Wound Debridement

While wound care varies around the world, there is universal consensus with historical and current literature documentation agreeing that the removal of exudates and devitalized tissue from wounds is essential for healing.Debridement is the removal of devitalised or contaminated tissue from, or adjacent to, a traumatic or infected lesion, until surrounding healthy tissue is exposed (Vowden & Vowden, 1999). Failure to debride will delay healing. Removal of dead tissue must be achieved in the shortest possible time, thus improving comfort and quality of life (Hampton, 1998). Also debridement of wounds is an important skill, particularly as toxins from these wounds contribute to morbidity and death. The presence of slough inhibits the migration of epithelial cells across the wound and predisposes the wound to infection. Vowden and Vowden (1999) contend that debridement is crucial to optimal wound healing and may be the most effective method available to stimulate wound healing. Nurses involved in debridement need to have a thorough knowledge of wound care, experience and clear documentation in order to provide excellent practice. Practitioners must be able to identify and describe the rationale for each type of debridement and understand the impact of these on the wound as well as being able to assess the cost effectiveness of each treatment modality. Bale (1997) agrees and states that success of the treatment depends on the skill, ability and knowledge of the practitioner to select the appropriate method for each wound and to apply it correctly. There are certain types or methods of debridement. These are autolytic, biological, enzymatic, mechanical and Conservative Sharp Wound Debridement (CSWD). Conservative sharp wound debridement (CSWD)of devitalized tissue is considered the quickest and most cost-effective method of wound debridement, but it carries a high level of clinical risk and may not be appropriate for all patients or in all health-care settings. There are risks associated with any procedure, and in the case of CSD these are pain, bleeding and infection when the practitioner is not acqauainted enough with the procedure. But these happen very rarely and ifany of them do occur, the health care professional should stop the procedure immediately and take appropriate action, including seeking assistance ifrequired. CSWD is a specialized level of wound care that requires practice based,mentored educational preparation and a regulatory process for ongoing competency assessment. Based on therapeutic outcomes, not offering CSWD as a wound-care option may have legal, ethical and economic implications for health-care facilities. Both collectively and individually, nurses must be responsible for their practice standards, with the aim of promoting clinical competency beyond proficient and toward an expert level. CSWD is a valuable tool for wound care, but it is best practised within a supportive, multidisciplinary framework that promotes safe, ethical and competent care.

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