[Wound Care Topics]The hospital sets up a wound care team to help patients recover early and suffer less pain

(Kuantan News) The Ministry of Health established a wound care team in a hospital in 2010, which is led by doctors and assisted by nurses or other medical personnel.

Thanks to the annual funding, the group is able to introduce advanced wound care equipment and increase training for medical staff, so it can help patients recover as soon as possible, reduce side effects or deterioration, and achieve the purpose of relieving pain.

Wound care has formed a specialty in the medical field, and hospitals in many countries will set up this specialty to provide professional care for various injured patients.

Introduce equipment to train medical staff

Dr Lee Chin Yen, Director of the Orthopedic Wound Care Group at Kuantan General Hospital, returned to Malaysia after graduation and internship in the UK, hoping to provide professional services in this area. However, he said that wound care is still not a common practice in Malaysia. , and has not been recognized as an independent specialty.

He pointed out that wound care groups are led by different medical personnel in different countries, some countries are led by doctors, while the UK and most European countries are led by nurses with professional training in wound care. In Malaysia, wound care is doctor-led.

Another rare role in wound care in Malaysia is the podiatrist, who specializes in treating patients with foot, ankle and calf problems, but there are no more than 10 people with this qualification in the country.

“The Ministry of Health of our country set up a wound care group in the hospital in 2010, led by doctors and assisted by nurses or other medical personnel. The group receives funding every year, introduces advanced wound care equipment, increases training for medical personnel, etc., so that more Many people have benefited.”

Not all wound cases have to be referred to the wound care team for diagnosis and management, only chronic wounds, meaning wounds that have not progressed for 4 to 6 weeks, or complex wounds that are too large to affect other organs are referred to Wound Care Group.

“The main purpose of wound care is to help the patient heal as soon as possible, reduce side effects or deterioration, and reduce the patient’s suffering.”

He said with a smile that the traditional wound care is to “wash the wound every day”, so the patient will be very painful, and the wound may not heal quickly. Now it is different. Patients can wash their wounds once every two or three days, or even once every five days to one week. With the use of advanced equipment and dressings, patients’ wounds can not only heal quickly, but also reduce pain and shorten the time of nursing, so that Have more time with family and have a good quality of life.

Bed sores account for 40% of wound care

Wounds are mainly divided into chronic wounds and complex wounds. He pointed out that the most common chronic wound in Malaysia is pressure injury, also known as decubitus ulcer. Due to long-term bed rest, the body parts are damaged by long-term pressure and cause ulceration or wounds, which commonly occur on the patient’s buttocks, head, etc. Department etc.

“Some patients, such as diabetes, stroke, elderly dementia, car accident injuries or some back nerve injuries, can also cause bedsores on the feet or ankles. Bed sores are quite common in Malaysia, accounting for 40% of wound care.”

He pointed out that diabetic foot ulcer is one of the common decubitus ulcers, and its incidence accounts for 40% of decubitus wounds, mainly because diabetes is a common chronic disease in our country, and diabetic foot is one of the more serious complications of diabetes.

In foreign countries, bedsores have become a preventable injury, and some hospitals have even achieved the goal of “zero pressure injury incident”. However, the Malaysian public lacks awareness of prevention of bedsores, so many patients often suffer from wound deterioration. Or only seek treatment at a late stage.

There are still some patients whose decubitus is unavoidable. For example, some patients still have decubitus despite taking precautions and reducing wound pressure. Bed sores are mostly preventable if well managed.

Multidisciplinary Team Support

Diagnosis coordination and treatment sequence

Wound care requires a comprehensive or multidisciplinary team to treat, while wound care specialists are responsible for diagnosis, coordination, and prioritization of treatment.

Disciplines involved in wound care include internal medicine, endocrinology, vascular surgery, cardiology, orthopedics, surgeons (performing preventive surgery), dietitians, diabetes educators, and ankle nurses (often attached to a rehabilitation department).

Instrument-assisted pain and odor reduction

Wound care is to reduce morbidity and mortality, quality of life, reduce nursing time, reduce or shorten hospitalization rate, etc., thereby reducing treatment costs.

Li Jinyan revealed that the former patients would be very afraid of washing their wounds. Whenever they knew that they had to go to the hospital to wash their wounds, they would feel pain, pressure and shadow in their hearts. “For example, when using gauze to bandage a wound, it will stick tightly to the wound, and when you tear it off or pull it a little impatiently, you will feel the pain.

