which
absorbs exudate and slowly
releases iodine protecting
the wound from bacteria,
mycobacteria, fungi, protozoa,
viruses over 72 hours
Polyhexanide • Contains non-cytotoxic (not
deadly to cells) antiseptic
Silver • Contains silver
• Broad-spectrum antimicrobial
• Dressing may need to be
activated by moistening with
sterile water (not saline) before
applying
Safe disposal of waste
Waste will be generated through a wound management
service. Used wound dressings, bandages, disposable
gloves and other equipment may contain human blood
and/or body fluids. These materials have the potential
to cause injury, infection or offence.
Pharmacists have the responsibility of managing
the disposal of this waste. Most of the waste will be
non-reusable and/or non-recyclable and therefore
must be managed in a manner that protects both the
community and the environment. Some states and
territories require the incineration of this type of waste.
14 ACTION kit – Wound care: supplementary materials I © Pharmaceutical Society of Australia Ltd.
USE EXAMPLE
• Most commonly used to treat infected Actilite, Activon,
wounds such as leg ulcers, pressure ulcers, Algivon (alginate
diabetic foot ulcers, infected wounds as a dressing
result of injury or surgery, burns often when impregnated with
conventional therapy has failed honey)
• First aid treatment of burns
• Sloughy/infected wounds, diabetic wounds Povidone-iodine:
and wounds which are healing poorly, e.g. Inadine
leg and pressure ulcers Cadexomer iodine:
• Avoid or use with caution if patient is
Iodosorb, Iodoflex
sensitive to iodine, has thyroid disorders,
significant renal disease, children and
pregnant women
• Use with caution for long-term treatment
of large wounds and before and after
radio‑iodine tests
• Removal of wound debris and bacteria in Prontosan
acute and chronic skin wounds, superficial
and partial-thickness burns
• Cream used to treat burns and some wounds Allevyn Ag, Silvercel,
• Use on slow-to-heal and critically colonised Acticoat
wounds
• Choice of silver dressing depends on the
level of infection, size and depth of wound
and amount of exudate
• Avoid if patient is allergic to silver
• Use with caution in renally impaired patients
due to accumulate risk
State, territory and local council regulations have
different requirements for the disposal of this type of
waste. Before commencing a wound management
service, contact the pharmacy’s local council for current
local area advice on waste disposal. State and territory
health departments and environmental protection
agencies may also have advice on the correct disposal
of this type of waste. Once waste disposal requirements
have been determined, train the pharmacy staff on
both minimising waste and ensuring that it is properly
managed in the pharmacy.
Table 8. Wound assessment and dressing selection4,9
WOUND WOUND APPEARANCE DESCRIPTION DRESSING SELECTION
COLOUR
Pink • Wound in the final Protect and insulate new tissue and
stages of healing maintain a moist environment, e.g.
• Low exudate island dressings, non-adherent dressings,
hydrocolloids, hydroactives, tulle, zinc paste

Red • Wounds looks Absorb excess exudate, maintain a moist

granular and highly environment but not soggy, protect the
vascular (red) due to wound and promote tissue growth
new blood vessels Low exudate: hydrocolloids, films, foams,
• Low or high exudate sheet hydrogels
High exudate: foams, alginates, hydroactive
dressings

Black • Wound with hard, Rehydrate and loosen the hard tissue and
black and leathery remove infected and dead tissue, e.g.
tissue due to local foams, alginates, hydroactive dressings
tissue death
• Low exudate

Yellow • Wound with a sloughy Maintain moist environment, remove

layer of non-viable slough, absorb exudate
tissue Low exudate: hydrogels to rehydrate the
• Low or high exudate slough, hydrocolloids, films and enzymes,
cadexomer iodine, silver dressings
High exudate: hydrocolloid paste or
powder, alginates, hydrogel, hydrofibres,
cadexomer iodine, silver dressings

Green • Infected wound with Absorb infected exudate and avoid the
large amount of breakdown of the surrounding skin,
exudate e.g. hypertonic saline, silver dressings,
• High exudate cadexomer iodine, interactive wet
dressings, hydrofibres

Images reproduced with permission from G. Sussman and J. Jones.

