ASEPTIC (SIMPLE) WOUND DRESSING

GNS 1 - GNS1500
Second Placement Procedure
Objectives

• Define related concepts

• Identify the wound classification

• Describe types of wounds healing

• Discuss the principles of wound care

Wound care and wound healing
• A wound is a disruption in the
continuity and regulatory of tissue cells

• Wound healing is the restoration of

that continuity; however it may not
restore normal cellular function.
Wound classification
Mechanism of injury
1.Incised wounds- made by a clean cut of a
sharp instrument, such as surgical incision with
a scalpel.
2.Contused wound – made by a blunt force that
typically does not break the skin but causes
considerable tissue damage with bruising and
swelling.
Wound classification
1.Lacerated wounds – made by an object that
tears tissue, producing jagged, irregular edges,
example includes glass, jagged wire and blunt
knife.
2.Puncture wounds – made by a pointed
instrument, such as an ice pick, bullet, or nail.
Degree of wound contamination
Clean wound are uninfected wounds in which
there is minimal inflammation and the
respiratory, gastrointestinal, genital, and urinary
tract are not entered. These wounds are primary
closed wound.
Clean-contaminated wounds are surgical
wounds in which the respiratory gastro-intestinal,
genital, and urinary tract has been entered.
Degree of wound contamination...
Contaminated wounds include open, fresh, accidental wound
and surgical wounds involving a major break in sterile
technique or a large amount of spillage from the
gastrointestinal tract. It shows evidence of inflammation.
Dirty or infected wounds include wounds containing dead
tissue and wounds with evidence of clinical infection such as
purulent drainage.
Physiology of wound healing
• The phase of wound healing – inflammation, reconstruction
(proliferation), and maturation (remodelling). - involve
continuous and overlapping process. (Nettina 2014:123).
Types of wound healing
First intention healing (Primary Closure)
- Wounds are made sterile by minor debridement
and irrigation, with a minimum of tissue damage
and tissue reaction; wound edges are properly
approximated with sutures.
- Granulation tissue is not visible and scar
formation is typically minimal (keloid may still
formed in susceptible person.)
Secondary intention healing (granulation)
- Wound left open to heal spontaneously or are
surgically closed at a later date; they need not
to be infected.
- Examples in which wounds may heal by
secondary intention include burns, traumatic
injuries, ulcers, and suppurative infected.
- The cavity of the wound fills with a red, soft,
sensitive tissue (granulation tissue), which
bleeds easily. A scar (cicatrix) eventually forms.
Secondary intention healing……
- In infected wound, drainage may be
accomplished by use of special dressings
and drains. Healing is thus improved.
- In wounds that are later sutured, the two
opposing granulation surfaces are brought
together.
- Secondary intention healing produce a
deeper, wider scar.
Factors that promote wound healing
• Many factors promote wound healing,
such as:
• Adequate nutrition, cleanliness, rest and
position, along with the patient’s
underlying psychological and physiologic
state.
Purpose of dressing
- To protect the wound from mechanical
injury.
- To splint or immobilise the wound.
- To absorb drainage.
- To prevent contamination from bodily
discharge (feces, urine).
Purpose of dressing…..
-To promote homeostasis, as in pressure dressing.
-To inhibit and kill microorganisms by using
dressings with antiseptic or antimicrobial
properties.
-To provide a physiologic environment conducive to
healing.
-To provide mental and physical comfort for the
patient.
-To encourage healing.
Type of dressing
• Dry dressing
• Wet dressing - to - dry
• Topical or ointment dress
(Nettina 2014:130)
Principles of wound care
These principle refer to as “five rules of
wound care”

Rule 1: Categorization.
- Learn about dressings by generic category
and compare the new products
- Be familiar with indication and contra-
indication.
Principles of wound care
Rule 2: Selection
- Select the fastest and most effective, easy-
to-use and cost-effective dressing possible
- In case of doctor prescription carry out the
physician’s order for dressing, but give
feedback about the dressing effect on the
wound.
Principles of wound care…..

•Rule 3: Change
-Change dressing based on patient,
wound and dressing assessment
•Rule 4: Evolution
-As wound progress through the phase
of wound healing, the dressing protocol
is altered to optimized wound healing.
Principles of wound care…..

Rule 5: Practise
- Practise with dressing material is required for the
nurse to learn the performance of parameters of
the particular dressing.

- Refining the skills of applying appropriate dressing

correctly and learning about the new dressing
products. (Bruner & Suddarth’s, 2010: 1678)
Promotion of healing of wound and septic lesion

Wounds heal best if:

- They are clean (free of necrotic tissue and
bacteria/yeast/fungi)
- They are moist (occlude dressing)

- They have a normal arterial and venous

blood supply (no constrictive dressings and
no swelling)
To achieve this:
Debride the wound with forceps, scissors,
and gently clean.
Apply an ointment and Secure with tape,
or apply one of the many semipermeable
dressings. Change as wound discharge
dictates.
Make sure that the wound dressing is not
restrictive. Try to keep extremity at heart-
level, not dependent.
Sterile technique
Sterile technique requires that the surgeon/nurse
is able:
• to open and don gloves without contamination to
the sterile surface of the gloves.
• to clean and drape the wound and surrounding
area,
• to control the instruments and sutures,
preventing them from the contamination by
contact with non-sterile surfaces.
Protective clothing
• Appropriate theatre dress reduces the dissemination
of pathogenic microorganisms from the staff
members.
• The risk of pathogen transfer can be reduced by
using protective barriers, especially surgical gowns
and drapes, that must exhibit the standard
performance properties, such as minimum strength,
fluid resistance, and an effective barrier protection
(even when wet). Bacteria penetrate wet gowns.
References
Nettina, S.M. (2010). Lippincott Manual of

Nursing Practice. Lippincott Williams &

Wilkins: Philadelphia.
Suzanne CS. 2010. Brunner and
Suddath’s textbook of Medical-Surgical.
12th edition. Wolters Kluwer
Health/Lippincott Williams & Wilkins.