Wounds/secondary Bacterial Skin Infections

Front 1

Wound Classification Acute

Back 1

Abrasions, punctures, lacerations, burns (injury)

Heal in approx. 1 month (healthy pts)

Wound depth determines treatment options

Self-care appropriate for those not extending beyond dermis

Front 2

Wound Classification Chronic:

Back 2

Require triage/intense medical treatment

Front 3

Three stages of wound healing:

Back 3

Inflammatory- immediate- 3,4 days-Hemostasis/inflammation
Proliferative Day 3 to 3 weeks, building of connective tissue/epidermis
Remodeling, 3 weeks--->,Continual collagen formation & breakdown

Front 4

Wound Staging

Back 4

Stage 1: no loss of skin layers; reddened, unbroken skin
Stage 2: superficial lesions, partial-thickness skin loss (epidermis +/- dermis)
Stage 3: full-thickness skin loss; damage to epidermis, dermis, +/- SC fat
Stage 4: full-thickness skin loss, involving more of SC fat, muscle, tendon, bone

Front 5

Treatment for minor wounds

Back 5

Treatment goals:

Promote healing, Protect wound from infection/trauma
Minimize scarring

Treatment approach:

Cleanse wound, Select topical antiseptic and/or antibiotics
Choose appropriate dressing (moist)

Front 6

Exclusions for self treatment

Back 6

Wound with foreign matter after irrigation
Chronic wound
Animal or human bite
Signs of infection
Involves face, mucous membrane, genitalia
Deep, acute wound
Patient with diabetes, immunocompromised

Front 7

Stage wounds you can self treat

Back 7

Stage 1 and 2

Front 8

MRSA infections: cellulitis

Back 8

Increased prevalence in community

Children, young,adults

At-risk:
Football players, Wrestlers, Prison inmates

REFER!!!

Front 9

Wound Dressing

Back 9

The ideal dressing:
1. Removes excess exudate
2. Maintains moist environment
3. Permeable to oxygen
4. Insulates wound
5. Protects from infection
6. Free of contaminants/particulate matter
7. Removable without disruption of new tissue

Front 10

Types of dressings (3)

Back 10

1. Moisture-absorbing:
2. Moisture-maintaining:
3. Moisture-providing:

Front 11

1. Moisture-absorbing:

Back 11

For Mod/Heavy draining wounds
Foams: Epi-Lock---Mostly non-adhesive, on-occlusive,Comfortable, trauma-free removal, Absorbent, Do not use for minimally draining wounds

Alginates: AlgiDERM---Fibers form gel at wound interface, Absorbent, non-occlusiveMore comfortable than foam; trauma-free removal, Use on infected wounds, minor bleeding

Carbon-impregnated: Carboflex---Use for malodorous wounds, Require seal, Carbon is inactivated if wet

Composite: Nu-Derm---Non-adherent, semi-occlusive, Impermeable to fluid/bacteria, Use for suture/staple lines, May cause trauma to surrounding tissue upon removal

Front 12

2. Moisture-maintaining:

Back 12

Hydrocolloid: Tegasorb--- Wafer or paste,** Waterproof**, Occlusive, Long wear time, Self-adherent, Impermeable to
fluid/bacteria, Uninfected wounds only,
Transparent film: Tegaderm--- Semi-occlusive, Permeable to gas, Comfortable and self-adherent, Impermeable to fluid/bacteria, May re-injure wound on removal, Uninfected wounds only

Front 13

3. Moisture-providing:

Back 13

Hydrogels/Gels: Vigilon

Non-adherent

Non-occlusive

Reduce pain; cooling effect

Comfortable, trauma-free removal

Variable absorption
Good for BURNS**

Front 14

Moist wound environment (New Strategies)

Back 14

1. Prevents scar
formation
2. Removes exudate
without dehydration
3. Prevents bacterial
growth

Front 15

Gauze pads (?) still use

Back 15

Used with semiocclusive
foam
dressings for exudate
absorption

Debridement of
necrotic tissue

Minor cuts and
abrasions

Front 16

TL is a 28 year old WM who sustained full-thickness
burns on his left arm from a four-wheeler accident at
deer camp last weekend. His physician suggested he
ask his pharmacist to recommend a suitable bandage
for his burns.
What is the MOST APPROPRIATE type of bandage for TL?
A. Hydrogel dressing
B. Gauze dressing
C. Carbon-impregnated dressing
D. Transparent film dressing

Back 16

A.. Hydrogel (good for burns)

Front 17

50 year old AAF

Wound on her R leg

Epidermis and dermis were impacted

Moderate drainage from the wound

No erythema or purulent discharge

Wound is not painful

What type of bandage should she use?

Back 17

Foam (Epi-Lock)
Alginates: (AlgiDERM) good for heavy drainage

Front 18

Wound irrigants:

Back 18

remove dirt/debris

Normal saline or bottled water

Chlorhexidine (Hibiclens)®

Instructions for use:
Brush wound will wet cotton ball 3x4 times a day

Front 19

Antiseptics:

Back 19

disinfection for **intact** skin, alcohol is very drying

Ethyl alcohol (48-95%)

Isopropyl alcohol (50-91%)

Iodine solution or tincture USP-do not bandage a wound you applied iodine to (inc, systemic absorption)

Povodine/iodine complex (5-10%) less irritating than iodine

Hydrogen peroxide USP (3%) let it dry fully before covering

Dakin’s solution (sodium hypochlorite) Bleaching agent, irritates skin, good anticeptic

Front 20

Topical antibiotics:

Back 20

Clean area first.

Bacitracin: Gram (+) bacteria

Neomycin: Gram (-) bacteria plus some Staph

Polymixin B: Gram (-) bacteria

Front 21

Topical antibiotics instructions:

Back 21

Apply within 4 hours, after cleansing, to reduce risk of infection
and promote healing

Clean wounds have low infection rate; may not require topical abx

Use for 3-5 days;consult PCP if no improvement

Front 22

Alternative Therapies: Witch Hazel

Back 22

Astringent (contains alcohol)

Inhibits bacterial growth

Primarily used for minor skin injuries and relieving
itch, pain from hemorrhoids

Front 23

Alternative Therapies: Aloe Vera Gel

Back 23

Antiviral, antibacterial, and antifungal

Primarily for burns, frostbite, and some minor
cuts/abrasions

Front 24

Alternative Therapies: Goldenseal

Back 24

Contains alkaloids with weak antimicrobial activity

No documented evidence of any benefits

Front 25

Alternative Therapies: Vitamins E and C

Back 25

Necessary for proper healing

Supplementation acutely probably not necessary for
minor wounds

Possible antioxidant effects

Front 26

Tetanus Vaccination

Back 26

All wounds warrant checking tetanus
vaccination status (1 every 10 years or recommend if deep puncture wound)

CDC wound care guidelines must be followed

Front 27

Neosporin vs Polysporin

Back 27

Polysporin, better for larger wounds and burns, so no neomycin (amino glycoside) absorption

Front 28

Pharmacists Assesment of wounds

Back 28

1. Type, depth, location, contamination
2. Signs of infection
3. Patient’s health status, current medications
4. Need for antimicrobials (20 infection)
5. Need for tetanus booster