ACTION kit – Wound care: supplementary materials I © Pharmaceutical Society of Australia Ltd. 15
 Health promotion
Health promotion engages consumers and the
community to promote health and wellbeing at a
population or group level, and includes strategies such
as health education, health counselling, provision of
health information and skills development.
A health promotion campaign focused on wound care
could raise consumer awareness of the importance
of appropriate and timely management of wounds.
Effective management of wounds can minimise healing
time and scarring and reduce the chance of wounds
becoming chronic.
Through a wound care health promotion, consumers
can be encouraged to take immediate care of acute
wounds. A catch phrase for the promotion such as Act
now on wounds, can be used to highlight the need
for immediate and effective wound care treatment.
Chronic wounds are known to affect a person’s physical,
social and psychological health as well as imparting a
huge cost on the community.8,14 Through a wound care
health promotion, consumers with chronic wounds may
be identified and referred for further medical treatment
as required.
A wound care health promotion campaign could also
identify people at risk of wounds. Elderly people, for
example, are at risk of skin tears. Their skin is fragile and
easily damaged. It is drier, less elastic and often very
thin. Bleeding and skin discolouration and bruising are
common. Alert them to the risks of skin tears especially
on the upper limbs and encourage them to come to
the pharmacy for assessment and treatment if a wound
occurs. This type of wound can be effectively and
efficiently managed in the community pharmacy.8
Therefore, it is very important to be familiar with your local
wound care network. Identify hospitals, outpatient clinics,
general practitioner surgeries, dietitians, dermatologists,
oncologists, and community nurses in your area who
contribute to wound management. Contact them before
hosting a wound care health promotion and discuss their
roles in wound management. For example, if a patient
with a chronic wound needs more specialised care, you
will need to know how to access the most appropriate
local wound care services such as community nursing.
A wound management service must be community-wide,
not limited to the pharmacy. It must involve all local area
wound management services.
Through wound care demonstrations and training,
consumers can be encouraged to take an active role in
the management of their wounds. The risk factors for
wounds can be highlighted and information provided on
how to take preventive action to avoid injuries.
Pharmacies wanting to host a wound care promotion
could partner with healthcare organisations, such as
Wounds Australia as well as manufacturers of wound
16 ACTION kit – Wound care: supplementary materials I © Pharmaceutical Society of Australia Ltd.
care products. These organisations have resources and
materials that can be used during the promotion period.
A wound care health promotion could be coordinated with
national awareness campaigns such as Wound Awareness
Week. These campaigns often have accompanying posters
and consumer brochures. Suppliers of wound products
should also be contacted and an agreement established to
ensure a regular supply of wound care products.
Further information about health promotion activities
in pharmacies is available in the PSA Self Care Manual for
delivering professional services, Professional Practice Standards
Standard 13: Health promotion, and Professional Practice
Standards Appendix 3: The Health promotion planning cycle.
Wound management service
A wound management service is an advanced level of
practice focusing on wound assessment, treatment and
timely referral to other members of the healthcare team,
if required. This service offers consumers easier access
to enhanced wound management, support and advice.
Pharmacists offering this service will commonly treat acute
wounds such as abrasions, cuts, burns and skin tears, often
in a first aid situation. However, as many chronic wounds
are now being managed in the community,14 pharmacists
may also be involved in the care of chronic wounds.
To establish a pharmacy wound management service:
• Develop a pharmacy first aid protocol (see Appendix 1:
Pharmacy first aid protocol for treating wounds)
• Ensure all pharmacy staff involved in the wound
management service have current first aid certificates
(see PSA at: www.psa.org.au)
• Assess the wound to determine the optimal management
required (see Appendix 2: Wound assessment tool)
• Select the most appropriate wound care products and
dressings (see Appendix 3: Wound dressing selection tool
and Appendix 4: Summary of dressings based on wound
type chart)
• Provide the person with the wound a wound care
management plan (see Appendix 5: Wound management
plan)
• Identify those people at risk of wounding and provide
information about how to prevent wounds (see Appendix
2: Wound assessment tool and Appendix 6: Reducing the risk
of acute wounds)
• Identify when referral for further medical review is
needed (see Appendix 2: Wound assessment tool)
• Establish relationships with local healthcare providers
and suppliers of wound care products
• Distribute patient counselling material and wound care
information (see Appendix 5: Wound management plan
tool, Appendix 6: Reducing the risk of acute wounds and
Appendix 7: Pharmacist and consumer resources)
• Provide ongoing wound care education for all pharmacy
staff (see Appendix 7: Pharmacist and consumer resources).
Appendix 1: Pharmacy first aid protocol for treating wounds
A first aid protocol is designed to prevent the spread of infection between the patient and the pharmacy member
treating the wound, between patients and between the pharmacy staff and the patient. High standards of hygiene
must be adhered to at all times.

