How to Change a Wound Dressing

Perhaps you’ve had a slip, a cut, a hard fall. Your injury may seem small and insignificant, so you shrug it off. However, even small wounds can develop into bigger problems if you do not properly care for them. You must clean and dress the injury, occasionally monitoring its healing process. In this article, we will delve into the subject of wound care, how to properly change your dressing, and how often, as well as possible complications. 

Wounds

An open wound occurs when there is an external or internal break in your body tissue. Typically this type of trauma is not serious and can be treated at home. They are usually caused by falls, sharp objects, or car accidents. However, if there is a lot of bleeding or the bleeding lasts for more than 20 minutes it is best to seek immediate medical care. 

There are two classifications of wounds: acute or chronic. Acute refers to a new injury, while chronic means lasting over a longer period. Acute wounds can turn into chronic ones if they last more than a couple of weeks. Sometimes chronic wounds can even last years. An example of a common chronic trauma would be pressure ulcers. Typically occurring in patients lying in hospital beds, these ulcers can become long-lasting, especially if not being taken care of properly.  

Wound Complications

Infections: Infections occur when bacteria or other germs enter the injury and multiply. This can greatly delay the healing of the injury. Some doctors prescribe antibiotics. These may not be necessary, however, since most lesions are not infected. The overuse of antibiotic ointment or antibiotics in pill form can toughen the bacteria to where they are immune to the medication. But if your doctor believes you have an infection or even an infection in the peri-wound skin, antibiotics will be prescribed. If you have pain, this is the first sign of infection. 

Necrosis: If your injury is not healing, this may be due to necrosis. Necrosis is dead tissue in the lesion and occurs when parts of the skin or tissue under the skin dies. It is necessary to remove this dead tissue to allow new cells to regenerate. Removal can be done by your doctor with a sharp knife or surgical instrument. Your doctor may even recommend a medication that will help necrosis. 

Debridement: The removal of necrotic tissue or infected tissue is called debridement. When the body is allowed to remove the dead tissue on its own, this is called autolytic debridement. This works well with certain types of wound and their dressings. 

Once the doctor has cleaned and debrided your injury, they will place a temporary dressing, like a gauze dressing or gauze pad. This is called a dry dressing because no medication or ointment has been applied. 

Types of Open Wounds

• Abrasion: Also known as a scrape or a graze, this happens when your skin is rubbed against a rough surface. Road rash is a common example. This type of open lesion typically does not have a lot of bleeding. To avoid an infection, abrasions need to be scrubbed and cleaned before they are dressed. 

• Laceration: This is a cut or tearing of soft tissue. This occurs from sharp objects, tools, or machinery. If the laceration is deep, there may be a fast rate and amount of blood flow.

• Puncture: Punctures are small holes produced by long, pointy objects like nails or needles. A bullet can even cause a puncture. They do not bleed much, however, they can be so deep that they damage organs. It is important to get a tetanus shot if you get even a small puncture. 

• Avulsion: Avulsions occur when skin and tissue have been partially or completely torn away. This can happen from explosions, gunshots, and other brutal accidents. 

Depending on the severity of the injury, it can be treated at home, or in a doctor’s office. 

Home Wound Care

If your injury is minor, you can easily treat the trauma at home. Practice good hand hygiene when touching your injury or items that come in contact with the injury. Sterile technique is imperative in reducing the spread of microorganisms to the wound.

Make sure to wash and disinfect the area, making sure to clean away any dirt or debris. Apply direct pleasure and elevate the injury to slow down the bleeding and swelling. Wrap it with a sterile dressing. You may not even need a bandage if the injury is minor enough. Keep the injury clean and dry for about five days. 

If you experience some pain from the injury, you can take a Tylenol as directed on the package. Stay away from aspirin as it can stimulate blood flow. If you have any bruising or swelling, apply an ice pack. If you will be outside, use a sunscreen with an SPF of at least 30 on the area. 

Medical Wound Care

If your injury is more serious, a doctor will need to take care of the wound. He or she will clean and may numb the area, then close it with skin glue, sutures, or stitches. A tetanus shot will be administered if the injury is a puncture. 

