Wound Bed Preparation – TIME Mnemonic

As we have seen, the TIME mnemonic can be used to capture the fundamental principles of wound bed preparation.^1,2 Become a professional at appropriate dressing selection for the different stages of wound healing within the TIME trick. As no single wound dressing is suitable for all wound types or healing stages, wounds should be assessed at every dressing change to ensure the most suitable product is always used.³

T: Tissue Debridement

Autolytic and enzymatic debridement can be achieved through the appropriate choice of product or dressing. Enzymatic debridement requires the use of a topical enzymatic agent to digest and liquefy necrotic tissue, while autolytic debridement can be accomplished using moist, interactive dressings such as amorphous hydrogels, impregnated hydrogels, and hydrogel sheets, or by using occlusive or semiocclusive dressings such as transparent films and hydrocolloids. Polysaccharides such as honey-based products may also be effective.³

I: Infection/Inflammation

Bacterial load may be reduced using dressings containing iodine silver or chlorhexidine, or honey-based products. Hydrophobic dressings attract microorganisms and therefore reduce the bioload, while an antiseptic solution may be used for a limited period to stabilize bacterial load. Deep infections require treatment with systemic antibiotics, while use of metronidazole gel is effective for the control of anaerobic bacteria.³

M: Moisture Balance

A granulating, moist wound bed may be dressed with hydrocolloid or permeable film dressings to maintain fluid balance. However, if exudate levels are high, an absorptive dressing such as an alginate, or hydrophilic foam product may be required.³

E: Edge of Wound

Wound healing can be assessed by the extent of granulation tissue formation around the wound edges. It is essential that this wound edge and the surrounding skin should not be damaged by the repeated application or removal of adhesive dressings. Dressings may be kept in place with bandages, while use of very thin hydrocolloid dressings may protect the skin. Barrier creams and barrier spray can also be used to protect the skin against potential damage.³

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References

1. Schultz G, Dowsett C. Wound bed preparation revisited. Wounds International March 3(1).
2. Ayello EA, Dowsett C, Schultz GS, et al. TIME heals all wounds Nursing. 2004;34(4):36-41.
3. Mulder M. The selection of wound care products for wound bed preparation. Prof Nurs Today 2011; 15(6):30–36.