Do you know the 3 steps for proper wound care for patients?

Every nurse should know the basics of proper wound care.

That's because, regardless of where you work -- acute, long-term or outpatient care, you likely see a variety of wounds on patients on a routine basis. Whether their wounds are from trauma, surgery or are chronic, all wounds require special care. Understanding basic, proper wound care skills is essential to help your patients achieve optimum outcomes. We spoke with Bill Richlen, PT, WCC, DWC, clinical instructor with the Wound Care Education Institute to better understand the basic skills required for providing wound care to your patients. Regardless of what setting you work in, Richlen said, a wound is a wound, and proper wound care requires clinicians practice the same three steps in the correct manner. "The only difference your setting makes is what your facility's policies and procedures are with regards to wound care," Richlen, who also is owner of Infinitus LLC, in Santa Claus, Ind., a wound care instruction and consulting company, said. "This encompasses the products your facility provides for wound care and the frequency of wound care procedures."

Special tools are typically not needed for basic wound care unless you work in a state that allows you to perform sharp debridement, said Richlen.

"Sharp debridement involves additional training, skills and tools to perform," he said. The three steps for basic wound care, according to Richlen include accurate assessment, thorough cleansing of wounds and appropriate dressing of wounds.

1--Proper wound care starts with accurate and timely wound assessments

Having a comprehensive understanding regarding the basics of assessing wounds is imperative, said Richlen. "It's important to assess a wound accurately as you'll base your treatment choices off of your assessment," he said. Areas in which you'll want to gain skills include:

Understanding wound characteristics
Learning about wound etiologies
Proper measuring techniques
Accurate wound staging

2--Thorough cleansing of wounds

Richlen said from a treatment standpoint, it's imperative you learn to properly clean wounds. "The process of cleaning wounds is a policy and procedure that is facility specific," he said. "You'll want to follow the protocols in place where you work regarding what you use to clean wounds, as well as how often (the frequency) wound cleansing needs to be performed."

3--Appropriate dressing of wounds

"The choice of dressings you have to work with also depends on your facility," Richlen said. "You'll want to understand which dressing is the most appropriate for the type of wound you're treating, and know how to apply it accurately as per the manufacturer's specifications." Knowing the correct application of dressings is essential.

"If the wrong dressing is used, or the right dressing is used but not applied correctly using the appropriate steps required, your wound will not heal," he said.

Richlen pointed out the use of some dressings, foams and high-end products such as negative pressure wound therapy (PTWT) systems, may involve several specific steps for the appropriate application. "Some products require significant training so staff know how to use them properly," Richlen said. "Many times, manufacturers provide training as an in-service for staff, at other times, facilities may designate a wound care provider to teach fellow staffers how to use the products correctly."

Managers play a role in helping staff provide proper wound care

Managers are key in encouraging their staff to expand their wound care skills, Richlen said.

"One way for managers to encourage their staff to gain wound care knowledge and skills, is to provide financial reimbursement for wound care continuing education units for attending wound care classes, seminars and certification courses," he said.

Richlen described another strategy for management to use to promote optimum wound care for their patients is to hold routine in-services for staff on wound care assessment, treatment, and the correct use of the wound care products in their facility. If you're a clinician who provides wound care, Richlen said it's important to obtain wound care education and training. "Research has shown us that wound care education is minimal for clinicians across all disciplines during their basic education and training in their licensure programs," he said. "When most clinicians graduate, they're not prepared to provide the best wound care to achieve optimum patient outcomes." If you're providing wound care, it's important to update your training periodically as wound care techniques and products can change over time, Richlen said. You can do this by:

Subscribing to a wound care journal
Attending one or two live wound care conferences each year, such as Wild on Wounds
Attending online wound care webinars and seminars (sometimes these are offered for free)

Becoming wound care certified

Some clinicians may decide they want to take the leap and become wound care certified. "Any clinician working on a day-to-day basis in wound care should strongly consider enrolling in formal wound care training before getting certified," said Richlen. "If you decide to get certified, it will involve comprehensive training. You'll also be required to complete all the training mandated to be eligible to sit for the certification exam."

If you're looking for wound care CEUs or want to earn your wound care certification, check out the Nurse.com CEUs, Nurse.com Wound Care Nursing Certification (CWCN) Review Course, and the Wound Care Education Institute online and onsite classes.

Take these courses to learn more about proper wound care:

Wounds, Part 1 (1 contact hr) Nurses in most settings frequently encounter acute and chronic wounds during routine patient care. Applying the appropriate nursing measures and carefully selecting the right wound care products promotes optimal healing. This program presents nurses with current concepts in wound care within the framework of the nursing process. Wounds, Part 2 (1 contact hr) The goal of treatment is to provide the optimum environment so wound repair can take place without interference. Nurses often must make recommendations for dressings. By understanding the indications, actions, and contraindications of products and their classification, nurses can effectively individualize treatments for each patient. This module describes the different categories of products and adjuvant therapies. Providing Relief for Patients With Malignant Wounds (1 contact hr) Treatment options for malignant fungating wounds are aimed at the specific underlying cancer. Malignant wounds have a high rate of recurrence and tend to cause major alterations in patients' physical and psychosocial well-being. Malignant wounds can result in many problems, including odor, bleeding, exudate, pruritis, and pain. Before starting treatment, healthcare professionals as a team need to determine which problems patients consider the most distressing. Even though bleeding may be more life-threatening, many patients may find the odor unbearable and may need to have it resolved first.