“The current wound care is completely different. In addition to advanced equipment, there are dressings with various functions to protect the wound from foreign objects or bacterial invasion, and reduce various discomforts caused by wound treatment, including pain and fluid leakage. , stench, etc.”

Some dressings do not even stick to the wound, and can also absorb blood, pus, etc. from the wound, so as to avoid seeping out and staining clothes, making people feel comfortable.

Negative pressure therapy is recommended for large wounds

Negative pressure therapy is recommended for wounds that often need dressing changes, large wounds, deep wounds, or a lot of fluid outflow.

“Negative pressure therapy is a kind of auxiliary treatment for wounds. Using the principle of suction, the air between the wound and the dressing is evacuated to a negative pressure or vacuum state, which can promote healing, avoid infection, and reduce the frequency of dressing changes and discomfort.”

When the wound is in a controlled vacuum-tight environment, the wound exudate can be evacuated, which helps to stimulate the growth of healthy granulation tissue and achieve rapid healing.

At present, government hospitals provide rental of negative pressure therapy equipment. Patients only need to pay a deposit, which can be refunded after the treatment is completed. In addition to the convenience that patients do not need to go to the hospital to change their wounds, for him, the number of patients seen in the clinic has decreased, and the medical staff can focus on other patients who need more care, and the care of patients at home is more enjoyable than traveling to the hospital for treatment.

Usually, it takes a month or two for a patient receiving negative pressure therapy to allow the wound to heal. Once the condition improves, the patient can switch to modern dressings or visit the clinic regularly for dressing changes.

The negative pressure therapy equipment is operated 24 hours a day, and the body machine is small and portable, which provides comfort and convenience for the patient.

moist wound care

Helps cut healing time in half

The traditional wound care is that the drier the wound, the better, but the concept of modern wound care is different, using moist wound healing (moist wound healing),

In fact, it is best for the wound to be neither wet nor dry, which is conducive to angiogenesis and cell growth, and helps healing and recovery.

Studies have shown that the healing time of dry wounds is twice that of wet wounds. In other words, moist wound care can halve the healing time, which can achieve the effect of “doubling the result with half the effort”.

Humid environment is suitable for wound growth

Dr. Lee Chin Yen, Director of the Orthopedic Wound Care Group of Kuantan General Hospital, said that when the skin surface cells migrate and proliferate, dry wounds are more likely to scab. When scabs occur, the cortical cells are difficult to move and the wound heals The longer the time, the humid environment is not easy to scab, which is most suitable for wound growth.

The concept that dry wounds are beneficial to recovery originated from experiments in 1962, while the concept of moist wound care and modern dressings began to be popularized in 1990, but it was not popularized in Malaysia until 2000.

Generally, dressings sold on the market have waterproof and moisturizing functions. In fact, modern dressings also include silver ions, foam dressings (foam), gel dressings (hydrogels), and film dressings (films) with disinfection and sterilization functions.

“General people can buy and use these dressings, but wrong use can be self-defeating, such as wrong diagnosis and insufficient dosage may cause bacterial infection, not only waste time and money, but may cause irreversible or more complicated treatment such as excision Therefore, it is best to consult a professional and make a diagnosis before purchasing or using it.”

Patient’s family and caregivers are required to cooperate

In our country, many patients lack awareness of wound care, and often seek formal treatment when the wound is worsening or in an advanced stage. Some patients seek traditional treatment, asking gods or witchcraft.

In some patients, it is difficult to heal the wound due to uncontrolled diseases, such as low treatment compliance of diabetic patients or poor blood sugar control.

However, there are indeed a small number of patients, about 10% to 20% of chronic wounds are difficult to heal, such as skin cancer patients. If wound care is neglected, the consequences can be wound deterioration, complications, amputation, and even death.

In addition to medical personnel, wound care often requires the cooperation of the patient’s family members or caregivers in order to be more effective or accelerate wound healing.

He said that there was a patient who had been bedridden for a long time in a car accident and had more than 50 types of bedsores on his body. After communicating with the patient’s family and teaching correct wound care, the patient received careful care and the wound healed after just one year. Although the patient Long-term bed rest is inevitable, but the quality of life is more comfortable with fewer wounds.

Lead physicians in wound care also come into contact with palliative care patients, especially late-stage palliative care patients, but the goal of treatment is not to heal the wound, but to improve the patient’s well-being by reducing pain, risk of infection, and reducing wound odor. Comfort and ease the pain of the patient.

