A Patient Journey for wound care

A wound is a break in the skin and for many people a plaster or larger dressing is all that is needed to stop the bleeding.

There are different kinds of wounds from minor cuts and grazes, to pressure sores/ulcers and wound after surgery. Some can be treated at home, whilst others require treatment and monitoring by a healthcare professional.

Below is general information on some of the different types of wounds.

Preventing infection

Before putting on or changing a plaster or dressing, the wound needs to be cleaned and this will help prevent it from becoming infected:

• Wash and dry your hands thoroughly
• If you have any cuts on your own hands, you should cover them
• If the wound has something embedded in it, leave it in place until you seek medical advice
• Clean the wound under running tap water - do not use any antiseptic, as it may damage the skin
• Gently pat the area dry using a clean towel or a pad of tissues, but nothing fluffy such as cotton wool, as strands can get stuck to the wound
• Apply a sterile dressing, such as a bandage or plaster and, if blood continues to seep through the bandage, leave it in place and another bandage while continuing to apply pressure on the wound for several minutes
• Keep the dressing clean by changing it as often as necessary
• When showering, keep the wound dry by using waterproof dressings

A wound is at risk of infection if:

• It has been contaminated with dirt, pus or bodily fluids
• There was something in the wound before it was cleaned, such as gravel or a shard of glass
• It has a jagged edge and/or is longer than 5cm (2 inches)

Signs that a wound has become infected include:

• Swelling, redness and increasing pain in the affected area
• Feeling generally unwell, maybe with a high temperature of 38C (100.4F) or above
• Swollen glands under the chin, in the neck, armpits or groin

When to seek help

You should always get medical advice if the wound:

• has something embedded in it or does not stop bleeding
• is very large/very deep
• is to an artery or on a joint crease
• is red, sore and painful, or has pus coming out of it
• is an old wound that looks like it might have become infected
• was caused by an animal or human bite, which will need medical attention

If any of these are present, call NHS 111, visit your local walk-in centre/minor injuries unit or GP surgery.

Wounds following surgery

After surgery, it's important to follow your doctor's advice on getting active again. Move around as soon as possible after surgery as this encourages your blood to flow, which helps your wounds to heal while building up strength in your muscles.

If you have a dressing covering the area operated on, make sure you understand and follow the instructions the nursing staff give you to care for your wound once at home.

Look out for signs of a blood clot - typically pain or swelling in your leg, the skin of your leg feeling hot or discoloured, or the veins near the surface of your leg appearing larger than normal.

Pressure sores & ulcers

Pressure sores, also known as pressure ulcers and bed sores, are injuries to the skin and underlying tissue, mainly caused by prolonged pressure on the skin.

They can happen to anyone, but usually affect people confined to bed or who sit in a chair or wheelchair for long periods of time.

Sores can become infected, and in more serious cases can lead to blood poisoning, bone infection and, in extreme cases, can become life-threatening

As with other wounds, seek medical advice if there is red or swollen skin; pus is coming from the wound; the skin is cold combined with a fast heartbeat; the pain is worsening; or the person has a temperature of 38C/100.4F or higher

Scarring

A number of treatments are available if you have a scar that's painful, itchy or unsightly, or if it restricts your movement.

While scars can't be removed completely, they can often be made less visible. In some cases, your GP may refer you to a dermatologist (skin specialist) or a plastic surgeon for treatment.

More information around scars can be found via this link.

Tissue Viability

Tissue viability is a growing speciality to promote wound healing and preventing further skin damage. Some hospitals and NHS Trusts have Tissue Viability Nurses, who provide expert knowledge for patients with unusual or hard-to-heal wounds, often at home.

They are usually called on for advice or support by someone who is treating a patient’s wound, e.g. their GP, Ward Nurse, Practice Nurse, Community Nurse or Consultant.

And in the future?

Wound care costs the NHS billions of pounds every year and costs are expected to rise along with the ageing population. Estimates suggest that one-quarter of the costs are attributed to wound management products.

As a result, there are new and innovative products in development that could benefit both the patient as well as provide cost savings for the NHS. For example, Swansea University’s Institute of Life Science may soon be trialling a ‘smart’ bandage, which uses technology to detect how a wound is healing and send messages back to clinicians.

More information around wound care can be found within the links below

Colour changing dressings can detect infection

Pressure ulcers – what you need to know

Patient discussion forum around scars and wound care

Online clinic on skin conditions – burns & scars

If you have a wound you are treating or caring for someone with a wound, you may like to join the talkhealth mywound Support Programme. It’s free to join.

Sources used in the writing of this article are available on request..

_{Last revised: 22 November 2017}

_{Next review: 22 November 2020}