5 Myths Related to Wound Care

Myth # 4-Common wound care practice is always evidence based practice

Old habits die hard. Sometimes we do things a certain way simply because it is the way it has always been done. This is true even in medicine. We often get stuck in a rut of practicing a certain way through habit, and for no other reason.

Wound care is no exception. Many healthcare professionals continue to treat and dress wounds the way it has been done for years, despite the fact that new research shows this may not be the best treatment modality for the patient. This article will examine three common myths in wound care that have been found to delay wound healing, increase patient discomfort, and that may place you and your employer at risk for negligence.

Betadine and peroxide help wound healing by reducing the bacteria in the wound bed

This has been a common practice in the treatment of wounds for many years; however, it is no longer acceptable practice and continuing to use these agents (and other similar agents) is actually harmful instead of helpful. The Agency for Health Care Research and Policy (2008) states, “Do not use povidone iodine, iodophor, sodium hypochlorite solution, hydrogen peroxide and acetic acid as they have been shown to be cytotoxic. Use normal saline at a pressure between 4 and 15 pounds per square inch (psi).
Using cytotoxic agents to cleanse wounds can increase your patients discomfort, as well as delay wound healing. Dallam et al (2004) reiterate this point: “Do not use cytotoxic solutions, such as Betadine or hydrogen peroxide, to cleanse wounds. They not only deter wound healing, but they may also cause burning and cold to patient discomfort”.

Gauze dressings are an effective and cost-efficient way to promote wound healing

Ovington (2001) states that in order for gauze dressings to provide optimal healing, they must be changed frequently or, at the very least, remoistened frequently. This is labor-intensive for health care practitioners or caregivers and not cost effective in today’s health care climate. Most importantly, gauze dressings do not support optimal wound healing. Ovington points out that the use of wet-to-dry dressings is not acceptable, as the debridement that takes place with this method of management is not selective, often removing healthy tissue and causing reinjury to the wound bed, not to mention additional pain for the patient.

Frequent dressing changes with gauze dressings will reduce wound infections

One study has shown that bacteria are capable of penetrating up to 64 layers of dry gauze, thus negating the idea that gauze provides an effective barrier to bacteria. Frequent dressing changes only provide more opportunity for bacteria to enter the wound. In addition, the labor that is involved with 2-3 times a day dressing changes is just not feasible in many cases.

The practices mentioned are not only harmful to the patient, causing delayed wound healing and increased pain, but are also a liability risk for the practitioner and agency who use these methods of wound management. They are no longer considered best practice and are no longer the standard of care.
In these days of rapid change and an explosion in new research and knowledge, how can practitioners be expected to keep up with new standards of care? Online learning at woundeducators.com is one method that can help you stay current with the new guidelines and the knowledge that supports them. We are dedicated to ensuring that practitioners have the most up-to-date information they need to manage wounds in their patients safely and effectively.

Myth # 3-Wound dressings cover a wound and offer little in the way of healing

Choosing the right type of dressing to optimize wound healing and prevent complications is key to wound management. However, the proliferation of wound dressings that have flooded the market in recent years causes confusion among healthcare professionals. How can we, as wound care practitioners, be expected to keep up with new advances and new knowledge in the specialty of wound care management? I hope that the following will shed some light on new advances in wound dressings.

Moist Wound Healing

The old standard of wet-to-dry dressings has been replaced with a myriad of wound dressings that are geared towards treating specific wound care issues, but moist wound healing remains an important concept in wound care management. Moist wound healing is still the gold standard, as it provides and maintains moisture of exposed tissues and does not encourage these fragile tissues to dry out. Research has shown that keeping wound tissues moist has the following benefits:

• Increased rates of healing
• Improved cosmetic results
• Reduced pain for the patient
• Reduced rates of infection
• Reduced associated costs

In general, wound tissues should be moist; that is, not dry and not wet.

Dressings That Absorb Exudate

These dressings are used for wounds that create levels of exudate that are moderate to high. They have the ability to capture and hold fluid, which means that patients will require fewer dressing changes. The advantage of these dressings is that they permit undisturbed wound healing, are less labor intensive for caregivers, and afford increased cost savings. Examples of these types of dressings include foams and calcium alginate dressings.

Dressings That Maintain Hydration

These dressings are used on wounds that have progressed to the formation of granulation tissue, and have begun to fill in with new connective tissue. Wounds of this nature have decreasing levels of exudate, so continuing use of an absorbent dressing could dehydrate the wound tissues, causing delayed healing. These types of dressings actually maintain the natural moisture levels of the wound without active absorption. Examples of dressings that maintain hydration include hydrocolloid and transparent film dressings.

Dressings That Donate Moisture

These dressings are designed for wounds that are already dehydrated and covered by dry, dead tissue. Wounds such as these will not heal unless these tissues are removed. These dressings promote autolytic digestion, or the slow digestion of dead cells by the process of phagocytosis. These dressings maintain a moist environment to facilitate the process of breaking down these dead cells, and to actively add moisture to the wound. These dressings contain water. Examples of these types of dressings are amorphous hydrogels and sheet or water hydrogels.

Dressings That Address The Biochemical Wound Environment

Newer dressings can be particularly useful for wounds that have stalled in the healing process. They function by interacting with the chemical environment of the wound itself, and are considered an “active” dressing because they actually change the environment of the wound. There are several biochemical aspects of a wound that may affect the cells or cellular processes thought to be important in the healing process. Some of these include:

• Local levels of tissue proteases
• Levels of cytokines and growth factors
• Presence and duration of tissue hypoxia
• Reactive oxygen species
• Levels of bacteria (bioburden)

New dressings are currently available (and more are being developed) which will address the biochemical imbalance that occurs in chronic and nonhealing wounds. Three types of dressings are available that seek to correct imbalances in levels of proteolytic enzymes (specifically MMP’s), collagen, and microbes.

