Disinfection of wounds

VentMedic said:
http://www.wocncb.org/become-certified/how_to_choose.pdf

The requirements are extensive and recertification is required every 5 years.

Sidenote: Some health professions are now requiring their practitioners to retest for their specialty or licensure cert or both every five years to ensure quality.

mycroft wrote:

Netty pot
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Wow, that is actually impressive. Is this something all nurses certify in and stay current with? (ICU, ED, Transport, etc. nurses) Is it something that EMS profoessionals could attend and certify in as well? More for ED techs though, I would agree with covering and saving the irrigation for the controlled environment.
 
FF894 said:
Wow, that is actually impressive. Is this something all nurses certify in and stay current with? (ICU, ED, Transport, etc. nurses) Is it something that EMS profoessionals could attend and certify in as well? More for ED techs though, I would agree with covering and saving the irrigation for the controlled environment.
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Wound care is a specialty. RNs (or others) are trained in broad general terms to manage wounds or identify ones that require special attention from a wound nurse. For the treatment to be a covered therapy, doctors will just write "per the wound specialist".

There are also specialists in infection control.
http://www.cbic.org/Becoming_Certified.asp


Infection Control Today: Excellent magazine with lots of info.
http://www.infectioncontroltoday.com/

Some good reading for infection control. You can read for free if you don't want the CEUs.
http://www.nurse.com/ce/InfectionControl/

The hospitals and colleges usually offer several courses for infection control and wound care in their continuing ed department. I also advise taking a class about the various vascular access devices such as PICCs and Porto-Caths.
 
There is a lot more information on wound care in Wilderness EMS because we can be with the pt for a much longer period of time. While a 15 minute ambulance ride isn't long enough for signs of infection to develop, a two day pack out certainly is. Plus, in wilderness EMS, you are generally working with injuries that occur in dirty places.

If you are working on a primarily urban ambulance system, your wound care shouldn't go much beyond cleaning off the big chunks, being able to visualize the wound intially and then stop the bleeding and stop any further dirtiness from getting into it. Infection is the reason antibiotics were invented. Let the RNs and the Docs do that part.
 
At one time, I was Director of a Home Health Agency (yeah shocking) and went partially went through an ostomy nurse course. I agree it is a speciality upon its own and wound healing and irrigation has to be done specifically and NO its not always H2S or NSS, Iodine or simple techniques.

There are several types of wounds. Much more than we have time or interest discussing. For example stages of decubitus ulcers are alike burns, only such wounds may have a "tunnelling effect". These wounds takes months to years to heal or what is considered a success is formation of scar tissue.

It has been over ten years since I reviewed any current literature on long term wounds and I am sure there has been much changes. I admit I was more a pencil pusher and I hired an ostomy nurse consultant and had her train my nursing staff for daily care and aggressive treatment. The physicians would co-sign her orders to make it legitimate as most well inform you that they are not abreast on wound care and the specifics of irrigation solutions, packing, dressing, etc....


R/r 911
 
This is really interesting, didn't know wound care was a specialty. Always thought each nurse had basic training and developed their own style.

Bossy- you have probably answered this before but how long are the transport times where you are?
 
HAHA! Nurses need to do what to keep doing which?

There are wound care specialists among nurses, but the run of the mill registered nurse is supposed to be capable of at least carrying out a MD order for dressings, observe and record wound status, and get the doc's attention when things aren't going well. At least in this state, LVN's can do the actual dressing, but unless they have some sort of extraordinary certificate or something they are not allowed to observe and record wound status themselves.

I've seen some vague MD orders result in every different nurse taking a different approach within the boundaries of the order. "DSD"'s (dry sterile dressings) I have seen ranged from whole-roll 4 inch fluffed Kerlix over two ABD's mummy affairs, to a large bandaid, on the same pt at different shifts. (Of course mine are always pefect!). I keep incident reports in my desk just for those.
 
BossyCow said:
Infection is the reason antibiotics were invented.
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Often the hospitals will try everything in their tool box of knowledge to keep from using antibiotics on wounds especially in the elderly. Their immune systems are too fragile as are the many organs that will be affected by the antibiotics. Too many people end up on dialysis permanently (that can also include young people) after an infection which had to be treated aggressively with the big gun antibiotics. C. Diff also runs amok because of antibiotic over use coupled with poor infection control techniques. It is a vicious circle or cycle that can be easily broken if people would pay attention to a few very basic steps when handling patients or their own possessions and hands.
 
OK folks , ridryder and ventmedic have talked a lot of sense in this thread

topical ABx forget it if you want to stick anything in the wound stick some honey in ! or the shavings off a silver dollar ! because long before topical ABX - dressings containing honey or silver will be used ....

iodine has it's place but there are risks associated with topicla iptake if you use too much too often on open wounds ...

THE SOLUTION TO POLLUTION IS DILUTION !!!!! if a wound needs cleaning it needs cleaning with lots of of water either potable water straight from the tap or sterile water or NS for irrigation if you don't have a convenient source of potable mains water...

you are not going to achieve a sterile wound unless you create the wound yourself in surgical conditions



here in rightpondia topical Abx are used extremely rarely apart from topical metronidazole in when you have a fungating tumour and the use of neosporin would be considered malpractice ( if you can even get it .)
 
We include honey in our wilderness protocols, but anyone shaving a silver dollar into a wound better be prepared to face disciplinary action.
 
Foxbat said:
We carry peroxide but I have never seen anyone using it.

Another question on the same topic: I heard that in case of animal bites it is better not to stop the bleeding (unless it's severe) for a few minutes to let the bloodstream carry some of the saliva/poison away. Comments?
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BLS - "Keep the red stuff in" So control the bleeding, let the Docs worry about infection. :unsure:
 
BossyCow said:
We include honey in our wilderness protocols, but anyone shaving a silver dollar into a wound better be prepared to face disciplinary action.
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Wow! Guess we're both old enough to remember when silver trachs were the norm and copper mesh was use in heated water "kettles" for devices such as vent or room humidifiers.

The male WWII vets had their war medallions placed on their trach tubes and the women had their precious stones set on them.

Since silver's use has a long, long history...Happy Birthday!

For interesting pics:
http://www.tracheostomy.com/resources/history/antiques.htm
 
EMT271WNY said:
BLS - "Keep the red stuff in" So control the bleeding, let the Docs worry about infection. :unsure:
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While I'm not 100% sure on the validity of the 'let animal bites bleed' statement, if you can do something that can help prevent infection without compromising the patient's health, why not? Not all bleeds are life threatening.
 
Animal and human bites are NOT recommended to be sutured if possible since (especially humans) contain large number of bacteria. Irrigation and cleansing of these wounds along with prophylactic antibiotics is administered.

R/r 911
 
We were told in my class just to put a bandage over it, the hospital will irrigate. Not to mention with iodine some people are allergic to it and I would not want to use on someone who didnt know they were or someone who was not able to tell us and create another emergency
 
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