SEQUENCE EXPLANATION
1 Appoint Appoint a member of staff as the pharmacy’s first aid officer who will be responsible for:
a first aid • maintaining a current first aid qualification
officer • maintaining the wound assessment and treatment area
• ensuring stock levels of wound dressings and associated wound care products are adequate
• cleaning, disinfecting and sterilising the treatment area and non-disposable items after use
• safe collection, storage and disposal of contaminated waste
• contacting an ambulance in an emergency situation
• sourcing and maintaining wound care supplies and educational material for people with wounds and pharmacy staff
members
2 Establish a • Establish a designated area within the pharmacy for patient triage to assess, treat and review wounds
treatment • Treatment area must contain chairs, treatment tables, access to a water supply, sealed contaminated waste disposal,
area dressings and associated wound care products, disposable treatment items such as gloves, masks, swabs
3 Ensure • Before examining a wound, wash hands with soap and water for 15 seconds and dry on a clean towel.
infection An antibacterial hand gel can be used if your hands are not visibly dirty
control • Use gloves, masks and other protective equipment, if necessary, before examining the wound especially when there is
risk of contamination. Also ensure washing of hands before touching any surfaces or after the dressing is completed.
• Ensure the correct disposal of contaminated waste in a sealed disposal container
• Ensure all wound care products and materials are stored according to the manufacturer’s instructions

4 First aid Abrasion (graze)5

treatment of • Stop the bleeding by applying pressure to the wound
a wound • Gently clean the wound under running water with a non-fibre shedding material or sterile gauze to remove dirt and
debris
• Don’t scrub at embedded dirt, as this can further traumatise the site
• Cover the cleaned wound with an appropriate non-stick sterile dressing
• Change the dressing according to the manufacturer’s instructions (some may be left in place for several days to
a week)
• Do not use any product on the wound that will dry or traumatise the wound
• Offer appropriate pain management
Laceration (cut)4,12
• Stop the bleeding of a small laceration by applying firm pressure to the wound with a towel for 5–10 minutes.
A haemostatic dressing (e.g. alginate) may also be applied initially to stop the bleeding. If the laceration is large,
continue applying pressure for at least 10 minutes. If possible, raise the wound area to try to stop the bleeding.
• If blood is squirting from the laceration, or bleeding cannot be stopped, ring Triple Zero (000). Apply a tourniquet
5 cm above the wound and tie tightly to reduce the blood flow to the area
• Clean a small laceration as for an abrasion
• Apply wound closure strips across a deep cut to close the wound
• Dress with a simple permeable dressing either waterproof or not
• Wrap in a lightweight cohesive bandage over the dressing to further inhibit bleeding if necessary
Burn13
• Place the burnt area under running tap water for at least 20 minutes (thermal burn) or at least 1 hour for a
chemical burn
• Do not apply ice, creams, lotions, or butter to the burnt area
• Remove any jewellery that is near the burn if not stuck to the skin
• Apply a non-stick dressing to the wound area, e.g. hydrogel, hydrocolloid and change according to
manufacturer’s instructions
• If the burn covers a large area or is deep, refer immediately to hospital
• For further information see Australian and New Zealand Burn Association, Wounds Australia, The Royal Children’s Hospital
Melbourne Clinical Practice Guidelines (Burns/management of burn wounds)
Skin tears8,16
• If bleeding, place a clean towel on the wound and apply gentle pressure until bleeding stops
• Clean a minor skin tear using clean water, normal saline or non-toxic surfactant wash. If wound starts bleeding,
re-apply pressure and very carefully pat dry
• If there is a skin flap, gently replace it over the wound (a moist cotton bud can be used) but do not pull it into place.
• Use a silicone dressing that has silicone over its entire wound contact surface as this will secure the flap. Only use
elasticised skin fasteners if silicone dressings are not available or the flap has a complex shape. Take care to allow
for wound drainage.
• Cover the wound with a non-adhesive dressing and hold in place with a paper tape or cloth bandage to reduce
further trauma to the skin
• If the skin flap is partially or totally missing, or is very deep, refer for further medical advice
• For further information, see STAR Skin Tear Classification System, CWC Skin tears assessment and management
5 Safe disposal Safely dispose of any waste generated through the service according to local council, state and territory waste
of clinical disposal requirements
waste

ACTION kit – Wound care: supplementary materials I © Pharmaceutical Society of Australia Ltd. 17
 Appendix 2: Wound assessment and treatment tool
Use a wound assessment and treatment tool when reviewing the wound and recording
patient details and determining treatment*

Date of presentation:.. ....................................................................