Your doctor may not close it, depending on its location. Some circumstances necessitate natural healing. This is called healing by secondary intention, where healing starts from the base of the wound bed to the epidermis. Often this kind of injury is packed with gauze to prevent infection and abscesses. 

Doctors often prescribe pain medications for open wounds. Penicillin or another antibiotic is prescribed if an infection has occurred, or if there is a risk of developing one. If something as serious as the severing of a body part has occurred, the body part should be brought to the hospital. To preserve it as best as possible, wrap it in a moist gauze, then pack it in ice. The sooner it arrives at the hospital, the better chance it can successfully be reattached. 

How Often to Change a Wound Dressing

The frequency of changing a wound dressing largely depends on the injury, and what type of dressing you are using. You will be advised by your doctor how often to change it. It will also be necessary to change it if it happens to fall off, becomes too wet, or gets dirtied by the external environment. 

After surgery: The first few days after surgery the wound will drain fluid. Bandages will quickly soak this up. Change as often as needed to keep the area clean and dry. The wound care dressings should be changed before the gauze becomes soaked by drainage. With a surgical wound, this could be anywhere from one to four times daily. If the bandage is wet when you change it, this is a sign you need to change it more often. 

Wound Dressing Change

Make sure you have all your wound care supplies assembled before getting started. You will need:

• A pair of non-sterile gloves
• A clean surface to place everything. You can place a clean piece of aluminum foil or paper to cover if your surface is not clean. 
• Ointment, if prescribed
• Q-tips
• Bandage tape, if needed
• The new dressing or dressings you are going to apply
• Normal saline or wound cleanser
• Sterile gauze for cleaning or wiping the injury
• Plastic bag for trash

1. Remove the Old Dressing

1. Thoroughly wash your hands with soap and warm water.
2. Put on non-sterile gloves.
3. Remove the tape carefully.
4. Gently remove the old dressing. It may stick to the skin; if so, sprinkle some warm water to loosen it. 
5. Remove any gauze pads or packing tape inside the injury. 
6. Place the old dressing and packing material into a plastic bag. Then remove your gloves and place them in the bag; set the bag aside. 

2. Assess the Wound

Wound assessment is important for catching any possible complications. Take a good look at the amount of blood exiting the injury. Notice the color and any drainage that is occurring. Is the drainage darker or thicker? Is there any increased redness, swelling, or bad odors? A small amount of bleeding is ok because it helps purge dirt and other contaminants out of the lesion. If there is heavy bleeding or worsening of the injury, medical care may be needed. Consult your healthcare professional. 

3. Clean the Wound

To clean a fresh wound: 

1. Wash hands and put on a pair of non-sterile gloves.
2. Clean the injury with running water, or use a moistened, soft washcloth.
3. Gently wash the skin surrounding the area of trauma with soap. Be careful not to get soap in the injury, as it can sting and cause irritation. However, it will not harm otherwise. 
4. Rinse thoroughly. Gently pat dry with a clean towel. Be sure not to rub it dry. 
5. If there are any particles like gravel or broken glass use tweezers to carefully remove them. 
6. Remove gloves and put them in the plastic bag.
7. Wash hands again.

You can use wound cleansers or saline to clean the injury as well. Here are some things to clean an injury with, and some to avoid:

• Saline: Considered the most appropriate cleaning solution, saline can easily be made at home. To make saline, sterilize water by boiling it for 20 to 30 minutes. Or you can use distilled water that has been boiled and filtered. Mix one cup, or 8 ounces, of distilled water with ½ teaspoon of table salt. Do not use sea salt since it contains additional chemicals. Stir salt in water till it has dissolved. Store in an airtight container in the refrigerator if possible. 

• Tap water: You can’t go wrong with cleaning with plain tap water. Along with saline, it is one of the most effective liquids that can be used to clean an injury. No need to complicate it.

• Wound cleansers: These are solutions that remove debris, exudate, and contaminants. They can also be used to irrigate an injury with a deep cavity. Some common ingredients could be surfactants, moisturizers, wetting agents, or antimicrobials. Wound cleansers can come in a rinse or no-rinse formula.  They can be used with gauze, sponges, or put into a device for irrigation and debridement.

• Antibiotic ointment: This ointment can be used to help reduce pain from raw injuries like abrasions. However, an antibiotic ointment is not necessary for cleaning. 

