Treating Pressure Ulcers: Cleaning and Dressing
Pressure ulcers/injuries may be open wounds or areas of damage to the skin or deeper level of tissues. It is important that pressure ulcers/injuries be kept clean, moist, and covered. Doing so helps reduce the risk of infection and speeds up the healing process. To promote healing, clean pressure ulcers/injuries at each dressing change. Take care to choose the most appropriate type of cleanser and dressing.
Keep in mind the following:
Don’t use heat lamps or drying agents, such as alcohol. They dry out wounds and can kill fragile new tissue.
Don’t use antiseptic agents, such as povidone-iodine and hydrogen peroxide, because they are toxic to new cells.
Be aware that if dressings become dry, they may fuse with new cells. This may cause loss of new tissue when dressings are removed. Remove or change dressings before they dry out.
Be aware that letting an open wound “air out” does not improve or speed healing.
Always wash your hands before and after dressing changes, even if using gloves.
Wound cleansing or irrigation
An irrigating catheter, wound cleanser, or saline may be used to flush the ulcer/injury free of debris. The amount of pressure used during irrigation should be enough to clean the wound without damaging it. Wound cleansers may also be used to loosen up and clean out debris. Use gauze to gently remove debris and dry the skin around the wound.
Keeping a clean, moist wound bed is essential for promoting healing. Certain dressings help keep ulcers/injuries moist. Be sure to fill spaces loosely with dressings to prevent fluid and bacteria from building up. Hydrogels can also help retain moisture. The skin around the wound or ulcer/injury should be protected from moisture or drainage. This can be done by keeping the dressing materials only on or in the open area.
Types of dressings
Many kinds of dressings are available. Be sure to follow the manufacturer’s instructions for the specific dressing used. If a wound doesn’t respond to one type of dressing, talk with your healthcare provider about changing the treatment plan. Hydrocolloids, hydrogels, and alginates interact with moisture from the ulcer/injury and can be mistaken for infected drainage. As the ulcers/injuries heal, the type of dressing used could change also.
Moist gauze. Thishelps keep the wound moist and absorbs excess fluid. Gauze should be damp—not wet—with saline or an antimicrobial solution. Gauze that is too wet can weaken surrounding tissue. Ideally, this type of dressing is changed 3 times a day.
Transparent films. Theseare thin and flexible, and help protect wounds from water and bacteria. Theymay be used over other dressings.
Hydrocolloids. These absorb wound drainage, forming a nonadhesive gel. This helps maintain a moist wound environment. They also protect the wound from water and bacteria.
Hydrogels. These are water-based gels and dressing sheets that keep wounds moist. They are also soothing and can help ease pain.
Alginates. These are highly absorbent dressings made from seaweed. When combined with wound drainage, the dressing may form a gel that helps maintain a moist wound bed.
Foams. Theseabsorb wound drainage and keep the wound moist. They are used to cover or fill wounds.
Collagens. Theseabsorb wound drainage and help maintain a moist wound environment. They may also promote new tissue growth.
Antimicrobials. These help prevent and treat infection. These dressings come in many forms.
Negative pressure wound therapy
Negative pressure wound therapy is also called vacuum-assisted closure. It removes wound drainage, helps reduce bacterial growth, and promotes blood flow and healing. First, a foam dressing is placed in the wound and it is covered with a dressing. Then tubing is attached to a pump, which creates pressure in the wound.
The dressing may need to be changed once or 3 times a week, depending on the type of pump used. If dressing changes are painful, an analgesia or pain medicine may be required.
To learn more
For more information, go to the Pressure Ulcer/Injury Resource mobile app.