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Wound Care Clinics

So many times those of us with lymphedema ignore those small draining areas that open up on our arms or legs and very quickly those tiny wounds become huge ugly, draining and infected wounds.

It is critical to take care of any open area immediately. Remember the lymphedematous limb is immunocompromised which means infections can develop quickly and we have weakened resistance to them.

There are other factors with lymphedema that makes wound healing more problematic and difficult to treat. For example, tissue fibrosis (hardening) and blood circulatory difficulties both hinder wound healing.

Finally, swelling itself causes difficulties in wound healing as the swelling literally pulls apart tissues that are trying to grow and heal.

If you have trouble with a wound healing, or if any complications such as infections, foul order, redness and or increased pain being you should (must) have your primary care doctor refer you to a wound care clinic.

Hopefully, this brief page will give you some insight to what a wound clinic is, what they do and how they can help.

Pat

What is a Wound Care Clinic?

Each year nearly twenty-five million people suffer from chronic non-healing wounds in the United States. With our aging population, the frequency of chronic disease is likely to continue to increase.

Wounds are treated in a variety of environments such as homes, hospitals, outpatient physical therapy, physicians' offices and other healthcare facilities. Often the focus of care is strictly on the wound and not on the causes and factors preventing the healing process.

A wound care clinic provides a system of wound healing. It's a comprehensive, multi-disciplinary approach of specialized care from a variety of specialists at one convenient location to not only promote healing, but prevent infection and re-injury.

Services provided by a wound care clinic

  • Thorough wound assessment - identify all underlying disease factors
  • Wide variety of conventional and specialty wound treatment
  • Patient/family/professional education - vital information on disease process, treatment, and services
  • Physician-directed care
  • Care management by a certified wound care nurse
  • Durable medical equipment consultants (provide medical equipment when needed)

When Should a Physician Refer a Patient to the Wound Care Clinic?

These are the indicators that would suggest referring a patient to the Wound Care Clinic:

  • Any non-healing wounds that have not shown improvement in 3 to 4 weeks.
  • Any wounds involving tendon, ligament, bone, or joint.
  • Any neuropathic/diabetic ulcers
  • Wounds in ischemic limbs
  • Any wounds in compromised patients
  • Any wound that is painful and has been present for at least 3 weeks

Certification in Wound Care Management

A physician specializing in the treatment of wounds and in wound care should be certified by the American College of Certified Wound Specialists or the American Academy of Wound Management.

Certification insures that your doctor has the training necessary to provide the best in wound care.

Why Certification?

  • Recognizes those who have met the eligibility requirements for board certification.
  • Identifies a standard of knowledge essential for developing a comprehensive wound management program.
  • Advances cooperation and resource exchange among the various disciplines and organizations involved in the treatment of patients with chronic wounds.
  • Encourages continued professional growth and development of individuals and the field of wound management.

Establishes a code of ethics, responsibility and high professional standards by all certified individuals.

Certification Status

The AAWM shall grant Diplomate status to those individuals who successfully pass the National Board Certification Examination for Wound Management Professionals. Such Diplomates shall be referred to as “Certified Wound Specialists® of the AAWM” and shall be entitled to use the title of Certified Wound Specialist and the designation CWS® after their name.

http://www.aawm.org/

All candidates for the CWS exam are required to have a Bachelors degree or higher in a life sciences related field plus 3 years of clinical experience in wound care. For more information the Candidate Handbook is available for download on the Application Materials page.

Wound Care Guide

A wound is a break in the tissues of the body. Injuries such as cuts and scrapes are called open wounds; others, such as deep bruises, are called closed wounds. Both types are usually caused by external forces such as motor vehicle accidents, falls, and the mishandling of sharp objects, tools, machinery and weapons.

This Wound Care Guide is to help you learn self ?care and first aid for your minor wounds. By learning the basics of minor wound care, you can help prevent infections and reduce the complications of your injuries. Keep this guide in a convenient location for future reference.

