Exudate Resources

Preventing and managing wound infection has sometimes resulted in inappropriate prescribing of antibiotics and overuse of topical antimicrobial wound dressings. This is partly due to the difficulties in identifying the early signs of wound infection and uncertainty as to who is at risk. This article guides the reader through the importance of considering antimicrobial stewardship (AMS), how to identify at-risk patients, how to reduce the risk through wound bed preparation, and how to identify wound infection. When reviewing wound infection management strategies, it particularly focuses on the role of non-medicated wound dressings, which are becoming a viable alternative to traditional antimicrobial dressings such as silver and iodine.

The recent Covid-19 pandemic has reinforced the need for health care to be delivered in a different way to enable the NHS to be fit for purpose and continue to provide high levels of health care at an affordable cost. One way of doing this is to utilise the benefits of shared care, a concept that is not new, but has not yet been fully embraced. This encourages sharing the responsibility of delivering care in a variety of ways. Wound care is one area that provides general practice nurses (GPNs) with a significant opportunity for patients to be involved in their own care. This can even include wounds producing a high volume of wound exudate, if an appropriate dressing is selected which gives the patient confidence that it will work, despite the unpredictable nature of chronic wounds. Patients need a package of information to reinforce the verbal education given to ensure that they know how to carry out their care, and what to do in the event of a problem or change in wound status. Virtual clinics, which have been especially useful during the recent pandemic, are also an option to replace some face-to-face contact.

Highly exuding wounds can affect people of all ages, often causing distress, anxiety and social isolation. Managing these challenging wounds can also represent a significant cost to the NHS. This article looks at exudate and the difference between normal and excessive exudate and examines the causes of a high volume of exudate and its effect on the patient. Exudate assessment is an important part of holistic assessment, which is also explored in the article. Strategies GPNs can employ to manage exudate, including wound dressings and other devices, are then discussed.

Exudate is produced as part of the inflammatory phase of wound healing and assists the healing process by providing essential nutrients to the wound, promoting moist wound healing and naturally debriding the wound bed. However, exudate can also be detrimental to the healing process and managing excessive exudate in clinical practice is often challenging. The key to managing exudate is accurate assessment and identifying the underlying cause of excessive production. Accurate diagnosis and assessment will assist general practice nurses (GPNs) in selecting appropriate treatment options and strategies that can help in managing exudate efficiently. This article discusses what exudate is and its function in wound healing. It also explores the causes of excessive exudate production and what GPNs can do to manage high volumes to prevent skin damage and improve patient quality of life.

Put simply, exudate is the fluid that leaks from the capillaries during the healing process. It helps to create a moist wound environment and assists with healing by removing devitalised tissue, repairing damaged cells and providing nourishment to assist with epithelialisation. Exudate is produced in the initial wound-healing process as part of the inflammation stage. 

Exudate is created in response to injury as neutrophils migrate to the wound site and cytokine messengers instruct the surrounding blood vessels to become more porous and leak protein-rich fluid into the wound bed. Exudate is full of nutrients and growth factors and, when produced in the right amount, ensures that there is a moist wound environment, which is essential for timely healing.