[jelamrn]

I am a Wound Care Coordinator @ a LTC Facility in Tennessee. I am hoping you can provide me with some basic info on wound cleansing. We recently had a contract company perform a “mock state survey” Audit on our facility. They harshly critiqued the way we perform wound cleansing on pressure ulcers. The technique is as follows per our facility protocol:

“Wash and dry your hands thoroughly, or wash hands with alcohol gel. Put on exam gloves. Position resident. Place disposable cloth next to resident (under the wound) to serve as a barrier to protect the bed linen and other body sites. Loosen tape and remove dressing. Pull glove over dressing and discard into appropriate receptacle. Wash and dry your hands thoroughly, or wash hands with alcohol gel. .Put on gloves. Fill prescribed irrigation device with prescribed irrigation solution, if ordered.
a. Hold the irrigation device one (1) to six (6) inches from the ulcer and spray with solution.
b. Use gentle force to remove dead tissue and old drainage, but not damage new tissue” (During the TX for Survey and Auditors the wound is touched with a gauze, not wiped d/t the potential for receiving a deficiency from state if the wound is touched with the same piece of gauze more than once)
“cleanse wound with ordered cleanser. Dry the skin surrounding the pressure ulcer by patting with a soft, clean towel.Assess the pressure ulcer. Dress the pressure ulcer with the prescribed dressing. Use no-touch technique. Use tongue blades and applicators to remove ointments and creams from their containers. Be certain all clean items are on clean field.Remove the disposable cloth next to the resident and discard into the designated container……..”

This is the way the policy has read since I started this position 2 ½ yrs ago and I have performed the TX per the protocol through our last 2 state surveys in which we received no wound/skin care related tags. The Auditors insisted that this was completely wrong and that we had “just been lucky”. They insist that the wound must be cleansed from the center out with one piece of gauze with the rationale that the center of the wound is the cleanest portion and the outer portion is the dirtiest and insisted we were contaminating the wound by pouring saline from the top of the wound down saying that we were washing the bacteria from the outer portion of the wound in to the clean area @ the center. I have been unsuccessful in finding anything to back up their theory in my research on the internet, of 3 wound care text books, our NHQI manuals, and all of the wound care seminar info I have collected over the last 4 years. I also spoke with the 2 RNs who do consults for us, one is a CWOCN and the other a CWS and they voiced they hadn’t been taught that approach especially not for pressure and vascular ulcers. I know that working your way out from the center while cleansing is appropriate for PICC/IV site care, and for cleansing prior to foley cath placement, and that you do this if you are painting a wound with betadine. But is it really effective for pressure and vascular ulcers? All of the information I have reviewed goes in to great depth about the appropriate psi for irrigation and the effects of antiseptics and commercial wound cleansers. I have found nothing on the actual technique of “wiping” or “scrubbing” the wound with gauze. I greatly appreciate any information you can give me in regards to this matter

:frustrated:

[cougarnurse]

I would say go with your consultants.....heck, they ARE the consultants for a reason. If you do get sited for this, ask for specific citations; I'd like to see that, also!

I would ask, as if the wound were done in a home setting by a nonprofessional (ie family), would it be done the way the auditors say it should be done???

'Cat'