• Hydrogen peroxide: We do not recommend using hydrogen peroxide for cleaning an injury. It can even be harmful. It tends to bubble, which creates oxygen gas. The blood cannot handle this and could cause a gas embolism, which could be fatal. There isn’t a lot of proof that hydrogen peroxide helps with minor lacerations. It is best to stay away from antiseptics and disinfectants when cleaning an open wound. 

4. Cover the Wound

You should cover the area if it will come in contact with clothing or dirt. Use adhesive bandages for minor lacerations and abrasions. If the cut is less than 2 cm long, you can close it with butterfly bandages. But if the edges of the lesion cannot be pulled together easily, you may need stitches. 

There are a wide variety of wound dressings out there on the market today. There are those that dry, those that moisten, and those that protect. It all depends on your injury’s needs. Here is a summary of some common dressings and their purposes: 

• Gauze dressings: Great for minor injuries, as a primary dressing, or secondary dressing.

• Hydrogels: These work well for dry wounds or especially painful ones. 

• Alginates: Helpful for injuries with lots of drainage due to their ability to absorb moisture. These dressings for moist wounds need to be changed often. 

• Foam dressings: These work well for odorous injuries, and those thick wounds with a lot of discharge. Use for pressure injuries. 

How to Apply a Wound Dressing

Healthcare providers may prescribe an ointment to put on the injury. They may be used to protect the skin, kill bacteria, or help the wound heal faster. One of the most commonly prescribed ointment is silver sulfadiazine, which has antimicrobial properties. Ointment comes in gel, liquid, or spray. Some people prefer Vaseline because some people have allergic reactions to some perfumes in other moisturizers. Additionally, you may want to stay away from drying medicines like mercurochrome or lotions containing alcohol. You will apply it before dressing the injury:

1. Rewash your hands with soap and warm water for 20 to 30 seconds, then dry. 
2. Put on a pair of clean non-sterile gloves. 
3. Apply any ointment your doctor may have prescribed. Apply as directed. If necessary, use a clean Q-tip or cotton swab to spread it across the area. 
4. Pour saline into a clean bowl. Then put gauze pads and packing tape that will be used into the bowl.
5. Take out of the bowl, and squeeze the saline out until it is not dripping. 
6. Place the gauze pads or packing tape in the injury. Make sure the wound is filled, with no spaces open under the skin. 
7. Cover the wet gauze or packing tape with the primary dressing. 
8. If recommended by your doctor, add a secondary dressing. This dressing may have an adhesive part that holds it in place. Or, you may have to secure it with bandage tape. If a secondary dressing has not been recommended,  you can secure the primary dressing with bandage tape. 
9. Remove gloves, throw them in a plastic bag. Close the bag, then place it into another plastic bag, then securely close it. Throw away. 
10. Wash your hands. 

Complications

The main complication to proper healing is the risk of infection. If you have a puncture, deep laceration, have had a serious accident, or are bleeding significantly, call a healthcare professional. Also, call a doctor if you have: 

• A wound that isn’t healing
• Increased pain
• Increased redness
• Swelling
• Bleeding
• A tender lump in your groin or armpit
• Increasing in size or depth
• Increased drainage
• Drainage has not decreased after 3 to 5 days
• Drainage has a foul odor, 
• Drainage is thick, tan, green, or yellow
• You have a temperature over 100.5°F (38°C) for more than 4 hours continuously

These are all signs of infection. Your doctor can drain or debride the lesion. They will probably prescribe an antibiotic if a bacterial infection has developed. You may have to receive surgery to remove infected or surrounding tissue. 

Here is a list of other possible conditions caused by open wounds: 

• Lockjaw: This occurs due to a bacterial infection, and is characterized by muscle contractions in your neck and jaw. 
• Necrotizing fasciitis: This is an infection caused by Clostridium and Streptococcus bacteria, and can lead to sepsis and tissue loss.
• Cellulitis: This is when an area of your skin becomes infected that is not in contact with the injury. 

Always Consult Your Doctor

As a disclaimer, we should say that this article is meant for informational purposes only, and not intended as medical advice. Always consult your doctor when it comes to your wound management needs. We here at CareAsOne wish you quick healing and recovery.