Patient name:.................................................................................... Date of birth:.. ............................................................................................

Address:.. .....................................................................................................................................................................................................................

Phone:. . ................................................................................................ Email:. . ..........................................................................................................

Current medicines:..................................................................................................................................................................................................

.......................................................................................................................................................................................................................................

.......................................................................................................................................................................................................................................

Reason for presentation:.......................................................................................................................................................................................

.......................................................................................................................................................................................................................................

.......................................................................................................................................................................................................................................

Duration of wound:. . .......................................................................

Pain assessment: 1 2 3 4 5 6 7 8 9 10
Mild Moderate Severe

Related health issues:

Diabetes Smoking Pain Malodorous Arthritis Psycho-social
Nutritional status: ..................................... Body mass index (BMI): ....................................... Other: ......................................

Tetanus status:..................................................................................

Previous wound history and outcome:............................................................................................................................................................

.......................................................................................................................................................................................................................................

Acute wound Chronic wound

Abrassion Leg ulcer
Incision Pressure wound
Laceration Post-operative wound
Puncture Cancer-related wound
Burn Chronically infected wound
Skin tear Other: .............................................................................................

18 ACTION kit – Wound care: supplementary materials I © Pharmaceutical Society of Australia Ltd.
Location

Size of wound:
...............................................................................................................

Underlying nerve, tissue, tendon damage:

...............................................................................................................

Assess movement:
...............................................................................................................

Assess tissue damage or loss:

...............................................................................................................

Description of wound
Colour: Shape and size:
Pink Red Yellow Black Green

Amount of exudate:
Nil Low High

Wound edge:
Level Raised Rolled

Infection:. . ...........................................................................................
Pain:......................................................................................................

Assessment of individual’s healing environment

Lifestyle factors:.. .............................................................................. Appropriate disposal of used wound products:
Hygiene status:................................................................................. ...............................................................................................................

Risk of contamination:................................................................... Other:...................................................................................................

Storage of wound products:........................................................

Treatment
Cleaning:. . ...........................................................................................
Dressing type:...................................................................................
Analgaesia:. . .......................................................................................
Frequency of review:......................................................................
Referral:...............................................................................................
Patient counselling:........................................................................
Outcome:............................................................................................

Risk assessment
Falls:..............................................................................................................................................................................................................................
Skin integrity:............................................................................................................................................................................................................
Other:...........................................................................................................................................................................................................................

*Adapted from www.awma.com.au/publications/2011_standards_for_wound_management_v2.pdf and www.rch.org.au/uploadedFiles/Main/

Content/rchcpg/Wound_assesment_and_Treatment_Plan_version_7__2_.pdf

ACTION kit – Wound care: supplementary materials I © Pharmaceutical Society of Australia Ltd. 19
 Appendix 3: Wound dressing selection tool
Before recommending a wound dressing, thoroughly assess the wound, and review and consider the patient’s needs.
Use the wound dressing selection tool to ensure the most appropriate dressing has been selected.

Wound dressing selection tool*

CONSIDERATIONS YES/NO

Match the dressing absorbency with the level of wound exudate

Identify wound bed tissue type – epithelialising, granulating, infected, necrotic, or sloughy (see Appendix 3)

Inspect the condition of the surrounding skin

Identify a method of holding the dressing onto the body to provide protection and not cause additional trauma to
the wound (e.g. tape, film, bandage)

Minimise pain and trauma i.e. silicone-based or non-adherent contact layers minimise trauma when the dressing is
changed; moisture-retentive dressings and moist wound healing environments usually reduce pain

Estimate the size of the wound and use an appropriately sized dressing

Determine how long the dressing will be worn and when the dressing will need to be replaced

Consider the wound management requirements e.g. frequency of review, application of antibiotic, compression
bandaging, etc.

Know the correct application and removal method of the dressing or secondary dressing

Know any precautions or contraindications for dressing use e.g. suitability on infected wounds

Aware and respectful of the patient’s needs and quality of life

*Adapted from Pharmaceutical Society of Australia. Wound care in practice. Canberra: PSA; 2013. p. 38.

