Chair: Samantha Morgan, BSN, RN CRRN, CCM, ET
The American Subacute Care Association Wound Care Alliance is comprised of healthcare professionals committed to promoting scientifically predicated treatment of acute and chronic tissue defects. These clinicians advocate the holistic treatment of the individual with wounds and represent such practices as infection control, medicine, nutrition, physical therapy, nursing, social service, pain management, speech language pathology, diabetes management, podiatry, etc.
The practices promoted by the alliance are based on the Standards of Care, Dermal Wounds: Pressure Ulcers, and Standards of Care: Dermal Wounds: Leg Ulcers issued by the Wound Ostomy and Continence Nurses Society and the clinical practice guidelines published by the Agency for Health Care Policy and Research. 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 Wound Alliance recommends cleansing and ulcer debridement for purulent or draining wounds. Increased frequency of wound cleansing may be indicated for more affected wounds.
It is the belief of the ASCA Alliance that 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 Alliance promotes careful handwashing with antimicrobial soap before and after any contact with a patient, before and after leaving a treatment area or patient room and the use of aseptic technique in the care and management of chronic wounds. Asepsis is defined at the purposeful prevention of the transfer of microbes; it includes the actions taken to keep an area as free from contamination as possible.
1The Alliance also strongly advises against the use of topical antiseptics to reduce bacteria in wound tissue. (eg., 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.
2Infection Control: 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 contract 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, face masks when secretions, excretions, blood or body fluids are likely to contaminate clothing, skin, mucous membranes, eyes, etc. 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. Avoid the use of needles, utilizing needless systems and devices as much as possible to reduce the risk of puncture wounds. Dispose of (do not recap) needles and sharps in puncture resistant, rigid containers. If needles must be used and such a disposal system is not available, recap using the one hand method. Assign patients with airborne transmittable diseases according to CDC policies. 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.
1 Crow, Sue: Asepsis: The right Touch, Something Old is Now New. Everett Publishing: Bossier City, LA. 1989. 2 Gilson, Greta: Topical Agents for Open Wounds. Support Systems International: Charleston, SC. 1991.
For more information, visit ASCA's web page at http://members.aol.com/ascamail or email ascamail@aol.com