UPDATING PRESSURE ULCER CARE

Abstract

Do not clean ulcer wounds with skin cleansers or antiseptic agents-e.g., povidone iodine, iodophor, sodium hypochlorite solution (Dakins solution), hydrogen peroxide, or acetic acid. Antiseptic agents are reactive chemicals that are cytotoxic to normal tissue. (Treatment of Pressure Ulcers, Clinical Practice Guideline #15, U.S. Department of Health and Human Services Agency for Health Care Policy and Research, pg. 50.) In the home care setting Medicare will not reimburse for dressing supplies if patients are receiving wound care treatment with products containing harmful substances, such as povidone iodine or hydrogen peroxide. When using a static support surface the guidelines recommend considering the characteristics of stiffness (indentation load deflection of 25% of 30 pounds), density (1.3 pounds/cubic foot) and thickness (3 to 4 inches). If the patient is unable to assume a variety of positions or compresses the static support surface, or if the pressure ulcer does not heal, the guidelines recommend use of a dynamic support surface and a low-air-loss bed or air-fluidized bed if the patient has a large Stage III or Stage IV ulcer. Care of pressure ulcers requires that: 1) pressure be relieved with frequent repositioning and pressure intensity be reduced with adequate support surfaces; 2) nutrition be addressed and malnutrition corrected; and 3) topical or local wound care be based on the use of physiologic products to cleanse the wound, the removal of necrotic tissue via debridement, and the use of dressings that support moist wound healing. JoAnn Maklebust, MSN, RN, CS, NP Mary Sieggreen, MSN, RN, CS, NP, CNS Detroit, MI