Especially for cancer patients, their wounds not only cannot heal, but also ooze out, and often emit an unbearable stench. As long as professional wound care, plus the use of various auxiliary equipment and modern dressings, It can effectively reduce or even make the wound completely odorless.

Exacerbated by informal treatment

Reducing the stench of wounds in advanced patients will not only make the patients feel comfortable, but also the patient’s family members or caregivers, even relatives and friends, and more people will be willing to visit and comfort the patients.

“There have been patients who sought and received various informal treatments, and only came to seek treatment after their condition deteriorated. In fact, it was a blood vessel blockage. After the Thongpo Tsai operation, the wound healed quickly.”

He pointed out that not every wound is as simple as most people think, because wounds occur in different parts of the body and may have different problems and diagnoses, such as vascular obstruction, platelet problems, etc.

If the first step of treatment has been done wrong, then the next treatment will not be done well.

The elderly cannot cut their toenails. It is not suitable to take care of people with diabetes easily.

Many elderly people are unable to trim their toenails due to limited mobility, making them thick and deformed, prone to infection, and making trimming more difficult.

It is recommended to observe whether there is any wound or fungal infection before pruning, soak the feet with warm water before pruning, pay attention to safety and prevent bacterial infection.

Many elderly people are limited in their daily life due to physical decline and limited mobility. They can’t even do simple toenail cutting. What should we do? The doctor said that the toenails of the elderly are often thick and deformed. It is safer to ask professionals to trim them. Before cutting, soak them in warm water to soften the toenails. When cutting, you must pay attention to avoid injury and prevent bacterial infection. And then worsened into cellulitis.

Too long toenails can easily cause paronychia

Huang Baiyao, director of the Department of Geriatric Medicine, said that the elderly often give up trimming their toenails due to inconvenient movement, inflexibility or long-term bed rest, which makes the toenails hard and thick, and more than 80% of them are combined with mold infection, resulting in rapid toenail growth. Increase the thickness and deform, and even grow into the nail groove, increasing the difficulty of pruning. It is recommended that the elderly should observe the toenails for fungal infection or unhealed wounds before trimming their toenails.

Too long toenails can easily cause paronychia and cellulitis

Huang Poyao pointed out that many 70-year-old elderly have not cut their toenails for more than half a year due to long-term bed rest or mobility issues. Slow speed delays treatment, resulting in cellulitis. When seeking medical treatment, redness, swelling, pain, etc. have appeared in the nail groove. Especially the bedridden elderly are the most common, but if they are not trimmed regularly, it will only become more and more difficult to cut. Many elderly people finally give up cutting toenails.

Dermatologist Zhao Zhaoming said that it is really inconvenient for the elderly to cut their toenails. They often cannot see clearly or focus on the focus due to poor eyesight, or cannot bend down, and their hands shake. The meat causes the wound to bleed, which increases the risk of bacterial infection. If the pruning is injured, it is recommended to apply wound ointment first, but if the inflammation symptoms such as redness, swelling and pain continue to worsen and expand, or the wound has not healed, you should seek medical treatment immediately.

Soaking in warm water is good for trimming, not suitable for sugar friends

“If the toenails are too thick and difficult to trim, you can soak your feet in warm water first to soften the toenails.” Huang Baiyao emphasized that when soaking feet in warm water, the water temperature should be maintained at 30 to 35°C, and it should not be too hot to prevent For skin burns, you can also cut the toenails after taking a bath when the toenails become soft. If you are worried about burns for the elderly, just soak them in cold water instead of hot water; Use specialized toenail clippers with a wide opening at the scissors for easier trimming and less risk of cutting flesh.

Especially for the elderly with diabetes, they must pay more attention when trimming their toenails. Huang Poyao and Zhao Zhaoming pointed out that the physical function and peripheral nerve response of the elderly with diabetes are degraded, and their perception of high temperature and pain is reduced. They are easy to burn without knowing it. Just soak in cold water; if you accidentally burn or cut a wound, bleeding will not heal easily, and once it becomes a chronic wound, it may cause cellulitis, so you must be vigilant.

Mold infection pruning and treatment

The toenails of the elderly are too long. When walking while wearing shoes, foreign body sensation and pain may affect the walking function. Children of elders over the age of 70 should pay more attention to whether the toenails of the elders are too long. If it is really difficult to cut the toenails of the elders, they should be trimmed regularly by professionals. If the toenails develop onychomycosis due to fungal infection, they should also be treated.

Text: Li Chenneng “Vitality Network”

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