WOUND CARE AND INFECTION
A wound is an injury that damages the skin and/or underlying tissue.
A wound may be:
• OPEN with broken skin and blood easily seen
• CLOSED where the bleeding is under the unbroken skin
Types of wounds include:
• Cuts (incisions) – usually caused by a sharp object cutting the skin cleanly
• Tears (lacerations) – usually caused by something sharp, such as barbed wire, causing a torn or ragged wound
• Grazes (abrasions) – occur when skin is scraped away
• Bruises – or bleeding under the skin caused by falls or knocks
• Punctures – caused by a sharp object penetrating the skin. Punctures can carry infection deep into the tissues
• Avulsions – or the tearing away of skin and tissue, leaving a flap held on by skin, muscle or tendon
• Crush – caused by blunt force that can damage underlying organs and cause internal bleeding
• Blisters – caused by friction Complications of wounds include:
• Blood loss and shock
• Swelling, which may affect circulation
• Loss of sensation and function
HYGIENE AND PERSONAL SAFETY
Diseases such as HIV, Hepatitis B and Hepatitis C can be spread when infected blood or body fluids enter another person’s body via cuts and scratches.
Unbroken skin forms a natural barrier to this method of infection. Never risk infection of yourself or your patient through contact with another person’s blood or body fluids. You may not know if your patient has a blood- or fluid-borne disease and they do not know if you do either. You may have tiny cuts to your skin that you are not aware of. Protect yourself and your patient by using surgical gloves, cling film or plastic bags.
If possible, get the patient to apply direct pressure to their wound, while you cover your own skin with gloves. Wash your hands thoroughly after treating a wounded patient. In snow, gloves can be impractical as they are slippery and cold. However, do your best to protect yourself.
In the outdoors, you should assess a wound to determine what treatment is needed and whether to continue the activity, rest or evacuate. Assess the wound by asking yourself the following questions:
• How big is the wound? Large open wounds are difficult to keep clean in the outdoors. They bleed and weep a lot, increasing the risk of infection and shock.
• How dirty is the wound? Foreign matter embedded in wounds carries bacteria, which can cause infection.
• How deep is the wound? Deep wounds can affect underlying structures and are difficult to keep clean.
• Could there be damage to underlying blood vessels, organs, bones, joints and muscles? Is the patient’s use of their hands and feet affected due to damaged tendons or nerves?
• Where is the wound? Can the patient walk? Will movement prevent the wound from healing? Can it be easily knocked? Does it involve the hands, and therefore restrict the patient’s ability to care for themselves?
• Is there circulation, sensation and movement below the wound site?
• When was the patient’s last tetanus injection? Tetanus can occur 1–60 days after infection. Tetanus vaccinations are usually given as part of childhood immunisations and again at ages 11, 45 and 65, and after major trauma or deep penetrating wounds in a dirty environment. Check with your doctor if you are unsure when you were last vaccinated.