Wound Care Guidelines

Introduction to Wound Care

A comprehensive approach to wound management is recommended, including wound cleansing, debridement, and dressing, as suggested by the American College of Physicians and the British Journal of Dermatology guidelines 1, 2, 3, 4
Hand hygiene should be performed before touching the wound, as recommended by the American Academy of Pediatrics 5

Gently cleanse the wound with antimicrobial solution, clean water, or saline, taking care not to rupture intact blisters during cleansing, as recommended by the British Journal of Dermatology guidelines and the American College of Physicians 1, 2, 3, 4
Perform debridement of necrotic tissue when possible, as recommended by the American College of Physicians and the American Diabetes Association 3, 4
Pierce intact blisters at the base with a sterile needle, select a site where fluid will drain by gravity to prevent refilling, and gently apply pressure with sterile gauze to facilitate drainage, as recommended by the British Journal of Dermatology guidelines 2
Do not remove the blister roof (leave it in place as a biological dressing), to promote healing and prevent further damage, as suggested by the British Journal of Dermatology guidelines 2

Apply a non-adherent dressing directly to the wound, such as Mepitel or Telfa, as recommended by the British Journal of Dermatology guidelines and the American College of Physicians 2, 6
Apply a greasy emollient, such as 50% white soft paraffin with 50% liquid paraffin, over denuded areas, as recommended by the British Journal of Dermatology guidelines and the American College of Physicians 2, 6
Apply a secondary foam dressing, such as Exu-Dry, to collect exudate, and change dressings every 2-3 days unless excessive exudate requires more frequent changes, as recommended by the American College of Physicians 6, 7
Secure secondary dressings with non-adhesive wraps or bandages to avoid adhesive tapes directly on fragile skin, as recommended by the British Journal of Dermatology 6
Use silicone medical adhesive removers (SMARs) when removing any adhered products to prevent further skin damage, and avoid the use of adhesive tapes or dressings directly on fragile skin, as suggested by the British Journal of Dermatology 8

Offer analgesia prior to starting any procedure, as many patients report pain or burning sensation during wound care, and pay attention to both acute and maintenance (background) analgesia, as recommended by the British Journal of Dermatology guidelines and the American College of Physicians 2, 9
Consider consulting a pain team for complex cases, to ensure adequate pain management, as suggested by the British Journal of Dermatology guidelines and the American College of Physicians 2, 9

Daily washing with an antibacterial product can decrease colonization, and use aseptic technique for dressing changes, as recommended by the British Journal of Dermatology guidelines and the Infectious Diseases Society of America 2, 10
Monitor for signs of infection, such as increasing pain, erythema extending >5cm beyond wound margins, temperature >38.5°C, or heart rate >110 beats/minute, and document the number and location of wounds to monitor progress, as recommended by the Infectious Diseases Society of America and the American College of Physicians 10, 11
Systemic antibiotics are only indicated if there are signs of disseminated infection or systemic symptoms, and treatment for wound infections should be directed against Gram-positive, Gram-negative, and anaerobic organisms, as recommended by the Infectious Diseases Society of America 10

Burn ulcers require early excision of necrotic tissue to decrease the incidence of invasive infection, and bacterial cultures should be taken to select appropriate antibiotics in case of resistance, as recommended by the American College of Physicians 10
Radiation dermatitis ulcers require verification of correct radiation dose and distribution, and consideration of anti-inflammatory emulsions such as trolamine, as recommended by the American College of Physicians 12
Facial skin ulcers should include proper cleaning, identification of the underlying cause, targeted antimicrobial treatment only when signs of infection are present, and the use of appropriate dressings to promote healing, as recommended by the American College of Physicians 6

Avoid skin irritants such as perfumes, deodorants, or alcohol-based lotions, and use soft clothing to cover affected areas, to prevent further skin tears, as recommended by the American College of Physicians 12
Ensure adequate offloading to minimize trauma to the ulcer site, in addition to regular cleaning and debridement, as recommended by the American College of Physicians 4, 13, 10, 1
Patients should avoid sun exposure, use soft clothing to cover the area, and/or use mineral sunblocks, and avoid using skin irritants such as perfumes, deodorants, or alcohol-based lotions, and avoid scratching the affected skin area, as recommended by the American College of Physicians 12