Why This Matters
Wound care isn't just about changing dressings—it's about understanding the science of tissue healing and making clinical decisions that directly impact patient outcomes. On your exams and in practice, you're being tested on your ability to assess wounds accurately, select appropriate interventions based on wound characteristics, and recognize when healing is progressing or complications are developing. These skills integrate concepts from infection control, pain management, tissue physiology, and evidence-based practice.
The techniques in this guide represent the foundation of wound management across acute and chronic care settings. Whether you're caring for a surgical incision, a pressure injury, or a diabetic ulcer, you need to know why certain approaches work and when to use them. Don't just memorize the steps—understand what each technique accomplishes physiologically and how to adapt your care based on wound assessment findings.
Assessment and Documentation
Effective wound care begins with systematic evaluation. Without accurate assessment, you cannot select appropriate interventions or track healing progress.
Wound Assessment Techniques
- Measure and classify the wound—document size (length × width × depth), wound bed characteristics (granulation, slough, eschar), and stage or classification to guide treatment planning
- Evaluate periwound skin for maceration, erythema, induration, or breakdown that may indicate moisture damage or spreading infection
- Identify infection indicators including increased exudate, odor, delayed healing, and systemic signs—early detection prevents complications and guides antibiotic therapy
Documentation of Wound Care
- Use standardized terminology to describe wound characteristics—consistent language ensures accurate communication across the healthcare team and legal protection
- Record interventions and patient response including dressing type, procedures performed, and tolerance to care for continuity and outcome tracking
- Document changes over time to establish healing trajectory—wounds that fail to show improvement within 2-4 weeks require care plan reassessment
Compare: Wound Assessment vs. Documentation—assessment is your clinical evaluation in the moment, while documentation creates the legal record and communication tool. Both require precision, but assessment drives immediate clinical decisions while documentation tracks patterns over time.
Infection Prevention Fundamentals
Preventing wound contamination is non-negotiable. Breaking the chain of infection protects both the wound and the patient's systemic health.
Proper Hand Hygiene and Sterile Technique
- Perform hand hygiene before and after every wound care encounter—this single intervention is the most effective method for preventing healthcare-associated infections
- Maintain sterile technique for open wounds using sterile gloves, drapes, and instruments to prevent introduction of pathogens into vulnerable tissue
- Establish and protect the sterile field by organizing supplies before beginning and avoiding contamination through proper technique
Infection Prevention and Control Measures
- Apply standard precautions consistently including appropriate PPE selection based on wound characteristics and anticipated exposure
- Educate patients on warning signs of infection—redness spreading beyond wound margins, increased pain, purulent drainage, fever, and delayed healing require prompt reporting
- Control environmental contamination through proper disposal of soiled dressings and equipment sterilization protocols
Compare: Hand Hygiene vs. Sterile Technique—hand hygiene is required for all patient contact, while sterile technique is specifically indicated for open wounds and invasive procedures. An FRQ might ask you to justify when clean technique is acceptable versus when sterile technique is mandatory.
Wound Bed Preparation
Preparing the wound environment optimizes conditions for healing. The goal is to remove barriers to healing while protecting viable tissue.
Wound Cleansing Methods
- Irrigate with saline or prescribed cleanser using gentle pressure (4-15 psi) to remove debris and bacteria without damaging granulation tissue
- Avoid cytotoxic agents like hydrogen peroxide and full-strength povidone-iodine that destroy healthy cells along with pathogens—evidence shows these delay healing
- Clean from least to most contaminated areas and ensure thorough rinsing before dressing application to prevent solution retention in tissue
Debridement Techniques
- Autolytic debridement uses the body's own enzymes under moisture-retentive dressings—slowest method but selective and painless, ideal for patients who cannot tolerate other methods
- Enzymatic debridement applies topical agents (collagenase) to dissolve necrotic tissue while sparing viable cells—requires prescription and careful application to wound bed only
- Sharp/surgical debridement removes necrotic tissue with instruments—fastest method, performed by qualified providers, indicated for infected wounds or extensive necrosis
Compare: Autolytic vs. Sharp Debridement—both remove non-viable tissue, but autolytic is slow, painless, and nurse-managed, while sharp is rapid, requires anesthesia, and is provider-performed. Select based on wound urgency, patient tolerance, and available resources.