Appendix 4: Summary of dressings based on wound type chart

Summary of dressings based on wound type chart*
TYPE OF WOUND AIM OF DRESSING LOW EXUDATE HIGH EXUDATE DEEP WOUNDS
Epithelialising Keep moist and warm Low or non-adherent Alginate or hydrofibres Not applicable
Protection dressing or with secondary
hydrocolloid absorbent dressing

Granulating Keep moist and Low or non-adherent Alginate or hydrofibres Alginate with a
protected dressing with secondary secondary absorbent
Manage exudate Hydrocolloid absorbent dressing dressing

Infected Reduce colonisation Alginate with Alginate with Alginate with

Manage exudate secondary absorbent secondary absorbent secondary absorbent
dressing and dressing and systemic dressing and systemic
antimicrobial dressing antibiotics antibiotics
(e.g. silver, iodine,
honey)
Necrotic Rehydrate, debride, Hydrogel and Alginate or hydrofibres Hydrogel and
and manage exudates semi-permeable with secondary semi‑permeable
(note vascular status if film dressing or absorbent dressing dressing
lower limbs affected) hydrocolloid
Sloughy Remove slough, Hydrogel and Alginate or hydrofibres Alginate with a
debride and semipermeable with a secondary secondary absorbent
film dressing or absorbent dressing dressing
absorb exudates
hydrocolloid or surgical
debridement
*Adapted from Clinical pharmacist 2010;2:363–6. At: www.pharmaceutical-journal.com/files/rps-pjonline/pdf/cp201011_practice_tools-363.pdf

20 ACTION kit – Wound care: supplementary materials I © Pharmaceutical Society of Australia Ltd.
Appendix 5: Wound management plan tool
An acute wound care management plan is a general plan for caring for a wound. Although every wound is different,
requiring different treatment and management strategies, a basic acute wound management plan can be useful
in the pharmacy as well as given to the patient/carer to take home. This is particularly helpful for treating and
managing acute wounds such as abrasions, minor cuts and burns.

1 Wash hands Before cleaning or dressing a wound, always thoroughly wash your hands with soap and water for
15 seconds. Dry them on a clean towel. An antibacterial hand gel can be used if your hands are not
visibly dirty (also wash hands after cleaning or dressing wounds or if touching any surface)
2 Stop the If the wound is bleeding, use a clean, dry towel and apply gentle pressure to stop the bleeding. If the
bleeding wound is large or bleeding a lot, elevate the wound to help stop the bleeding. If bleeding won’t stop
after 10 minutes or is squirting from the wound, call an ambulance immediately
3 Clean the Use running tap water to wash the wound. Remove any dirt or debris from the wound with a clean towel.
wound Do not use cotton wool balls. If the wound starts to bleed, apply gentle pressure. Avoid putting soap
onto the wound. Antiseptics are not recommended. If soap or antiseptics have been used on the wound,
flush or wash the wound with running tap water 3–4 minutes
4 Look for Examine the wound to see if there are any foreign bodies embedded in the wound. If unsure, go to the
foreign bodies emergency department at the hospital for investigation
5 Apply a Apply a dressing directly to the wound that is non-stick and able to absorb any wound fluid (exudate)
primary
dressing
6 Apply a Apply a dressing , tape or bandage that will hold the first dressing in place and fix to the body. Consider
secondary the patient’s age, skin type and activity levels, e.g. a cohesive bandage that does not stick to the skin or
dressing cause skin tears when removed would be appropriate for fragile skin, a water-resistant bandage should
be considered if the wound was on a part of the body that was to be regularly wet such as the hands
7 Wound Protect the wound if necessary with a firm covering such as a finger stall
protection
8 Keep it moist Wounds heal more quickly with less chance of scaring if kept moist. Only change the dressing when it
becomes soaked with wound fluid, dirty or soiled. Exposing the wound to the air will dry it and a scab
will form slowing healing
9 Changing Dressings usually need to be changed when they become soaked with wound fluid, dirty or soiled.
dressings Always change dressings in a clean area and wash your hands before changing the dressing
Carefully and slowly remove the old dressing starting at the corners. Support the skin around the
dressing to avoid damaging the skin and causing pain. If some of the old dressing is stuck to the wound,
soak it off with clean water
• Discard the used dressing in the bin
• Avoid touching the wound as much as possible and look for signs of infection
• Clean the wound with a non-fibre shedding towel dampened with a mild cleanser. Pat dry
• Apply the new dressing recommended by a pharmacist or doctor. Avoid touching the part of the dressing
that will go onto to the wound. If the dressing is not adhesive, secure it with tape or a bandage
10 Signs of Observe around the wound for signs of infection such as increased pain, swelling, heat, redness, or
infection discoloured and thick wound fluid (pus). Also if you feel unwell or develop a temperature. See your
pharmacist or doctor
11 Pain relief Some wounds are painful and you may need a pain relief medicine such as paracetamol. Always ask a
pharmacist or doctor before taking any medicine
12 Wounds that If the wound does not heal in four weeks or if it becomes larger, go to a pharmacist or doctor for advice
don’t heal
13 To assist • Stop or reduce smoking
wound healing • Drink plenty of fluid (but avoid too much caffeine or alcohol)
• Eat foods rich in protein (including meat, fish, nuts, low fat dairy products, legumes)
• Avoid removing dressings or treatments applied by a health practitioner unless you are instructed to
do so
• Avoid exposing your wound to the air
• Avoid bathing your wound in the sea