NEW WOUND DECISION-MAKING

The most important aspect of new wound care is to clean the wound thoroughly and examine it closely, as soon as possible. You must decide if the wound is severe in nature or if it is a minor wound. Then you must decide if you need to seek professional medical care, or if you can provide care yourself. Seek medical attention for any of the following:

  • a wound that has blood spurting from it or wounds that continue to bleed after applying direct pressure for five full minutes.
  • a puncture wound occurring from a nail, pen or other sharp object, whether the object is still impaled or is removed.
  • a gaping wound or any wound you think might need stitches.
  • a wound that has a fatty layer, white tissue, or muscle that is exposed.
  • a wound that has visible foreign material such as gravel, dirt, glass or metal.
  • any type of burn.
  • any type of bite - animal or human.
  • any wound causing severe pain.
  • any wound that causes numbness or loss of movement below the wound.
  • any new wound, if you are a patient with a chronic medical condition such as diabetes or a bleeding disorder.

if you are not sure about the status of your tetanus immunization:

if it has been ten years since your last tetanus shot.

if your last tetanus shot was more than five years ago, and the wound has been contaminated with dirt or debris.

WOUND CARE PACK

Wound care packs containing gauze, bandages, and antibiotic ointment are available in McKinley's Health Resource Centers. The following list outlines the contents of each wound care pack and gives suggestions for use of these supplies:

Item Use 1” bandage strips (#5) - small cuts or scrapes Large bandages (#3) - larger abrasions Cloth bandages (#3) - bending areas like elbows Gauze squares (#2) - cleansing or covering Bacitracin ointment - thin layer of antiseptic

TREATMENT FOR YOUR MINOR WOUNDS

The basics of wound care for small scratches, cuts and abrasions can be divided into three steps: cleansing the wound, cleansing the skin around the wound, and protecting the wound from further contamination.

Wash your hands - If your hands are not clean, you may spread bacteria (germs) into a new wound. When washing your hands, use soap and water, work up a good lather and rinse thoroughly.

Cleanse the wound - Gentle scrubbing with a mild soap and water, followed by flushing with lots of clean water, is the most effective method of cleansing the wound itself. The cleansing of the wound should be done carefully, to avoid further injury, but must be effective enough to remove foreign materials, such as dirt and gravel. Dead tissue and foreign matter in the wound provide an excellent medium for bacterial growth, so this is the most important step.

Some wounds are best left to the professional to clean: for example, deep puncture wounds, severe lacerations, burns (see Miscellaneous Wounds and Advice section) and wounds with extensive skin loss or damage. Such wounds should be protected with a sterile covering, if possible. Immediate treatment from a physician should be obtained.

Cleanse the skin around the wound - It is important to clean the skin around the wound to remove other dirt and oils that may enter the wound. Clean this area with soap and water, and rinse well. If soap and water are not available, rubbing alcohol or hydrogen peroxide are good choices.

Protecting the wound - A covering of sterile, “breathable” bandage material is ideal for new wounds. This will help to keep further bacteria out of the wound and prevent infection. The bandage should not be airtight, since this traps the normal moisture given off by the skin, which encourages bacteria to grow and may delay healing.

If the wound is more of a scrape than a cut, one of the non-stick coverings may be helpful. For most wounds, a scab will form in a few days.

Dressing changes - It is important that wounds be kept clean and dry. This helps healing. A suggested schedule would be to cover the wound during heavy activity and at times when dirt may enter the wound. Air the wound during quiet, less active times, like the evening or at night while you sleep. If the bandage becomes wet, it is important to change the bandage as soon as possible to prevent wound contamination. Use care in applying new bandages. Clean your hands first, and open the bandage carefully so that the pad that covers the wound is not touched or contaminated in any way. If a bandage becomes stuck to the wound, use care when removing. Do not rip the bandage off, as this can reopen the wound. You can soak the bandage in clean, warm water or 1/2 strength hydrogen peroxide to soften the point of attachment. Then, clean and dry the wound and apply a new bandage.

TYPES OF WOUNDS

Abrasions - These wounds are generally caused by scraping the skin's outer layers. Bleeding is usually minimal. Often, there is foreign matter (such as dirt or gravel) imbedded in the skin. If not properly removed immediately after the injury, dirt or matter left in the skin may cause a permanent tattooing effect. These wounds often become infected.

Incisions - Knives, metal edges, broken glass or other sharp objects commonly cause these types of cuts. The amount of bleeding depends on the depth and extent of the cut. Lacerations - These are jagged, irregular cuts or tears of the skin. Most lacerations are serious in nature and bleeding may be heavy. The deeper and more irregular the laceration, the greater the chance of infection.

