Wound committee’s advice: Back to basics

Handwashing, antibiotic restrictions advised

The American Subacute Care Association Wound Care Alliance committee is preparing a position statement on infection control to meet the threat of drug-resistant bacteria. A draft version provided by committee chairwoman Samantha Morgan, BSN, RN, CRRN, CCM, ET director of rehabilitation services for Tendercare in Bloomfield Hills, MI, includes the following general positions and recommendations pertinent to the issue:

• Because all dermal wounds are contaminated and stage II, III and IV ulcers are invariably colonized with bacteria and because of the increasing development of drug resistant pathogens, the committee recommends cleansing and ulcer debridement for purulent or draining wounds. Increased frequency of wound cleansing may be indicated for more affected wounds.

• The use of antibiotics for first line intervention of inflamed wounds is inappropriate. Swab cultures of wound sites are also not recommended due to the routine contamination of such sites.

• The committee strongly advises against the use of topical antiseptics to reduce bacteria in wound tissue (e.g., povidone iodine, iodophor, sodium hypochlorite, hydrogen peroxide, acetic acid). No controlled studies demonstrate that such agents decrease pathogens in wound tissue. However, many studies document the deleterious effects on the healing process.

• Thorough handwashing, including nail surfaces and wrists, is essential before and after patient contact. Removal of rings and watches is essential to effective cleansing of hands. The use of antimicrobial soap and running water is vital.

• Wear gloves for anticipated contact with blood, secretions, mucous membranes, deficient skin integrity, and moist body substances for all patients. Gloves are removed and hands washed prior to leaving the treatment area.

•Wear barriers such as gowns, plastic aprons, goggles, and face masks when secretions, excretions, blood, or body fluids are likely to contaminate clothing, skin, mucous membranes, and eyes. Protective face and eye wear is always worn for wound irrigation or anytime there is a possibility of aerosolized wound secretions.

• Place reusable, soiled articles and linens in containers sealed to prevent leakage. Follow this same procedure for trash.

• The use of isolation is indicated for patients whose wound sites can not covered or whose drainage can not be contained.

• Use sterile instruments for debridement.

• Use clean dressing rather than sterile dressing to treat pressure ulcers provided the procedures comply with institutional infection control guidelines.