ACTION kit – Wound care: supplementary materials I © Pharmaceutical Society of Australia Ltd. 21
 Appendix 6: Reducing the risk of acute wounds
Some wounds can be avoided by taking preventive measures. This information could be provided to consumers and
used as a teaching tool for pharmacy staff.

TYPE OF WOUND ADVICE5,12,13,15

Abrasion/graze • Protect your limbs by wearing long sleeves and pants
• Wear protective clothing when riding bicycles, skateboards, scooters or motorcycles such as helmets,
knee and elbow pads, clothing made of thick tear-proof material such as leather
• Keep skin in good condition and hydrated by using a good quality moisturiser and drinking adequate
fluid (i.e. water)
Laceration/cut • Take extreme care when using any sharp items such as knives, utensils, tools and razors
• Wear protective clothing when using sharp utensils and tools such as gloves, shoes, face protectors,
leather aprons
• Wear shoes with thick soles to avoid cuts to your feet. Do not walk around barefoot
Burn • Use extreme care when using heating devises such as kettles, stovetops, ovens, microwave ovens, hot
water tap, radiators
• Install a mixer tap in bathrooms to avoid scalds
• Do not handle caustic chemicals
• Do not touch electrical work unless you are trained to do so
• Do not add petrol or other flammable liquids to a fire
• Do not smoke around flammable liquids
• Apply sunscreen generously 20 minutes before going outside and re-apply every 2 hours
• Wear sun protective clothing when outside such as broad-brimmed hats, long sleeves and pants,
sunglasses
• Regularly have your skin checked for any changes such as new spots, or changes to existing freckles or
moles
Skin tear • Regularly apply a good quality moisturising cream
• Drink adequate amount of fluids such as water not caffeine or alcohol
• Eat a nourishing diet
• Ensure there is adequate lighting
• Protect limbs by wearing long sleeves, pants and gloves.
• Specialised limb protectors are available from some medical suppliers for persons at high risk of skin tears
• Use a walking aids such as a walking frame or stick to avoid falling
• Use foam or other cushioning and padding materials on corners and sharp edges of household furniture
• Use non-adherent dressings to avoid ripping the skin
• Use cohesive bandages to hold dressings in place
• If tape is required to hold dressings in place, use paper or cloth tape that can be easily removed or falls off
• Take extreme care when removing adhesive dressings always supporting the skin. Use an adhesive
dissolvent if necessary
• Use soft, moisturising soaps when washing such as sorbolene cream. Do not use alkaline soaps for
washing
• Educate family members and carers about preventing skin tears

22 ACTION kit – Wound care: supplementary materials I © Pharmaceutical Society of Australia Ltd.
Appendix 7: Pharmacy staff and consumer resources
Pharmacist
• PSA Self Care InPHARMation April 2016: Facts behind the fact cards – Wound care in pharmacy
• PSA First Aid training. At: www.psa.org.au
• Wounds Australia. Standards for wound management. 2nd edn. 2010; At: www.awma.com.au/publications/2011_
standards_for_wound_management_v2.pdf
• Training:
-- Monash University: Graduate certificate, Graduate diploma and Masters of wound care. At: www.monash.edu.au/
pharm/
-- Wounds Australia: Wound management courses. At: www.awma.com.au/pages/courses.php
-- Smith and Nephew: Wound management education. At: www.smith-nephew.com/professional/training-and-
education/wound-management

Pharmacy assistant
• PSA Self Care InPHARMation April 2016: Counter connection – Wound care in pharmacy
• PSA Self Care Fact Cards First aid in the home and Sense in the sun.