Punctures - These types of wounds are caused by an object piercing the skin layers and creating a small hole. Some punctures are superficial and some are very deep, depending on their source and cause. Common causes are wood splinters, pins, nails and glass. Infections are common, due to the difficulty of cleaning into the puncture site.

Burns - These injuries cause damage to skin cells that may vary greatly in depth, size and severity. Common causes include fire, hot liquids, household chemicals, and the sun or other radiation source. It is often difficult for the body to heal burns, so they may become infected or cause permanent scarring.

WOUND TROUBLE SIGNS

Serious complications may occur to neglected wounds and, at times, to even the best cared-for wounds. If you notice any of these signs when examining your wounds or injuries, you should see a doctor immediately:

  • Redness, excessive swelling, or increased warmth of the skin around the wound.
  • Throbbing pain or tenderness in the wound area.
  • Red streaks in the skin around the wound or progressing away from the wound.
  • Pus or watery discharge collected beneath the skin or draining from the wound.
  • Tender lumps or swelling in your armpit, groin, or neck.
  • Foul odor from the wound.
  • Generalized chills or fever.

PREVENTION OF INJURIES

An ounce of prevention is worth a pound of cure. At home, at work, at play, or on your way to wherever, keep in mind the actions you can take to prevent wounds from occurring:

  • Wear seat belts (and helmets if appropriate) when traveling. Wear goggles or glasses when riding a scooter if you choose not to wear a helmet. Drive defensively, do not drink and drive, and do not drive if you are tired.
  • Use sharp objects only for their intended purpose, handle with care, and keep out of reach of children.
  • Do not run with objects in hand such as glass bottles, wooden sticks or other penetrating devices.
  • Use appliances and tools following the manufacturer's instructions.
  • Unplug unused electrical items.
  • Always sweep up broken glass promptly and carefully.
  • Remove nails from boards and dispose of them properly.
  • Keep play and work areas free of trash and bottles.
  • Take special precautions with fireworks, firearms and ammunition

About ointments - Ointments are often promoted as aids in healing wounds, but this should not be taken to mean they speed healing. Antibiotic type ointments can be overused and can cause skin reactions and allergic responses, as well as set up a resistance bacterial growth cycle. If you do prefer the use of an ointment on your minor wounds, follow these suggestions:

Choose the ointment carefully. Consult your health care provider if you are unsure about which type to use. Bacitracin and Neomycin are commonly used ointments; however, they are best suited for use with small, minor wounds.

If you have a wound with a large area of skin damage, you are urged to consult your health care provider.

Always apply ointments to a well ?cleaned wound to avoid “sealing in” bacteria.

Apply a very thin layer of ointment. This will coat and protect the wound. Large amounts of ointment are not beneficial because the moisture can attract bacteria.

Apply the ointment with a clean swab or gauze. To avoid contamination of the wound, the tube and any future wounds, apply ointments using a cotton swab. Do not apply ointments directly from the tube.You may use ointments up to two times daily; however, you should always clean the wound before new applications of ointment.

Remember poor healing can result when ointments and bandages are overused. Exposing minor wounds to air each day will promote healing.

Injuries of the hand - Most wounds to the hand are superficial and cause few problems. However, infection or damage caused by cuts and punctures of the hand can cause serious complications to the tendons and nerves. Permanent functional impairment can occur from hand injuries left unattended. If you question whether your hand injury is serious, or if there is any loss of motion or sensation in your hand or fingers, it is very important to have a professional evaluation.

MISCELLANEOUS WOUNDS AND ADVICE

Burns - Burns call for special consideration. Immerse the affected part in cold water or apply cold, wet compresses immediately to avoid further tissue damage and to help relieve pain. Extensive burns (those involving either the face or more than just one or two small areas of the body), should be treated by a physician. The self-care of a serious burn is not recommended.

