Document Sample
					                                                                        Student Health Service

                             POLICIES & PROCEDURES

                         PROTOCOL FOR DRESSINGS / WOUNDCARE

To control any bleeding, protect the wound, promote healing and to minimise the risk
of infection and transmission of infection.

             Confirm that the student is registered with a GP, is aware of procedure for
              making an appointment within hours, and is aware of out of hours contact

Possible requirements
   Dressing pack containing sterile gloves, instruments, sterile dressings and
      disposal bag, etc
   Normal Saline or Tap Water (whichever available)
   Assorted Dressings
   Assorted Bandages
   Tape
   Cling film
   Apron if necessary
   Paper Towels
   Analgesia may be required, to be given following administration of medication

Assess severity of the Injury
  a) Check airway and breathing
  b) Control bleeding by applying direct pressure
  c) For burns or scalds –immediately apply cold (preferably) running water for at
     least 15 minutes (some effect for up to 3hours after burn) or apply a burnshield
     dressing. If clothing is stuck to wound, do not remove but refer immediately to
     A&E. ALL chemical burns should be irrigated for at least 20 minutes then
     referred to A&E, together with as many details as possible about the chemical,
     eg COSHH data. ALL burns or scalds to the face must be seen in A&E

    How and when did the injury occur
    Any loss of sensation or function
    Tetanus status if skin is broken
    Any previous medical intervention
    Nature of the Injury – Abrasion, contusion, laceration, incised, puncture wound,
      penetrating wound, foreign body, burn or scald

Assess at this stage whether it is safe to continue or need to refer on immediately. If
referring on cover the wound. For burns or scalds loosely cover with cling-film. Assess
for any further injuries and discuss potential management options with student.

        Remove any rings where there are finger or hand injuries
        Wash hands
        Use sterile dressing pack if appropriate
        Check for any loss of sensation or function.
        Thoroughly inspect wound for foreign bodies and irrigate with large volume of
         normal saline or tap water.
        Leave any blisters intact
        Thoroughly cleanse wound, remove any loose foreign bodies and dry
         carefully. Dress any wound with foreign body in a way which minimises
         pressure on foreign body.
        Up to 24 hours after an injury consider closing an incised wound with steri-
         strips. Unless the wound is considered to be high risk or
         contaminated (including - knife used to cut raw meat, animal bite,
         faeces, human bite, vaginal secretions, soil or manure). Lacerations
         that have not been sutured or steri-stripped within the first 24hrs will
         need to heal by secondary intent.
        Wounds to the scalp may require referral for gluing or suturing. However, it
         is worth trying hair tying first as a means to close the wound and control
        High risk or contaminated wounds consider delaying closure for 3-5
         days to assess for evidence of infection.
        Ensure student is not allergic to any adhesive tapes or dressings
        Cover all wounds with appropriate dressings
             Abrasions cover with 3 layers of Jelonet if necessary
             Burns –use triple layer Jelonet (PMP patients may be treated with
             Flamazine). Burns that require referral to A&E should have cling-film
             layered on them (not wrapped around a limb) and secured in place
        Wash hands thoroughly after procedure
        Dispose of clinical waste as per university policy

Give self-care advice
Keep the dressing dry
Change dressing if it gets wet (provide extra dressings)
Tetanus vaccinations - if there is a clear history of having had a total of 5 doses of
vaccine they do not need another tetanus vaccine. However, tetanus immunoglobulin
may be advised if the wound is particularly dirty and tetanus prone - e.g. contaminated
by soil, animal or human bites or penetrating wound

Signs of infection     -    increasing pain in or around wound
                       -    increased exudate
                       -    change in colour or odour of exudate
                       -    change in wound colour
                       -    reddening,or swelling around the wound
                       -    systemic symptoms, eg fever

If any of the above signs of infection are present the student must seek further medical

Arrange follow up/redressing if necessary


       Where bleeding cannot be controlled
       Infected wounds or those at risk of infection or contamination
       Burns or scalds as indicated previously
       Any loss of sensation, power or movement – especially fingers
       Any foreign body embedded in the wound, or where there is a possibility that
        glass may be present in the wound.
       Lacerations caused by a knife used to cut raw meat
       Animal or human bites
       A wound that has not begun to heal properly after 48 hours
       A wound that is showing signs of deterioration
       Anyone who has not had 5 Tetanus vaccinations or where Tetanus
        immunoglobulin is indicated

Date:         June 2009
Review:       June 2010


M Reay
L Charlesworth
C Hunter
A Goodwin


   1. Clinical Knowledge Summaries – Burns & Scalds.
      s - visited 26/02/08

   2. Prodigy Guidance – Lacerations -
      visited 26/02/08


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