Dressing Selection and Application
Choosing the right dressing depends on wound characteristics. The principle of moist wound healing guides modern dressing selection—wounds heal faster in a controlled moist environment.
Types of Wound Dressings and Their Applications
- Hydrocolloid dressings create a moist, occlusive environment for partial-thickness wounds with minimal exudate—promote autolytic debridement and can remain in place 3-7 days
- Alginate dressings are highly absorbent fibers derived from seaweed, ideal for moderate-to-heavily draining wounds—transform into gel upon contact with exudate and promote hemostasis
- Foam dressings provide absorption and cushioning for exudative wounds over bony prominences—maintain moisture balance without adhering to wound bed
Wound Packing Procedures
- Pack loosely to fill dead space without applying pressure—overpacking compromises circulation and delays healing, while underpacking allows fluid accumulation
- Moisten packing material with saline to prevent adherence to granulation tissue and facilitate atraumatic removal during dressing changes
- Change packing per protocol or when saturated—frequency depends on exudate volume, typically daily for heavily draining wounds
Compare: Alginate vs. Foam Dressings—both manage exudate, but alginates are better for heavily draining wounds and have hemostatic properties, while foams provide more cushioning for wounds over pressure points. Match absorbency to exudate level.
Advanced Interventions
Some wounds require specialized therapies beyond standard dressing changes. These techniques address complex wound healing challenges.
Negative Pressure Wound Therapy
- Apply vacuum-assisted closure to draw out excess fluid, reduce edema, and increase perfusion to the wound bed—accelerates granulation tissue formation in appropriate wounds
- Monitor pressure settings within prescribed parameters (typically 75-125 mmHg)—inadequate pressure reduces effectiveness while excessive pressure causes tissue damage
- Change dressings every 48-72 hours per protocol, assessing for complications including bleeding, infection, and tissue necrosis at wound edges
Pain Management During Wound Care
- Assess pain before, during, and after procedures using validated scales—wound care pain is often undertreated and significantly impacts patient cooperation and healing
- Premedicate with prescribed analgesics 30-60 minutes before dressing changes to achieve peak effect during the procedure
- Use non-pharmacological interventions including positioning, distraction, and gentle technique—rushing increases trauma and pain perception
Compare: Negative Pressure Wound Therapy vs. Traditional Dressings—NPWT actively promotes healing through mechanical forces and is indicated for complex, non-healing wounds, while traditional dressings provide passive protection. NPWT requires specialized equipment and training but can significantly reduce healing time for appropriate wounds.
Quick Reference Table
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| Infection Prevention | Hand hygiene, sterile technique, standard precautions |
| Wound Bed Preparation | Saline irrigation, autolytic debridement, enzymatic debridement |
| Moisture Management | Alginate dressings, foam dressings, hydrocolloids |
| Exudate Control | Alginate dressings, foam dressings, wound packing |
| Pain Control | Premedication, gentle technique, distraction |
| Advanced Therapy | Negative pressure wound therapy, sharp debridement |
| Documentation Elements | Size measurement, wound bed description, intervention record |
| Patient Education | Infection signs, hand hygiene, pain communication |
Self-Check Questions
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A wound has moderate exudate and is located over the patient's sacrum. Which two dressing types would be most appropriate, and why?
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Compare autolytic and sharp debridement: What patient factors would lead you to recommend one over the other?
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You're preparing for a dressing change on a deep wound requiring packing. Identify three key principles that guide proper packing technique and explain the rationale for each.
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A patient's wound shows increased erythema extending 2 cm beyond the wound margins, purulent drainage, and the patient reports increased pain. What assessment findings indicate infection, and what nursing interventions are priority?
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Explain why hydrogen peroxide is no longer recommended for wound cleansing, and identify what evidence-based alternative you would use instead.