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2017 HCHB_digital

Wound Care Our skin acts

Wound Care Our skin acts as a barrier to the outside world, protecting us from infection, temperature extremes and UV radiation; and internal organs and other structures from damage. A wound is a break in the skin which may be caused by cuts or abrasions (see also Cuts, Abrasions and Blisters), surgery, cancer, burns, trauma to fragile skin, penetrating objects, pressure sores, skin ulcers, and many other things. Some people are more prone to wounds, such as elderly people, people with diabetes, and people taking corticosteroids. Most wounds heal faster and with less scarring if the wound is kept moist. Modern dressings containing hydrogels and other substances prevent wounds from drying out and absorb fluid (exudate) from weeping wounds. Serious wounds often need long-term treatment and patients are usually under the ongoing care of a nurse and/or doctor. However, patients may wish to buy dressings at the pharmacy. Initial assessment If a customer presents to your pharmacy with an acute wound, get them to stem TREATMENT OPTIONS Category Examples Comments Sanitising products eg, MicroCleanz Eliminates most common harmful germs and bacteria. Convenient alternative to hand washing. Saline for cleansing [GENERAL SALE] eg, saline 0.9% (GP Wound Wash Saline) Normal saline (saline 0.9%) or tap water have similar outcomes when used to clean wounds. Antiseptic wound care applications Products to stop bleeding Wound healing products Dressings Topical anaesthetics [GENERAL SALE] benzalkonium chloride (eg, Bepanthen, Dettol Antiseptic Wound Wash Spray) bufexamac + chlorhexidine + lignocaine (eg, Ethics 4 Way Antiseptic Soothing Cream) chlorhexidine ± cetrimide (eg, Medipulv Antiseptic Powder (with allantoin), Savlon*, Soov Cream* [with lignocaine]) chloroxylenol (eg, Dettol Antiseptic) honey, medical grade topical (eg, Manuka Health Wound Gel, Medihoney Antibacterial Medical Honey) polyhexanide with betaine (eg, Prontosan) povidone iodine (eg, Betadine Antiseptic liquid/ointment/ spray*) silver (eg, Skybright Colloidal Silver) stabilised hydrogen peroxide (eg, Crystaderm*) super-oxidising solutions (eg, Microdacyn Wound Care solution/hydrogel*) [PHARMACY ONLY] eg, chlorhexidine, cetrimide, lignocaine (eg, Medicreme Antiseptic cream) eg, Celox Nose Bleed dressings, Celox Granules, Celox Gauze Pad [GENERAL SALE] eg, Mebo Wound repair eg, Manuka Health Wound Dressings, Nexcare Sensitive Skin range, Nexcare Waterproof Bandages [PHARMACY ONLY MEDICINE] eg, lignocaine/prilocaine (Emla cream) Topical antiseptic agents may help reduce the risk of future infection when applied to an acute wound. They are preferred over topical antibiotic agents because they are broader in their spectrum of activity, less likely to cause allergic reactions, and rarely associated with bacterial resistance. Ensure correct dilutions are used. Super-oxidising solutions, polyhexanide, diluted bleach, chlorhexidine, silver and cadexomer iodine cause less rejuvenating tissue damage than unstabilised hydrogen peroxide and povidone iodine. Super-oxidising solutions and solutions that contain betaine also possess antibiofilm activity. No clinically important resistance has been noted to super-oxidising solutions, polyhexanide, diluted bleach, silver, iodine, hydrogen peroxide and honey. Gram negative bacilli resistance has been reported with chlorhexidine and benzalkonium. Some strains of Staphylococcus aureus (including methicillin-resistant S. aureus [MRSA]) are resistant to chlorhexidine, cetrimide or benzalkonium. Honey has antibacterial properties and provides a moist environment for healing minor wounds. Diabetics may need to monitor blood sugars (refer to pharmacist). Hydrogels donate moisture to a dry wound, improving healing. Contain chitosan obtained from shrimp shells that clots blood within 30 seconds. Effective even for people who take anticoagulants such as warfarin. Does not affect long-term wound healing. No adverse reactions reported even in patients with a known hypersensitivity to shrimp or crab. Supports the body’s immune response to fight infection, and promotes natural skin healing, minimising scarring. Wound dressings containing medical grade manuka honey have natural antibacterial properties and help maintain a moist wound surface. For more information about other dressings see Treatment options in Cuts, Abrasions and Blisters. Lignocaine/prilocaine creams can be used before cleaning painful wounds, such as leg ulcers. Apply to the skin 45–60 minutes before the procedure. Natural / herbal products / supplements Honey, St John’s wort, trypsin, calendula ointment, zinc cream, vitamin A ointment Products with an asterisk have a detailed listing in the Wound Care section of OTC Products, starting on page 267. Topical honey-impregnated dressings or creams appear to