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Wound field concept ad
- 1. Wound FieldWound Field ConceptConcept Dr Clare FenwickDr Clare Fenwick Fatima College Health SciencesFatima College Health Sciences Griffith UniversityGriffith University 20102010
- 2. Dr Clare Fenwick 2010 TerminologyTerminology Wound ColonisationWound Colonisation Wound ContaminationWound Contamination Wound InfectionWound Infection
- 3. Dr Clare Fenwick 2010 Existence of bacteria with no obvious host reactionExistence of bacteria with no obvious host reaction All wounds are colonisedAll wounds are colonised WOUND COLONISATIONWOUND COLONISATION
- 4. Dr Clare Fenwick 2010 Introduction of micro-organisms into the wound or the presence ofIntroduction of micro-organisms into the wound or the presence of non-replicating micro-organisms on the wound surfacenon-replicating micro-organisms on the wound surface Re-introduction of the patient’s own microbes back into the woundRe-introduction of the patient’s own microbes back into the wound is NOT contaminationis NOT contamination WOUND CONTAMINATIONWOUND CONTAMINATION
- 5. Dr Clare Fenwick 2010 Invasion and multiplication of micro-organismsInvasion and multiplication of micro-organisms causing local and systemic effectscausing local and systemic effects WOUND INFECTIONWOUND INFECTION
- 6. Dr Clare Fenwick 2010 ContaminationContamination Host resistanceHost resistance Patients immune system, limited controlPatients immune system, limited control Environmental virulenceEnvironmental virulence What we carry on our bodies, innate objects, limited controlWhat we carry on our bodies, innate objects, limited control EndogenousEndogenous Patient’s own flora and bacteriaPatient’s own flora and bacteria ExogenousExogenous (most common cause)(most common cause) Foreign matter – hair, wool fibresForeign matter – hair, wool fibres Nurses hands are the worst offenderNurses hands are the worst offender If it is wet and not yours, protect yourselfIf it is wet and not yours, protect yourself Watch what you discard and whereWatch what you discard and where
- 7. Dr Clare Fenwick 2010 Things to considerThings to consider Acknowledge colonisation asAcknowledge colonisation as normalnormal Prevent/minimise contaminationPrevent/minimise contamination Identify and treat infectionIdentify and treat infection
- 8. Dr Clare Fenwick 2010 Wound Bed PreparationWound Bed Preparation Cleansing techniquesCleansing techniques DebridementDebridement SharpSharp AutolyticAutolytic EnzymaticEnzymatic MechanicalMechanical SurgicalSurgical Biodebridement (maggots)Biodebridement (maggots)
- 9. Dr Clare Fenwick 2010 Cleansing TechniqueCleansing Technique Clean versus sterile techniqueClean versus sterile technique Normal saline and tap water (safeNormal saline and tap water (safe enough to drink)enough to drink) Hand washing is essential to reduceHand washing is essential to reduce infectioninfection Dirty hand & clean handDirty hand & clean hand Wound field conceptWound field concept
- 10. Dr Clare Fenwick 2010 Clean and dirty handClean and dirty hand Dressing Equipment clean dirty
- 11. Dr Clare Fenwick 2010
- 12. Dr Clare Fenwick 2010 Wound Field conceptWound Field concept Dressing Equipment
- 13. Dr Clare Fenwick 2010 QUESTIONS???QUESTIONS???
- 14. Dr Clare Fenwick 2010 Reading SourcesReading Sources Ellis, T.,Beckmann, A. (1997) Wound Field Concept Primary Intention 5, (2) Ellis, T. (2004). CPD: Understanding the act of contamination in wound dressing procedure. Collegian, 11(3), 39-42. Fenwick, C. (2006) Wound fields and the undergraduate nurse. Australian Nursing Journal 13, (11) pp 41 Gillespie, B. & Fenwick, C. (2009) Comparison of the two leading approaches to attending wound care dressings. Wound Practice and Research 17 (2) pp 62-67
Editor's Notes
- CONTAMINATION Host resistance – Patients immune system you have little control over Environmental virulence - What each person carries on them or on innate objects you also have little control over Endogenous – patients own flora or bacteria Exogenous – is the most common cause of contamination. Anything foreign to the wound such as your microbes, your hair or clothes fibre can contribute to the deterioration of the wound. Cotton wool fibres left behind in the wound when cleaning can set up an inflammatory process. Nowadays gentle cleaning with warmed sterile water or normal saline using a 19 gauge needle with a 35ml syringe or tap water is sufficient to clean the wound bed of exudate. Always wear protective equipment (gloves, goggles, gown) if there is a contamination risk of body product. If it is wet and not yours you need to protect yourself Be aware of what you are discarding and where you are placing it. If the dressing is contaminated with body fluid such as blood or pus it should be disposed in a contaminant bin. If it is wet from dressing product discard in a plastic lined bin. If it is a dry dressing, discard in a normal bin. Always familiarise yourself with the hospital protocol regarding infection control. Sharps MUST always be discarded in the sharps container.
- CLEANSING TECHNIQUE Clean procedures and dressings are for areas that are already loaded with bacteria such as nasogastric insertion, the gut is full of bacteria or wound dressings, wounds have a bacterial load Sterile procedures and dressings are reserved for areas that have no bacterial load such as insertion of a urinary catheter or accessing a central venous catheter. Consider, is it safe to transfer bacteria from one area such as the skin to another area such as the urinary bladder. What would happen; sepsis. Research suggests that there is no significant increase in wound infection or wound colonisation when normal saline or tap water is used during wound cleansing. Antiseptics are no longer favoured as a wound cleansing agent as some will destroy epithelising tissue and can be deactivated by the presence of pus. However some antiseptics are still used for specific wound care such as MRSA and pseudomonas colonisation Hand washing is the single most effective intervention to prevent the spread of infection (Hollinworth & Kingston 1998) Showering postoperative wounds does not increase infection. Research suggests allow 48 to pass then shower. Chronic wounds can be showered with no increase in bacterial load Wound Field concept, this is concept where we acknowledge that the wound is contaminated with microbes, and anything not of the wound such as yourself or foreign matter should not be introduced. Dirty hand & clean hand is still used actively within a sterile environment however it is loosing favourability in the ward and community environment. This technique has been based on historical significance rather than research based.
- CLEAN AND DIRTY HAND The clean/dirty hand technique is when the dressing area is considered to be separate of the wound. The clean hand can only operate over the area of the dressing field. The dirty hand is allowed only over the wound area. Neither hand should cross the imaginary fence line. At this fence line cleaning product is passed to the dirty hand which cleans the wound. The product is discarded and the dirty hand returns to the fence line for more cleaning product from the clean hand Considering that wound care is now requiring wound irrigation the clean/dirty hand concept is becoming impractical and outdated.
- WOUND FIELD CONCEPT Infection occurs when an imbalance of normal flora numbers occurs and the body’s normal defences cannot confine or control them. A wound is considered infected if there is 100 000 (105) organisms per gram of tissue (Carville, 2001), a wound is contaminated if levels are lower than this The wound field concept is based upon the theory that the contaminants of the person and their wound will not further infect the wound. Only items introduced will cause further infection such as a sneeze across the wound bed or your clothing touching the wound. The wound field concept is an alternative to the clean/dirty hand theory.