Wound Bed Preparation – TIME

It can be argued that wound bed preparation is the one concept that has had the greatest impact on wound management practices over recent years. Wound bed preparation relies on a holistic view of a chronic wound in order to identify barriers to healing. The fundamental principles of wound bed preparation can be captured in the well-known mnemonic TIME, which was devised to provide a structured approach to wound management.^1,2

T= Tissue

Because devitalized or non-functional tissue can impede the movement of cells needed to build granulation tissue, regular debridement of a chronic wound is essential in order to restore viability to the wound base. The importance of debridement is recognized in the TIME mnemonic as tissue.^1,2 Different debridement techniques can be used depending on the type of wound, the patient, and other constraints.

I= Infection or Inflammation

Many wounds contain bacteria, but not all can be considered to be infected. Infection is defined the presence of reproducing bacteria that have invaded into the tissue and are causing a host reaction. Infection is clearly a major barrier to wound healing, and should be addressed immediately as one of the first stages of wound bed preparation.²

M= Moisture Balance

Achieving an optimal balance of moisture in the wound bed can have a dramatic effect on wound healing, but can also be one of the most challenging aspects of TIME in practice.² This is because of day-by-day variations in the amount of exudate produced by a wound and the significant impact this can have on a patient’s quality of life. Although wounds need a moist environment, too much moisture can lead to maceration and delayed wound healing. Judicious choice of dressings and therapies are essential to ensure optimal moisture balance.

E= Edge of the Wound

Epithelialization, the process by which epithelial cells close the wound surface, occurs from the edges of the wound. A hard, rolled wound edge or undermining can sometimes been seen at the wound edge of a chronic wound, indicating that the epithelial cells are not able to slide over one another.  Cell migration can be stimulated through debridement of the wound edges and use of biological agents such as growth factors, skin equivalents, as well as skin grafts and treatments such as electrical wound stimulation and negative-pressure wound closure therapy.²

To learn more about the fundamental stages of wound bed preparation and the TIME process, please visit www.woundeducators.com. There you will find information on our comprehensive range of wound management courses to suit healthcare professionals across the full spectrum of qualifications and experience.

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References

1. Schultz G, Dowsett C. Wound bed preparation revisited.  Wounds International March 3(1) (Available from http://www.woundsinternational.com/practice-development/wound-bed-preparation-revisited).
2. Ayello EA, Dowsett C, Schultz GS, et al. TIME heals all wounds Nursing. 2004;34(4):36-41