Consumer
• PSA Self Care Fact Cards First aid in the home and Sense in the sun.
• Better Health Channel. Wounds – how to care for them. 2014. At: www.betterhealth.vic.gov.au/health/
conditionsandtreatments/wounds-how-to-care-for-them
• Better Health Channel. Skin cuts and abrasions. 2016. www.betterhealth.vic.gov.au/health/
conditionsandtreatments/skin-cuts-and-abrasions
• healthdirect. Wounds, cuts and grazes. 2015. At: www.healthdirect.gov.au/wounds-cuts-and-grazes
• Department of Health & Human Services, State Government of Victoria. Emergency department fact sheet. Care of
open wounds, cuts and grazes. 2010; At: www.health.vic.gov.au/edfactsheets/downloads/care-of-open-wounds-
cuts-and-grazes.pdf

References
1. Australian Wound Management Association.
Standards for wound management. 2nd edn.
2010; At: www.awma.com.au/publications/2011_
standards_for_wound_management_v2.pdf
2. Wound management. In: Sansom LN, ed.
Australian pharmaceutical formulary and
handbook. 23rd edn. Canberra: Pharmaceutical
Society of Australia; 2015. p. 211–26.
3. Corbett LQ, Ennis WJ. What do patients want?
Patient preference in wound care. Adv Wound
Care (New Rochelle) 2014;3(8):537–43. At: www.
ncbi.nlm.nih.gov/pmc/articles/PMC4121048/
4. Pharmaceutical Society of Australia. Wound care
in practice. Canberra: PSA; 2013.
5. Australian Wound Management Association.
Abrasions; 2014. At: www.awma.com.au/2015/
awma-sa-Abrasions-2015-04-23.pdf
6. Guo S, DiPietro LA. Factors affecting wound
healing. J Dent Res 2010;89(3):219–29. At: www.
ncbi.nlm.nih.gov/pmc/articles/PMC2903966/
7. Mercandetti M. Wound healing and repair. In:
Medscape. 2015. At: http://emedicine.medscape.
com/article/1298129-overview#a5
8. Sussman G, Golding M. Skin tears: should the
emphasis be only their management? Wound
practice and research 2011;19(2):67–71. At: www.
awma.com.au/journal/1902_03.pdf
9. Weller C, Sussman G. Wound dressings update.
Journal of Pharmacy Practice and Research
2006;36(4):318–24. At: http://jppr.shpa.org.au/lib/
pdf/gt/GT0612.pdf
10. The Royal Children’s Hospital Melbourne. Clinical
guidelines (nursing). Wound care. 2013. At: www.
rch.org.au/rchcpg/hospital_clinical_guideline_
index/Wound_care/
11. The Royal Children’s Hospital Melbourne.
Clinical guidelines (nursing). Wound dressings
- acute traumatic wounds. At: www.rch.org.au/
clinicalguide/guideline_index/Wound_dressings_
acute_traumatic_wounds/
12. Australian Wound Management Association.
Lacerations; 2014. At: www.awma.com.au/2015/
awma-sa-Lacerations-2015-04-23.pdf
13. Australian Wound Management Association.
Minor burns and scalds; 2014. At: www.awma.
com.au/2015/awma-sa-Burns-2015-04-23.pdf
14. Australian Wound Management Association.
Background briefing paper: wound management
in Australia - improving wound care, saving
money. 2012; At: www.awma.com.au/
publications/2012_wounds_and_politicians_
kb.pdf
15. SunSmart Victoria. How to apply sunscreen. 2016.
At: www.sunsmart.com.au/uv-sun-protection/
slop-on-sunscreen
16. Connected Wound Care. Skin tears assessment
and management: a health care guide for nursing
staff; 2012. At: www.grhc.org.au/document-
library/doc_download/282-cwc-skin-tears-and-
assessment-print-version

ACTION kit – Wound care: supplementary materials I © Pharmaceutical Society of Australia Ltd. 23
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24 ACTION kit – Wound care: supplementary materials I © Pharmaceutical Society of Australia Ltd.