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Successful treatment of chronic wounds

Elżbieta Szwałkiewicz 

 National Consultant in Nursing Chronically Ill and Disabled People

„Even the most modern, well-matched to the wound type dressing will not facilitate the wound healing process if additional conditions conductive to further body regeneration will not be met.”

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These are:

  • proper body hygiene,
  • skin protect against irritating effects of urine,
  • suitable bed, mattress, bed linen and underwear,
  • elimination of pressure on the part of the body affected by a bedsore,
  • safe movement and positioning of the body,
  • adequate nutrition and hydration.

Modern technical solutions and technologies allow for the safe performance of hygienic activities, even in those patients with very sensitive skin and completely immobilised, without the risk and effort associated with their movement. On the market there is a wide range of skin care, hygiene facilitating devices available. When dealing with dry skin (frequently washed with soap), weakened, macerated, constantly subjected to the action of irritants, it is necessary to check the condition of the skin daily looking for signs of an allergic reaction. Appropriate preparations for cleansing and skin care of the sick are the ones that can be applied to sensitive and irritated skin, and have moisturising, greasing and elasticising properties. They should alleviate symptoms of inflammation, grease and protect the skin against irritants such as urine. For irritated and itchy skin soap should not be used only mild cleaning agents (lotions, foams). It is advisable to use cosmetics with as little allergic reactions as possible. The used cleaning and care products should be manufactured in sets by the same company as this will prevent the use of products of different chemical components coming into harmful interactions for the organism. Just wash the wound area, and always check the condition of the wound dressing and protection of the wound against pollution and getting wet during hygiene procedures.

Unpleasant for the patient and his/her environment urine odour can be eliminated by proper selection of absorbent materials and their appropriately frequent change – about four times a day. While changing be sure to cleanse the abdomen, genitalia, groin and buttocks.

A patient who cannot change the position from lying to sitting can be washed traditionally in bed, but can be also bathed in a special movable bathtub. The bathtub is taken into the patient’s room, one side wall is removed and is set along the bed. Then, using a cloth or a special sliding mat to move the patient (previously undressed and covered) into the tub. If the patient is on a drip, monitor, respirator, etc., the bath is carried out in the room next to the bed. This is possible when to the sink tap (located in the room) a shower hose of suitable length with a shower head is attached. Similarly, the drain hose must be of appropriate length to reach to a special outlet installed under the sink. If the patient is able to leave the room, he/she is taken on the bathtub to the bathroom with a shower post. The drain hose is introduced into the floor drain. Bathing in the supine position can also be done in a bathtub with an adjustable height. A person who cannot move, is moved (undressed and covered) by sliding onto a special man lift – a kind of trolley-stretcher. Following the transfer of the patient to the bathroom, the lift is placed on the bath, which rises (electric mechanism operated by means of a remote control) to the height appropriate for the carer, so that he/she does not to have to bend down. Then, the lift with the patient is lowered to the bottom of the tub. Most of the mentioned bathtubs has also an incorporated hydro massage device. The lift has the ability to raise the head rest so that the patient can be washed in a sitting or reclining position. In a set with the bathtub there are also available chair lifts that help people with paraplegia or the disabled to get to the bathtub and leave it. These people can also wash themselves in the shower using the lift or a sanitary chair. All institutions where there are patients with locomotor disabilities should have integrated systems for personal hygiene i.e. movable equipment integrated with cleaning equipment.

People unable to walk e.g. with paraplegia can use the toilet alone but there must be conditions created enabling the move from the wheelchair onto the toilet. The height of the toilet and the wheelchair should be similar. The side walls of the chair and security handles at the toilet should be tippable. Within easy reach of a person using the toilet there should be a shower head to wash and toilet paper to dry the skin. The ability to wash oneself with running water is highly important, because it is very difficult to clean the genital and anal area with toilet paper. In elderly people the skin is wrinkled and therefore its thorough cleaning off stool remnants is not possible by means of dry toilet paper, and repeatedly rubbing the sensitive and dry skin often leads to its damage. In the toilet there should be enough space for a disabled person to drive a wheelchair, park along the toilet, and after picking up the side part of the chair and the toilet handle, move onto the toilet. All people, regardless of their health and fitness, should be able to use the toilet. It should be kept in mind that when lifting and moving the patient strong point pressure on the body ought to be avoided and the sliding method to rotate the body ought to be applied. The need to clean and protect the skin is particularly important for people with disabilities who face the problem of urinary incontinence.

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Please note that urine in contact with the skin is an external irritant, causing inflammation. The inflamed skin is red, irritated and painful. There appears also often swelling, itching and flaking of the skin. Patients trying to reduce the annoying itch scratch themselves, and ultimately break the continuity of the skin, leading to the formation of wounds. These scratches are the site of bacterial infection and the development of complex infected bedsores.

The desired effect can be achieved using hygienic disposable absorbent materials, sets for urine collection, specialist personal hygiene and cosmetic and protective preparations. Their offers is very rich in the market.

Diapers, anatomically shaped diapers or urine pads should be chosen according to their absorbent ability, the content of a urine binder, the type of protection against the leakage from the diaper, the ability to reduce unpleasant odours and the possibility to closely adjust to the body. It is also important that the absorbent body is covered with special nonwoven, which also separates the urine absorbed from the skin.

Urinary incontinence leads to constant moisture and maceration of the skin, which promotes its inflammation, damaging, resulting in the formation of bedsores. Therefore, it is necessary to systematically check the condition of the skin in areas exposed to moisture and the state of dressings, and maximally shorten the time of skin contact with urine.

Therefore, the selection of an absorbent product should be determined by the degree of urinary incontinence, the patient’s level of consciousness, time of the day and level of activity. People with pressure ulcers or very sensitive dry skin prone to irritation, should use the so-called breathable diapers. They differ from other diapers for instead of the protective film they have to a special air-permeable laminate.

While nurturing a bedridden person with urinary incontinence (UI) it necessary to use hygienic underpads to maintain the cleanliness of linen or to secure the chair. Do not use rubber underpads but pads made of cellulose with one side coated with special film protecting the chair or the bed against wetness. Here also breathable absorbent products should be applied. People with bedsores should avoid overheating in warm clothes and airless or overly heated rooms, and above all, they should avoid long-term pressure on the damaged skin and skin friction over the ground. This effect can be achieved by using a special sliding and equipment for sliding repositioning, pressure relief mattresses and pillows, frequent change of body position, the application of proper rules for lifting and moving the patient.

Significant reduction or elimination of pressure on the skin can be achieved by equipping the bed with an anti-bedsore mattress:

  • alternating pressure (so-called dynamic) anti-bedsore mattress where a motor pumps air into individual chambers of the mattress, filling them only some of them which allows to temporarily relieve another part of the body. Using the mattress does not cancel the obligation to adequately frequent change body position.
  • constant pressure anti-bedsore mattress, pumped using a hand pump, enabling to achieve appropriate pressure and reduce the pressure on the body surface. It is also important that it is made ​​of a material with a unique antibacterial formula inhibiting the growth of bacteria and odour inhibitor. Using this mattress has a preventive effect and accelerates healing of existing wounds. This mattress is particularly useful in patients who dislike the sound of the pump motor in the dynamic mattress.

The time of healing a bedsore or any other chronic wound depends on the general state of health and on good nutrition with adequate supply of protein, calories and fluids.