improve wound healing, reduce odours, help clean the wound and decrease risk of infection. Topical St John’s wort, trypsin, calendula, vitamin A and zinc also have skin healing properties. PharmacyToday.co.nz A part of your everyday. New Zealand’s premier pharmacy website keeping you up to date between issues. www.pharmacytoday.co.nz Page 172 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION any bleeding with a gauze pad, while you quickly assess the wound to determine if it is appropriate to deal with in a pharmacy setting. Some wounds are best referred straight away to the nearest accident and emergency or medical centre. If the wound is relatively minor and you are comfortable treating it, put on gloves and apply first aid. Otherwise refer the customer to a pharmacist. Also refer any customers with "yes" answers to the Refer to Pharmacist questions. Treatment of acute wounds Proper wound care aims to minimise the risk of infection and scarring. See table, next page, for treatment advice for different types of wounds. Generally: • Stop any bleeding. »» Using a clean bandage apply pressure to the area for 10 minutes. »» If bleeding is brisk and does not stop or spurts out with the heartbeat seek urgent medical attention. • Clean the wound. »» Use water, saline, or a low-toxicity antiseptic solution to gently clean the wound. Pay particular attention to removing any small pieces of foreign material (such as wood, soil and clay) or non-viable tissue; moist gauze, gentle scrubbing with a brush, or tweezers may aid removal. If the wound cannot be cleaned thoroughly, refer the customer to a doctor. »» Apply a topical antiseptic agent to reduce the risk of infection. Superoxidising solutions, polyhexanide, diluted bleach, chlorhexidine, silver and cadexomer iodine cause less rejuvenating tissue damage than unstabilised hydrogen peroxide and povidone iodine. Ensure product instructions for correct dilution are followed. • Apply a dressing to protect against further trauma. The dressing should keep the wound moist, but not wet; have the capacity to absorb discharging fluid or blood; and be shower-proof (eg, island dressings). Change regularly depending on dressing type. • A booster tetanus shot may be needed if it is more than five years since the person’s last tetanus vaccination. Advice for customers • Watch for signs of infection (eg, redness spreading out from the wound or yellow drainage from the area) and seek medical advice if this occurs. • Topical antibiotics are usually not necessary. Overuse of these medicines can lead to bacterial resistance and oral antibiotics are usually more effective if a wound infection is present. • Do not pick scabs off as the wound heals – this can cause scarring. • Correct any nutritional deficiencies. Deficiencies of vitamins A, C, and zinc and poor dietary protein intake impair normal wound-healing mechanisms. • People with diabetes should seek medical advice with any wound, especially wounds on the lower extremities (ie, feet, lower leg). People with diabetes: »» have a reduced blood flow to their extremities (delays healing) »» commonly have peripheral neuropathy, a reduced sensation in the hands and feet, which means an injury may not be noticed straight away. Refer to PHARMACIST If there is copious bleeding call for an ambulance immediately. Seek medical advice if the wound is extensive or it has been difficult to completely clean. For all other customers, aim to identify those who would benefit from further input from a pharmacist. Your initial assessment may have already provided some answers. Decide if any further questions still need to be asked and refer any “yes” answers to a pharmacist. • Does the person have any other health conditions (eg, immunosuppression, diabetes)? • Is the person elderly, frail, on immunosuppressing medicines (such as prednisone) or have a chronic illness? • Does the person have a chronic wound, eg, leg ulcers, varicose ulcers or bleeding moles, that is not being managed by a doctor? • Is there copious bleeding? • Is the wound extensive, deep or very dirty, or contain pus? • Does the wound contain a foreign object which is embedded or unable to be easily removed? • Is the wound and surrounding area painful and warm? • Does the person also have a fever or flu-like symptoms? • Has it been more than five years since the person had a tetanus vaccination? • Does the person have known allergies, especially to topical agents (eg, antiseptics, plasters containing resins) or eczema? • For elderly people at risk of skin tears: » » keep skin moisturised and use sheepskin boots and elbow pads to reduce friction » » self-adhesive bandages are less likely to damage the skin than adhesive tapes and dressings » » assist those at risk of falling, and pad furniture and equipment to prevent bruising from collisions. Page 173

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