As is obvious, rapid changes in knowledge and technology have led to the development of numerous dressings that are specifically targeted towards the treatment of different types and stages of wounds. In this day and age of such rapid development, it is imperative that healthcare professionals stay abreast of the most current and evidence based knowledge available. Woundeducators.com can help you stay current by providing up-to-date information as it becomes available and by making it easy for you to become certified in wound care. Wound care certification provides documentation of a health care practitioner’s knowledge in current dressing availability and use.

Take the first step towards improving your life and the life of the patients that you care for.  Become wound care certified.   Register Today!

Myth # 2 - “Liability for wound treatment is limited to the doctor who writes the order”

As a healthcare professional, it is no longer enough to simply “follow orders”. All professionals who care for patients with wounds are now being held to a standard of care, and may be held liable for providing wound care of substandard quality, regardless of whether they believe they are covered by a physician’s order. Therefore, wound care practitioners need to be aware of these standards in order to protect their patients and avoid legal issues and denial of reimbursement.

Legal issues involving wound care management are generally an issue of negligence, or failure to meet the standard of care.

Malpractice can be defined as failure to meet standards of care that results in harm to another person. Healthcare professionals may be held liable in the event it is determined that standards of care have not been met, and may be guilty of malpractice if a patient under their care is harmed.

What is the standard of care in wound care management?

Standards of care can be defined as the care that any reasonably prudent health care provider would provide in the same or a similar situation. Standards for wound care practice have been determined by several sources:

• Agency for Healthcare Research and Quality- the Agency for Healthcare Research and Quality (AHRQ) has set out guidelines for the prevention and treatment of pressure ulcers.
• Patient Care Partnership-the patient care partnership includes basic patient rights, one of which is safe, quality care
• State nurse practice acts and guidelines-these acts regulate the practice of nurses, and define which treatments and actions may be performed by the nurse in each state
• Employer policies and procedures-policies and procedures are used to establish standards of care, and may be invoked in litigation claims-such claims may reflect either lack of knowledge or blatant disregard for a policy, and may show negligence
• Job descriptions-health care employees who provide care outside their formal job description may be held liable
• Standards of practice-various professions have individual standards of practice, set by the professional organizations

Medicare has determined that, as of October 2008, they will no longer reimburse for mainly preventable conditions, including pressure ulcers!

This ruling means that healthcare professionals must focus not only on preventing pressure ulcers, but also in treating them when they occur using evidence based wound management procedures. This is but one example of how all healthcare professionals are being held to certain standards in wound care management. It is likely that this trend will continue and that, increasingly, professionals who care for patients with wounds will be held responsible for meeting these standards.

Becoming a Certified Wound Care Professional not only guarantees knowledge of the current standards in wound care, but also ensures that the certified wound care practitioner stays current with best practice standards, as maintenance of wound certification requires proof of yearly continuing education as well as periodic retesting.

WoundEducators.com is an excellent way to prepare for certification as a wound care practitioner. As well, our program enables those who take the program to stay current with changes in the industry.

The standards are constantly undergoing change and refinement as new evidence in wound care is uncovered. Our goal at WoundEducators.com is to keep you, the reader, current with new knowledge as it becomes available.

Myth # 1 – Wound Certification is only for “specialists”

Certification is important for any healthcare professional who is involved in the care of patients with various types of wounds, not just those who specialize in treating complicated wounds.

In current practice, no matter which area you practice in, you are likely to come in contact with patients who have wounds. Increasingly, healthcare professionals are being held to a higher standard of wound care management. Old methods of wound care management have proven to be detrimental to wound healing and can result in infection and delayed wound healing.

Treatment of wounds, whether they are complicated or uncomplicated, should adhere to evidence-based wound management principles. New treatment modalities have been proven to decrease the risk of infection and promote faster wound healing with less complications and less pain for the patient. This should be the goal of all who practice wound care, whether it is your specialty or not.

Health care professionals are increasingly being held accountable for their actions in treating wounds. Simple wounds can rapidly become complicated wounds if not treated adequately, leading to liability issues for the healthcare professional and the facility they are affiliated with. When simple acute wounds develop into complicated chronic wounds, the patient endures increased pain and morbidity. As well, complicated wounds lead to increased costs in an already strained healthcare system.

Due to the rapid explosion in information that has taken place in the wound care milieu over the past several years, many healthcare professionals do not have the most current, up-to-date information in wound care management, information that is based on the best research evidence. Obtaining wound care certification helps to ensure that healthcare practices are consistent with national standards. Healthcare professionals seek wound care certification as a way to validate their knowledge, experience, and competency. Hospitals and other health care organizations can benefit from wound certification as an indicator that their staff provide quality care, and can use this fact as a way to differentiate themselves from others in today’s competitive market.

Woundeducators.com offers comprehensive online courses to educate professionals with varying levels of clinical experience, background, and education, and prepares them to take and pass the wound care certification examination. Our online program makes it convenient and affordable for any professional who is involved in wound care to learn the new standards of evidence based wound management.

If you would like more information on how our online wound management program can help you achieve certification in wound care, please visit woundeducators.com. We owe it to our patients and ourselves to be the best that we can be.