Bee stings and insect bites - Stings from insects can be serious. A non-allergic person may experience various reactions, ranging from mild irritation and itching to swelling of an entire extremity. Persons who are highly sensitive to the venom released by insects may be subject to a serious systemic (anaphylactic) reaction that is very dangerous. It is best, in cases of moderate to severe reactions, to seek immediate medical care. It is helpful to apply ice to bee stings to reduce inflammation and pain. Be sure to place a cloth under the ice pack to prevent freezing the skin.

Animal or human bites - Bites can be very traumatic and dangerous. These wounds can be difficult to clean and the chance of infection is very high. It is important to have a history taken by a medically trained professional about the conditions surrounding any type of bite so that proper care can be provided. Please note that any break in the skin caused by teeth (i.e., a cut on a hand sustained in a fight) should be treated as though it was a bite. Wounds with foreign or impaled objects - The importance of having a medically trained specialist provide care to this type of wound cannot be over ?emphasized. Often, X-rays are needed to ensure that all foreign bodies are removed. Any impaled objects (such as a fishhook or nail through a finger) should not be removed, except by a professional, to avoid further damage.

Wounds requiring stitches - Any wound that gapes open should be evaluated by a doctor. It is very important to have such wounds evaluated as soon as possible or within six hours of injury. Infection may set in if care is delayed and suturing may not be possible. This can cause difficulty with healing, scarring and serious complications. If your wound requires stitches, your doctor will provide instructions about the care and follow-up needed.

Wounds of the eyes, ears, nose, face, or head - Any type of laceration, injury, or foreign object affecting these body parts should be professionally evaluated. Infection or trauma can cause serious and permanent damage to the cartilage of the nose and ears. Eyes need particular care to ensure that permanent damage is avoided. Facial scarring may be avoided with special care. Head injuries should always be considered serious and life threatening. Wound Guide

Medicare Part B Surgical Dressing Policy

Are surgical / wound dressings covered?

Yes. Both primary and secondary dressings are covered when either of the following criteria are met: 1) they are medically necessary for the treatment of a wound caused by, or treated by, a surgical procedure; or 2) they are medically necessary when debridement of a wound is medically necessary.

The surgical procedure or debridement must be performed by a physician or other health care professional to the extent permissible under State law. Surgical dressings must be ordered by a physician or a Nurse Practitioner, Clinical Nurse Specialist, Certified Nurse-Midwife or Physician's Assistant who was acting within the scope of his or her legal authority as defined by State law or regulation.

Debridement of a wound may be any type of debridement such as; mechanical, surgical, autolytic or chemical.. Dressings used for mechanical debridement are covered.

Complete article:

Wound Care Information Network

What to Expect at the Wound Care Center

Your First Visit: Patients visiting a wound care center receive a comprehensive examination and interview related to their wound problem, followed by a discussion of treatment options. Please be prepared to discuss your health history as well as provide a current list of your medications, allergies, surgeries and hospitalizations.

Following a thorough exam, the clinitians will develop a plan of care that will begin on your next visit. The team members will instruct you on how to care for your wound until your next visit as well as discuss ways to decrease the development of future wounds.

Will it Hurt

Members of your Wound Care team will apply medication to numb the skin around the wound to make you as comfortable as possible while we treat it. If you normally take pain medication please do so before your visit.

Treatment on non-healing wounds

For wounds that are not responsive or are having difficulty in healing, s variety of treatment options are available depending on type and severity of a wound. Treatment may include the following:

Infectious disease management Physical therapy Vascular evaluation Laboratory evaluation Nutritional management Pain management Diabetic education Nuclear medicine Radiology Debridement Hyperbaric Oxygen Therapy

The clinic after your examination will be able to decide what particular care is required for your individual wound.

External Links

Wound Care Information Network

Wound Care Watch Wounds Heal

Wound Care Tips & Tricks

Wound Care – Types of Dressings

Canadian Association of Wound Care

The World Union of Wound Healing Societies

Wound Care Scientific Societies and groups

Wound Care Information Network

European Wound Management Association

Wound Care Information Network

Wound Care Discussion Forums

http://www.medicaledu.com/forum.htm

Electronic Journal of Wound Management Practice

Wound Care Society

Wound Management Association of Ireland

American Academy of Wound Management

LYMPHOVENOUS CANADA

Lymphedema People Internal Lnks

Lymphedema People Resources

wound_care_clinics.txt · Last modified: 2012/10/16 14:40 (external edit)