Serani

Working in a surg ward caring for a Chinese lady who spoke no English (was visiting relatives in Aus). Very sweet little lady - lovely relatives...brought us nurses in wonderful food which we gratefully scoffed into (as only nurses can do!).... Emptying her colostomy bag and notice something strange -liquid faeces...tip it into a jug and see a 4 inch round work squirming about - ALIVE - Needless to say - we did not eat any more of those food gifts! Don't think I ever washed my hands so much that day.

I am a wound care nurse for a community/home health nursing service. We do not use any wet to dry wound dressings (we have a policy which states this!) due to the continual disturbance of new granulation tissue, the inability to keep the wound moist and thus delay epithelialisation and the need to change the dressing more often resulting in wound temperature loss again resulting in delayed healing (each time a wound is exposed it take approx 4 hours to regain the temp required for active healing). If a wound requires rapid debridement as this may I would consider the use of Iodosorb or Iodoflex (providing the client has no allergy to iodine or a previous thyriod issue, I presume she is not pregnant at 98) short term which assists with wound bed preparation - that is preparing the wound bed for optimum healing - ie. reducing slough, reducing colonisation (bugs on wounds but not at infection stage) and also has the added benefit of reducing odour if this is a concern. I believe as an RN we have the responsibility to ensure we are kept up to date with 'best practice' and evidence based research and 'wet to dry dressings' are not recommended with the advent of more appropriate and effective dressing products. I always encourage our RN's to question orders and to request rationale. In my experience I have written to doctors and made suggestions for wound management with rationale for each step of the wound plan and have had positive responses - I think many doctors have NO idea of wound management. If we receive a medical order which is not considered 'best practice' we will not carry this out. ( I do live in Australia - maybe it is different here to the US) We educate all our clients as to modern wound care practice. MOST IMPORTANT WOUND CARE TIP: Always seek to identify and control the underlying cause of the wound.